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29–961 PDF 2018

THE OPIOID EPIDEMIC IN APPALACHIA: ADDRESSING HURDLES TO ECONOMIC DEVELOPMENT 

IN THE REGION 

(115–31) 

HEARING 

BEFORE THE

SUBCOMMITTEE ON 

ECONOMIC DEVELOPMENT, PUBLIC BUILDINGS, AND 

EMERGENCY MANAGEMENT 

OF THE

COMMITTEE ON TRANSPORTATION AND 

INFRASTRUCTURE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

DECEMBER 12, 2017 

Printed for the use of the 

Committee on Transportation and Infrastructure 

( 

Available online at: https://www.govinfo.gov/committee/house-transportation?path=/ 

browsecommittee/chamber/house/committee/transportation 

(II) 

COMMITTEE ON TRANSPORTATION AND INFRASTRUCTURE 

BILL SHUSTER, Pennsylvania, Chairman 

DON YOUNG, Alaska 

JOHN J. DUNCAN, JR., Tennessee, 

Vice Chair 

FRANK A. LOBIONDO, New Jersey 

SAM GRAVES, Missouri 

DUNCAN HUNTER, California 

ERIC A. ‘‘RICK’’ CRAWFORD, Arkansas 

LOU BARLETTA, Pennsylvania 

BLAKE FARENTHOLD, Texas 

BOB GIBBS, Ohio 

DANIEL WEBSTER, Florida 

JEFF DENHAM, California 

THOMAS MASSIE, Kentucky 

MARK MEADOWS, North Carolina 

SCOTT PERRY, Pennsylvania 

RODNEY DAVIS, Illinois 

MARK SANFORD, South Carolina 

ROB WOODALL, Georgia 

TODD ROKITA, Indiana 

JOHN KATKO, New York 

BRIAN BABIN, Texas 

GARRET GRAVES, Louisiana 

BARBARA COMSTOCK, Virginia 

DAVID ROUZER, North Carolina 

MIKE BOST, Illinois 

RANDY K. WEBER, SR., Texas 

DOUG LAMALFA, California 

BRUCE WESTERMAN, Arkansas 

LLOYD SMUCKER, Pennsylvania 

PAUL MITCHELL, Michigan 

JOHN J. FASO, New York 

A. DREW FERGUSON IV, Georgia 

BRIAN J. MAST, Florida 

JASON LEWIS, Minnesota 

PETER A. DEFAZIO, Oregon 

ELEANOR HOLMES NORTON, District of 

Columbia 

JERROLD NADLER, New York 

EDDIE BERNICE JOHNSON, Texas 

ELIJAH E. CUMMINGS, Maryland 

RICK LARSEN, Washington 

MICHAEL E. CAPUANO, Massachusetts 

GRACE F. NAPOLITANO, California 

DANIEL LIPINSKI, Illinois 

STEVE COHEN, Tennessee 

ALBIO SIRES, New Jersey 

JOHN GARAMENDI, California 

HENRY C. ‘‘HANK’’ JOHNSON, JR., Georgia 

ANDRE ́ CARSON, Indiana 

RICHARD M. NOLAN, Minnesota 

DINA TITUS, Nevada 

SEAN PATRICK MALONEY, New York 

ELIZABETH H. ESTY, Connecticut, Vice 

Ranking Member 

LOIS FRANKEL, Florida 

CHERI BUSTOS, Illinois 

JARED HUFFMAN, California 

JULIA BROWNLEY, California 

FREDERICA S. WILSON, Florida 

DONALD M. PAYNE, JR., New Jersey 

ALAN S. LOWENTHAL, California 

BRENDA L. LAWRENCE, Michigan 

MARK DESAULNIER, California 

SUBCOMMITTEE ON ECONOMIC DEVELOPMENT, PUBLIC BUILDINGS, AND EMERGENCY

MANAGEMENT

LOU BARLETTA, Pennsylvania, Chairman 

ERIC A. ‘‘RICK’’ CRAWFORD, Arkansas 

BARBARA COMSTOCK, Virginia 

MIKE BOST, Illinois 

LLOYD SMUCKER, Pennsylvania 

JOHN J. FASO, New York 

A. DREW FERGUSON IV, Georgia, 

Vice Chair 

BRIAN J. MAST, Florida 

BILL SHUSTER, Pennsylvania (Ex Officio) 

HENRY C. ‘‘HANK’’ JOHNSON, JR., Georgia 

ELEANOR HOLMES NORTON, District of 

Columbia 

ALBIO SIRES, New Jersey 

GRACE F. NAPOLITANO, California 

MICHAEL E. CAPUANO, Massachusetts 

PETER A. DEFAZIO, Oregon (Ex Officio) 

(III) 

CONTENTS Page 

Summary of Subject Matter .................................................................................... iv 

TESTIMONY 

PANEL 1 

Hon. Harold Rogers, a Representative in Congress from the State of Kentucky ...................................................................................................................... 3 

PANEL 2 

Hon. Earl Gohl, Federal Cochair, Appalachian Regional Commission ............... 6 

Barry L. Denk, Director, The Center for Rural Pennsylvania ............................. 6 

Nancy Hale, President and Chief Executive Officer, Operation UNITE ............ 6 

Jonathan P. Novak, Esq., Former Attorney for the Drug Enforcement Administration ................................................................................................................. 6 

PREPARED STATEMENTS SUBMITTED BY MEMBERS OF CONGRESS 

Hon. Tom Marino of Pennsylvania ......................................................................... 28 

PREPARED STATEMENTS SUBMITTED BY WITNESSES 

Hon. Harold Rogers ................................................................................................. 31 

Hon. Earl Gohl ......................................................................................................... 35 

Barry L. Denk .......................................................................................................... 42 

Nancy Hale ............................................................................................................... 48 

Jonathan P. Novak, Esq. ......................................................................................... 54 

iv 


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v 


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vi 


Insert offset folio 3 here 29961.003
(1) 

THE OPIOID EPIDEMIC IN APPALACHIA: ADDRESSING HURDLES TO ECONOMIC DEVELOPMENT IN THE REGION 

TUESDAY, TUESDAY, DECEMBER 12, 2017 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON ECONOMIC DEVELOPMENT, PUBLIC

BUILDINGS, AND EMERGENCY MANAGEMENT, 

COMMITTEE ON TRANSPORTATION AND INFRASTRUCTURE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 10:01 a.m., in room 

2167, Rayburn House Office Building, Hon. Lou Barletta (Chairman of the subcommittee) presiding. 

Mr. BARLETTA. The subcommittee will come to order. 

The purpose of today’s hearing is to examine the impact of the 

opioid crisis on economic development in Appalachia. The opioid 

crisis has touched the lives of countless Americans. This public 

health emergency has taken the lives of far too many of our Nation’s citizens, and has had significant adverse effects on our economy and labor force participation. As a subcommittee with jurisdiction over a number of economic development agencies, including 

the Appalachian Regional Commission, we are specifically focusing 

today on the ways the opioid crisis has affected the Appalachian 

workforce, and efforts to promote economic development in the region. 

The opioid epidemic has profoundly affected all of our districts 

and uprooted the lives of so many of our constituents. Ninety-one 

Americans die every single day of an opioid overdose. In my home 

State of Pennsylvania, 4,642 drug-related overdose deaths were reported in 2016. In 2015, there were 5,594 overdose deaths in Appalachia—a drug-related death rate 65 percent higher than the rest 

of the Nation. Sixty-nine percent of those deaths were caused by 

opioids. An overwhelming majority of these deaths throughout Appalachia were individuals between the ages of 25 and 44, people 

who were in their prime working years. These troubling statistics 

makes it clear that the opioid crisis is not only destroying lives, it 

has created a significant challenge to workforce expansion and economic development throughout Appalachia. 

This crisis is economically disastrous for our Nation. This past 

month, the White House office of economic advisers released a report that estimated the opioid epidemic cost our Nation $504 billion 

in 2015. That is an important number to remember as we begin today’s hearing, because it points to the lost potential for economic 

2 

activity and productivity in communities battling opioid addiction. 

That is our focus here today. 

To that end, I remind our witnesses and my fellow Members that 

this subcommittee’s jurisdiction is economic development programs 

in the Appalachian Regional Commission. We have no oversight of 

the Department of Justice or the DEA. Our goal is to have a hearing that this subcommittee can use to inform our committee’s decisions regarding agencies within our jurisdiction. Therefore, I would 

ask that all testimony and questions be confined to the issues within our jurisdiction. Further, I would like to reiterate that today’s 

hearing is meant to be bipartisan. The opioid crisis does not recognize political parties. I think that we can all agree, Republicans 

and Democrats alike, that the priority here is to finding solutions 

for the communities and the families who are being devastated by 

this epidemic, not playing politics with people’s lives. 

Just a few days ago, the Transportation and Infrastructure Committee showed what it can accomplish when we work in a bipartisan fashion. We unanimously approved the Disaster Recovery Reform Act because of the good work that was started here in this 

subcommittee. Let’s continue to work in that same fashion here 

today to look for solutions within the programs and agencies under 

our jurisdiction. 

It is my hope that today we can come together to examine the 

impact of opioids in Appalachia and the ways in which existing 

Federal economic development programs can help States and communities address and combat this growing epidemic. I am sure our 

witnesses today will help us answer those questions. I thank you 

for being here. 

I now recognize the ranking member of this subcommittee, Mr. 

Johnson, for a brief opening statement. 

Mr. JOHNSON. Thank you, Mr. Chairman. Good morning, and I 

would like to thank Chairman Barletta for holding this very important hearing on the opioid epidemic in Appalachia and how it is impacting adversely and severely the lives of our brothers and sisters 

in Appalachia. 

Since the formation of the Appalachian Regional Commission in 

1965, Appalachia has made significant progress in executing its 

mission of addressing persistent poverty and economic despair. 

However, the progress made in attracting industry to Appalachia 

and reducing poverty has been threatened by the current opioid 

epidemic sweeping the Nation. 

According to the Centers for Disease Control and Prevention, the 

CDC, drug overdoses are now a leading cause of death in the 

United States resulting in approximately 52,000 deaths in 2015. 

Fifty-two thousand deaths in 2015, or 142 deaths every day. In Appalachia, the problem is even worse. In 2009, the mortality rate in 

the Appalachian region was 24 percent higher than the non-Appalachian United States. By 2016, the mortality rate was 37 percent 

higher than the rest of the Nation. 

The opioid epidemic also happens to strike in the most devastating way men and women between the prime working ages of 

25 and 44. Although the mortality rate is lower in the Georgia 

counties in my congressional district covered by the ARC, I think 

there can be important lessons learned for the Southeast Crescent 

3 

Regional Commission, another economic development commission 

that I introduced legislation reauthorizing earlier this year. 

This is a full-blown crisis that demands the attention of Congress. The high rates of substance abuse and mortality in Appalachia compared to the rest of the United States is a serious impediment to sustained economic growth. Employers are seeking a 

healthy workforce when making decisions about where they will locate their businesses. High rates of substance abuse and mortality 

make it difficult for employers to find and hire qualified candidates. The ARC in its mission to promote economic development 

in the region has understood the great threat of opioid addiction to 

the economic viability of the region. 

In 2017, the ARC commissioned two reports that clearly outlined 

that men and women of prime working ages are beset with high 

rates of substance abuse and mortality. I support ARC’s conclusion 

that increased access to treatment services, prevention, and overdose medications to address the opioid epidemic are necessary. I 

am pleased that the approach to the opioid epidemic in all of ARC’s 

commissioned reports discuss this problem in the context of it 

being a public health issue as much as it is a law enforcement 

issue. We must not repeat the mistakes of the past where drug 

abuse was overcriminalized as it was during the crack cocaine epidemic of the 1980s. The Government’s response to drugs in the 

1980s did not have the effect of easing the problem, but instead, 

only intensified the severity of the problem. 

Hopefully, we have learned some things from our past. Today, 

the comprehensive reports and testimony before this committee 

make clear that the genesis and driving force for this epidemic 

starts with the proliferation of prescription drugs. I am glad that 

we will have a former DEA official talk about how changes in the 

law and policy at DEA contributed to the explosion in prescription 

pills in Appalachia. There is no silver bullet to solve the opioid epidemic, but I look forward to hearing from today’s witnesses on how 

a comprehensive multifaceted approach can address this crisis. 

And with that, I yield back. 

Mr. BARLETTA. Thank you. The Chair now recognizes the ranking 

member of the full committee, Mr. DeFazio. 

Mr. DEFAZIO. Thanks, Mr. Chairman. I won’t delay things here. 

I am here in the hope of hearing from the witnesses before I have 

to leave. 

Thank you. 

Mr. BARLETTA. OK. I am pleased to welcome on our first panel, 

our colleague, Representative Harold Rogers of Kentucky. I ask 

unanimous consent that our witness’ full statement be included in 

the record. Without objection, so ordered. 

For our witness, since your written testimony has been made a 

part of the record, the subcommittee would request that you limit 

your oral testimony to 5 minutes. 

Representative Rogers, you may proceed. 

TESTIMONY OF HON. HAROLD ROGERS, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF KENTUCKY 

Mr. ROGERS. Thank you, Mr. Chairman. And thank you, members of the committee, for holding this hearing and for allowing me 

4 

to be here to introduce a constituent who will be testifying immediately after me. 

It is a pleasure to introduce Nancy Hale. She is the president 

and CEO of a group called Operation UNITE. My area was impacted most severely at the very outset. It is where this epidemic 

began. 

Mr. BARLETTA. Excuse me. Can you pull that microphone a little 

bit closer to you? 

Mr. ROGERS. Is that OK? 

Mr. BARLETTA. Yep. 

Mr. ROGERS. Unbeknownst to anyone, I am talking 2002 or so, 

the State newspaper had this banner headline saying that eastern 

Kentucky is the painkiller capital of the world. It is where 

OxyContin got its start, in the coalmine fields of east Kentucky. I 

didn’t know what to do. This is completely out of the blue. No one 

knew or suspected that this was going on. So I called together, over 

several weekends, people from all walks of life, from all professions: 

preachers, doctors, orators, judges, social workers, you name it. 

And we barnstormed, what in the dickens can we do to stem the 

tide? Kids were dying in the hospitals every night. 

And out of that came this organization called UNITE. Unlawful 

Narcotics Investigations, Treatment and Education. Holistic threepronged attack. You can’t arrest your way out of the problem. You 

can’t treat your way out of the problem alone. And you can’t educate your way out of it. You got to do all of them at the same time, 

across the board, in every community, with everyone involved. And 

you got to involve the public. So the public pressure comes to bear 

on judges, prosecutors, the law enforcement community, the medical community, the education system and the like. And so, there 

are 32 counties in Operation UNITE. We had 35 undercover agents 

that could work in those 32 counties. So far, they have arrested 

and convicted some 4,300-and-so pushers. 

But now with this Operation UNITE program, we have got treatment centers. We have got counselors in schools. We have got drug 

courts in every county, every community. And we have got law enforcement that is now pushing and pushing and pushing. 

So the operation is a success. Is it solving the problem? No. We 

are still going up in drug use. It has shifted a lot from prescription 

pills to heroin laced with fentanyl, meth, and other substances. I 

am sure all of you have the same problem in your own districts 

back home. All of us in Congress have been touched, in some way, 

by opioid abuse. As the flames of addiction have fanned across communities small and large, my area spanning Kentucky’s Appalachian region, the very heart of Appalachia, has been acutely impacted. 

While I was first initially skeptical of that newspaper story about 

the widespread abuse of OxyContin, it didn’t take me long to find 

out it was true. The overprescription diversion of painkillers was 

wreaking havoc on our small towns. Addiction was pervasive and 

deadly, with overdoses tragically far too common. Something had 

to be done. 

But addressing this issue, the misuse of illegal drugs, was far 

from black and white. And that is how we came by the Operation 

UNITE organization. 

5 

I don’t want to steal Nancy’s thunder when she testifies in a few 

minutes, but I want to emphasize that this organization is the national leader now in combating opioid addiction at the regional 

level. UNITE has taken this holistic model to the national stage by 

hosting and putting on the National Prescription Drug Abuse and 

Heroin Summit, now in its seventh year. We will meet again in 

April in Atlanta. We will have all of the agencies there: The DEA, 

the FBI, Department of Justice. Last year, we had the President 

come. We will have the head of the CDC, NIH, DEA, the drug czar, 

you name it. And I hope a number of Members of Congress. The 

chairman graced us with his presence a couple of years ago. And, 

Mr. Chairman, we want all of you back again next April. 

I know today, given the jurisdiction of your subcommittee over 

the Appalachian Regional Commission, you are focused on finding 

solutions in this geographical area which has been a bellwether for 

national trends in the opioid’s space. 

Let me state that ARC has been a valued partner. And Mr. Gohl 

answered the call when UNITE asked for support for this summit 

8 years ago. And, Mr. Gohl, we are grateful for your support for 

the ARC summit, and we would not be where we are today without 

you. 

But I also believe that the opioid epidemic is indelibly tied to the 

future economic development of Appalachia, and that ARC could be 

doing more to help organizations like UNITE tackle the challenges 

associated with substance abuse. UNITE has found creative ways 

to do more with less as funding has become more difficult to come 

by. But I believe, Mr. Chairman, a vision without funding is a hallucination. Without additional Federal support, UNITE simply cannot maintain the level of service that will be necessary to save lives 

in our region and in communities around the country. 

As a long-time appropriator, I understand better than most that 

ARC has a broad mission and limited resources. However, one 

thing is painfully clear. The continuation of our addiction crisis and 

a vibrant Appalachian economy cannot coexist. The need for more 

targeted action is urgent as innocent children are left behind in the 

wake of deadly overdoses, and as more employers search for a 

drug-free workplace, both in Appalachia and across the country. 

I think today’s hearing, Mr. Chairman, is an important first step, 

and I am grateful that you have made it a priority. I stand ready 

to assist the members of your subcommittee and you in any way 

as we work together to find solutions to this crisis. 

So thank you, Mr. Chairman, for allowing me these minutes and 

for your hospitality towards Nancy Hale, who is on the next panel. 

Thank you, and I yield back. 

Mr. BARLETTA. Thank you. Thank you for your testimony. Your 

comments have been very helpful to today’s discussion. 

We will now move to our second panel. 

Mr. BARLETTA. On our second panel, we have the Honorable Earl 

Gohl, Federal Cochair of the Appalachian Regional Commission; 

Mr. Barry L. Denk, director, The Center for Rural Pennsylvania; 

Ms. Nancy Hale, president and chief executive officer, Operation 

UNITE; and Mr. Jonathan P. Novak, former attorney for the Drug 

Enforcement Administration. 

6 

I ask unanimous consent that our witnesses’ full statements be 

included in the record. Without objection, so ordered. 

For our witnesses, since your written testimony has been made 

a part of the record, the subcommittee would request that you limit 

your oral testimony to 5 minutes. 

Chairman Gohl, you may proceed. 

TESTIMONY OF HON. EARL GOHL, FEDERAL COCHAIR, APPALACHIAN REGIONAL COMMISSION; BARRY L. DENK, DIRECTOR, THE CENTER FOR RURAL PENNSYLVANIA; NANCY 

HALE, PRESIDENT AND CHIEF EXECUTIVE OFFICER, OPERATION UNITE; AND JONATHAN P. NOVAK, ESQ., FORMER ATTORNEY FOR THE DRUG ENFORCEMENT ADMINISTRATION 

Mr. GOHL. Thank you, Mr. Chairman, and members of the subcommittee for holding this hearing examining the impact of opioids 

in Appalachia. I also want to acknowledge Congressman Rogers 

whose leadership has challenged us all to look at how opioids are 

holding Appalachia’s economy back. 

My name is Earl Gohl. I serve as the Federal Cochair of the Appalachian Regional Commission. ARC is a partnership between the 

Governors of the 13 Appalachian States and the Federal Government. The Commission was created by Congress to help Appalachia 

achieve socioeconomic parity with the rest of the Nation. ARC has 

a broad mandate to foster and support economic growth across the 

region’s 420 counties. 

Mr. Chairman, opioid abuse poses a major threat to the economic 

prosperity of Appalachia. It is not just a public health and public 

safety issue. It is an economic issue. It drains the region’s resources, both human and financial. It shatters Appalachia’s families and communities. It would be understandable if this scenario 

led to a narrative of defeat. 

But my narrative, based on 8 years of intensive engagement, 

working with communities, partnering with a variety of groups and 

interests and making hundreds of friendships is not a tale of woe. 

It is, rather, a narrative of proud Americans who are resilient, determined, and full of grit. There is an army of Appalachians with 

ambition and hopes who get up every day and work incredibly hard 

to make their communities better places for their kids and their 

grandkids. 

Today, these folks bring energy and innovation and determination to many communities. They are focused on the challenge of a 

stronger, new, and diverse local economy. It is a story of groups 

like SOAR in eastern Kentucky, Coalfield Development Corporation 

in West Virginia, the Foundation for Appalachian Kentucky, the 

Pennsylvania Wilds, and the West Virginia Hub, the list goes on, 

who are incredibly focused on writing the narrative of Appalachia’s 

future. 

But we also know the studies, the data, the roundtables, the 

focus groups, the discussions, the casual conversations with friends 

and partners make it clear. Opioid addiction is a significant barrier 

preventing Appalachian communities from reaching their economic 

potential. Mayors tell me that prospective employers ask about the 

state of opioid addiction in their communities. Law enforcement 

understands they are confronting a disease. Friends and partners, 

7 

employers will pull you aside and say, this is touching every family, with the emphasis being on ‘‘every.’’ 

In 2008, ARC published a research report by the Walsh Center 

for Rural Health Analysis that showed Appalachian hospital admission rates for abuse of prescription painkillers were more than 

twice those in the rest of the United States. It showed the rate rising, both nationally and regionally, but it was rising faster in Appalachia. The ARC study was the first to document that Appalachia was being disproportionately harmed by the growth of prescription drug abuse. 

This fall, the President released the opioid commission report 

that outlined the challenges of opioid abuse nationwide. ARC recently published another study from the Walsh Center that described the extent of the opioid challenge in our region. It put 

opioid-related drug abuse in context with two other diseases of despair, suicide and alcoholic liver disease, and showed that the region’s mortality rate for all three combined is 37 percent higher 

than the rest of the Nation. The same study also illustrates that 

the gaps between Appalachian and non-Appalachian mortality 

rates are highest among people in their prime working years. 

In 2015, overdose-related mortality rates for Appalachia’s 25-to44-year-old age group were more than 70 percent higher than the 

same age group in the country’s non-Appalachian areas. Seventy 

percent of all the data points. This is the one that all of us need 

to focus on. It is the one that will have the greatest impact on the 

economic growth—economic opportunities of the Appalachian region. 

You probably already know that Appalachians are not folks who 

are going to stand by and wait for someone to tell them what to 

do when there is a problem that impacts their families and their 

community. Appalachians recognize that the opioid challenge requires everyone’s engagement and commitment. They understand 

that ARC can partner with them and—to help them take on the 

region’s toughest challenges. 

You will hear from Nancy Hale. The story of UNITE is an example of what Appalachian communities can accomplish. ARC is very 

proud to call ourselves a partner of Operation UNITE. We have all 

heard about the heroics of the Huntington, West Virginia, city 

emergency responders who have been on the front line of this 

opioid crisis. ARC is currently supporting the work of the CabellHuntington Health Department to expand its opioid harm reduction services from one site to six, making the program available 

countywide. 

Organizations like FAHE [Federation of Appalachian Housing 

Enterprises] in Kentucky recognize that they can contribute to this 

effort by partnering with service providers to develop recovery 

housing and employment support for individuals. ARC has invested 

$1 million in our POWER [Partnerships for Opportunity and Workforce and Economic Revitalization] Initiative that targets coal-impacted communities to help FAHE establish three treatment and 

recovery facilities in Kentucky. 

Using the ARC funds, the Center for Rural Health Development 

in Hurricane, West Virginia, is strengthening the healthcare indusVerDate Aug 31 2005 10:14 May 08, 2018 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 P:\HEARINGS\115\ED\2017\12-12-~1\29961.TXT JEAN
8 

try in a 15-county region by providing business development systems to care providers. 

At its core, each one of these examples is about creating job opportunities in Appalachia, which is what ARC’s core mission is. 

ARC believes that supporting the workforce and creating new 

jobs and businesses are strategically important in solving the region’s opioid crisis. Over the past 5 years, ARC’s investments have 

helped create and retain over 100,000 jobs. Each of these jobs gives 

someone hope, a reason to get up every day, and make the region 

a better place for their kids, their grandkids, and themselves. 

Mr. Chairman, thanks so much for this opportunity. 

Mr. BARLETTA. Thank you for your testimony, Chairman Gohl. 

Mr. Denk, you may proceed. 

Mr. DENK. Thank you. 

Good morning, Chairman Barletta, Ranking Member Johnson, 

and members of the House Subcommittee on Economic Development, Public Buildings, and Emergency Management. I appreciate 

the opportunity to be with you today. I am Barry Denk, the director of The Center for Rural Pennsylvania. The center is a bipartisan, bicameral legislative research agency serving the Pennsylvania General Assembly. For those who may not know, Pennsylvania has the third largest rural population in the Nation with 3.5 

million rural residents. Rural Pennsylvania compromises 75 percent of our Commonwealth’s land area. 

The center began sponsoring a series of public hearings in July 

2014, on the issue of what we now know is the public health epidemic of substance use disorder due to heroin and opioid addiction. 

We conducted our 13th hearing just this past October of 2017. The 

Center for Rural Pennsylvania received testimony from over 150 

professionals totaling over 35 hours, all viewable on my chairman’s 

website as well as their written testimony. We heard firsthand 

from the attorney general, from police officers, district attorneys, 

judges, EMS professionals, coroners, doctors, superintendents, business leaders, treatment providers, Federal and State government 

officials, and we heard from families who have lost loved ones to 

addiction, and we heard from persons in recovery. 

One of the individuals who testified at two of our hearings, the 

most recent being in October of 2017, is the president and CEO of 

the Pennsylvania Chamber of Business and Industry. He noted a 

Princeton economist, Alan Krueger, who released a report in September 2017 that analyzed how the opioid crisis has contributed to 

workforce challenges. By comparing county level data for opioid 

prescription rates, and labor force data for the periods of 1999 to 

2001, and from 2014 to 2016, Dr. Krueger concluded that opioid 

prescriptions accounted for a 20-percent decline in the workforce 

participation among men, and a 25-percent decline among women. 

The Pennsylvania Chamber of Commerce also commissioned a 

survey of its members in 2016 about their experiences and expectations concerning the workforce. Over 400 of the members responded to the survey, and they painted a daunting picture. A combined 52 percent said it is very, or extremely difficult to recruit 

qualified candidates to fill the workforce needs for their companies. 

Over 61 percent said finding qualified applicants has become much 

9 

more difficult within the past 5 years, and over 57 percent expect 

that same situation to play out over the next 5 years. 

Over 20 percent of the respondents said the job applicants or potential new hirees very often, or somewhat often, failed to pass a 

drug test. He also stated that it is becoming increasingly evident 

that addressing the prescription drug and opioid epidemic must be 

an integral component of any workforce development strategy. 

We are also aware of a study that was completed in two Appalachian counties in Pennsylvania, namely Allegheny, where Pittsburgh is located, and Westmoreland County. The Allegheny Institute for Public Policy released its report in May 2017, stating that 

their estimate is that there are 16,000 opioid medicine abusers in 

Allegheny County, and over 5,000 heroin abusers/users in Allegheny County coming at a cost for healthcare, crime, and lost 

wages and benefits estimated at $472 million for those opioid medicine users and over $350 million for heroin users. 

For Westmoreland County, the costs were placed at $102 million for opioids, and $108 million for heroin. We are also aware of a 

study by the National Bureau of Economic Research that surveyed 

35 Appalachia counties known for a high propensity for heroin use. 

It found that, as unemployment increases by 1 percent, there is a 

3.6-percent increase in opioid-related deaths, and an over 7-percent 

increase in emergency room visits for opioid-related health crises. 

These are just a few examples, given the time today, to help document the impact that the heroin and opioid epidemic is having on 

our workforce and our economy in Appalachia, and, specifically, in 

rural Pennsylvania. 

A few closing comments. Specifically, I will provide a quote from 

my chairman, Senator Gene Yaw, who testified before the Pennsylvania Senate Health and Human Services Committee in May of 

2017. And his quote is this: ‘‘Today, 13 Pennsylvanians will lose 

their lives to a drug overdose. This week, over 1,000 people will die 

of an overdose in the United States. By comparison, the Vietnam 

War, a period that spanned 10 to 12 years, claimed more than 

56,000 American lives. We are now approaching that level of lives 

lost every year due to drug abuse and misuse, and estimates are 

that these numbers will continue to surge.’’ 

The Center for Rural Pennsylvania since 2014 has been investigating this issue. But our work addressing rural Pennsylvania 

and the challenges and opportunities that face those residents in 

those communities dates back to 1987. 

I will leave this final comment with you: While the heroin and 

opioid crisis is an unbelievable impact for our communities and our 

citizens, it is also important to put it in the context of much broader challenges that are ongoing and systemic in rural Pennsylvania, 

and, I would offer, in rural Appalachia. 

Two things are constant, regardless of what we are talking 

about: geographic isolation, and lack of density population. And 

that makes it extremely challenging to aggregate, to get return on 

investment, and to provide goods and services that can move the 

economies for rural Pennsylvania. 

One of the maps that I provided for you in my written testimony 

shows the per capita income gap between urban and rural Pennsylvania. That gap in 1970 was just under $5,500. That income gap, 

10 

adjusted for inflation in 2015, increased to over $12,000, a per capita income gap. That means an awful lot of things for how rural 

Pennsylvania can do a lot of things, invest in a lot of programs, 

whether it is drug treatment or whether it is economic development 

programs. Those are constants that remain in rural Pennsylvania 

and speak to the broader picture of some of the challenges, but 

also, some of the opportunities that can turn things around for our 

Commonwealth. 

Chairman, thank you so much for the privilege to be here. 

Mr. BARLETTA. Thank you for your testimony, Mr. Denk. 

Ms. Hale, you may proceed. 

Ms. HALE. Good morning, Chairman Barletta, Ranking Member 

Johnson, and members of the subcommittee. Thank you for giving 

me the opportunity to speak with you. I am Nancy Hale, president 

and CEO of Operation UNITE. 

UNITE stands for Unlawful Narcotics Investigations, Treatment 

and Education. Operation UNITE was launched in 2003 by Congressman Hal Rogers, after the Lexington Herald-Leader published 

a report on addiction and corruption. Per capita, we were the top 

painkiller users in the entire world. UNITE pioneered a holistic approach that has become a model for other States and the Nation. 

Eastern Kentucky’s economy has been hard hit by the rising rate 

of substance abuse among its residents. Local employers are losing 

skilled workers to substance use and are unable to find qualified 

employees who can pass a drug test. 

So how is UNITE addressing the problem? UNITE’s enforcement 

effort has resulted in the removal of more than $12.3 million worth 

of drugs from the street, 4,400 arrests with a conviction rate of 

more than 97 percent, and nearly 22,000 calls to our tip line. But 

we realize that we cannot arrest our way out of this epidemic. 

We staff a statewide treatment line to connect people to resources, and have supplied vouchers to help more than 4,000 people enter long-term rehabilitation. In addition, the number of drug 

court programs has increased from 5 to serving all 32 counties in 

our region. But prevention is paramount. UNITE has reached more 

than 100,000 students through our drug education programs. 

A National Center for Injury Prevention and Control study estimated that prescription opioid abuse cost the economy $78.5 billion 

in 2013. That did not include factors like lost productivity. We have 

provided State-certified, drug-free workplace training to more than 

two dozen companies which benefit from reduced workers’ compensation insurance premiums, safer workplaces, increased productivity, and reduced absenteeism. UNITE focuses on addiction, the 

signs of drug use, the effects in the workplace, and how to find support services. We also help with employee assistance programs. We 

have implemented many evidence-based solutions. The good news 

is that these programs can be replicated. The bad news is they require funding. 

You have already heard Congressman Rogers say a vision without funding is a hallucination. Operation UNITE received Federal 

appropriations in the early 2000s for enforcement efforts. SAMHSA 

helped provide treatment vouchers. Through our AmeriCorps program, students show a more than 50-percent growth in math 

knowledge and drug education knowledge. Our achievements would 

11 

not have been possible without these appropriations, many of 

which are no longer available. We seek private and State investments, and continue to explore opportunities through the competitive grant process. Our unique regional holistic structure does not 

fit many funding models. 

The Appalachian Regional Commission has been invaluable. 

Please refer to my written testimony for those details. I would like 

to focus today, though, on the National Prescription Drug Abuse 

and Heroin Summit. Congressman Rogers asked UNITE to create 

a summit where stakeholders could collaborate, cooperate, and discover data-driven solutions to the epidemic. The ARC agreed to 

serve as educational partner for the first summit in 2012. Its investment of $50,000 paid for travel expenses for more than 200 

leading experts and the ability to offer continuing education credits. 

Since inception, attendance has more than tripled, attracting 

nearly 2,400 people in 2017. The Institute for the Advancement of 

Behavioral Healthcare now promotes and stages the summit. 

UNITE remains active as the educational adviser. In 2016, UNITE 

received ARC funding for effective sustainable social media strategies. UNITE implemented a campaign to raise awareness of the 

summit, and received training from Oak Ridge Associated Universities, enabling us to build a strong regional presence and increase 

Facebook followers by 24 percent. 

In 2017, ARC provided funding to share social media best practices at the summit; to expand our media presence in the Appalachia region; to assist with the CDC’s campaign to prevent prescription opioid abuse; and, create a strategic plan, a sustainability 

roadmap. 

Unfortunately, many people are unaware of how to replicate our 

initiatives, and UNITE has endured drastic funding cuts. UNITE 

and organizations utilizing our model are desperate for Federal 

support to keep the doors open. We hope we can maintain and expand upon our partnership with ARC and other Federal agencies. 

UNITE helps ARC fulfill its mission. And ARC support has enabled 

UNITE to create hope and change the culture, not only in southeastern Kentucky or Appalachia, but on a national stage. By supporting a national dialogue through the Rx summit, ARC is creating positive changes well beyond its service area. But we need 

the ARC to do more. Funding and expansion of our drug-free workplace training would help economic development in Appalachia. In 

addition, we need funding to support medical symposiums on prescribing addiction, alternative treatments, and recovery. 

UNITE looks forward to working with other communities across 

the Nation to address our Nation’s opioid epidemic. And thank you 

for giving me the opportunity to share today. 

Mr. BARLETTA. Thank you for your testimony, Ms. Hale. 

Mr. Novak, you may proceed. 

Mr. NOVAK. Good morning, and thank you for the honor of speaking here today. 

From 2010 through 2015, I had the great honor to serve as an 

attorney for the Drug Enforcement Administration. My work was 

focused almost entirely on enforcement actions against doctors, 

12 

pharmacies, distributors, and manufacturers of opioid controlled 

substances, all registrants under the Controlled Substances Act. 

For several years, with an eye on protecting the public health 

and safety, DEA shut down pill mills and practices run by greedy, 

immoral drug dealers in lab coats, all betraying not only their duties under the CSA, but their ethical obligations to their fellow 

human beings. I watched as DEA fought hard against the rising 

tide and struggled not to drown as the opioid epidemic swelled 

around us. 

The opioid epidemic was a slow burn fire. Traditionally, many 

opioids used to treat pain included acetaminophen, a drug which, 

if taken long term, caused severe liver damage. So in the 1990s, 

a pharmaceutical company decided to remove the acetaminophen 

and start promoting the use of opioids for long-term pain management. Their proposal was backed by claims that opioid medicines 

are rarely addictive. Too late. We now know that this is not true. 

As these drugs were marketed, the very people selling the pills 

went about changing hearts and minds about the dangers of 

opioids. Soon, opioid phobia was replaced with frowny-faced pain 

measurement and a general misunderstanding by many physicians 

of what exactly they were prescribing. Over the course of time, 

opioid usage was normalized in America and heralded as a wonder 

drug. Opioids were digging in everywhere across the country, especially in blue collar and poorer areas, where those seeking a prescription felt validated by the fact that their drugs came from a 

doctor and where those seeking a buck found incredible profits in 

sharing their stash. Unemployment and disability numbers rose, 

and the number of employable members of the workforce diminished. 

As DEA endeavored to help the people of this country, we began 

broadening our investigations and enforcement actions to look at 

the role of distributors and manufacturers in this threat of opioid 

addiction. Then, for no readily apparent reason, DEA began to slow 

down, not ramp up, its enforcement. And DEA became afraid to use 

its strongest enforcement tool: the immediate suspension order. 

The ISO was a tool for immediately halting the shipments of 

opioid controlled substances sent by a distributor to a pharmacy. 

During my time at DEA, it seemed to me that these larger pharmaceutical corporations and industries were not interested in doing 

the right thing, at least until their profits were hurt and their 

names were being tied to the opioid epidemic in the headlines. 

Soon after, DEA began losing more and more attorneys recruited 

over to represent the industry. When these attorneys left for the 

industry, they brought with them an intense and brilliant understanding of DEA regulations and case law. I believe this brilliance 

and understanding, now representing some of the largest DEA registrants in the country, was what DEA began to fear. This was, to 

my understanding, what caused much of the slowdown in DEA enforcement. 

It was, to my knowledge, a former DEA attorney who drafted the 

Ensuring Patient Access and Effective Drug Enforcement Act 

which stripped DEA of the ISO. While DEA attorneys feared that 

a bad decision in Federal court might strip DEA of the ISO, Congress effectively legislated the ISO away, ostensibly in the name of 

13 

ensuring patient access to opioid controlled substances. Without 

the ISO in its tool belt, DEA will likely have little effect enforcing 

regulations against manufacturers, distributors, and large pharmacy chains who, in my experience, only ever seem to listen when 

it hurt their bottom line. Ensuring patient access is a misleading 

description painting the picture of an altruistic industry only concerned with saving lives and easing pain. 

While we may not consider corporations to be people, there is 

simply no such thing as an altruistic corporation. And by limiting 

DEA’s ability to enforce its regulation and the CSA against these 

pharmaceutical corporations, we have effectively condoned the poisoning of our populous, and ushered in the loss of an entire generation to highly addictive and deadly drugs. 

According to the CDC, 80 percent of heroin users in America 

today got their start on opioid painkillers. Overdose deaths in 

America are at an all-time high, making the heroin epidemic of the 

1970s and the cocaine epidemic of the 1980s look tiny in comparison. We are killing our own people, and DEA is falling down on the 

job. This is an epidemic that focuses on no race, no gender, no socioeconomic classification, because it affects them all. 

Everyone has a story of a loved one injured on the job now living 

a life of addiction, pain management, and unemployment, because 

their doctor kept increasing their prescribed dosage, or of a student 

injured in a high school football game prescribed opioids by a wellintentioned physician, and now in jail for possession of heroin or 

dead of an accidental overdose. 

Significant damage has been done not only to those who now are 

addicts, but to our communities, our workforces, and our economies. Old methods of treatment are failing in the face of this longterm physical and biological addiction. And yet, these pills seem 

easier and easier to find and harder and harder to avoid. We need 

to focus on changing the laws, restoring DEA’s ability to enforce, 

and looking at funding to educate our population, and to help those 

already addicted to fully recover and become productive members 

of our society again. We need to focus on local law enforcement and 

legal actions by States and counties. All of this starts with effective 

enforcement to shut off the overflow of opioids into our communities. 

And thank you very much for this opportunity today. 

Mr. BARLETTA. Thank you for your testimony, Mr. Novak. 

I will now begin the first round of questions limited to 5 minutes 

for each Member. If there are additional questions following the 

first round, we will have additional rounds of questions as needed. 

Mr. Denk, The Center for Rural Pennsylvania has done a lot of 

work for the Pennsylvania General Assembly. It seems the impact 

of the opioid crisis on the workforce is significant. 

From the information the center has gathered, can you highlight 

how opioid abuse has created barriers for attracting jobs? And how 

will the general assembly use the information you have collected to 

address this issue? 

Mr. DENK. We have heard from a number of testifiers, particularly those in recovery, where prior felony convictions still linger 

for them, not just in employment opportunities, but with regard to 

14 

housing itself. And so I know my boss, Senator Gene Yaw, is looking at that issue. 

There is concern that those felonies, while committed because 

somebody was addicted to a substance, need to be looked at. And 

at some point in time, maybe that can be removed from their 

record. 

We heard from one young individual in Greensburg, Pennsylvania. Started the path into drugs at age 13 because of her home 

environment. And she eventually went to heroin. She committed 

two felonies by the age of 20. That woman turned her life around 

completely. She now has a master’s degree, and she now works for 

the Allegheny Health Network as an addictions counselor, helping 

individuals. Those two felony convictions still linger on her record. 

And she has been turned down for housing because she reports, 

yes, I have been convicted of two felonies. 

So we have heard that. We have heard from employers, particularly in the gas industry, which is important to Pennsylvania’s 

economy with the drilling, of individuals who fail to pass some drug 

tests. We heard at one of our hearings in Williamsport where the 

local single county authority, the agency that provides treatment 

services, they are meeting with employers and developing a list of 

employers who are willing to give a second chance to an individual 

who may have had a substance use disorder, may have had some 

kind of criminal activity as a result of that. 

We also heard from a number of judges about the effects of drug 

courts and how helpful they are, and somebody who has committed 

a crime but needs to turn their life around. And so we are looking 

to expand drug courts across the Commonwealth. 

Currently, out of 67 counties, only 38 drug courts exist in those 

counties. There are a number of things that are being looked at to 

further document the question that you raise and take a look at 

from a legislative standpoint as to what might be done. 

Mr. BARLETTA. Thank you. 

Ms. Hale, Operation UNITE has done a lot in eastern Kentucky 

and has become a resource for other communities. 

What types of programs have you found to be the most impactful 

in addressing the opioid crisis? And are there models that other 

States like Pennsylvania can use? 

Ms. HALE. I think our education prevention programs have had 

the greatest impact. We have seen and heard anecdotal evidence 

from some of our summer interns who were students in college 

share that, on their college campus in attending frat parties and 

sorority parties, where there, unfortunately, is a great deal of alcohol and drugs being used at the parties, the students have noted 

that there are a number of students who do not engage in those 

activities, and then they begin noting that those students were 

from eastern Kentucky, and have grown up for the last 10 to 12 

years hearing about substance abuse, being trained in making 

healthy choices and things such as that. We are seeing an impact 

on that generation. 

Also, we are seeing an impact in our program in working with 

the administrative office of the courts through our drug court programs. We are learning that drug courts do work. There are many 

people who are in recovery who make excellent employees because 

15 

of what they have endured, what they now understand, the structure that has been brought into their lives through the drug court 

programmings. 

Education and prevention. We have a mobile prevention unit 

that we target 7th and 10th graders. That has had a huge impact. 

The University of Kentucky compiles the data from the pre- and 

post-surveys with that program. We also have programs that we 

are taking into the elementary schools where we are introducing 

young people at an early age to the dangers, the harms, preparing 

them with knowledge, helping them make healthy decisions, even 

as early as third grade. 

And then, of course, our AmeriCorps program. We have 54 

AmeriCorps members serving in 13 counties in our district. And 

those AmeriCorps members work primarily on math tutoring. But 

they also are introducing a Too Good for Drugs curriculum that impacts the parents, the staff, and the community in prevention initiatives. 

Mr. BARLETTA. Thank you. 

The Chair now recognizes Mr. Johnson for 5 minutes. 

Mr. JOHNSON. Thank you, Mr. Chairman. 

Mr. Denk, you have testified that alcohol and drug treatment 

funding has been cut by 25 percent, while requests for service have 

quadrupled since 2014. 

Mr. DENK. Yes, sir. 

Mr. JOHNSON. Have you identified either Federal or State funds 

that could reverse those cuts in future fiscal years? 

Mr. DENK. That testimony came from one of the single county 

authority directors, who specifically gave those statistics. There is 

hope that at the Federal level, there might be some funds that 

would be earmarked, additional funds that would be made available. The CURE’s [Commonwealth Universal Research Enhancement program] grant. Pennsylvania received about $26.5 million 

under the CURE’s grant from the Federal Government to deal with 

drug addiction and treatment services. Also, the Pennsylvania General Assembly, our budgets are extremely strapped, but I know 

there is interest in looking at expanding treatment options. There 

was over $30 million provided in the State budget to set up what 

we are calling Centers of Excellence around the Commonwealth. So 

there has been new money provided at the Federal and State levels 

to support treatment programs. 

Mr. JOHNSON. Well, are you fearful that the passage of the tax 

cut bill that is pending before Congress now will have an adverse 

impact on the ability of the Federal Government to fund these 

grants that have been insufficient in the past? 

Mr. DENK. I really can’t speak to that, sir, quite honestly, in 

terms of not knowing all the details of the tax cut bill. I think, you 

know, priorities need to be made in terms of what works best for 

the Nation as a whole. But, quite honestly, I have not looked at the 

specifics of the tax cut bill. 

Mr. JOHNSON. Well, let me ask you this question. 

Mr. DENK. Sure. 

Mr. JOHNSON. Do you anticipate that future healthcare cuts 

based on changes in Federal healthcare laws and regulations, such 

as the repeal of the Affordable Care Act, also known as Obamacare, 

16 

do you think that that could have an impact on the ability of those 

seeking treatment to get drug treatment? 

Mr. DENK. If funds are cut serving Medicaid-eligible individuals 

who are in need of drug treatment, then there will be challenges 

that present themselves for those individuals. We have found community foundations and others stepping up to the plate and helping out in terms of providing services for indigent individuals. Time 

will see as to what impacts at the Federal level that filter down 

to the State play out for those audiences, sir. 

Mr. JOHNSON. Well, thank you. 

Ms. Hale, in your testimony, you state that the second pillar of 

addressing the opioid epidemic is treatment. 

Has the Affordable Care Act, also known as Obamacare, affected 

the ability of residents of Kentucky to get treatment for drug addiction? 

Ms. HALE. Has it affected the ability? I probably can’t address 

that properly. 

Mr. JOHNSON. Let me ask it this way then: Have there been opportunities for people to get treatment in Kentucky for drug abuse 

and drug addiction, because they had access to the healthcare system through the Affordable Care Act, and the State’s expansion of 

Medicaid under the Affordable Care Act? 

Ms. HALE. There have been opportunities, I am sure, that that 

has resulted. One of the things that UNITE did before is, in providing the vouchers for people who did not qualify, did not have 

private insurance or Medicaid, to enter long-term rehabilitation. 

Mr. JOHNSON. Well, do you worry that a withdrawal of Federal 

resources from social services can adversely impact the ability of 

people to get treatment for drug abuse in Kentucky? 

Ms. HALE. I think our communities are rallying, our State is rallying around to fit those needs. What I would be concerned about 

is if the system could handle all of that. 

Mr. JOHNSON. I know it is a political football, but we got to get 

away from politics and start looking at how we help people, and 

whether or not Federal policies are helping. 

Now, Mr. Novak, what is the historic role of the DEA in stopping 

the flow of suspicious drug shipments in Appalachia? 

Mr. NOVAK. Historically, that was exactly the purview of what 

DEA was doing nationwide. Appalachia was especially hard hit. 

And, you know, the problem is the suspicious orders are to be monitored and reported by registrants. DEA has historically been, you 

know, reactive, not proactive, because there are suspicious orders 

going into West Virginia, in a town of 925 people, that is getting 

9 million oxycodone pills, and that is not reported to DEA. DEA 

then finds out about things like that, and can go in and try to shut 

them down. 

But, you know, that is exactly what DEA relies on in putting together its cases and trying to have a registrant, like a distributor 

or a manufacturer, monitor what is going out. Unfortunately, historically, we found that they weren’t and they were just pushing 

orders of that size into regions with no concern whether or not that 

order was suspicious. 

Mr. JOHNSON. Thank you. My time has expired. 

17 

Mr. BARLETTA. Again, just a reminder that our committee’s jurisdiction is not a healthcare policy or DEA enforcement. We want to 

find solutions that we can act on as this committee. 

The Chair now recognizes Mr. Mast for 5 minutes. 

Mr. MAST. I want to thank you for the time, Mr. Chairman. 

This epidemic is something that greatly affects my region in 

Florida, as well as it does many other areas of the country. I have 

three beautiful children. I literally couldn’t imagine this being 

something that affects my family. I have a very good old military 

friend of mine I speak to reasonably often, and he lost his son. So 

it is something that touches close to home for me. 

I just want to ask a couple of questions quickly, just a little bit 

of fact-based questions here. What are the quantity of opioids that 

are obtained legally versus those that are obtained illegally that 

are relating to whether an overdose or an overdose resulting in 

death? What are the statistics that we are looking at comparatively, whoever can answer that? 

Mr. NOVAK. I can at least start with that. The problem that we 

are seeing in this epidemic is that you can’t get the pills, for the 

most part—every pill that is getting out on the street was prescribed by a doctor, filled by a pharmacy. 

The problem is the people who are overdosing aren’t just people 

abusing. The directions for taking your oxycodone, it is not a onesize-fits-all. Addiction can be caused as quickly as after a 10-day 

program of opioids. There is a 20-percent chance you are addicted 

a year later. 

The overdoses are happening, not just from abuse, but from 

standard use, because I don’t believe that our medical community 

is nearly as informed about the dangers of these or the potential 

for overdoses as they need to be. 

Mr. MAST. Certainly. But do you have a number saying this is 

how many opioid deaths or overdoses that were treated that are as 

a result of somebody that filled the prescription that was assigned 

to them, or somebody that purchased it secondhand from somebody 

else? That is what I am asking. 

Mr. DENK. Sir, I am not aware that that information is available 

in Pennsylvania. 

One of the challenges would be is, who collects that data. If it 

is stolen medication or taken out of a house, whether law enforcement gathers that information, the county coroner upon autopsy or 

a hospital, there could be a number of organizations involved in 

dealing with that death from an overdose. And, so, the data analytics on that is challenging to get. 

I have one statistic for you, but it doesn’t distinguish your specific question. This is from the U.S. Drug Enforcement Administration in a report in July of 2017 for Pennsylvania. 

‘‘In 2016, the presence of an opioid, either illicit or prescribed by 

a doctor, was identified in 85 percent of drug-related overdose 

deaths.’’ So whether it is illicit or actually prescribed, opioids are 

still a major, major player, obviously, in overdose deaths in Pennsylvania. 

Mr. MAST. Very good. Thank you for your response. 

What is the most commonly used opioid for overdose? Is it methadone? Oxycodone? Hydrocodone? Fentanyl? What ranks as the 

18 

number one drug within this epidemic, or number two. You can 

give me a couple. 

Mr. DENK. In Pennsylvania, it is a mix. Oxycodone. But we are 

seeing because of Pennsylvania now has in force for a couple years, 

our prescription drug monitoring program, which is cutting back 

dramatically on opioid prescriptions out on the streets, illicit or 

otherwise. The presence of fentanyl, increasing deaths in Pennsylvania due to fentanyl. 

Mr. MAST. So are you saying that filled the gap that was created 

by enforcement elsewhere? 

Mr. DENK. I am not sure that it filled the gap. I think those that 

are in the drug-dealing business can make more money by mixing 

fentanyl into their heroin. The person who uses it has no idea of 

the purity of that heroin. And that, because of the PDMP [Prescription Drug Monitoring Program] being in place and controlling 

opioids, it was predicted that we would see a rise in heroin use and 

overdose deaths. But now with the influx of fentanyl, what we are 

seeing is a major cause of overdose deaths now in certain counties. 

Mr. MAST. Thank you for your responses. This is undoubtedly 

something that we all need to find the absolute best way to work 

together on this across the States, across the Federal Government, 

across every locality to combat this. 

I thank you for your responses, and I yield back, Mr. Chairman. 

Mr. BARLETTA. Thank you. I ask unanimous consent that members not on the subcommittee be permitted to sit with the subcommittee at today’s hearing and ask questions. 

The Chair now recognizes Ms. Norton for 5 minutes. 

Ms. NORTON. Thank you very much, Mr. Chairman. 

I thank you for calling this hearing. Of course, it focuses on Appalachia. We know that opioids are a problem throughout the 

United States. It is interesting how drugs tend to find their favorite places, and the link between opioids and heroin and how that 

is playing out. But this is particularly bothersome, because we find 

opioids here in Appalachia where there is, to begin with, poor education, low income, often rural areas, the last place that needs this 

kind of epidemic. It is really heartbreaking. Opioids, of course, the 

difference between opioids and heroin is that ain’t nobody prescribes heroin. Initially, opioids are prescribed and then they become a kind of rogue drug. 

What interested me was to note that the Chamber of Commerce 

in Pennsylvania has seen a link between employability and the 

skills gap and this opioid crisis. And I am wondering, in light of 

a survey that has been cited to us, for example, that businesses 

find that over 20 percent of applicants, or their potential new hires, 

often fail a drug test. 

So I am interested, Mr. Denk, in what your legislature is doing, 

given what appears to be an effect on the economy itself and on 

getting people who might otherwise be employed a job. 

Mr. DENK. There has been no legislation with regard to the issue 

of the business and industry with employers in terms of their right 

to issue, you know, drug tests on individuals. That—— 

Ms. NORTON. I understand their right, but they are having to do 

it because they suspect so many of those who are applying for jobs 

have been caught up in this crisis. And I wonder if the legislature 

19 

has found any way to address this problem of employability with 

an ultimate effect on your economy—— 

Mr. DENK. Sure. 

Ms. NORTON [continuing]. In Pennsylvania. 

Mr. DENK. Ma’am, no short-term answers. No quick fixes. I think 

it has been recognized, certainly from the public hearings that we 

have held across the Commonwealth, education on prevention, and 

education starting at the lowest levels. And we heard this from the 

UNITE program. That has been seen as the long-term fix in this 

long-term crisis. 

Ms. NORTON. So if people are better educated, or they are not 

caught up in this opioid crisis, and they can pass the drug test, and 

it is basically poor people that are involved. If it is a question of 

education, is the link between education and employability such 

that you can get a hold of these people once you try to get them 

off of the drug and deal with the education problem at the same 

time? 

Mr. DENK. Yes, ma’am. Pennsylvania implements what is called 

a PAYS study. Pennsylvania Youth Survey. It is done every year. 

And that measures attitudes, behaviors, influences of youth in 6th 

and 10th and 12th grades. 

We are seeing individuals coming from family members where 

parents are approving marijuana use. They would rather them do 

that, or they would rather them drink in the home as opposed to 

going outside. So with this whole education, it is getting in early 

and changing attitudes and behaviors and mindsets. It is going to 

be a long-term solution. 

Ms. NORTON. I want to ask this before my time runs out. 

Mr. DENK. I am sorry. 

Ms. NORTON. I appreciate that answer. I want to ask Mr. Novak 

a question. Because I am wondering, why this problem has grounded itself in areas like Appalachia, whether or not the DEA had a 

role in stopping this kind of entrenchment at any time, and when 

did it become so entrenched, and why did it become so entrenched 

in an area like this? 

Mr. NOVAK. First of all—— 

Ms. NORTON. I want to know all I can to keep it from becoming 

entrenched in the big cities. 

Mr. NOVAK. And, you know, what we are seeing now is it is becoming entrenched everywhere, or rather, it has become entrenched everywhere. It is a problem that we didn’t recognize until 

it was far too late. Poor areas or isolated areas, they found a market for these kinds of drugs, because they seem to be valid because 

a doctor is prescribing you. And if a doctor is prescribing it, it must 

be good for you. But it is also, you know, that almost gave people 

a pass. ‘‘Well, I am not abusing, I am just using what my doctor 

prescribed to me for my pain management.’’ 

DEA, again, you need to look at the fact that there are divisions 

around the country and the larger an area and the bigger the population and the more funding that that division has, you know, the 

more proactive they could be. And unfortunately, some of the worst 

problems I saw at DEA were cases coming out of areas that nobody 

cared about until it was too late. 

20 

I know Florida, for instance, got hit devastatingly with all of this, 

but it was always in the smaller towns, a little farther away. You 

know, it wasn’t Miami, it was Oviedo. And that is where this all 

took route. It took route with the populous that, you know, could 

get these drugs for much cheaper at the time, and then felt validated in using them. Again, it is staggering how addictive these 

things are, and 2 months of being on an opioid, suddenly you are 

addicted. And it just escalates and escalates. 

Ms. NORTON. Thank you, Mr. Chairman. 

Mr. BARLETTA. Thank you. The chairman now recognizes Mr. 

Faso for 5 minutes. 

Mr. FASO. Thank you, Mr. Chairman. I appreciate the witnesses 

being here today on this topic. 

I am wondering, Ms. Hale, if you could tell us what you think 

it would take to replicate the type of program that you are operating in Kentucky around the country, and what kind of funding 

streams have you been able to—you or others—been able to postulate? Maybe even Mr. Denk may have some ideas in that regard 

as well. 

Ms. HALE. To replicate the holistic approach that Operation 

UNITE, when we first began, when Congressman Rogers launched 

the program, we had Federal grants from the Department of Justice working, starting out with about $12 million and in receiving 

other grants, you know, like our AmeriCorps grant, funding from 

ARC, that sort of thing. 

Mr. FASO. So, in other words, you would cobble together, whether 

they were specific appropriations that Mr. Rogers was able to secure, or specific funding streams from other agencies, cobble that 

together to run your program? 

Ms. HALE. Correct. The State support that we receive now allows 

us to keep our doors open somewhat. One of the things that we 

have done is developed community coalitions within every one of 

our 32 counties. These are people in that county who are volunteers who serve. They have their own nonprofit status, and they 

are working to secure grants and funding. We have several drugfree community grants in our area that we are working with those 

areas as well. 

Mr. FASO. So I guess our task is to find out how we can maybe 

combine some existing Federal funding streams together with perhaps some new efforts in order to attempt to replicate these efforts 

around the country. 

You had mentioned that you had also been able to fund vouchers, 

you said, I think, 4,000 vouchers, for people to get substance abuse 

treatment. I guess that would be short- and/or long-term. 

Ms. HALE. No, sir, we only fund long-term treatment. 

Mr. FASO. Long-term. And so where did you get the money for 

that? 

Ms. HALE. Starting out, that money came from SAMHSA. The 

Commonwealth of Kentucky supports that. We use the proceeds 

from the National Prescription Drug Summit. We also had a lot of 

buy-in from businesses and organizations, such as Kentucky River 

Properties gave us $500,000, because they understood the need for 

helping their employees who were suffering from substance abuse, 

get into long-term treatment. 

21 

Mr. FASO. Yeah, I would think, in line with what you just said, 

that it would be important for us to try to not just simply let people 

think that there is one source of funding for this from Washington, 

but combining sources from States, localities, but also the private 

sector. Because I think that if everyone has some skin in the 

game—Mr. Denk, did you have something to add in that regard? 

Mr. DENK. Not on the scale of Operation UNITE, but there is an 

entity in Williamsport, Pennsylvania, called Project Bald Eagle. 

Similar concepts, doing a lot in the area of prevention and education, nothing in the area of treatment. 

Their core funding came from higher education, the healthcare 

system and the Chamber of Commerce. They all kicked in $25,000 

apiece to jump start what’s called Project Bald Eagle. So I think 

there is local money to be had. There is community foundation 

funding. I think as long as there is a solid game plan, local investment can occur, and certainly, if that can be piggybacked and 

parlayed with other moneys, Federal, State, I think you get a 

greater return on investment. 

The investment, as has been demonstrated, must be owned at 

the local level. 

Mr. FASO. Yes. And I think that is a very important point that 

you just made. 

Now back to you, Ms. Hale. Again, you mentioned that you conduct drug-free workplace training that is a State-certified training, 

I think you said. How prevalent is that among the States? Do all 

50 States have such programs or is this unique to your area? 

Ms. HALE. I don’t know if all the other States have that program. 

It has been unique to our area in Appalachia, simply because before UNITE, we weren’t aware of any drug-free workplace training 

that was taking place. 

Mr. FASO. Thank you. I think, Mr. Chairman, the fact is that we 

are seeing, right now, among the lowest workforce participation 

rates of able-bodied people between 18 and 65. And this, in line 

with what the Pennsylvania study suggested, is really a prevalent 

problem that exists all across the country. 

In my district, I have counties that have under 60 percent workforce participation rates of people between 18 and 65, and I think 

opioid and drug abuse is a major part of that. And I appreciate 

your convening this hearing, and I appreciate the witnesses being 

here today on this topic. And I yield back. 

Mr. BARLETTA. The Chair recognizes Mr. Smucker for 5 minutes. 

Mr. SMUCKER. Thank you, Mr. Chairman, for the time. I appreciate it. 

Mr. Denk, thank you for your testimony. Welcome to Washington, DC. 

Mr. DENK. Thank you. My pleasure. 

Mr. SMUCKER. It is great to see you. 

Mr. DENK. Thank you. 

Mr. SMUCKER. As you know, I am also from Pennsylvania, served 

in the legislature and State senate for 8 years, and so I am familiar 

with the work of your organization. You have been a tremendous 

resource to the legislature in Pennsylvania. And, Senator Yaw, the 

chairman, is a good friend. In fact, I sat next to him in our caucus 

22 

for much of the time that I spent there, so really great to hear from 

you. 

Mr. DENK. Thank you. 

Mr. SMUCKER. Senator Yaw, I know, and your organization did 

a lot of work, hearings all across the State, really bringing an 

awareness to this issue a number of years ago when you started 

the work that was so valuable to all of us. And we have had a lot 

of conversations in caucus in the State senate in regards to how we 

can respond. And, you know, just the magnitude of this is hard to 

imagine at times. And just repeating what you said in your testimony, 4,642 Pennsylvanians died in 2016 as a result of a drug 

overdose with thousands more affected by addiction, either personally or through family, friends, coworkers, employees or neighbors. 

That was an increase of 37 percent from 2015 when, as you mentioned, 13 people died each day of a drug-related overdose. 

Just specifically, my area in 2016, my district includes portions 

of three counties, Lancaster averaged 22.3 deaths per 100,000 people; Chester County averaged 19.4; and Bucks County, 28.4 overdose deaths per 100,000 people. It is just absolutely devastating to 

our communities. 

One of the takeaways that I always heard from Senator Yaw, 

and you mentioned here this morning, is there are no simple shortterm solutions. In fact, there is no silver bullet here to solve this. 

And, you know, we think it can be solved but it will take a number 

of solutions, a broad range of solutions, from enforcement to treatment to—you mentioned drug courts, which have been particularly 

effective in my area. 

We did a number of pieces of legislation at the State level as a 

result of the hearings that you have done. One of those you mentioned was a prescription drug monitoring program. And as with 

any new program there was pushback. It, of course, was additional 

work for every party, you know, including medical doctors, pharmacies and all. But I am curious, how well do you think it is working, and are there ways that we should improve a program of that 

type? 

Mr. DENK. Thank you. The office of the PDMP is right next door 

to my office, so I do meet with them on a regular basis. It is working in Pennsylvania. I don’t have the figure in front of me, but I 

know that the director has talked on numerous occasions about the 

thousands of pounds of opioids that have been stopped because of 

the PDMP and the doc shopping that was occurring. And so that 

has been critical. 

There is interest in revisiting the prescription drug monitoring 

program to tighten it up a little bit. We had one doctor who oversees a residency program, and he would like language that allows 

someone to query the querier, kind of a checks and balance as to 

who is checking into the system and using it, that type of thing. 

Some comments that we have heard that dentists should be required to subscribe to that. Dentists prescribe opioids. And from a 

medical standpoint, often opioids are not what is needed to deal 

with pain from a dental procedure. 

So there is interest in reopening it. As you know so well, you 

open any piece of legislation, and it is ripe for a lot of other things 

to be taken a look at. 

23 

Mr. SMUCKER. And sorry to cut you off, but I am running close 

to the end of my time. 

I am curious, from your perspective, what is it that we could do 

at the Federal level to help? What would be your number 1, number 2 things that we should be—specific actions that we can do to 

help communities combat this? 

Mr. DENK. The public face of this epidemic, I think the Federal 

Government can play an even greater role in recognizing that it is 

an epidemic affecting all segments of our society, and has direct 

impact on the economy, on infrastructure, you name it. 

I think a much stronger face and getting Federal agencies, and 

I see this in Pennsylvania, and State agencies, to really work together. Unfortunately there is still too much siloing in our work to 

address this epidemic. 

Mr. SMUCKER. Thank you. Mr. Chairman, I have additional questions. Do you want me to wait for the second round? 

Mr. BARLETTA. Yeah, sure. 

Mr. SMUCKER. Thank you. 

Mr. BARLETTA. I will now recognize each Member for an additional 5 minutes of questions. 

Mr. Gohl, the ARC is a Federal economic development agency. 

How did the problem of opioids get on your radar, and do you think 

ARC’s programs are good templates for other Federal economic development agencies, such as the EDA, and if so, how? 

Mr. GOHL. Thank you, Mr. Chairman. I think that, a couple 

things. In our work within the region, this clearly became an issue 

within several communities. 

And you know, part of the work of Operation UNITE has a little 

bit of magic about it, because it is not just the money, but it is the 

leadership, and the long-term leadership. And the effort and the 

work that Congressman Rogers has put into growing Operation 

UNITE is a lot of the reason for its success and its recognition. 

And not every community has a Harold Rogers to be there all the 

time pushing, pushing, pushing, challenging people like me. And 

that is an important part of it. So, you know, giving money to folks 

is one thing, but having leadership pays huge dividends. 

In terms of our experience, in one of the research projects that 

we did back in 2008, the data showed that Appalachia was leading 

the Nation in the hospitalization as a result of prescription drugs. 

And that really was a surprise to us. That really got our attention. 

In working and talking with Congressman Rogers and his staff 

around an agenda, we got to a point of developing and working 

with Operation UNITE to do a national prescription drug abuse 

summit and to take a role in terms of education—the extended 

education—as our contribution to the summit. 

And I think that really, for us, put us in a position where we 

weren’t just supporting a conference, but we were supporting education and the development and strengthening of the workforce. 

That is where we felt pretty comfortable. And clearly, as you look 

at our plans and look at our strategies, developing and strengthening the workforce is a critical area of our work. 

The other thing I would say is that we currently have a partnership with NIDA, the National Institute on Drug Abuse, where we, 

with CDC and a couple agencies—but NIDA is really the lead—are 

24 

working in five different communities, or five different initiatives 

around the region to focus on community-based solutions to treatment and prevention of substance abuse. 

And we are very hopeful that that evidence-based work would 

really provide some direction and some really strong guidance for 

going forward. 

Mr. BARLETTA. And what would help ARC’s work on opioids be 

more effective? 

Mr. GOHL. You know, I would say that a seat at the table is 

probably the most effective thing that works in this town, that 

when ARC is part of the discussion, or ARC is part of the development and ARC is part of hearings like this, it makes sure that the 

rural voice is heard. And oftentimes, I think you just heard one of 

the witnesses talk about that nobody really knew. Well, it is collecting data and making sure that the rural communities are part 

of the discussion is often the biggest part of the challenge. And so, 

it is hearings like this; it is being a part of initiatives and work, 

not only in the Appalachian region, but to partner with other folks 

who are doing work outside the region is very helpful. I think that 

our partnerships with CDC, and NIDA in particular, over the last 

few years, has given us, not only resources, but it has also given 

us a place and a voice to raise the issues of Appalachia and the 

challenges that we have. 

Mr. BARLETTA. And what is the role of ARC in helping to address 

the opioid problem? 

Mr. GOHL. I think we have several roles. I think that it is important for us to work with our State partners who really are the 

agenda setters for the Commission in terms of investment of dollars, to work with them and make sure that the issue of opioids 

in the workforce and how it affects communities is a challenge that 

they focus on and that they use the resources to invest in. 

I think that we need to continue to work around community organizations and being able to empower them and give them the 

tools. I think it is important for us to invest in initiatives like 

NIDA as a way of really getting to strategies that work. There is 

no reason to invest in strategies that don’t work. 

I think part of the ongoing effort right now is around social 

media, and how do you use social media as part of this? Social 

media just consumes us all, and it is a way of communicating. It 

is a way to share challenges and issues. And I think as you go forward, we are going to learn more about effective strategies for how 

do we communicate. Groups like Operation UNITE can engage 

their communities. It is not just a matter of ‘‘just say no.’’ It is really a matter of these are the reasons, these are the challenges we 

face, and to be able to drill down and get people to understand the 

challenges and the dangers that they are facing. 

And I think one of the other issues that we really need to focus 

on is making sure that people understand that this is a disease and 

that we need to treat it like a disease. And, you know, this country 

has faced a lot of diseases over the years with polio, or small pox, 

or the flu, or HIV/AIDS, and we defeated each one of those. And 

the challenge is to look at the history and look at what has worked 

in the past and how do we move forward to make sure that we defeat this disease as well. 

25 

Mr. BARLETTA. Thank you. The Chair now recognizes Mr. Johnson for 5 minutes. 

Mr. JOHNSON. Thank you. Mr. Gohl, given the Appalachian Regional Commission’s efforts to address the opioid epidemic in Appalachia, if the President’s fiscal year 2018 budget recommendation 

to eliminate the ARC were affirmed by Congress, what other Federal agency would be able to meet the needs of Appalachia? 

So in other words, if the Appalachian Regional Commission 

ceases to exist, as is called for under President Trump’s 2018 budget, what would be the effect on Appalachia, and on the drug epidemic that ravages America and Appalachia? 

Mr. GOHL. You know, ARC over the last number of years has 

been very focused on creating opportunities, changing the level of 

education, working, you know, very deliberately for the region to be 

on parity with the rest of the Nation in terms of socioeconomic—— 

Mr. JOHNSON. Well, let me ask you the question this way. I really want to get a yes or no, a quick answer. 

Will the defunding and the removal of the Appalachian Regional 

Commission from the Federal budget, that would hurt Appalachia, 

wouldn’t it? Yes or no? 

Mr. GOHL. Mr. Johnson, I have a great deal of respect for you, 

and I appreciate your work—— 

Mr. JOHNSON. And I really just want to get—I am not trying to 

be political. I am just making a point. I think it is a fair point. Because what we do up here, the Federal policies that we enact up 

here have an impact back at home, back on the streets. People pay 

taxes, people deserve a fair deal. When they pay in, they should get 

a return on it. 

So when we start talking about giving tax cuts to wealthy individuals, multinational corporations and the like, it has an impact 

on people on the street who are paying taxes. And when we have 

a proposal to eliminate the Appalachian Regional Commission because we are spending too much money and the Federal Government has to cut its deficit and debt, so we sacrifice the Appalachian 

Regional Commission because we want to give tax cuts to the 

wealthy. I mean, that is a fair point, I think, for me to make and 

for me to ask you. And I am just asking you what the impact of 

that policy would be on the Appalachian region? And this is what 

I was talking about in terms of us being honest and not playing 

politics, and let us really look at the impact of our policies on how 

it affects people in Appalachia. That is the only thing I am trying 

to do. 

And I know that you don’t want to answer the question. It is 

hard to—the truth hurts. And that is the bottom line. 

Mr. GOHL. Sir, I would say this: Every year we release a document that talks about what we did. And the document talks about 

the number of folks we educate, the number of jobs we help folks 

create, and if ARC isn’t here, we are not going to issue that report 

any longer. 

But in all fairness, Mr. Johnson, the support that was vocalized 

in March of this year by a bipartisan group of Members about 

ARC, which was really very impressive, and what we did was we 

got to work on doing our jobs, of taking the funds that the ConVerDate Aug 31 2005 10:14 May 08, 2018 Jkt 000000 PO 00000 Frm 00031 Fmt 6633 Sfmt 6633 P:\HEARINGS\115\ED\2017\12-12-~1\29961.TXT JEAN
26 

gress provided us, and worked diligently every day to focus in on 

our work and what Congress told us to do. 

Mr. JOHNSON. Well, if those funds went away, it would hurt the 

people of Appalachia, who I really feel for, suffering and pain and 

no hope about the future. And I believe that there is something 

that the Federal Government can do, should do, and must do in 

order to help the people of Appalachia and the people throughout 

this country who are suffering and looking for a better deal from 

their Government. And with that, I will yield back. 

Mr. BARLETTA. The Chair recognizes Mr. Smucker for 5 minutes. 

Mr. SMUCKER. Thank you, Mr. Chair. 

Ms. Hale, impressive program, it sounds like, in your community. 

For the benefit of our communities who are interested in similar 

initiatives, how important were the coalitions that you built within 

the community, and who should be at the table for that? 

Ms. HALE. The coalitions are really the foundation of Operation 

UNITE. Those people within those communities from all sectors, 

whether it is education, law enforcement, treatment, faith-based. 

Every one of them lives in those communities, they understand the 

problems and they are looking for the solutions themselves. They 

are the ones who are motivated to work within their communities. 

They are the ones who are motivated to look for sources of funding 

and not depend totally on the Federal Government. However, the 

Federal Government has done things, just like CARA has brought 

a renewed sense of hope into our Commonwealth. We are looking 

at programs that will allow us to be more proactive rather than, 

as Mr. Novak said, you know, we have had to react for so long. 

And so those coalitions are the grassroots of what we are doing 

in Operation UNITE, and throughout the Commonwealth. 

Mr. SMUCKER. How do you measure success? And maybe talk a 

little bit about how success for your program has been. What are 

some of your key performance indicators, if you will? 

Ms. HALE. Well, one of the ways that we measure success is taking, for example, the vouchers that we have provided to over 4,000 

residents, and looking at the followup, coming back, you know, 

when they are coming out of long-term recovery, moving back into 

their communities. UNITE follows that with looking at how we can 

support them, how can we work with our administrative office and 

the courts to help them find jobs, to build the economy. 

The University of Kentucky is helping us collect data on each one 

of our programs to show the success. Some of our success has been 

anecdotal, but then, we are looking at developing those programs, 

our educational programs that we can use, evidence-based, we are 

using evidence-based programs to find those solutions. 

Mr. SMUCKER. I will ask the same question I asked Mr. Denk. 

What is it that we could be doing at the Federal level to better 

help? I know funding is one. Is there anything else? 

Ms. HALE. I think looking at programs that will be proactive. 

One of those that Kentucky is looking at this year with our legislators is developing an essential skills bill. We are working with the 

Kentucky Chamber of Commerce, our business and industry, and 

our education system to develop K through 12, helping young people develop those skills that they are going to need for them to be 

effective members of the workforce. And included in that essential 

27 

skills bill is going to be a huge prevention component in educating 

them on how to be drug free. 

Mr. SMUCKER. Thank you. It sounds like you are doing great 

work. I really appreciate all of you taking the time to share with 

us the good things that are happening in your communities. 

Mr. BARLETTA. Thank you. I ask unanimous consent to enter into 

the record a statement of Congressman Tom Marino. Without objection, so ordered. 

[The statement of Congressman Tom Marino is on pages 28–30.] 

Mr. BARLETTA. Thank you all for your testimony. If there are no 

further questions, I would ask unanimous consent that the record 

of today’s hearing remain open until such time as our witnesses 

have provided answers to any questions that may be submitted to 

them in writing, and unanimous consent that the record remain 

open for 15 days for any additional comments and information submitted by Members or witnesses to be included in the record of today’s hearing. 

Without objection, so ordered. 

I would like to thank our witnesses again for their testimony 

today. If no other Members have anything to add, the subcommittee stands adjourned. 

[Whereupon, at 11:36 a.m., the subcommittee was adjourned.] 

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