WARNING: THE GROWING DANGER OF 

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AND TRADE 

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COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

APRIL 14, 2011 

Serial No. 112–39 

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WARNING: THE GROWING DANGER OF 

PRESCRIPTION DRUG DIVERSION 

HEARING 

BEFORE THE

SUBCOMMITTEE ON COMMERCE, MANUFACTURING, 

AND TRADE 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

APRIL 14, 2011 

Serial No. 112–39 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

JOE BARTON, Texas 

Chairman Emeritus 

CLIFF STEARNS, Florida 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

Vice Chair 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

BRIAN P. BILBRAY, California 

CHARLES F. BASS, New Hampshire 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

CORY GARDNER, Colorado 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

HENRY A. WAXMAN, California 

Ranking Member 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

EDWARD J. MARKEY, Massachusetts 

EDOLPHUS TOWNS, New York 

FRANK PALLONE, JR., New Jersey 

BOBBY L. RUSH, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

SUBCOMMITTEE ON COMMERCE, MANUFACTURING AND TRADE

MARY BONO MACK, California 

Chairman 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

CLIFF STEARNS, Florida 

CHARLES F. BASS, New Hampshire 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

G.K. BUTTERFIELD, North Carolina 

Ranking Member 

CHARLES A. GONZALEZ, Texas 

JIM MATHESON, Utah 

JOHN D. DINGELL, Michigan 

EDOLPHUS TOWNS, New York 

BOBBY L. RUSH, Illinois 

JANICE D. SCHAKOWSKY, Illinois 

MIKE ROSS, Arkansas 

HENRY A. WAXMAN, California (ex officio) 

(II) 

(III) 

C O N T E N T S 

Page 

Hon. Mary Bono Mack, a Representative in Congress from the State of 

California, opening statement ............................................................................. 1 

Prepared statement .......................................................................................... 3 

Hon. Charles A. Gonzalez, a Representative in Congress from the State 

of Texas, opening statement ................................................................................ 4 

Hon. Mike Pompeo, a Representative in Congress from the State of Kansas, 

prepared statement .............................................................................................. 5 

Hon. Brett Guthrie, a Representative in Congress from the Commonwealth 

of Kentucky, prepared statement ....................................................................... 6 

Hon. Pete Olson, a Representative in Congress from the State of Texas, 

prepared statement .............................................................................................. 6 

Hon. Gregg Harper, a Representative in Congress from the State of Mississippi, prepared statement ............................................................................... 6 

Hon. David B. McKinley, a Representative in Congress from the State of 

West Virginia, prepared statement .................................................................... 7 

Hon. Marsha Blackburn, a Representative in Congress from the State of 

Tennessee, prepared statement .......................................................................... 7 

Hon. Edolphus Towns, a Representative in Congress from the State of New 

York, opening statement ...................................................................................... 7 

Hon. Fred Upton, a Representative in Congress from the State of Michigan, 

prepared statement .............................................................................................. 296 

Hon. Joe Barton, a Representative in Congress from the State of Texas, 

prepared statement .............................................................................................. 297 

Hon. John D. Dingell, a Representative in Congress from the State of Michigan, prepared statement ...................................................................................... 299 

WITNESSES

R. Gil Kerlikowske, Director, Office of National Drug Control Policy ................ 9 

Prepared statement .......................................................................................... 11 

Answers to submitted questions ...................................................................... 301 

Michele M. Leonhart, Administrator, Drug Enforcement Administration ......... 17 

Prepared statement .......................................................................................... 19 

Answers to submitted questions ...................................................................... 305 

Rick Scott, Governor, State of Florida ................................................................... 41 

Prepared statement .......................................................................................... 44 

Steve Beshear, Governor, Commonwealth of Kentucky ....................................... 51 

Prepared statement .......................................................................................... 53 

Phil Bauer, father of Mark Bauer and Parents Advisory Board member, 

Partnership at Drugfree.org ................................................................................ 82 

Prepared statement .......................................................................................... 85 

Kathy Creedon, mother of Ryan Creedon and founder, Mothers Against Prescription Drug Abuse, accompanied by Courtney Creedon, sister of Ryan 

Creedon ................................................................................................................. 91 

Prepared statement .......................................................................................... 93 

April Rovero, mother of Joey Rovero, and founder, National Coalition Against 

Prescription Drug Abuse, and Parent Ambassador, Partnership at 

Drugfree.org .......................................................................................................... 102 

Prepared statement .......................................................................................... 104 

Dan Harrison, Drug Court graduate ...................................................................... 111 

Prepared statement .......................................................................................... 113 

Carol J. Boyd, Director, Institute for Research on Women and Gender, and 

Professor of Nursing, University of Michigan, Ann Arbor ................................ 119 

Prepared statement .......................................................................................... 121 

Answers to submitted questions ...................................................................... 321 

Page

IV 

Amelia M. Arria, Director, Center on Young Adult Health and Development, 

University of Maryland ........................................................................................ 158 

Prepared statement .......................................................................................... 160 

Answers to submitted questions ...................................................................... 330 

Sean Clarkin, Executive Vice President and Director of Strategy, Partnership 

at Drugfree.org ..................................................................................................... 175 

Prepared statement .......................................................................................... 178 

Arthur T. Dean, Chairman and Chief Executive Officer, Community AntiDrug Coalitions of America ................................................................................. 186 

Prepared statement .......................................................................................... 188 

John M. Coster, Senior Vice President, Government Affairs, Generic Pharmaceutical Association .............................................................................................. 211 

Prepared statement .......................................................................................... 213 

Answers to submitted questions ...................................................................... 340 

Kendra Martello, Assistant General Counsel, Pharmaceutical Research and 

Manufacturers of America ................................................................................... 221 

Prepared statement .......................................................................................... 223 

Answers to submitted questions ...................................................................... 345 

Michael S. Mayer, President, MedReturn, LLC .................................................... 236 

Prepared statement .......................................................................................... 238 

Patrick Coyne, Clinical Director, Thomas Palliative Care Unit, Virginia Commonwealth University Medical Center, on behalf of the Oncology Nursing 

Society ................................................................................................................... 250 

Prepared statement .......................................................................................... 252 

Answers to submitted questions ...................................................................... 356 

SUBMITTED MATERIAL

Article, ‘‘UW a force in pain drug growth,’’ by John Fauber of the Journal 

Sentinel, dated April 2, 2011, submitted by Mrs. Bono Mack .......................... 71 

Letter, dated April 11, 2011, from George Doyle, President and CEO, 

Boehringer Ingelheim Roxane, Inc., to Hon. Michele Leonhart, Administrator, Drug Enforcement Administration, Department of Justice, submitted 

by Mrs. Bono Mack .............................................................................................. 265 

Report, ‘‘The Importance of On-Dose Technologies in the Fight Against Misuse, Abuse and Illegal Diversion of Opioids,’’ by John Glover, undated, 

submitted by Mrs. Bono Mack ............................................................................ 267 

Statement, dated April 2011, of the National Association of Chain Drug 

Stores, submitted by Mrs. Bono Mack ................................................................ 278 

Statement, dated April 14, 2011, of the National Community Pharmacists 

Association, submitted by Mrs. Bono Mack ....................................................... 284 

Letter, dated April 13, 2011, from American Academy of Pain Management 

et al., to Mrs. Bono Mack and subcommittee members, submitted by Mrs. 

Bono Mack ............................................................................................................ 289 

Statement, dated April 14, 2011, of Hon. Harold Rogers, a Representative 

in Congress from the Commonwealth of Kentucky, submitted by Mrs. Bono 

Mack ...................................................................................................................... 292 

(1) 

WARNING: THE GROWING DANGER OF 

PRESCRIPTION DRUG DIVERSION 

THURSDAY, APRIL 14, 2011 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON COMMERCE, MANUFACTURING, AND

TRADE, COMMITTEE ON ENERGY AND COMMERCE, Washington, DC. 

The subcommittee met, pursuant to call, at 8:05 a.m., in room 

2123 of the Rayburn House Office Building, Hon. Bono Mack 

(chairman of the subcommittee) presiding. 

Members present: Representatives Bono Mack, Blackburn, 

Stearns, Harper, Lance, Cassidy, Guthrie, Olson, McKinley, 

Pompeo, Kinzinger, Butterfield, Gonzalez, Towns and Inslee. 

Staff present: Paul Cancienne, Policy Coordinator, Commerce, 

Manufacturing, and Trade; Brian McCullough, Senior Professional 

Staff Member, Commerce, Manufacturing, and Trade; Gib Mullan, 

Chief Counsel, Commerce, Manufacturing, and Trade; Anita Bradley, Senior Policy Advisor, Chairman Emeritus; Shannon Weinberg, 

Counsel, Commerce, Manufacturing, and Trade; Alex Yergin, Legislative Clerk; Michelle Ash, Democratic Chief Counsel; and William 

Wallace, Democratic Policy Analyst. 

Mrs. BONO MACK. Good morning. The subcommittee can now 

please come to order. 

Someone once said, I would like mornings better if they started 

later, and amen to that, especially as a Californian. But I truly appreciate the effort that everyone has made to be here for a somewhat unprecedented 8:00 in the morning hearing, although as I 

said, as a Californian, my clock still says it is 5:00 in the morning. 

But seriously, when it comes to the topic at hand, there is no better time than right now to discuss it. Today, prescription drug 

abuse is a deadly serious and rapidly escalating problem all across 

America. We have an obligation to tackle it head on. The chair now 

recognizes herself for an opening statement. 

OPENING STATEMENT OF HON. MARY BONO BACK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Since 2003, more than 5,000 U.S. service men and women have 

died in Iraq and Afghanistan. As Americans, we celebrate their 

lives and we mourn their deaths. They will always be remembered 

by a grateful nation. 

Yet today, there is a mostly forgotten war also being fought right 

here at home in both small towns and large cities all across the 

2 

United States. This costly and rapidly escalating struggle against 

prescription drug abuse and addiction is expected to claim the lives 

of some 30,000 Americans this year alone. 

For the most part, this battle is being waged in remote outposts 

of the human mind, where scientists now tell us that childhood 

trauma, genetics, mental disorders, stress, thrill seeking, social 

pressures, severe pain from injuries and illnesses, and, yes, the 

horrors of combat, all contribute to devastating addictions, which 

in turn, all too often lead to tragic and avoidable deaths. But what 

is even more insidious is the way these powerfully addictive drugs 

quickly turn people without any real emotional or physical problems into desperate people suddenly facing life-or-death problems. 

Few things are more destructive. 

According to the Centers for Disease Control, drug overdose is 

the second leading cause of accidental death in the United States, 

in large part due to prescription drug abuse, and the problem is 

growing every single day. According to a recent national survey, 

some 7 million people age 12 or older regularly abuse prescription 

drugs, and there are approximately 7,000 new abusers every single 

day, many of them teenagers and young adults. That alarming 

trend is taking a huge toll on society. 

Today, the abuse of prescription drugs, especially painkillers, 

stimulants and depressants, is the fastest-growing drug problem in 

America. As someone who has been deeply and personally affected 

by this issue, I hope today’s hearing will lead to a better understanding of the enormous scope of this problem, the staggering 

costs, both emotionally and financially, that it imposes on families 

and communities, and the need for a greater sense of urgency as 

a Nation in addressing it. 

I believe one critically important first step is to do a better job 

of monitoring and limiting access to prescription drugs containing 

controlled-released oxycodone hydrochloride, including the popular 

painkiller OxyContin. Originally, OxyContin was intended to be 

prescribed only for severe pain as a way to help patients dealing 

with late-stage cancer and other severe illnesses. Today, however, 

more and more people across America are being prescribed 

OxyContin, as well as other generic oxycodone drugs, for less severe reasons, clinically known as moderate pain, greatly expanding 

the availability and potential for abuse of these powerfully addictive narcotics. 

For people all across America, prescription drug abuse is a dayto-day struggle. Over time, it destroys families and wreaks havoc 

on communities all across the Nation. Someone with a toothache or 

a sore back should not be prescribed a potentially addictive painkiller. I agree that expanded public education plays a role in addressing the problem, but we are not going to make any real 

progress until we limit access to these powerful narcotic drugs and 

ensure that only patients in severe pain can obtain them. 

The pervasiveness of prescription drug abuse made national 

headlines recently when Federal, State, and local law enforcement 

agencies, led by the Drug Enforcement Agency, cracked down on 

so-called ‘‘pill mills’’ in Florida, resulting in dozens of arrests, including five doctors. 

3 

Congress needs to make it much more difficult for these rogue 

pain clinics to operate, and we should treat offenders like any other 

street drug dealer. By better coordinating the efforts of local, State 

and national agencies and by reducing the supply of highly addictive opioid painkillers, I am convinced that we can eventually save 

thousands of lives and spare millions of families from the headache 

and heartache of addiction. 

A recent Denver Post article highlighted why these powerful 

drugs are so attractive to thieves, drug dealers and unscrupulous 

doctors. According to the Post, OxyContin costs $1 per milligram on 

the street and comes in doses ranging from 15 to 80 milligrams. So 

a dealer selling 1,000 tablets can make up to $80,000. 

What does that mean in human terms? Well, a recent report by 

the National Institute on Drug Abuse has found that nearly one in 

20 high school seniors have reported abuse of OxyContin. And yet 

another disturbing report by the Substance Abuse and Mental 

Health Services Administration shows a staggering 400 percent increase in admissions of people aged 12 years and older for treatment of prescription drug abuse between 1998 and 2008. Clearly, 

we have a daunting challenge in front of us. 

I would like to thank all of our distinguished panelists, especially 

DEA Administrator Leonhart, ONDCP Director Kerlikowske, Governor Scott and Governor Beshear for their personal commitment 

to this important issue. If we are going to win the war against prescription drug abuse, we must all serve as soldiers. 

[The prepared statement of Mrs. Bono Mack follows:] 

PREPARED STATEMENT OF HON. MARY BONO MACK

Since 2003, more than 5,000 U.S. service men and women have died in Iraq and 

Afghanistan. As Americans, we celebrated their lives and mourned their deaths. 

They will always be remembered by a grateful nation. 

Yet today, there is a mostly forgotten war also being fought—right here at home— 

in both small towns and large cities all across the United States. This costly and 

rapidly escalating struggle against prescription drug abuse and addiction is expected to claim the lives of some 30,000 Americans this year alone. 

For the most part, this battle is being waged in remote outposts of the human 

mind, where scientists now tell us that childhood trauma, genetics, mental disorders, stress, thrill seeking, social pressures, severe pain from injuries and illnesses, and, yes, the horrors of combat—all contribute to devastating addictions, 

which in turn all too often lead to tragic and avoidable deaths. 

But what’s even more insidious is the way these powerfully addictive drugs quickly turn people without any real emotional or physical problems into desperate people suddenly facing life-or-death problems. Few things are more destructive. 

According to the Centers for Disease Control, drug overdose is the second leading 

cause of accidental death in the United States—in large part due to prescription 

drug abuse. And the problem is growing every single day. 

According to a recent national survey, some 7 million people age 12 or older regularly abuse prescription drugs, and there are approximately 7,000 new abusers 

every day—many of them teenagers and young adults. That alarming trend is taking a huge toll on society. 

Today, the abuse of prescription drugs—especially painkillers, stimulants, and depressants—is the fastest-growing drug problem in America. As someone who has 

been deeply and personally effected by this issue, I hope today’s hearing will lead 

to a better understanding of the enormous scope of this problem, the staggering 

costs—both emotionally and financially—that it imposes on families and communities, and the need for a greater ‘‘sense of urgency’’ as a nation in addressing it. 

I believe one critically important first step is to do a better job of monitoring and 

limiting access to prescription drugs containing controlled-release oxycodone hydrochloride, including the popular pain killer OxyContin. 

4 

Originally, OxyContin was intended to be prescribed only for severe pain as a way 

to help patients dealing with late-stage cancer and other severe illnesses. Today, 

however, more and more people across America are being prescribed OxyContin, as 

well as other generic oxycodone drugs, for less severe reasons—clinically known as 

moderate pain—greatly expanding the availability and potential for abuse of these 

powerfully addictive narcotics. 

For people all across America, prescription drug abuse is a day-to-day struggle. 

Over time, it destroys families and wreaks havoc on communities all across the nation. Someone with a toothache or a sore back should not be prescribed a potentially 

addictive painkiller. I agree that expanded public education plays a role in addressing the problem, but we’re not going to make any real progress until we limit access 

to these powerful narcotic drugs and ensure that only patients in severe pain can 

obtain them. 

The pervasiveness of prescription drug abuse made national headlines recently 

when Federal, state, and local law enforcement agencies, led by the Drug Enforcement Agency, cracked down on so-called ‘‘pill mills’’ in Florida, resulting in dozens 

of arrests—including five doctors. 

Congress needs to make it much more difficult for these rogue pain clinics to operate, and we should treat offenders like any other street drug dealer. By better coordinating the efforts of local, state and national agencies—and by reducing the supply of highly addictive opioid painkillers—I am convinced that we can eventually 

save thousands of lives and spare millions of families from the heartache of addiction. 

A recent Denver Post article highlighted why these powerful drugs are so attractive to thieves, drug dealers and unscrupulous doctors. According to the Post, 

Oxycontin costs $1 per milligram on the street and comes in doses ranging from 15 

to 80 milligrams. So a dealer selling 1,000 tablets can make up to $80,000. 

What does this mean in human terms? Well, a recent report by the National Institute on Drug Abuse has found that nearly 1 in 20 high school seniors have reported 

abuse of OxyContin. 

And yet another disturbing report by the Substance Abuse and Mental Health 

Services Administration shows a staggering 400 percent increase in admissions of 

people aged 12 years and older for treatment of prescription drug abuse between 

1998 and 2008. 

Clearly, we have a daunting challenge in front of us. I would like to thank all 

of our distinguished panelists—especially DEA Administrator Leonhart, ONDCP Director Kerlikowske, Governor Scott, and Governor Beshear—for your personal commitments to this important issue. 

If we are going to win the war against prescription drug abuse, we must all serve 

as soldiers. 

Mrs. BONO MACK. The gentleman from Texas is now recognized 

for 5 minutes for an opening statement. 

OPENING STATEMENT OF HON. CHARLES A. GONZALEZ, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. GONZALEZ. Madam Chair, thank you very much, and thank 

you for calling this most important hearing and for inviting so 

many experts that will create our four distinguished panels of witnesses. 

I need to apologize because I will be absent for part of the hearing and hopefully will be returning, but at around 8:30 I will have 

to go to another presentation and hopefully come back, but we 

should have some members on our side of the aisle. 

I also wish to extend the apologies of ranking members 

Butterfield and Waxman, who are disappointed that they cannot be 

here at this time, obviously due to a conflict in commitments. 

According to the 2010 National Drug Control Strategy, the fastest growing form of substance abuse in the United States is the 

non-medical use of prescription drugs including opiates, pain relievers, tranquilizers, sedatives and stimulants. Under the careful supervision of a doctor, these medications can alleviate severe pain 

5 

or help those suffering from mental disorders like psychosis, depression, anxiety, insomnia or attention deficit hyperactivity disorder. 

Teens and young adults are increasingly susceptible to prescription drug abuse. Seven out of the top 10 substances most abused 

by young people are prescription medications. Like their older 

counterparts, teens most frequently obtain non-medical pain relievers, tranquilizers and stimulants from a friend or a family member. 

Despite popular misconceptions to the contrary, research indicates 

that even teens and young adults misuse prescription drugs not 

just to get high but for a variety of reasons. The Partnership for 

a Drug-Free America answers that teens do so to party, to get high 

in some cases but also to manage or regulate their lives. They are 

abusing some prescription stimulants to give them additional energy and ability to focus when they are studying or taking tests. 

They are abusing prescription pain relievers and tranquilizers to 

cope with academic, social or emotional stress. 

Many teenagers draw key distinctions between these drugs and 

illicit street drugs, characterizing their use of prescription drugs as 

responsible, controlled or even safe. Researchers have concluded 

that the growing popularity of prescription drugs also reflects the 

perception that these drugs are safer than street drugs. There are 

several programs at the Federal, State, and local level that seek to 

curb prescription drug abuse and diversion. 

I look forward to the testimony of our witnesses so that we may 

determine what is working and what more can be done to stop the 

growing problems. And Madam Chair, unlike many of the hearings 

we have, and we have such contentious differences of opinion, I 

don’t think we are going to have that today. I think we are just 

going to try to identify what works and that we move forward and 

lend the assistance at the Federal level to everyone out there in attempting to curb a very serious problem, and I yield back at this 

time. 

Mrs. BONO MACK. I thank the gentleman for his words and for 

the spirit with which he said them, and now the chair recognizes 

Mr. Pompeo for 1 minute. 

OPENING STATEMENT OF HON. MIKE POMPEO, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF KANSAS 

Mr. POMPEO. Thank you, Madam Chair. 

I just briefly want to say thank you for holding this hearing. 

Thanks for bringing attention to this incredibly important issue. I 

am the father of a 20-year-old son. I know the kinds of things he 

is seeing at Kansas University. I know the kinds of challenges that 

young people have, and I look forward to your testimony this morning so that we can get the facts, learn a little bit about what works 

so that we can develop good Federal policy that will minimize the 

risk from this very real concern that I think lots of parents have 

all across the country. 

So thank you all for coming this morning. Thank you, Madam 

Chairwoman. I yield back the balance of my time. 

Mrs. BONO MACK. I thank the gentleman, and the chair recognizes Mr. Guthrie for 1–1/2 minutes. 

6 

OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH 

OF KENTUCKY 

Mr. GUTHRIE. Thank you, Madam Chairman. I won’t take too 

much time because I will speak a little later when our governor is 

here in the next panel. But I just want to thank you for bringing 

attention to this issue. It is important. It is important in my State, 

like all States, but we particularly have a problem and we are looking forward to the next panel, but I just wanted to say thank you 

so much for having this hearing today. 

Mrs. BONO MACK. I thank the gentleman, and recognize the gentleman from Texas, Mr. Olson, for 1–1/2 minutes. 

OPENING STATEMENT OF HON. PETE OLSON, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. OLSON. I am pleased to be here early this morning, and I 

thank the chair for her leadership in holding this hearing to shed 

light on a problem of prescription drug diversion and abuse. I know 

this issue is greatly important to the chair, and I commend her on 

assembling an impressive group of witnesses. 

Prescription drug abuse in America is not an issue we should 

take lightly. As a parent of two children, it is very concerning to 

me to see statistics showing that on a daily basis 2,500 American 

teenagers are trying prescription drugs for the first time, 2,500 per 

day. The vast majority of these teens are getting drugs from their 

own house, taking them from their parents’ medicine cabinet and 

using them or giving them to friends. Given this, it is so important 

that parents are educated about the risks of prescription drug 

abuse in addition to knowing about and utilizing drug disposal and 

take-back programs. 

I thank the chair for her commitment to America’s youth and I 

look forward to hearing from our witnesses. I yield back. 

Mrs. BONO MACK. I thank the gentleman, and the chair recognizes Mr. Harper for 30 seconds. 

OPENING STATEMENT OF HON. GREGG HARPER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MISSISSIPPI 

Mr. HARPER. Thank you, Madam Chair, and I certainly welcome 

the witnesses. It is quite an impressive lineup. We look forward to 

hearing what each has to say today. 

This is an important issue, and it has devastated families that 

I know back home. Spending years as a prosecutor, you see what 

it does to many unintended victims in this, and I just look forward 

to looking for solutions and ways that we can solve this and help 

these families, and I want to thank you, Madam Chair, for holding 

this very important hearing. 

Mrs. BONO MACK. I thank the gentleman. Everybody is so happy 

this morning. The chair recognizes Mr. McKinley for 30 seconds. 

7 

OPENING STATEMENT OF HON. DAVID B. MCKINLEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF WEST 

VIRGINIA 

Mr. MCKINLEY. Thank you, Madam Chairman, and I join that. 

I thank you for holding this hearing this morning on this topic. As 

a father of four and a grandfather of six, I see what they are going 

to be facing. I saw what happened in our society back in the 1960s. 

It wasn’t pretty, and what these kids are facing today is shocking. 

My wife is a critical care nurse and works in the emergency room 

of a hospital, and she tells me time and time again of the horrors, 

so many people come in that have abused the drugs and what it 

is doing to our Nation. 

So I welcome you and thank you very much for holding this hearing so we can learn more how we can address this and save our 

next generation. Thank you very much. 

Mrs. BONO MACK. I thank the gentleman, and the chair is 

pleased to recognize the vice chair of the committee, Ms. 

Blackburn, for 30 seconds. 

OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TENNESSEE 

Mrs. BLACKBURN. And thank you, Madam Chairman. 

Welcome to our witnesses, and thank you all for being here with 

us today. 

There are three points that I think that as we work through 

what is an emotional debate that we need to be thinking about. 

First, to what extent should duly licensed prescription drug manufacturers be required to spend time, money and resources on trying 

to envision every new way that their product might be abused? Secondly, if we begin to restrict the approval of new prescription 

drugs, what impact will it have on patients who desperately rely 

on them to cope with debilitating pain and are just trying to make 

it through another day? And perhaps the most important question 

is, How do we deal with personal and parental responsibility? And 

I yield back. 

Mrs. BONO MACK. I thank the gentlelady, and the chair recognizes the gentleman from New York, Mr. Towns, for 5 minutes. 

OPENING STATEMENT OF HON. EDOLPHUS TOWNS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW 

YORK 

Mr. TOWNS. Thank you very much, Madam Chair. Let me thank 

you and Congressman Butterfield for having this hearing and also 

I want to thank Congressman Gonzalez for filling in on his behalf. 

This is a very serious issue, and I am very pleased, however, that 

a number of provisions in the recently enacted Patient Protection 

and Affordable Care Act could yield some very positive results in 

our efforts to curb this growing problem. 

We must educate families about the dangers of loose prescription 

drugs in their households. We must also utilize other relevant Federal laws and procedures in order to safeguard against prescription 

drug diversion. Some of these safeguards include a recently proposed risk evaluation and mitigation strategy. If implemented by 

8 

the FDA, this strategy could train prescribers, catalog patient information and administer periodic effectiveness assessment tests. 

Other safeguards would involve improving the communication 

abilities of our law enforcement officials, doctors, pharmaceutical 

dispensers so that frequent abusers can be brought to justice. 

Tackling the growing danger of prescription drug abuse will require bipartisan support, and that is the reason I was happy to 

hear the comment made by Congressman Gonzalez, that we are all 

on the same team when it comes to these kinds of things and when 

it comes to protecting our young people, and I am really happy 

about that. 

This public health issue requires the input and resources of all 

relevant stakeholders to ensure this problem is fully addressed. 

This is not one that we should get involved in the blame game. I 

think there is enough blame here for everybody to share. I think 

it is time to come together to see in terms of what we can do on 

both sides of the aisle, of course, every stakeholder that is involved 

in this issue, because this is an issue that if blame would solve it, 

then it would not even be here because of all the years we have 

been complaining about it. 

But I think the time now has come when we must roll up our 

sleeves and together work to see what we can do to be able to curtail the fact that especially with our young people who the numbers 

seem to keep going up and up. 

I look forward to hearing from our witnesses today and working 

with my colleagues to ensure Congress plays a vital role in protecting families from the growing danger of prescription drugs. And 

let me say to the chairperson that I really, really appreciate her involvement here and hope that we will continue to work together to 

see in terms of what we might be able to do to protect the lives 

of many of our young people who have gotten involved in this and 

of course I think that we can do a lot better. 

Thank you very much. I yield back. 

Mrs. BONO MACK. I thank the gentleman, and now to move to 

the panel. We have the first panel, one of four that will be before 

us today. Each of the witnesses has prepared an opening statement 

that will be placed in the record. Each of you will have 5 minutes 

to summarize that statement in your remarks. 

On our first panel, I am honored that we would have these two 

distinguished witnesses, the Hon. Gil Kerlikowske. When I first 

met him, I couldn’t say the name and so I have come a long way. 

Hon. Gil Kerlikowske, Director of the Office of National Drug Control Policy, and the Hon. Michele Leonhart, Administrator of the 

Drug Enforcement Agency. 

Good morning to both of you, and thank you for your hard work, 

and you will each be recognized for 5 minutes. You probably know 

the drill. There are lights over there, and as they are green, you 

are well on your way. When you see the yellow lights, you are 

down to the wrap-up time, and when you hit red on the light, if 

you could then sum up your comments and we will then move on 

to the next witness. 

So Director Kerlikowske, you may begin with your first 5 minutes. Thank you. 

9 

STATEMENTS OF R. GIL KERLIKOWSKE, DIRECTOR, OFFICE OF 

NATIONAL DRUG CONTROL POLICY; AND MICHELE M. 

LEONHART, ADMINISTRATOR, DRUG ENFORCEMENT ADMINISTRATION 

STATEMENT OF GIL KERLIKOWSKE 

Mr. KERLIKOWSKE. Well, thank you, Ms. Chairman Bono Mack, 

and thank you, Ranking Member Gonzalez and the distinguished 

members of the committee for the opportunity to address prescription drug issues. 

I really applaud the committee’s focus on this topic. Prescription 

drug abuse has been a major focus since my confirmation, and I 

have directed that the national drug control program agencies address this epidemic in our country. 

Let me pause for a minute. As a long-time police chief in Seattle 

for 9 years, I paid attention to what caused harm in my community. Quite frankly, the abuse of prescription drugs wasn’t on my 

radar screen, and quite frankly, I believe that around the country 

this has not received the attention that it needs. 

As the President’s chief advisor on drug policy, this position demands that I raise public awareness and take action on drug issues 

affecting the Nation. The efforts in the President’s drug control 

strategy are balanced. They incorporate new research, evidencebased approaches to address drug use and its consequences. 

In 2008, over 23 million Americans ages 12 or older needed treatment for an illicit drug or alcohol use problem. However, only 11 

percent received that necessary treatment for that substance use 

disorder. 

Well, today I am here to talk about prescription drug abuse. Prescription drug abuse, as was mentioned, is the fastest growing drug 

problem in the United States and it is categorized as a public 

health epidemic by the Centers for Disease Control and Prevention, 

and in recent years the number of individuals who for the first 

time consumed prescription drugs for non-medical purposes was 

similar to the number of first-time marijuana users. The 2010 Monitoring the Future, a national survey on youth drug use, found that 

six of the top 10 substances used by 12th graders were pharmaceuticals. We have also seen a fourfold increase in addiction treatment admissions for individuals, primarily abusing prescription 

painkillers. That was from 1997 to 2007. And even more alarming 

is the fact that over the last 5 years, emergency visits linked to 

misuse or abuse of pharmaceuticals has nearly doubled, and at the 

same time emergency room visits for illegal drugs like heroin and 

cocaine remained relatively flat. 

Furthermore, deaths from prescription drugs are increasing at a 

staggering rate, and State data show that seven people in Florida, 

four people in Ohio, three people in Kentucky die every day from 

an unintentional overdose. The latest national data found that 

more than 27,000 Americans died from unintentional drug 

overdoses in 2007. Prescription drugs, particularly the opioid painkillers that were mentioned, are considered major contributors to 

the total number of drug deaths. And in 17 States and the District 

of Columbia, drug-induced deaths are now the leading cause of injury death. 

10 

And there are two unique reasons for the growth of the prescription drug abuse: easy accessibility to these drugs and the perception of risk. For instance, persons age 12 or older who use pain relievers non-medically in the past year between 2008 and 2009, 

nearly 70 percent obtained the drug they abused from a friend or 

a relative. And research shows that because prescription drugs are 

manufactured by reputable pharmaceutical companies, they are 

prescribed by licensed clinicians, they are dispensed by pharmacists, they are perceived as safer to abuse than illegal drugs, 

and we know that is not true and we know that young people 

aren’t buying them in a piece of tinfoil from behind a gas station. 

In addition, recent studies found perceived prescription drug 

abuse as safer, less addictive and less risky than using illegal 

drugs, and the drugs obtained from the medicine cabinet or the 

pharmacy were in their perception not as dangerous as those drugs 

that were obtained in other ways. 

A comprehensive approach is required to address the epidemic 

because prescription drug abuse problems pose unique challenges. 

It is important to balance prevention, education and something 

close to my heart, enforcement, with the need for legitimate access 

to the controlled substances was mentioned. Therefore, the Administration has created an inclusive plan which brings together a variety of Federal, State, local, and tribal groups to reduce prescription drug diversion and abuse, and while we have outlined our approach to this issue in the 2010 Drug Control Strategy, the Administration developed a separate plan focused specifically on prescription drugs and next week Director Leonhart and I along with our 

Federal partners will release the Administration’s plan. Our prescription drug abuse prevention plan has four parts: education, prescription drug monitoring programs, proper medication disposal 

and enforcement, and the first part of our response plan is education. Mandatory prescriber education as well as patient and parental education is essential. 

Second, each State should have a prescription drug monitoring 

program. These known as PDMPs are statewide databases that 

contain information on dispensed and controlled substances prescribed by health care providers. PDMPs should be interoperable 

and have the ability to share prescriber information. 

The third part of our plan calls for proper medication disposal. 

Seventy percent of the people, as I said, reported getting their 

painkillers from a friend or relative, and we need to ensure that 

proper medication disposal programs are available, and in September, DEA held their National Take Back Day and collected over 

120 tons. 

Let me just close and say that I thank you for your attention, 

and I really appreciate the witnesses that will be coming after me, 

and my heart as a police chief goes out to those that have suffered. 

[The prepared statement of Mr. Kerlikowske follows:] 

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Mrs. BONO MACK. Thank you. 

Administrator Leonhart, 5 minutes. 

STATEMENT OF MICHELE LEONHART 

Ms. LEONHART. Chairman Bono Mack and Ranking Member Gonzalez, distinguished members of the subcommittee, thank you for 

the opportunity to discuss the growing epidemic of prescription 

drug abuse and the critical role of the Drug Enforcement Administration in the enforcement of our Nation’s drugs laws and regulations. 

The diversion and abuse of pharmaceutical controlled substances 

is a significant and growing problem in the United States. Every 

leading indicator shows increases over relatively short periods of 

time in the use and abuse of these drugs. Pain clinics have 

emerged as a major source of controlled substances for non-legitimate medical purposes. DEA and other Federal, State, and local 

law enforcement agencies have developed great working relationships and continuously coordinate efforts to combat this emerging 

threat. Federal administrative and criminal actions against a physician with controlled substance privileges are rare. However, such 

actions are warranted when a physician is issuing controlled substance prescriptions for an illegitimate purpose and operating outside the usual course of professional practice, and as Administrator, I have made prescription drug abuse a top priority for the 

DEA. 

I am especially alarmed that another contributing factor to the 

increase of prescription drug abuse is the availability of these 

drugs in the household. In many cases, prescription drugs remain 

in household medicine cabinets well after medication therapy has 

been completed, thus providing easy access for non-medical users 

for abuse, accidental ingestion or illegal distribution for profit. The 

2010 Partnership Attitude Tracking Study, PATS, as we call it, 

noted that 51 percent of those surveyed believe that most teens get 

prescription drugs from their own family’s medicine cabinets. DEA 

manages a robust regulatory program aimed at preventing and 

curbing diversion all the way from manufacturing levels to the dispensing of these medications to patients, and in working with Congress, DEA also obtained new authority last year to regulate the 

disposal of unused medications by ultimate users, thereby getting 

unused medications out of household medicine cabinets in a lawful 

and safe manner. 

DEA is working diligently to promulgate disposal regulations, 

and in the interim, DEA launched a nationwide take-back initiative 

in September of last year, resulting in the collection of 121 tons of 

unwanted or expired medications, and I am pleased to announce 

that DEA is planning a second nationwide take-back initiative on 

April 30th, and we will continue to hold periodic take-back events 

until regulations are in place. 

DEA’s obligation under the law and to the public is to ensure 

that pharmaceutical controlled substances are prescribed and dispensed only for legitimate medical purposes in accordance with the 

Controlled Substances Act. By carrying out this obligation, DEA 

strives to minimize the diversion of pharmaceutical controlled substances for abuse while ensuring that such medications are fully 

18 

available to patients in accordance with the sound medical judgments of their physicians. In this manner, DEA is committed to 

balancing the need for diversion control and enforcement with the 

need for legitimate access to these drugs. 

DEA closely monitors the closed system through recordkeeping 

requirements and mandatory reporting at all levels through the 

supply chain, and due to enhancements to our regulatory resources, 

controlled substance manufacturers, distributors, importers, exporters and narcotic treatment programs are receiving more inspections 

and audits than ever before. 

A key component to our enhanced investigative resources are tactical diversion squads. These are unique groups that combine the 

skills of special agents, diversion investigators, intelligence analysts and taskforce operators. TDS groups are dedicated solely towards investigating, disrupting and dismantling those individuals 

or organizations involved in diversion schemes, and as of today, 

DEA has 37 operational TDS groups across the country, and we 

plan to add an additional 26 more over the next few years. 

One example of the effectiveness of these tactical diversion 

squads is Operation Pill Nation, which targeted rogue pain clinics 

in south Florida since February of last year and culminated in a 

series of major takedowns in February of this year. This led to 32 

arrests including 12 doctors and five pain clinic owners. DEA also 

immediately suspended 63 DEA registrations and issued orders to 

show cause on six more, which resulted in the surrender of 29 DEA 

registration numbers, and this caused a ripple effect throughout 

south Florida and resulted in 50 more DEA registrations being surrendered, and in total, we closed down 38 clinics. 

DEA recognizes that it can’t solve this problem alone. DEA is 

working closely with our Federal, state, and local and private-sector partners as a part of the Administration’s comprehensive approach to combating prescription drug abuse. Many States have 

also adopted prescription drug monitoring programs which are 

deemed to be a valuable tool in curbing diversion. 

In closing, I want to commend the courage of those who are testifying later this morning for putting names and faces of loved ones 

to this problem, and I want to express my heartfelt sympathy on 

behalf of the men and women of DEA for their loss. I am keenly 

aware that many others possibly here even today have struggled 

with drug abuse by friends and family, and DEA joins in this fight. 

So thank you for the opportunity to appear here today. 

[The prepared statement of Ms. Leonhart follows:] 

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Mrs. BONO MACK. I thank both of the panelists, and I will recognize myself for the first 5 minutes of questions, and I will begin 

by asking both of you to turn your attention to the charts on your 

right. Although the data is old—2007, 2006—would you both just, 

yes or no, is it fair to assume that the trend continues to grow at 

an alarming rate, that the numbers today are far worse than they 

were in 2006 and 2007? 

Mr. KERLIKOWSKE. Yes. 

Ms. LEONHART. Yes. 

Mrs. BONO MACK. Thank you. Administrator Leonhart, you were 

specifically talking about Florida. Can you tell me how many doctors have been convicted or have had their DEA registration denied 

or revoked for over-prescribing schedule II prescription drugs? 

When Governor Scott points out that 98 of the 100 top prescribing 

doctors who prescribe these painkillers that are in Florida, doesn’t 

that send up a huge warning flag? 

Ms. LEONHART. Absolutely, Chairman. The actual numbers of 

doctors across the country that have been convicted or prosecuted, 

I can get you those numbers, but I can tell you that you are absolutely correct in that 90 of the top 100 are in Florida, and Operation Pill Nation identified those top doctors. 

Mrs. BONO MACK. Can you tell me what took so long? 

Ms. LEONHART. Well, I can tell you that the trends have changed. 

The pill situation, the pill mill situation in Florida is a really new 

phenomenon. We first targeted the Internet, which if you go back 

4 and 5 years ago, drugs that we were finding on the street and 

we were asking where they came from, they were coming from the 

Internet, and it was unregulated, uncontrolled, and our first efforts 

were there. It is because of the Ryan Haight Act that Congress 

gave us and our actions going after those organizations and individuals dealing on the Internet that we were able to basically shut 

those rogue Internet sites down, and then we saw the shift over the 

last couple of years in Florida. We spent the last year identifying 

the pill mills and with a huge operation involving 12 of these tactical diversion squads over a period of a year were able to do those 

undercover buys that resulted in the takedown of Pill Nation, and 

we believe that that one consolidated takedown and actions over 

the past year will have a chilling effect on anyone attempting to 

open up a clinic or to continue in the same manner that they have 

continued over the past couple of years. 

Mrs. BONO MACK. I see you have a chart on page 10 of your testimony that sort of reflects how effective the raids were, but I have 

a couple of questions for you just on basic math and perhaps to 

both of you. Some people will say that last year we took back 272 

tons of unwanted prescription drugs. Does that mean we are overprescribing 272 tons of these prescription drugs? And if that is the 

case, can you explain the quota system to me? It seems to me that 

there is simple math that you all are overlooking in a quota system. You both have the ability to determine how much of these 

painkillers are manufactured and pumped out into our society but 

the quota is just simply based upon demand? I will turn to both 

of you. 

More specifically, if you look, Florida dispensed more than 41 

million oxycodone pills. The second highest prescribing State disVerDate Aug 31 2005 10:04 Nov 08, 2012 Jkt 037690 PO 00000 Frm 00037 Fmt 6633 Sfmt 6633 F:\112-00~1\112-03~1\112-39~3 WAYNE
32 

pensed 1 million pills. Large States like California have dispensed 

fewer than 400,000. What a disparity. Doesn’t that clearly indicate 

that there are probably 40 million extra pills in the supply chain 

if you look at that mathematical equation? 

Mr. KERLIKOWSKE. Let me mention, I think, two things, and you 

bring up an excellent point on the quotas. So one thing is that the 

most recent data for all of 2010 for the first time in 8 years shows 

that the aggregate production of opioid painkillers actually flattened, so instead of seeing that incredibly steep increase in abuse 

and the increase in manufacturing, we also saw a flattening. I 

think as we brought more attention to this, it is going to be coming 

down. 

The other concern would be trying to restrict particular quotas 

for particular drugs. We will just turn to a different drug with a 

different problem, and it could lead to subsequent abuse. So I think 

quotas is one answer and I think that it needs to be more robustly 

looked at, and I think those questions along with our FDA partners 

are important ones, but I also think that we are beginning to turn 

the corner on not only the aggregate amount of these painkillers 

that are produced but also on the registrants who will have to have 

the mandatory education, the number of scripts they write. 

Ms. LEONHART. And I agree with Director Kerlikowske. A hundred and twenty-one tons of pills were collected at the take-back 

in September. There are a number of reasons, a number of things 

we need to look at. Over-prescribing, you brought up as an issue. 

I believe that is correct. I believe that it requires more education 

for the practitioners who are prescribing, more education for parents, more education for young adults and teens who are turning 

in amazing numbers to prescription drugs as their drug of choice, 

and DEA is looking at the entire spectrum, and we are striking at 

every level of the distribution chain, and our problem is that with 

quotas, you know, we have a job to make sure that there is enough 

medication produced and available for patients in need and we 

need to balance that with making sure that people that are not patients that have a medical reason for these drugs don’t get it. So 

it is that balancing act, and the problem with quotas is also that 

no matter what we do there, there will still be a legitimate group 

of people that need that medication and so we try to get that target 

number. 

Mrs. BONO MACK. Excuse me. My time is expired. I just wish I 

would hear you focus more on the people who are dying from these 

narcotics and painkillers than worrying about getting more out 

there. To me, the problem is 30,000 people a year are dying. 

And with that, I need to yield to Mr. Gonzalez for 5 minutes. 

Mr. GONZALEZ. Thank you very much, Madam Chair, and again, 

thanks to the witnesses. And I understand that once a drug is 

manufactured, there are only certain ways it gets out there to the 

consumer, and that is going to be—it is on the shelves of the hospitals or the pharmacist and then there is the prescription written 

by the doctor. So I want to talk about databases. 

The first thing that occurs to me is that the most effective databases, and you have to have the assistance of all these individuals 

I just indicated. Those are the points of origin. So like you are 

going to deal with any problem, you have to figure out if you go 

33 

there first and try to control it the best you can, then we can deal 

with the other things that take the responsibilities of parents and 

such to make sure that there is not the availability of those drugs 

in the medicine cabinet and so on. And then there are some other 

issues but I will discuss it with another panel, and it is going to 

go to what the chairwoman was talking about, the amount of prescription drugs out there and what we can do. 

But until we really have, in my opinion, a truly robust and very 

effective, widespread adoption of electronic medical records, health 

information technology, which is something that we have been attempting to do since I got here some years ago, I don’t see how effective it is really going to be. Do you have any concerns about the 

abilities of all these different providers or points of origin to be able 

to access and to supply information in a manner that is timely and 

is going to be available and of course electronically based? 

Mr. KERLIKOWSKE. You are absolutely right. I think it is a shame 

that when we have to have a chart that goes to the most recent 

data of 2006 or 2007. The President’s Drug Control Strategy devoted an entire chapter to the fact that timely, robust, critical information, whether it is the Drug Abuse Warning Network, which 

is number of people brought into the emergency rooms, whether it 

is the number of people we test in only 10 jails in the country for 

the drug problems of people coming in to the jail regardless of what 

they were arrested for. All of that information is so helpful, and 

frankly, it is not timely and it is not as relevant as it should be 

and therefore it makes it difficult, I am sure for you in the policymaking area and it certainly makes it very difficult for us in that 

area. So we have devoted this entire chapter to strengthening these 

kinds of systems, and I agree with you, electronic health records 

will be an important step forward. 

Mr. GONZALEZ. Administrator Leonhart? 

Ms. LEONHART. I agree as well, and last June we started the eprescribing. I had signed for that, and it went into effect in June 

and we are hoping that e-prescribing helps. I agree with you completely. And also, we do have 34 States that currently are using 

prescription drug monitoring program system and we see the value 

in doing that, how having a doctor or a pharmacist have the ability 

to look into a system and find out that someone has been doctor 

shopping or going from pharmacy to pharmacy has definitely assisted the States that have enacted those systems in preventing diversion. 

Mr. GONZALEZ. And I know that we are always going to have this 

conflict. First of all, you have to respect confidentiality, the relationship of the patient with the doctor or the pharmacist, the professional and so on. How do we balance all that? I mean, my fear 

is that people—one of the greatest impediments is people don’t like 

the fact that this kind of information is going to be shared or is 

going to be made available. Now, I just believe that if it is made 

available to the health care professional and in fact they act professionally, they are an incredible player or actor in this whole chain 

of how these drugs get out there. How do we balance the confidentiality aspects of it with, as we have said, a timely and robust database? 

34 

Mr. KERLIKOWSKE. The PDMPs, I think the value in them is that 

they are designed by the States. So when the States enact them, 

they can put in the patient privacy and the confidentiality rules 

that they feel are best. They can also design them as to who has 

access to them. Some allow at certain points access by law enforcement agencies. But frankly, the practice of medicine is governed by 

the States, the boards of pharmacy and the medical boards in each 

of those States having access to those including routine reports 

that are generated from the PDMPs actually put the information 

in the hands of the people that have the power to regulate medicine within each particular State. 

Ms. LEONHART. On your next panel, you have Governor Beshear 

here, and I know Kentucky is a State that implemented PDMPs, 

was very concerned about privacy issues and their systems have 

been up and running and have not had problems in that area, and 

as we look at the other 33 States that have PDMPs up and running, they have addressed those privacy issues and that has not 

been a deterrent that has worked and that is why nine additional 

States have moved and have pending legislation in their States and 

are moving towards PDMPs. They have worked those issues out. 

Mr. GONZALEZ. Thank you very much. I yield back. 

Mrs. BONO MACK. I thank the gentleman. The chair recognizes 

Mr. Guthrie for 5 minutes. 

Mr. GUTHRIE. Thank you, Madam Chairman. In the interest of 

time, I just want to ask one question and throw it out to both of 

you. 

I understand that prescription drugs are more accessible to people in the family. They get them from family members. You know, 

a parent may have OxyContin in the house where they wouldn’t 

hopefully have one that you would typically get on the street without prescription drugs. But however, what level is the prescription 

drug trade also in organized crime, the drug cartels? You know, is 

it just doctors over-prescribing or is there a whole network like you 

have in other type of drug issues? 

Ms. LEONHART. I can tell you from our enforcement cases, and 

we were surprised a few years back, we thought that they would 

act, there would be different organizations, they would act differently because they for the most part are from the medical profession, they are pharmacists, and actually they are organized. We 

learned from Florida, these pill mill organizations, they are organized just like other organized crime and other crime groups selling 

coke and heroin. 

Mr. GUTHRIE. Are they the same groups? Are the cartels organizing the pill mills or is a different structure, I guess is my question? 

Ms. LEONHART. I will say that they are for the most part different groups. We don’t have a problem with prescription drugs 

coming from the Mexican drug cartels, for instance. This is one of 

those cases where the sources of supply are not in Columbia, are 

not in Mexico. The sources of supply are right here domestically. 

Mr. KERLIKOWSKE. I held a law enforcement roundtable last 

month in Buffalo, and one of the enforcement agents talked about 

a drug dealer in a particular section of the city in which heroin was 

35 

being dealt and then they had a subcomponent with a dealer dealing prescription drugs across the street. 

Mr. GUTHRIE. Thank you, Madam Chairwoman. I will yield back 

in the interest of time. 

Mrs. BONO MACK. Will the gentleman just yield for one quick 

question? 

Mr. GUTHRIE. Yes, I will yield to the chairwoman. 

Mrs. BONO MACK. Just briefly, can you explain how many people 

are dying from the illicit drugs any longer as compared to prescription drugs? 

Mr. KERLIKOWSKE. The prescription drug overdose death, that is 

driving the numbers that have spiked so significantly. They cause 

more deaths than both heroin and cocaine combined. 

Mrs. BONO MACK. Thank you, and the gentleman yields back so 

the chair recognizes Mr. Towns for 5 minutes. 

Mr. TOWNS. Thank you very much. 

Let me begin by—you mentioned the fact that there were 34 

States using the monitoring system. Have you been able to detect 

that those States that are using the monitoring system, that the 

problem is not as severe in those States? 

Mr. KERLIKOWSKE. There are two things that I think will be 

helpful, and one is that there is a recent evaluation done by the 

CDC through a contract, I believe, on prescription drug monitoring 

programs. They are relatively new. Some are used more and some 

are more robust than others. The other issue will be, how can they 

exchange information across State lines. All of the physicians that 

I have talked to and all the people that I have been privileged to 

be engaged with that have had these programs find them not only 

to be helpful in identifying doctors who may be over-prescribing but 

patients who may be doctor shopping, and the doctors themselves 

talk about it as a patient safety tool. 

Ms. LEONHART. I will say that we are looking at the trends. Florida is ground zero for prescription drug abuse, and there is—— 

Mr. TOWNS. Do they monitor? 

Ms. LEONHART. There is no current PDMP in place in Florida. As 

we took action over the last year in Operation Pill Nation, we are 

seeing these pill mills actually move and they are starting to show 

up in Georgia. Georgia is a State without a prescription drug monitoring program. So we are concerned. We believe that States that 

do enact prescription drug monitoring programs, that is one of the 

first things they can do to combat diversion in their States. 

Mr. TOWNS. Is there any program in place to work with families 

that might be taking a certain type of medication that might be 

very susceptible to illegal use in terms of a drug, if it in a cabinet 

that is locked? Is there any kind of training program in place? 

Mr. KERLIKOWSKE. And I think when you hear later on from 

General Dean and the CADCA group, and we fund through our 

partner SAMHSA 740 drug-free communities, part of those coalitions will be, part of their mission is to educate people about the 

dangers of the prescription drugs. There are now locking medicine 

cabinets that have been made available. There are pill containers 

that have locks. But we also think the important part is bringing 

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try in one 4-hour period, thanks to the leadership of DEA, that 

should be in my old job a clue that we have a problem. 

Ms. LEONHART. We have been able to use the take-back initiative 

and will on April 30th do the same thing to make it not only be 

a way to safely dispose of your expired and unused medication but 

also to educate, and I attended one of the sites on September 25th 

for the take-back, talked to a number of people who showed up 

turning in their prescription drugs, and to a T they all said they 

didn’t realize they had the medications stacking up in their medicine cabinet because they didn’t want to flush it, they didn’t want 

to throw it in the trash in case could someone else could get it, they 

didn’t know what to do with it. So the beauty of the take-back has 

been a way to educate, educate families about how to secure the 

medications, and overall having people realize that they don’t need 

to hold on to that medication and that they have elderly in the 

home that could be confused and take the wrong medication and 

they have young adults in the home, and that is the number one 

source of supply for them. 

Mr. TOWNS. Thank you very much, Madam Chair. I yield back. 

Mrs. BONO MACK. I thank the gentleman. The chair recognizes 

Mr. McKinley for 5 minutes. 

Mr. MCKINLEY. Thank you, Madam Chairman. 

I am just curious. In the Appalachian area of this country that 

has such a high prevalence of misuse, why is that occurring? Is 

that because the medical community is abusing their prescription 

authority? I am just trying to get a sense of why is one area so 

highly using painkilling medicine? 

Mr. KERLIKOWSKE. We just spent 4 days, 3 days in eastern Kentucky and 1 day in West Virginia, and spent a lot of time asking 

people and looking at that including interviewing 14 women who 

were in the jail system as a result, 13 of them for—— 

Mr. MCKINLEY. Can you speak up just a little bit, please? 

Mr. KERLIKOWSKE. Thirteen of them as a result of prescription 

drugs, and what we found, particularly in Appalachia, was that, 

one, people all know each other and they sometimes share those 

drugs that are in their medicine cabinet, somebody has a back pain 

and somebody else shares and says here is something that I found 

helpful. The other problem came about as a result of people who 

had been prescribed a painkiller as a result of an injury, it could 

have been even a mining injury, and then ended up in a problem 

with that. It is a huge and significant problem and we couldn’t 

have made the inroads in understanding it better without the support of Congressional staff that spent the 4 days with us there just 

less than 2 months ago. 

Ms. LEONHART. And I would like to add that from our investigations and what we see, just as Kentucky, Ohio, Tennessee, we saw 

people that went down to Florida and would go to these pill mills. 

We saw that that is a major source of supply for the pills that are 

on the streets in West Virginia, junkets, people that, you know, 

busloads of people that would go down to Florida, go to all these 

pill mills, get as many pills as they can, return to your area and 

not only were some of them addicted themselves but they had multiple—— 

37 

Mr. MCKINLEY. I am just struggling to understand why Appalachia. Why not Georgia? Why not Alabama? Why is it the Appalachia area is singled out for such high drug use, high painkiller 

use. I just wonder if the prescribing physicians are—if it is the prescribing physician. Maybe it is a pill mill. But what can we do? Because I struggle with it is just a region. I think it is a national 

issue. 

Mr. KERLIKOWSKE. It is. 

Mr. MCKINLEY. Because I think neighbors in New York City 

know their neighbors just as well as we do in West Virginia. 

Mr. KERLIKOWSKE. And you are absolutely right. As my travels 

across the country have clearly shown, the prescription drug problem affects everyone regardless of race, ethnicity, gender or economic station in life. In particular, I think it gets more attention 

in Appalachia because of the abuse, and we heard a number of different reasons. I also think that it doesn’t get quite the attention 

perhaps in some places because everyone that we met, they are 

community minded, they know each other, and there were no secrets. So if you had a friend or a relative that was suffering as a 

result of prescription drug abuse, other folks knew about it. But I 

think that bringing attention to it, I think the work that the Congressional staff has done in both places, West Virginia and Kentucky, will make a big difference. 

Mr. MCKINLEY. Thank you. I yield back my time. 

Mrs. BONO MACK. I thank the gentleman. The chair recognizes 

Mr. Harper for 5 minutes. 

Mr. HARPER. Thank you, Madam Chair. 

Director Kerlikowske, as you look at this issue, are PDMPs the 

only option out there for States to implement the sharing of this 

type of information? 

Mr. KERLIKOWSKE. Right now for looking at doctors who may be 

over-prescribing or patients who may be doctor shopping, the only 

systems available are those state-run, statewide PDMPs. 

Mr. HARPER. Well, are there any State PDMPs that stand out to 

you as a role model for other States to follow that you really are 

impressed with? 

Mr. KERLIKOWSKE. As the Administrator also mentioned, I think 

we are both very impressed with what has happened in Kentucky. 

Mr. HARPER. With that, I yield back, Madam Chair. 

Mrs. BONO MACK. I thank the gentleman, and the chair now recognizes Ms. Blackburn for 5 minutes. 

Mrs. BLACKBURN. Thank you so much, and I want to thank you 

all for being here. Very quickly, just a couple of things. 

Listening to you, reading your opening statements, accessibility 

is the big problem, it seems, and you are trying to get into that, 

part of that, as I mentioned in my questions to you, looking at both 

the education components with individuals’ physicians and I think 

also personal responsibility and parental participation in this. 

Let me talk just a minute with you. Ms. Leonhart, you mentioned State monitoring systems, the problems in Florida, the pain 

clinics as being a problem. In Tennessee, I mean, we have been 

talking about over-prescribing by physicians since the days of 

Elvis, and, you know, how are you all working with that? If you 

are doing State monitoring systems, is there a method that you are 

38 

using to incentivize or grant to the States? What is your position 

on that and how are you helping with the local and the State component of that, and if you want to submit this in writing, because 

I know we are tight on time, that is fine. But listening to you, it 

seems if you going to say let us get to the crux of this, that getting 

to that linkage between your local and State agencies is part of the 

crux and dealing with that over-prescribing is another component. 

Ms. LEONHART. We would be glad to submit to you after the 

hearing information on specifically what we are doing in Tennessee 

and know that the law enforcement officials in Tennessee have 

worked with us, are partnered with us to do what we can to help 

Tennessee and in many ways they were kind of ahead of everyone, 

Tennessee and Kentucky, when it came to use of the Internet. We 

learned from Kentucky and Tennessee, for instance, that there 

were all these deliveries being made to people who were ordering 

substances over the Internet. Working with them, they helped us 

develop an Internet strategy. They are up on the problem. They 

have worked with us on the problem. But I will provide additional 

information. 

Mrs. BLACKBURN. That will be great, and articulate what you are 

doing with the grants and the incentive end. 

Thank you. Yield back. 

Mrs. BONO MACK. I thank the gentlelady. The chair recognizes 

Dr. Cassidy for 5 minutes. 

Mr. CASSIDY. I will also submit a few extra questions for the 

record, but in the interest of time, I will limit myself. 

Ms. Leonhart, in your testimony you refer to civil penalties levied 

against McKesson, CVS, Cardinal. So what is the role of these 

intermediaries and what is the role of the manufacturer in terms 

of controlling this problem? 

Ms. LEONHART. Well, manufacturers and distributors have a part 

to play. They have responsibilities, and what we do at DEA is we 

make sure that we make them aware of methods of diversion and 

ways that their companies, their organizations can do more to prevent diversion. In these cases, our investigations showed over and 

over again that these companies were not doing enough to prevent 

diversion. So we used our administrative authorities working with 

U.S. Attorney’s offices around the country. We have brought more 

civil—— 

Mr. CASSIDY. Well, let me ask you, I am sure there is supply 

chain control. Are they required to report to you that Smith’s Pharmacy in Dade County is ordering 500 percent more prescription 

drugs than you would think normally such a pharmacy would? 

Ms. LEONHART. Yes, they have a responsibility to report diversion. They have a responsibility to report any suspicious order. 

Mr. CASSIDY. Define ‘‘diversion.’’ 

Ms. LEONHART. I am sorry. 

Mr. CASSIDY. Define ‘‘diversion.’’ 

Ms. LEONHART. Diversion is where the controlled system for 

pharmaceuticals is not used, where pills and substances find their 

way outside of this closed distribution system. For instance, thefts, 

they are to report thefts and losses but they are also to report 

pharmacies or rogue pharmacies that are ordering from them and 

ordering amounts that changed or anything that raises a red flag 

39 

that they are outside of their normal practices. We have investigated many cases that have actually started from tips from the 

companies who have reported these suspicious orders. 

Mr. CASSIDY. OK. Thank you very much. 

Ms. LEONHART. And those that are not doing it, then we hold 

them responsible. 

Mr. CASSIDY. I yield back. 

Mrs. BONO MACK. I thank the gentleman, and the chair recognizes the gentleman from Washington, Mr. Inslee, for 5 minutes. 

Mr. INSLEE. Thank you, Madam Chair. Thanks for letting me 

join you today. 

Chief, thanks for your leadership here. I just wonder if you can 

give us an update on the implementation of our drug take-back legislation, and it is very timely. I just left Lisa Jackson, the EPA Administrator, and we were talking about endocrine disruptors in the 

water system that are changing the basic physiology of fish and 

frogs in rather disturbing ways. So we would like to know how we 

are doing on this. 

Mr. KERLIKOWSKE. Earlier, the remarks were made about truly 

what a bipartisan issue this is, and to see the legislation passed 

in both Houses and the President sign it and then DEA to be so 

involved and having public hearings already to look at how to restructure the way that pills can be safely disposed of and not causing environmental damage has been really heartening. We have 

had great cooperation from EPA. DEA is certainly the lead and I 

am sure the Administrator can mention that. But we are making 

good progress, and I think the other part is the interim steps that 

DEA has been taking through the drug take-backs. The next one 

will be April 30th for your calendar. 

Mr. INSLEE. Thank you. 

Ms. LEONHART. And I will add that we did hold a hearing a few 

months ago. Over 150 witnesses appeared. We took their information, their comments. We are working that, and we believe that we 

will actually have a proposed rule by the end of the summer. We 

will publish that proposed rule. That will go out for a comment period and we will then review all those comments and move forward 

with a final rule. But it is on track and comments have come in. 

We are reviewing them, and we want to especially thank you for 

participating in that. 

Mr. INSLEE. So what would you describe as your biggest challenges to make this actually work? You know, law enforcement is 

stressed. We have had reductions in the COPS program, and everybody has budgetary issues. If you were going to describe challenges 

that perhaps we could help you with in any way, what would you 

say they are? 

Ms. LEONHART. Well, making sure that law enforcement has the 

tools to combat this at every level of the distribution chain, but it 

is also doing what we can. One of your panels has a number of the 

community coalitions and the community groups, the prevention 

groups. It is making sure that they are getting the message out 

and they are getting the support to be able to do that. It is working 

with doctors and prescribers and the medical community. It is what 

Director Kerlikowske and I will be announcing next week with this 

new prescription plan. 

40 

Mr. KERLIKOWSKE. Reauthorizing NASPER, removing the barrier 

that restricts the Veterans Administration from sharing prescription drug information, these are all things that Congress can actually do, requiring mandatory prescriber education, those things. 

Mr. INSLEE. Thank you very much. 

Mrs. BONO MACK. I thank the gentleman. The chair recognizes 

Mr. Kinzinger for 5 minutes. 

Mr. KINZINGER. Thank you, Madam Chairwoman. 

In the interest of time, I am going to keep this pretty short. For 

Ms. Leonhart, I have learned that certain companies are beginning 

to do a lot of reformulating of opiates drugs to make it more difficult for abusers to use and abuse the product. Do you believe reformulating has been effective in preventing the abuse of these 

drugs? 

Ms. LEONHART. I appreciate the efforts in trying to reformulate 

so that they are not easily abused. However, I am concerned because we have seen with OxyContin that as soon as that was put 

out, we heard that even on the Internet they were announcing 

ways that you could go around that. So we are very concerned but 

we don’t want to discourage industry from continuing to develop 

these drugs that can’t be easily abused. 

Mr. KINZINGER. So have there been for either of you any discussions about encouraging drug companies and generics to follow suit 

or is this something that you personally feel is ineffective and not 

really worth pursuing? 

Ms. LEONHART. I believe it is worth pursuing. 

Mr. KINZINGER. That is pretty much all I have unless you have 

something, sir. All right. I will yield back. 

Mrs. BONO MACK. I thank the gentleman very much, and I believe that concludes this panel. I want to thank our witnesses very, 

very much for your hard work on this issue, certainly the boots on 

the ground who are working this day in and day out and risking 

their lives to keep our society safe. We thank them all very much. 

Again, appreciate your being here. 

The subcommittee will take about a 5-minute recess while we 

switch panels. 

[Recess.] 

Mrs. BONO MACK. The hearing will come back to order, please. 

On our second panel today, we have two very distinguished witnesses who are both deeply involved in the issues of prescription 

drug abuse and prescription drug diversion, which obviously go 

hand and hand. We are honored to have Florida Government Rick 

Scott and Kentucky Governor Steve Beshear with us today for a 

perspective on how this battle is faring in their States. 

Without objection, I would like to yield 1 minute each to Mr. 

Stearns and to Mr. Guthrie for welcoming remarks. Mr. Stearns, 

you are recognized for 1 minute. 

Mr. STEARNS. Good morning, and thank you, Madam Chair. 

I am delighted to introduce my distinguished governor, Rick 

Scott, to testify today on prescription drug abuse. He is a U.S. 

naval veteran and a lawyer from Southern Methodist where he received his law degree. He started a business himself and met a 

payroll. He actually started Columbia Hospital Corporation and 

later became HCA. He has had experience with small business that 

41 

he and his wife and family and mother started to eventually become a large business. He was elected the governor in November 

2010. He is the 45th governor in our State. He lives in Naples, 

Florida, with his wife, Ann, of 38 years and they have two lovely 

daughters, and I am certainly very proud to introduce Governor 

Rick Scott. 

Thank you, Madam Chair. 

Mrs. BONO MACK. And thank you. Mr. Guthrie, you are recognized for 1 minute to introduce your witness. 

Mr. GUTHRIE. Thank you, Madam Chairman, and my voice is 

kind of raspy because Kentucky is in full splendor. Its bloom is 

there and it is a beautiful place to be, and I invite people to come. 

And in a month, we will have the world watching us, which we are 

excited about, with the Kentucky Derby. 

But I am pleased to have Governor Beshear here, and I can 

speak for the whole delegation on our side that we worked together 

on this issue and we will work with our governor on this issue and 

make sure we move forward in Kentucky because it is a big issue. 

We have a great State, a beautiful State, but this is a problem that 

we are exposing here today and we are working to address. 

And Governor Beshear has been involved in Kentucky politics 

since being elected president of his UK class, University of Kentucky, so just a few years ago he got started in politics. But he has 

been in the General Assembly, attorney general, lieutenant governor, and very active in civic life as an attorney in Lexington, and 

actually from West Kentucky, but practiced in the Lexington area. 

We are really pleased to have you here. Unfortunately, he got elected in 2007, I got elected here in 2008, so we only had a year that 

we worked together in Frankfort but enjoyed working with you and 

I am pleased to have you here today. Thank you. 

Mrs. BONO MACK. I thank my colleagues, and also join them 

along with the entire subcommittee in welcoming the two of you 

today. You will each be recognized for 5 minutes. There are timers 

on either side of your table that will reflect green. As they turn yellow, that means you are, surprise, surprise, getting close to needing 

to wrap it up, and when it hits red, if you could come to a conclusion of your remarks as quickly as you can, we would appreciate 

it very much. 

So Governor Scott, you are recognized for 5 minutes. 

STATEMENTS OF RICK SCOTT, GOVERNOR, STATE OF FLORIDA; AND STEVE BESHEAR, GOVERNOR, COMMONWEALTH 

OF KENTUCKY 

STATEMENT OF RICK SCOTT 

Mr. SCOTT. Chairman Bono Mack and members of the subcommittee, thank you for convening this important hearing on the 

perils of the illegal distribution of prescription drugs. I ask that my 

full testimony be submitted for the record. 

During my campaign and since becoming Florida’s governor on 

January 4th, I have heard firsthand the heart-wrenching stories 

from family members and friends of those who have lost their livelihoods and tragically their loved ones to prescription drug addiction. So I have been working on solutions to this problem since 

42 

being elected. And Chairman Bono Mack, I know you have been 

personally touched by this epidemic. 

Florida, like much of the Nation, has a long history in the fight 

against criminal drug distribution. The names of the drugs have 

changed but the problem has remained. Today, one of the most 

common names in the fight is oxycodone. Consider some of the statistics from my State and the scope of the problem becomes clear. 

Ninety-eight of the top 100 doctors dispensing oxycodone nationally 

are in Florida concentrated around Miami, Tampa and Orlando. A 

hundred and twenty-six million pills of oxycodone are dispensed 

through Florida pharmacies. By far, more oxycodone is dispensed 

in the State of Florida than in the rest of the Nation combined. 

The targets for law enforcement have often been the street dealers and addicts, essentially the bottom level of the distribution 

chain. One tool that focuses on end users is a database focused on 

the patient level. This month in Florida, my Department of Health 

began implementation of such a database. While the database 

moves forward, I am working on satisfying the privacy concerns of 

law-abiding concerns. In 2009, the Associated Press reported a 

massive privacy breach when hackers broke into Virginia’s prescription drug database. They obtained more than 8.2 million patient records and a total of nearly 36 million prescriptions. In Florida, I continue working with my legislative partners to find solution that protect patient privacy. 

More important than computer databases, though, is focus on the 

resources of my administration on a law enforcement solution that 

starts at the top of the distribution chain instead of the bottom. 

Every day, we see that pharmaceutical manufacturers and wholesalers turned a blind eye when massive amounts of narcotics 

stream into the same regions of Florida. Meanwhile, unscrupulous 

doctors work with storefront pill mills masquerading as legitimate 

health clinics. At each level, there is an opportunity for law enforcement to intervene and stop the illegal flow of drugs into our 

communities. 

In these first few months of my administration, I committed to 

provide a law enforcement solution, a statewide drug strike forces. 

It ensures open channels of communication and multi-agency cooperation. The goal is clear: target the sources of these drugs before 

they hit the streets. It gives our local sheriffs and police chiefs a 

statewide coordinated effort that provides intelligence, analytical 

and investigative support. As I speak to you today, local law enforcement strike teams are working to identify, investigate and apprehend those in the medical and pharmaceutical distribution 

chains. I also directed all the state agencies in Florida to identify 

investigative resources, licensing and registration information and 

analytical research that can be used by law enforcement. Florida 

Attorney General Pam Bondi is working with prosecutors across 

our State to ensure these criminals are prosecuted to the fullest extent of the law. I am grateful to all of these professionals for their 

commitment to this important work. 

Not only are these efforts focused on Florida, we are also coordinating with other States to shut down a national prescription drug 

pipeline that some have called the Oxy Express. We are aggressively working to shut down the illegal supply of prescription drugs 

43 

from our State both inside and outside of Florida. Since the beginning of my administration, there have been more than 50 arrests 

around the State including a statewide sweep by law enforcement 

that raided 15 pill mills in three south Florida counties. 

Just the other day, I was disappointed to learn that a deputy 

sheriff in south Florida was the first drug trafficking arrest made 

since the initiation of the strike force. It is too early to go into the 

details on this and other cases but I can tell you more investigations are underway and arrests will continue. 

With my partners in the Florida Legislature, we will pass legislation in the next 3 weeks to prevent doctors from dispensing narcotics and require doctors to divest of their pharmacies. Doctors 

who have forsaken their commitment to people’s health in exchange for the quick buck of unethical and criminal dispensing 

must be put to an end. We will also closely review the activities 

of wholesalers in Florida and we will put in place tough penalties 

for these manufacturers and distributors who fail to help us turn 

off the illegal supply chain. 

Let me conclude by telling you that this strategy centered on a 

law enforcement solution and targeting the top of the distribution 

chain rather than the bottom will make a difference. I applaud this 

committee for taking a serious look at the issue and I want to ask 

you to also focus your energy at the sources of this problem. Together, if we hold the manufacturers, wholesalers, doctors and 

pharmacies accountable, we can win this fight. Thank you very 

much. 

[The prepared statement of Mr. Scott follows:] 

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Mrs. BONO MACK. Thank you, Governor Scott. 

Governor Beshear, you are recognized for 5 minutes. 

STATEMENT OF STEVE BESHEAR 

Mr. BESHEAR. Thank you, Madam Chairwoman, members of the 

committee. Thank you for allowing us to come here and discuss a 

national crisis that has been particularly destructive in Kentucky 

and in Appalachia in general, and that is the crisis of prescription 

drug abuse. 

Let me be frank. Our people in Kentucky are dying. An average 

of 82 Kentuckians each month fall victim to drug overdoses, the 

majority related to prescription drugs. That is more than two people a day. To put that in perspective, more people in Kentucky die 

from overdoses than from car wrecks. Greater still is the number 

of families decimated by the financial and social toll of this illicit 

drug use. In the words of our law enforcement officials, medical 

professionals and coroners, what has long been a problem has become an epidemic. 

Our response in Kentucky has been aggressive. We have ramped 

up enforcement. We have expanded the availability of treatment 

and we have implemented high-tech monitoring and recordkeeping 

while working to share that information with other States. Our 

prescription drug monitoring program called KASPER was created 

more than a decade ago as a tool for both the medical and law enforcement communities and is now available electronically. Singled 

out by the White House in 2006 as a national model, KASPER is 

inclusive and easily accessible. Furthermore, in 2005 Kentucky became one of the first States to require a doctor’s examination for 

the writing of scripts for powerful painkillers and to require Internet pharmacies to be licensed in the State. Three years later, Congress passed the Ryan Haight Act. 

But these innovative efforts have not been enough because as 

Kentucky has tightened its net, illicit drug users have found ready 

supplies of prescription drugs in other States with looser regulations, and we are not equipped to stop that. What is needed clear 

is an aggressive nationwide response, one that recognizes that this 

country’s prescription drug strategy is only as strong as the weakest link in the chain. 

I am here to push three thoughts. One, I urge Congress to continue providing resources to the Harold Rogers Prescription Drug 

Monitoring Grant Program so that the work toward data sharing 

among States can continue. We have come too far with that program to stop now. Forty-five States have authorized prescription 

drug monitoring programs and 34 are currently operating. 

At this point I want to stop and salute the efforts of Congressman Harold Rogers of Kentucky. He has been a warrior on this 

issue of prescription drug abuse. 

Secondly, training must be mandated for those who prescribe 

controlled substance, especially schedule II narcotics. These drugs 

and the risk of addiction and fatal overdoses must be more clearly 

understood by both doctors and patients. We can’t leave this education simply to the pharmaceutical sales reps. 

And three, the Department of Justice must focus more attention 

and resources on Florida, especially south Florida, to stop the flow 

52 

of prescription drugs. As Governor Scott and I have talked, it is a 

tremendous issue in his State and we both acknowledge that. Some 

60 percent of the prescription drugs sold and consumed illegally in 

Kentucky come from the loosely regulated pain clinics in Florida 

with each trafficker bringing back on average more than $10,000 

worth of drugs. In 2009, Kentucky State Police arrested more than 

500 people from eastern Kentucky in its largest drug roundup ever, 

and every single suspect had ties to Florida. These pill traffickers 

are not amateurs. They are sophisticated. They are well-organized 

operations. And the fight against them must be well organized as 

well. 

I appreciate the very aggressive efforts that Governor Scott is 

implementing in Florida to attack this problem. I appreciate the 

fact that I believe now they are going ahead to implement the monitoring system that they passed a year or so ago. 

And that, my friends, is good but it is a start. As we both know, 

it is just a start. It is one piece of a much larger strategy that we 

have to apply. This is a national problem that demands national 

solutions, and the sooner we come together to recognize that, the 

greater our success will be. Thank you. 

[The prepared statement of Mr. Beshear follows:] 

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Mrs. BONO MACK. I thank both our governors and recognize myself for the first 5 minutes. 

I want to thank you both very much. I have encouragement that 

the two of you are sitting together, for those in the audience to recognize this is a bipartisan panel, and if you were to have only read 

your written testimony, you would have thought there would have 

been some sparks flying, but it seems that there is definitely a 

meeting of the minds here and a recognition first and foremost that 

the problem exists. 

Governor Scott, congratulations on your recent election, but to 

you, I am encouraged to hear you are going to move forward now 

but I am also hoping you are going to continue to reject the $1 million that Purdue Pharma offered you. Are you going to accept or 

reject that $1 million Purdue Pharma offered you to fund a database? 

Mr. SCOTT. We are not accepting it. 

Mrs. BONO MACK. I thank you for that very much. Can you 

speak a little more as a businessman? You saw first and foremost 

that the law was being broken and you wanted to come at it from 

law enforcement. Can you speak a little bit more about this approach? Because I would love to see people go to jail. I would love 

to see some of these bad actors in handcuffs being taken off. Can 

you speak to your efforts a little bit more thoroughly from the law 

enforcement side? 

Mr. SCOTT. Well, here is what we can do. We are in legislative 

session right now and so we have a very aggressive bill that is 

going forward that will help law enforcement, but in the meantime, 

we have a strike force. Our Florida Department of Law Enforcement, we took monies out of that budget right now and we took a 

lot of investigators from there, from the Department of Health and 

other agencies and provided help to each of our sheriffs and each 

of our police chiefs because they are just overwhelmed with this 

issue right now. At the State, we have got a lot more analytical and 

investigative research that we can do, so we are helping them deal 

with that. On top of that, we have a very aggressive attorney general. Attorney General Bondi is very aggressive on this issue and 

so we have done a good job with arrests so far. Eighty-seven percent of the oxycodone that comes out of the country comes out of 

Florida right now. So the strike force is going to have a big impact. 

But I think a bigger impact is going to be the fact that the doctors 

will not be able to both prescribe and dispense, so that will stop 

that. They are not going to be able to own the pharmacies. We are 

going to limit the number of prescriptions they can do a day. That 

will have a big impact. So it is just piece after piece after piece. 

And then of course, as we know, they will figure out something and 

then we will have to continue to change. But I think all those 

things put together with all the data that we are helping our local 

law enforcement will have a big impact. 

Mrs. BONO MACK. Governor, do you need any help changing laws 

up here in Washington that you have found? Are you changing 

state law? 

Mr. SCOTT. You know, I think that probably the biggest thing we 

need to look at is regulating these manufacturers and what should 

these drugs be allowed to be used for. So I think, you know, the 

61 

usage of it—I mean, the fact that you can prescribe for these 

things, you know, as Governor Beshear said, some of the things requiring the doctors to have to do a medical exam and all that, you 

know, that is already being done and it is never enough. There is 

always something else we are going to have to keep doing. But the 

first thing is, why are they even able to sell these things and for 

what purpose and should there be a much more limited purpose 

that these drugs can be used for. 

Mrs. BONO MACK. Well, I look forward to working with you on 

these answers and moving forward, and I applaud that you are in 

the fight. I also would like to mention Governor Kasich as a third 

governor who has become very involved. 

Governor Beshear, just a little bit of information. My parents 

met and fell in love before World War II at a little teeny tiny college called Berea, if you know Berea College in Kentucky. So it is 

a near and dear place to my heart. 

But you also came in here sort of loaded for bear, ready to set 

your sights only on Florida, but can you speak a little bit about 

what you are hearing the governor say? You are encouraged about 

this willingness to cooperate? 

Mr. BESHEAR. Listen, this is not a partisan issue. This is a lifeand-death issue as we all know, and it requires us to work together. I don’t know that there is ever going to be total solution to 

this problem. It is always going to be with us, but we can sure 

make a significant impact if we work together and bring all the 

tools that we have got and cooperate together. You mentioned Governor Kasich in Ohio. You know, we are working right now with 

Ohio trying to figure out how to share the information between our 

monitoring systems so that we can do an even better job than what 

we are doing. 

Mrs. BONO MACK. For the sake of time, one of the biggest concerns of course is a privacy breach, and we are all very sensitive 

to that, and I think nowhere more so than in health care. Can you 

speak specifically how you are protecting that data and consumers 

can feel confident that they have privacy that they need? 

Mr. BESHEAR. You know, we have had the system now for 10 

years and we have got very strict privacy guidelines. It has a successful track record. It has never been breached. It is a felony for 

folks to breach that system. And it has worked. The integrity of the 

system has held together. I don’t know of any system, whether it 

is with the CIA or the State Department or the Defense Department or our monitoring system that you can guarantee will never 

be breached, that will never find a way for somebody to hack into 

it. We obviously will continue to strengthen with the latest technology those security systems. 

But is really a matter of weighing the issues here. You know, 

there is a slight risk always whether it is e-health records or whatever that some breach can occur, but when you are looking at 82 

Kentuckians a month dying, when you are looking at about seven 

Floridians a day dying because of drug overdoses of legal prescription drugs, that is a pretty easy answer for me. 

Mrs. BONO MACK. I thank you very much, and my time is expired. I recognize Ms. Blackburn for 5 minutes. 

62 

Mrs. BLACKBURN. I want to stay right there with the privacy and 

the online database issue because we are the committee of jurisdiction with telecommunications and the Internet. That is one of our 

subcommittees. And the privacy issue is one that we will do some 

work on this year. And Governor Beshear, you have had KASPER 

for 10 years, and I think it would be helpful to us as a committee 

as we consider both the larger privacy debate and as we look specifically at the prescription drug program to have some guidance 

from you all, some suggestions of what you think we could focus 

on. 

And Governor Scott, let me just continue with the chairman’s 

question to you. With these databases, what suggestions do you 

have and where are you seeing the problems? Have you all come 

up with a way to guard against the breaches and have you had any 

breaches? 

Mr. SCOTT. Well, we just started to implement ours. When I 

came to office, there was a lawsuit that prevented us from implementing it. So we are just now getting started. And so what we are 

doing is, we are looking at what all the different States are doing 

with regard to privacy to come up with the best answer on dealing 

with that, because it is a big issue and we have people worried 

about it. 

Mrs. BLACKBURN. All right. And Governor Beshear, did you say 

that you had or had not had a breach on your system? 

Mr. BESHEAR. No, we have never had a breach. 

Mrs. BLACKBURN. You have never had a breach in the 10 years? 

Mr. BESHEAR. Right. 

Mrs. BLACKBURN. So you feel like your firewalls—and do you do 

an opt-in or opt-out on information and data share? Get back to me 

on that. I know time is—— 

Mr. BESHEAR. I will. I am not sure on that. 

Mrs. BLACKBURN. OK. Let us talk about education just a second 

because this is something with the prior panel as we had the DEA 

before us that we looked on just a little bit, and I think that it is 

important for us to continue to move forward with education. I 

would like for you each to give me just a 1-minute response on 

what you are doing with public education, with personal responsibility education, with parental education. I know in Florida the 

pain clinics are a problem that was recently discussed, and then 

you have a little bit of history, Governor Beshear, so if you all 

would talk about the education component, that would be helpful. 

Governor Scott first. 

Mr. SCOTT. Sure. Well, what we are doing is, first off is making 

sure the public knows just through articles and things like that, 

make sure the public knows how big the problem is. I have done 

press conferences and things like that. I have brought it up 

through—we have had testimony in the legislature to talk about 

the issue. We spent a lot of time this legislative session going 

through what the problems are. So that is the biggest thing we are 

doing right now. 

Mr. BESHEAR. Certainly the public education part of it in terms 

of talking about it publicly, and it is talked about a lot publicly in 

Kentucky right now, and I am glad of it because at least it is exposing all of our citizens to this dreaded problem. Also in our pharVerDate Aug 31 2005 10:04 Nov 08, 2012 Jkt 037690 PO 00000 Frm 00068 Fmt 6633 Sfmt 6633 F:\112-00~1\112-03~1\112-39~3 WAYNE
63 

macy schools, in our medical schools, we are pushing to make sure 

that our doctors really understand, the ones that are coming out, 

and the pharmacists understand what they are really doing and 

that they don’t get their information just from the drug reps, that 

they have the kind of information they need to handle these kinds 

of drugs very carefully and very effectively. 

Mrs. BLACKBURN. Do you think most Kentuckians realize you 

have the KASPER system in place? 

Mr. BESHEAR. I think there is probably a general knowledge we 

do, although it is probably not understood in terms of what it really 

does. But we are looking at strengthening that system. Right now, 

you know, doctors can voluntarily be in it or not be in it. I am 

thinking of beginning discussions about making that a little stronger. 

Mrs. BLACKBURN. Having it be mandatory? 

Mr. BESHEAR. Making that a little stronger. You know, I think 

doctors ought to be in that program. 

Mrs. BLACKBURN. Thank you both, and I yield back in the interest of time. 

Mrs. BONO MACK. I thank the gentlelady. The chair recognizes 

Mr. Stearns for 5 minutes. 

Mr. STEARNS. Thank you, Madam Chair. 

Governor Beshear, when you mentioned that more people are 

dying from overdose than automobile accidents, that is appalling. 

That is just a frightening statistic. 

Governor Scott, earlier we had a Florida delegation, Madam 

Chair, so I heard some of the testimony from the governor, and I 

guess the question that came up when we had the delegation meeting, can pain clinics be subject to additional scrutiny before they 

are licensed to practice? Is that a place where we could start? 

Mr. SCOTT. We are doing that now. We are doing it through— 

we already have where they have to be licensed so we are doing 

that. But it is not perfect. It is not easy to get around, but you can 

get around it. So that is actually one of the things that is in our 

bill. But the big thing is, think about this. We know the manufacturer, we know the distributor, we know the doctors that are distributing it. We ought to be able to stop this if we just keep tracking it. Now, people will change and there will be a new drug or 

something like that but this is a legal distribution system that is 

doing it the wrong way so we ought to be able to—if we track it 

all the way and have criminal penalties and civil penalties for everybody that is doing the wrong thing, I think we will have a dramatic impact in Florida for a period of time and then something 

will change. 

Mr. STEARNS. Governor Beshear, anything you want to add to 

that? 

Mr. BESHEAR. No. I think we need to be as aggressive as possible 

in all of these areas. We need to be aggressive in regulation of all 

of these folks and regulation of what the pharmaceutical companies 

can do in terms of who gets these drugs and how they are dispensed. We need to be very aggressive in the law enforcement area. 

And I think what Governor Scott is doing in Florida is showing 

that kind of commitment very quickly, and we have been doing 

that in Kentucky for some time also. 

64 

Mr. STEARNS. Intuitively, the relationship between the doctors 

and the pharmacies, is that anything that you as a governor, either 

one of you can do in terms of educating or threatening or somehow 

trying to influence the relationship between the pharmacy and the 

doctor, or is that sort of sacrosanct, that there is nothing you can 

do? 

Mr. SCOTT. We are doing it in our bill. The doctor that prescribes 

will not be able to own a pharmacy. 

Mr. STEARNS. Oh, that is good. 

Mr. SCOTT. So we are going to completely separate it, and then 

we will have the data. We will be able to track all the way through. 

But I think stopping the ownership will have a significant impact. 

Mr. STEARNS. Is there any State that has in place some of the 

things you have already talked about, Governor? 

Mr. SCOTT. I haven’t seen anybody that restricted the ownership 

of pharmacies. 

Mr. STEARNS. Yes? 

Mr. BESHEAR. One of the other things, and I am not sure how 

his laws are set up, but I appoint the doctors to the board of medical licensure and the pharmacists to the pharmacy regulatory 

board, and I have made it a very clear point before I appoint anybody, I have them come in and we talk about these kinds of issues, 

and I get a commitment from these folks to really bore in and try 

to address these kinds of issues as much as possible, and I think 

that is just another tool that we have to attack this problem. 

Mr. STEARNS. Now, is there anything that the Federal Government, either one of you think we as legislators on the Federal side 

or perhaps direct the Federal agencies in some way that could 

make your job easier so we can stop these drugs from coming down 

the pipeline? So any suggestions you have would be very helpful. 

Governor Scott? 

Mr. SCOTT. Sure. I think the biggest thing is, why—I mean, there 

ought to be restrictions on how these drugs can be used and what 

they can be prescribed for. 

Mr. STEARNS. From the Federal level? 

Mr. SCOTT. Yes. 

Mr. STEARNS. From the FDA? 

Mr. SCOTT. Right. 

Mr. STEARNS. OK. 

Mr. BESHEAR. Another area that I hope you all will pay particular attention to are continued funding for the Hal Rogers Act 

that is on the books now. That will help the States to share information and develop the systems to share information, and that will 

be effective in this battle, the HIDA, the Erns Jag awards and 

grants that are made that help us fight this specific problem. I 

know that just as Governor Scott and I are fighting budget battles 

every day, you all are too, but some things are more important 

than others and that is the way we all have to look at the way we 

balance our budget. That is what I do. That is what he does. And 

I just ask you in that priority, put this priority up there. 

Mr. STEARNS. Well, I want to thank you. My time is expired. But 

I think the fact that both of you governors took the time to come 

up here to talk about this serious problem, I think is a commendation to you and also for us having this hearing, Madam Chairman, 

65 

because this shows that even though we are trying to reduce 

spending up here, this is a priority, I think, that is very serious in 

this country, and we have ways to stop it. So thank you for your 

testimony. 

Mrs. BONO MACK. Thank you, Mr. Stearns. Mr. Guthrie, you are 

recognized for 5 minutes. 

Mr. GUTHRIE. Thank you very much, Madam Chairwoman. And 

also your roots are from Muhlenberg County, or several generations back, I believe. 

Mrs. BONO MACK. That is right. 

Mr. GUTHRIE. Which is near where the governor is from, a couple 

counties over from where the governor is from. So thanks so much. 

And I did mention the first lady, she is from my area, so I should 

have mentioned that in the introduction. So I appreciate what she 

is doing as well for our State. 

When we did KASPER, I remember it coming forth, and I will 

tell you, there is not a legislative session that doesn’t go on, particularly the legislators from Appalachia, have always pushed what 

can we do to improve monitoring, interdiction. So the Kentucky 

leadership is focused on this and trying to help solve this problem. 

If I remember some of the participation in the Medicaid, because 

it seems that the prescription drug problem is in areas that are 

heavily Medicaid as well, and I don’t know if you know the correlation between that or if you have seen as well, Governor. 

Mr. BESHEAR. Certainly, you know, prescription drugs are allowed under the Medicaid program obviously and every State is involved in that program, and you are going to have some abuse 

within that program, and we are very aggressive in the Medicaid 

area of trying to weed that out and at the same time educate people. You know, we are pushing in the Medicaid program the ability 

of our local health departments and those regional medical centers 

to educate our folks about the dangers of these narcotics. You 

know, so many of these people that end up being addicts start out 

as legitimate drug users, you know, that they need something for 

their pain or this or that, and they start out in a very legitimate 

way and then they end up being addicted and then they get into 

this cycle of buying the drugs illegally, and that just grows the 

problem. 

Mr. GUTHRIE. And I know you weren’t governor at the time, but 

when we passed KASPER, I don’t remember Florida being such a 

big issue for us 10 years ago, but KASPER, did it just move—because I–75, wonderful highway, we love I–75 and people go to Florida and enjoy it and love it, but it also seems to be a pathway for 

the prescription drugs to come to Kentucky. Is that because we had 

KASPER because it helped curtail some of the problems we had so 

it just has moved? 

Mr. BESHEAR. Sure. You know, before we had KASPER, they 

would just stay in Kentucky and get these drugs illegally, and we 

haven’t cut all of that out. I don’t want to even imply that. But we 

made a significant impact in it by having this monitoring system 

among several tools that we have, and the fact is, no State is an 

island, you know. Folks, if we stop them doing something in Kentucky but they can do it across the State line, they will go do it 

across the State line. And that is why it is so important for all of 

66 

us all across this country to find ways to address this. It doesn’t 

have to be uniform everywhere but it has to be everywhere for this 

to really work. 

Mr. GUTHRIE. Well, thanks. And I think I saw you on the news 

a couple of weeks ago. I know Florida is in session, and I guess a 

bill had seemed to have failed in Florida that might have addressed this, but it sounds like Florida does have a bill moving forward in the legislature now. I don’t know if it stalled or whatever. 

I am glad to see you all together working on this because it is a 

problem for all of us. But what is going on in the Florida legislature to address the tracking or the similar KASPER deal? 

Mr. SCOTT. Well, first off, the monitoring bill was passed last 

year, and there was a lawsuit that just got finished last Friday. 

Mr. GUTHRIE. Maybe that is what you were referring to. 

Mr. SCOTT. So that has finished. But we have a very good bill 

that looks like it is going to get out of both the house and the senate, which everybody has signed off on including the attorney general, who is very focused on this, and if you prescribe the drug, you 

can’t dispense it out of your office. You can’t own part of a pharmacy. There is a restriction on the number of prescriptions you can 

do a day. We have got tamper-resistant pads to write the prescriptions. We have got licensing of the pill mills and we have got criminal penalties, civil penalties going all the way up to the manufacturer. We are going to try to do everything we can to stop it. It is 

a big issue when 98 of the top 100 doctors in the country prescribing oxycodone are in Florida. 

Mr. GUTHRIE. So are Florida’s laws different? Because I–75, you 

have to go through Tennessee and Georgia to get to Florida. Are 

you all just so different? I know you are working on that? But is 

it so different now, the current status than Georgia or Tennessee? 

I mean, Kentuckians aren’t going to Tennessee, they are going to 

Florida, so what is the difference, I guess? 

Mr. SCOTT. Every State has been different. 

Mr. BESHEAR. And what has happened is that some of this is 

starting to move to Georgia because Georgia doesn’t have a monitoring system. Tennessee does. And that is, I think, initially what 

pushed it south, and you know, Georgia may be the next place that 

we really have to push hard to get them to address this situation. 

Mr. GUTHRIE. Thanks, Governors. Thanks for making the trip to 

Washington today. I appreciate it. I have to yield back now. I am 

out of time. 

Mrs. BONO MACK. I thank the gentleman. Mr. Harper, you are 

recognized for 5 minutes. 

Mr. HARPER. Thank you, Madam Chair, and welcome to each of 

you, and it is an honor to have you here. This is a very important 

issue. We all have friends who have had their families devastated, 

primarily by young people who get those prescription drugs from 

their medicine cabinet at home. That seems to be a major problem. 

So how do we solve the underlying problem here is that no matter what regulations we put on, which will be very helpful, how do 

we convince these young people not to use the drugs, not to take 

them? Are you doing anything in conjunction with, say, success in 

drug courts or any faith-based programs? Governor Beshear, I will 

ask you that first. 

67 

Mr. BESHEAR. Yes, we have drug courts, we have faith-based initiatives that all work in this area. Obviously a part of it is education, and we are pushing that both in the public school system 

as well as through faith-based initiatives. The other end of it is 

treatment and rehabilitation, and we took a significant step recently in Kentucky by revising a major part of our corrections system and our approach to corrections to put a lot of time and effort 

into treatment and rehabilitation so that we can stop recidivism 

and stop that revolving door to where folks just get out, you don’t 

give them any help, you just turn them loose again, and, you know, 

within 30 days, they are out trying to buy the drugs again and they 

are back in. And we brought the Pew Foundation into Kentucky 

and had a bipartisan effort of Republicans and Democrats, our 

house, our senate, our supreme court, the court system as well as 

the governor all got together, and we have made some major 

changes that I think on that end of the spectrum will address the 

recidivism rate. 

Mr. HARPER. And Governor Scott, your State dealing with drug 

courts or faith-based initiatives to help in this effort, what is the 

story there? 

Mr. SCOTT. Well, the big thing we are doing since I have been 

in office is educate the public to make sure everybody gets on 

board, first off, making sure we get this legislation passed so that 

was very important to get that done. The strike force is very important. On top of that, just continuing to educate the public. The 

schools are educating the public. Also, the individual I put in 

charge of Department of Corrections is very focused on this and the 

same thing as Kentucky, very focused on the number of people that 

get out of prison and go right back and have the same problem. So 

he is somebody that is very focused on that issue. 

Mr. HARPER. Well, obviously our goal is to make sure they never 

get into the court system in the first place and how do we encourage folks this is not the route to go? 

Mr. SCOTT. Well, one thing we have done is, our juvenile justice 

is run by an individual from Miami. She came up to work with me, 

and she is focused on a program that she has worked for 20 years 

in Miami that has had a dramatic impact in stopping sort of the— 

the first time you get stopped for something, you don’t end up in 

prison just because it ends up being a cycle. So all the things she 

has done starting with civil citations and starting with, if you get 

stopped for the first time, it is not just that issue. You might have 

an issue over food, shelter, family issues, things like that, and having a holistic approach to it to stop them from ultimately ending 

up in prison. So we are taking all the things that she is doing and 

spreading them across the State. On top of that, we have legislation that would allow us to do a civil citation program rather than 

immediately moving into a criminal program. 

Mr. HARPER. And how you secure the prescriptions at someone’s 

home so that no one other than the intended patient gets it is a 

really tough thing to do. 

Mr. SCOTT. That is the hardest. 

Mr. HARPER. I am interested in what you said about your task 

force that you have in place. How are you going to measure the 

68 

success of the mission of that task force? What are you anticipating 

or hoping for out of that? 

Mr. SCOTT. Well, the numbers have to get better. We can’t have 

98 of the top 100 doctors, 126 million pills. It is basically, how do 

we stop basically all this happening in our State. But it is going 

to be arrests, it is going to be the number of prescriptions that are 

done. In the end, it is prescriptions and deaths. 

Mr. HARPER. What about working in conjunction with your State 

medical association? What input have they given either of you? 

Mr. SCOTT. Well, in our case, they are very focused. I am doing 

something similar because I have the opportunity to appoint the 

members of the board of medicine, so as I am going through that 

process and talking to individuals about those positions, I have 

talked to them about how important this issue is and the fact that 

they have got to be engaged and the board of medicine has to be 

engaged. 

Mr. HARPER. Governor Beshear? 

Mr. BESHEAR. Same thing here. You know, we are engaging the 

medical profession, the pharmacy profession as well as their regulatory boards, and you know, as I am sure Governor Scott would 

point out, those boards, their first duty is to protect the public and 

not just protect themselves, and we see a little bit of that in every 

regulatory environment whether that is lawyers, doctors, pharmacists, and I am a lawyer so I can say that about myself. But, 

you know, we have got to emphasize that their first duty is to the 

public and to protect the public, and it just comes down to appointing the right people. 

Mr. HARPER. Thank you each for being here, and Madam Chair, 

I yield back. 

Mrs. BONO MACK. I thank the gentleman. The chair recognizes 

Dr. Cassidy for 5 minutes. 

Mr. CASSIDY. Thank you for being here, gentlemen. My pain doctors really like the PDMPs because they feel like the pill mills give 

everybody else a bad name. Now, that said, I gather from testimony that some of these PDMPs are robust and some of them are 

limited in ability. 

Now, Governor Scott, clearly you have legitimate concerns regarding the privacy, but as much as you can say, and I gather Kentucky has a rather robust program, where do you imagine yours 

will be on the spectrum? And I just mention that because at the 

previous meeting, Florida was described as ground zero for the promulgation, if you will, or the source, if you will, for these drugs 

across the Nation. 

Mr. SCOTT. Well, it is clearly ground zero, so it is a significant 

issue and things that are—Florida’s problem is a problem for the 

whole country because we haven’t stopped the abuse. So our database will be—what we are doing is, being one of the later States 

to do it, we will be able to take all the benefits, take all the knowledge from the other States, which is what we are doing, both to 

make sure we have the right information and also have the right 

privacy concerns that we can address, so we will be doing both of 

those. But on top of that, we are going to make sure we are tracking from the manufacturer to the wholesaler to the doctor, not just 

at the pharmacy after the fact, because after the fact is going to 

69 

be part of what we do but I think the biggest part is going to be, 

we are going to stop the distribution of it. 

Mr. CASSIDY. I see that. OK. Now, let me ask you, my pain doctors also tell me part of the problem is that someone may live on 

the Pearl River borders between Louisiana and Mississippi, and I 

think there is a Pearl, Mississippi, and a Pearl, Louisiana, and 

they say live in one State and go to the other and they will get as 

much they can below the threshold here and then they will go back 

here, and they will do as well on the other side. Now, clearly, that 

just may require a Federal overlay, but as two fellows who obviously will be jealous and respective of States’ prerogatives, how do 

we keep folks from popping across State borders to maximize—do 

you see where I am going with that, Governor Beshear? 

Mr. BESHEAR. Well, first of all, both States need the monitoring 

program, and do both of them have that? 

Mr. CASSIDY. They both do, but each is self-contained. 

Mr. BESHEAR. Right, and they need to be doing what we are 

doing with Ohio right now. We are sitting down and trying to work 

out how to share information, and we are going to do that. Governor Kasich and I will end up—we will find a way to do that. And 

we are being helped by this Hal Rogers grant program. That is the 

money that has been provided to help States work to share information in these monitoring systems, and we need to continue that. 

We need that funding to continue doing this so that every State ultimately will be sharing across State lines. That is the only ultimate way that these programs will be as effective as possible. 

Mr. CASSIDY. And so although you start off with Ohio, you share 

a border, you actually envision that eventually you may partner 

with Governor Scott, for example? 

Mr. BESHEAR. Yes. 

Mr. CASSIDY. And wherever there is a potential distribution, to 

be able to go there? 

Mr. BESHEAR. Yes. We all need to partner eventually so that 

there is no place in this Nation that people can go and be able to 

do what they are doing now as freely as they do it. 

Mr. CASSIDY. Now, Governor Scott, I have to admit, I am a gastroenterologist, which I tell people prepared me very well for Washington, D.C. So if what I am about to ask you seems very simplistic, it may be, but it seems like if you know who those 98 docs 

are, all you need to do is have an undercover person walk in. I am 

told these pill mills, you may $250 or something for a visit. Five 

minutes later, you walk out with a handful of prescriptions. It 

seems like you could go to each of these and put them out of business for inappropriate prescribing. Why not? 

Mr. SCOTT. The difficulty is that the smart ones, what they are 

doing is, it will appear legitimate. They will do the MRI, they will 

do the history, they will do all these things, and so it is not as easy 

as just walking in and saying that you are doing something wrong. 

You have to have—that is why we spent a lot of time on this legislation with the attorney general and with the sheriffs and the police chiefs to make sure that what we are passing is something 

they are going to be to convict with because they will do all the— 

everything I have been told, they will do all the basic things to 

make sure it is very difficult to stop them. 

70 

Mr. STEARNS. Will the gentleman yield just for one second? 

Mr. CASSIDY. I will. 

Mr. STEARNS. I would think if you just let out the word that you 

are going to do sting operations, I mean, I would think that would 

create a pale over those physicians that might retard them from 

doing this. So I know, Governor Scott, it sounds difficult but I 

think what the gentleman is saying is, the fact that these stings 

might or might not come would create some caution. 

Mr. SCOTT. I think the difficulty is, there is a lot of money in 

this. There is a lot of money being made. 

Mrs. BONO MACK. I thank the gentleman. We are fortunate to 

have the governors, I understand, until 10:15, so we would like to 

do a second round of questions until that point if my colleagues are 

so inclined, and I will recognize myself for the first 5 minutes and 

just point out a few things that I think are essential for this discussion. 

First and foremost, it was my understanding that OxyContin was 

originally approved for severe cancer, late stages of cancer for severe pain yet the number-one prescriber today of OxyContin to children 12 and over is dentists, and I think that should be pointed 

out. 

I would also like to talk a little bit about the parental education, 

words that keep coming up, and point out that we have two panels 

yet to speak who will show that parents of all walks of life are affected by this and that it is impossible to detect this problem until 

it is too late. 

Governors, in your travels and your meetings with addicts and 

loved ones of addicts, first of all, would you be—I contend that 

OxyContin is heroin. Would you take big umbrage with that? 

Would you say that is about right, what you are seeing? 

Mr. SCOTT. You know, you never know the definition, but I can 

tell you, we ought to really restrict what it can be prescribed for. 

Mrs. BONO MACK. I have a bill that does just that, and I will be 

looking forward to working with you on that. You keep speaking 

also, Governor, about limiting all of these leftover pills in the medicine chest, and I keep wondering why we are prescribing, you 

know, hundreds of tons of pills a year that go unused. If patients 

don’t want them, why are they getting out there? That is another 

question that I look forward to exploring with you. 

And Governor Scott, I want to applaud you on your decision to 

reject the $1 million from Purdue Pharma for your database. Just 

recently there was an article here that points out that the CDC authored a study where they linked these powerful painkillers to 

deaths and the University of Wisconsin School of Medicine released 

a study that disputed that and talked about liberalizing opioids, 

and lo and behold, financed by Purdue Pharma, and I would like 

to submit this article for the record. 

[The information follows:] 

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76303.033
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76303.034
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76303.035
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76303.036
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76303.037
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76303.038
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76303.039
78 

Mrs. BONO MACK. And I think people need to start looking at the 

connection between these studies and these policies and the big 

money that you were just speaking about, Governor Scott. 

Governor Beshear, clarification again if I might. You did say the 

number of fatalities in Kentucky from drug overdoses has now surpassed automobile accidents. Is that legal or illegal drugs, again? 

Mr. BESHEAR. It is a combination but the majority of it is legal 

drugs, abuse of legal drugs. 

Mrs. BONO MACK. Thank you. And then Governor Scott, as a 

businessman, when you look at the chart for the dramatic increase 

of opioid abuse, it is ironic that the trend line started screaming 

upward shortly after OxyContin was approved. As a businessman, 

does that look kind of fishy to you like it does to me? 

Mr. SCOTT. Yes. 

Mrs. BONO MACK. Thank you. 

Mr. SCOTT. If you look at my testimony, you see how many—I 

mean, 87 percent of it coming out of Florida too and just the dramatic increase. 

Mrs. BONO MACK. Thank you. And another point, as somebody 

who has spoken publicly about my family’s problem with this or 

being involved with this disease of addiction—and it is a disease 

and I am happy that Congressman Harper brought up that side, 

that they shouldn’t be necessarily in the courts but we should treat 

it as a disease first and foremost. But as governors, when you meet 

the families that are suffering, aren’t these just normal families, 

regular families? I can show you stacks and stacks, I know you 

have pictures too, of kids who are in their senior year of high 

school, one family whose son died just a week before his graduation 

from high school, and he was an all-star athlete, on the dean’s list. 

Everything is right about these kids. Do you believe like I do that 

when these kids get access to these powerful painkillers they don’t 

stand a prayer in the ability to stay off of them? 

Mr. BESHEAR. This cuts across income brackets, it cuts across 

every bracket. This is a problem that everybody is having, and I 

don’t know that there is anyone in my State or any other State 

anymore that doesn’t know somebody, whether it is in their own 

family or a friend or another family that has been affected by this. 

Mr. SCOTT. Yes. A good friend of mine’s 18-year-old just died 2 

weeks ago of an overdose, and he found her. It would be horrible. 

But it impacts everybody. 

Mrs. BONO MACK. Was your friend aware that his daughter was 

using? 

Mr. SCOTT. He had found out, sent her to a program. What happens to a lot of people is that, you know, the kids turn 18, they 

don’t have to be in a problem. 

Mrs. BONO MACK. There is a mother who will speak to that on 

the next panel, to that very thing. 

Have either one of you ever met somebody who wanted to be addicted? 

Mr. SCOTT. No. I have a family member that has been addicted 

his whole life, never beat it. He started at a young age and never 

beat. 

79 

Mrs. BONO MACK. And it is a lifelong struggle. Again, I thank 

you two very much. I look forward to our continued working relationship. Again, I appreciate your courage in being here today. 

I will now yield to Ms. Blackburn for 5 minutes. 

Mrs. BLACKBURN. Just a follow-on. Governor Beshear, you mentioned you were thinking about putting your program as a mandate, and as I have sat here listening to you all respond to the 

questions, I am thinking, you know, it must be very difficult, and 

you may have some guidance for having a program that is an optin for your pharmacists and your physicians, and it seems as if 

those who are illegally prescribing or illegitimately prescribing, 

over-prescribing, would choose not to use the system. So I wonder 

what—if you would just explain a little bit about what has led you 

to that, and as Governor Scott is setting his program up, what 

would you advise him? Would you advise him for it to be a mandate from the get-go? 

Mr. BESHEAR. Well, I am going to be sitting down with our medical licensure board and our medical association and the dentists 

and the pharmacists and talk about this, but so far it has proven 

effective the way it is set up in that the doctors that are using it 

can actually detect other doctors even if they are not using it that 

are over-prescribing and are abusing the system as well as being 

able to detect those who—— 

Mrs. BLACKBURN. So you are using it as an accountability tool 

even for those that are outside of the system? 

Mr. BESHEAR. Yes. 

Mrs. BLACKBURN. OK. That is great. Now, how do you pay for 

your system and what is the cost of it each year? 

Mr. BESHEAR. It is paid for by State funds. 

Mrs. BLACKBURN. Taxpayer dollars? 

Mr. BESHEAR. Taxpayer dollars, and I am not sure, I can’t tell 

you offhand what it costs. 

Mrs. BLACKBURN. If you would submit that? 

Mr. BESHEAR. It costs a fraction of what it costs to handle the 

problem the other way. 

Mrs. BLACKBURN. All right. And Governor Scott, you said you are 

not taking a grant that was offered to you so how do you all intend 

to pay for your system? 

Mr. SCOTT. We have funding from other individuals and companies that are putting the money up. 

Mrs. BLACKBURN. Are they pharmaceutical companies or—— 

Mr. SCOTT. No. We have got 2 years of funding right now. We 

are just starting to implement ours. 

Mrs. BLACKBURN. Correct. 

Mr. SCOTT. But no, it is not pharmaceutical companies. 

Mrs. BLACKBURN. So it is private funding? 

Mr. SCOTT. Right. 

Mrs. BLACKBURN. So there is no taxpayer dollar involved? 

Mr. SCOTT. No. 

Mrs. BLACKBURN. OK. Thank you. I yield back. 

Mrs. BONO MACK. The chair recognizes Mr. Guthrie for 5 minutes. 

Mr. GUTHRIE. Thank you, Madam Chairwoman. 

80 

Again, I think that if I remember the problem, we were trying 

to define it in the legislature, it seemed to be Medicaid, you know, 

where if you have private insurance and they limit how many prescriptions you can get over and over, and we had to address that 

with the Medicaid but it just seemed that is where a lot of the prescriptions were coming, not everyone. It cuts across all swaths of 

people. But the concentration of it was. And you weren’t here, Governor Beshear, earlier but Mr. McKinley asked the question to the 

panel before, to the DEA, about why does Appalachia seem to be 

in a bigger—you know, because it is not only Appalachia using 

drugs in Kentucky, I can tell you that. In my area, though, it is 

methamphetamine. So every time we would show up in Frankfort 

for our legislative sessions, groups of us were trying to fight meth 

and other groups were fighting this. But it does seem the prescription drug part of it is concentrated in Appalachia where in my area 

it is the illegal manufacture of meth. I don’t know the answer to 

that, and I thought it was a good question. I don’t know if you all 

have looked at that way, why Appalachia seems to be more on the 

prescription side. Maybe it is I–75 access to Florida versus our area 

is not that way. I don’t know. 

Mr. BESHEAR. Well, it is obviously a nationwide problem. There 

are, I think, concentrations of prescription drug abuse in some 

places. There are concentrations of things like meth—— 

Mr. GUTHRIE. In my area. 

Mr. BESHEAR [continuing]. And illegal drugs in other places, but 

obviously it blankets the United States and it is getting worse, not 

better. 

Mr. GUTHRIE. You know, when we come to Washington and talk 

about problems in our State, we have to do that, but obviously we 

have—and you are the governor of my favorite State and obviously 

a beautiful place, but we have to talk about these problems and we 

have to get together and try to solve them. So thank you very much 

for being here today. 

Mr. BESHEAR. Well, the first step is to recognize that we have got 

the problem. 

Mr. GUTHRIE. I think Governor Scott wants to comment. 

Mr. SCOTT. Somebody just told me that there are no State taxpayer dollars but we are going to get some dollars from the Hal 

Rogers Federal grant, but there is no State taxpayer dollars. 

Mrs. BONO MACK. Thank you for the clarification. 

Mr. GUTHRIE. If you want my time, Madam Chairwoman, I will 

yield you my time back. 

Mrs. BONO MACK. Oh, thank you. I was taking it anyway. 

Mr. GUTHRIE. OK. Go ahead. 

Mrs. BONO MACK. I think an important issue is whether or not 

there was other pharmaceutical money involved, which is a question we debate here on many things, but in this specific instance, 

I thought the Purdue Pharma, your decision on that was a good 

one, and I applaud both of you to wrap it up and to thank you for 

your time today and your spirit and the willingness to truly address this problem. We are not going to end it. We are not going 

to solve it entirely. But I do believe good, innocent people are suffering, and crime, it is a very basic situation for me. The FDA approves and regulates and the DEA is supposed to control, and with 

81 

statistics like that, it shows that we are failing, and it is time to 

stop. Too many people are dying and too many of our constituents, 

and more and more of my colleagues would have participated 

today. I know Congressman Vern Buchanan is very interested now, 

Congressmen from Massachusetts are very interested. This is not 

only Kentucky and Florida, it is nationwide, and as the panels go 

on, we will focus on California and what is happening. So Florida, 

don’t feel that it is all you because it is throughout the country. 

But thank you, gentlemen, very much. I look forward to working 

with you. 

At this point the subcommittee will take a very brief recess to 

seat the third panel. 

[Recess.] 

Mrs. BONO MACK. The subcommittee will come back to order, 

please. I thank the staff for being so quick in switching the panels 

over. 

On our third panel, as you can see, we have seven witnesses as 

I introduce them all at once. First is Phil Bauer, surviving father 

of Mark Bauer. Phil serves on the Parent Advisory Board for the 

Partnership for a Drug-Free America. Our next witnesses are 

Kathy and Courtney Creedon, surviving mother and sister of Ryan 

Creedon. Kathy is also Founder of Mothers against Prescription 

Drug Abuse, and I am blessed and lucky enough to call them my 

own constituents. Also testifying will be April Rovero, surviving 

mother of Joey Rovero and Founder of the National Coalition 

against Prescription Drug Abuse. Our next panelist is Dan Harris, 

who overcame a prescription drug addiction to gain custody of his 

children. He is a drug court graduate and also a constituent of 

mine. And finally, we are pleased to have Dr. Carol Boyd and Dr. 

Amelia Arria, who are widely respected nationally for their insight 

into addiction. On a personal note, staff told me to say what I already said about how proud I am to have some constituents on this 

panel. 

So welcome to each and every one of you. I really appreciate your 

being here. If you can see the timer boxes down there, it is just like 

a traffic light, green, yellow and red. You know what they mean. 

The total time you are allotted will be 5 minutes each, so we are 

now going to recognize Phil Bauer for 5 minutes. 

82 

STATEMENTS OF PHIL BAUER, FATHER OF MARK BAUER AND 

PARENTS ADVISORY BOARD MEMBER, PARTNERSHIP AT 

DRUGFREE.ORG; KATHY CREEDON, MOTHER OF RYAN 

CREEDON AND FOUNDER, MOTHERS AGAINST PRESCRIPTION DRUG ABUSE, ACCOMPANIED BY COURTNEY 

CREEDON, SISTER OF RYAN CREEDON; APRIL ROVERO, 

MOTHER OF JOEY ROVERO AND FOUNDER, NATIONAL COALITION AGAINST PRESCRIPTION DRUG ABUSE, AND PARENT 

AMBASSADOR, PARTNERSHIP AT DRUGFREE.ORG; DAN HARRISON, DRUG COURT GRADUATE; CAROL J. BOYD, PH.D., 

R.N., F.A.A.N, DIRECTOR, INSTITUTE FOR RESEARCH ON 

WOMEN AND GENDER, PROFESSOR OF NURSING, UNIVERSITY OF MICHIGAN, ANN ARBOR; AND AMELIA M. ARRIA, 

PH.D., DIRECTOR, CENTER ON YOUNG ADULT HEALTH AND 

DEVELOPMENT, UNIVERSITY OF MARYLAND 

STATEMENT OF PHIL BAUER 

Mr. BAUER. Good morning, Chairman Bono Mack, Ranking Member Butterfield and members of the subcommittee. My name is Phil 

and I am from York, Pennsylvania, and I am here today speaking 

as a dad. 

If you were to ask any parent what their biggest fear in life is, 

their worst nightmare, most would tell it would be losing a child. 

We are living that nightmare and it is worse than we ever could 

have imagined. 

Our youngest son, Mark, died from prescription drugs. His death 

was preventable and avoidable, and I believe the underlying cause 

was ignorance: my ignorance. Of all the things I worried about as 

a dad, abuse of medicine wasn’t among them. Unfortunately, there 

are many people who continue to underestimate the dangers of 

abusing prescription drugs and, as I know all too well, ignorance 

can be fatal. 

On June 4, 2004, my wife Cookie and I, along with our oldest son 

Brian, attended the high school graduation of our youngest son 

Mark. As you know, there are many emotions that come with graduation, and it is a significant milestone and accomplishment in a 

young person’s life, and the emotions are not just for the graduate 

but for their families as well—pride, happiness, relief, fear, sadness. It is a transition in life, and some refer to it as the beginning. 

The words I would use to describe our emotions at Mark’s graduation are devastation, emptiness and confusion. It marked the end 

of our son’s life. I can remember so well sitting there and staring 

at an empty chair where Mark should have been sitting with his 

cap and gown draped over the back of the chair, and his diploma 

and yearbook laying on the seat, but Mark wasn’t there. 

On May 28, 2004, on what would have been his last day of high 

school, just one week before graduation, Mark died. That morning, 

I responded to my wife’s screams and went to see what was wrong, 

and she said that she couldn’t wake Mark up. I started CPR and 

Cookie called 911. When the emergency personnel arrived, we followed the ambulance to the hospital, were escorted to the little 

room, and then heard the words that our son was dead. We went 

back to see him to try to say our goodbyes, and we cried on his lifeless body. For Cookie and I, life as we knew it ended that day. 

83 

In his room that morning, we found a clear plastic bag of loose 

pills. They weren’t his, nor did they belong to anyone else in our 

family. There were seven different types of pills in the bag, and 119 

pills in all. When the toxicology report came back 3 months later, 

it was consistent with what we found in the bag in his room. Mark 

died from a lethal mix of oxycodone, acetaminophen, morphine and 

stimulants. 

Just to give you a little background of our family, when our sons 

were born, they became the focal point of our lives. Their mom quit 

work and became a stay-at-home mom, and she has been a terrific 

mom. To me, being their dad has been the most rewarding and important part of my life. I was a diaper-changing, bath giving, storyreading, full-service dad. I took them everywhere I went, diaper 

bag and all, and we were together constantly. Throughout the 

school years, our sons never came home to an empty house. 

Mark was quiet and an introvert. He didn’t let many people into 

his life; you had to bring him into yours. When people took the 

time to get to know him they found a wonderful, caring person. 

Never much for words, he had a terrific sense of humor and could 

make you laugh just by his expressions and mannerisms. He loved 

sports, especially basketball, and was an avid weightlifter from the 

time he was 11. In the later stages of his life, Mark was 5-foot-9, 

175 pounds. He could dunk a basketball and bench-press 400 lbs. 

Besides sports, he loved his family, friends, the Outer Banks of 

North Carolina, puppies, Star Wars, playing video games, any Leslie Nielson movie, shopping with his mom, and making fun of his 

dad. 

One thing we will never know is why Mark chose to take these 

pills. We don’t know if he was abusing prescription drugs to get 

high or self-medicate or to self-regulate. We also don’t know if he 

had an addiction problem that went undetected, or if this was just 

an opportunity that presented itself. I know now that abuse of 

medicine can lead to the same dependence and addiction as that 

of illicit drugs. They can also be lethal on the first use, especially 

if mixed with other substances. 

Unfortunately, there are still many people who underestimate 

the dangers of abusing prescription drugs. They believe that abusing these medicines is safer than using illicit drugs yet it is causing 

more deaths in our country than heroin and cocaine combined, and 

filling up our treatment centers. Based on the numbers from the 

CDC, on an average day in the United States, 31 people will die 

from prescription painkillers alone. 

From the motivation and inspiration that I draw from Mark’s life 

and death, I have dedicated myself to do anything possible to raise 

awareness about prescription drug abuse. I have learned so much 

about this issue over the past several years and have had many 

mentors. My journey has included forging partnerships with organizations and agencies which share my passion and commitment to 

combat this issue. I am pleased and grateful to have the opportunity to now serve on the Parent Advisory Board of The Partnership at DrugFree.org and to help promote and support their wonderful tools for parents. 

I have also had many opportunities to speak on this topic at national conferences, to law enforcement, to health care professionals, 

84 

to community groups and parent groups throughout Pennsylvania, 

and to high school students. I plan to continue these efforts as long 

as I am able. Abuse and misuse of prescription drugs is devastating 

too many families, causing crime and other social issues, filling our 

treatment centers, and killing too many of our children. 

There is no way to tell someone what it is like to lose a child. 

You either know what it is like or you don’t, and I truly hope you 

don’t. I am committed to do anything I can to help others avoid the 

devastation that Cookie and I live with every day. Today, I would 

like to offer my assistance to this subcommittee, if there is anything at all that I can do to support or promote your efforts to combat this public health crisis. Thank you. 

[The prepared statement of Mr. Bauer follows:] 

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Mrs. BONO MACK. Thank you very much. 

Ms. Creedon, you are recognized for 5 minutes. 

STATEMENT OF KATHY CREEDON 

Ms. KATHY CREEDON. Thank you. Good morning, everyone. 

Thank you, Chairman Bono Mack. I am so grateful to be here 

today, and I hope that my testimony provides valuable information 

that will help bring awareness about the epidemic of prescription 

drug abuse and diversion we currently face in our Nation. 

My story is about the most severe consequences of abusing prescription drugs. I lost my son Ryan on September 4, 2009, to an 

overdose of OxyContin. He was just 21 years old, and I agreed to 

come here today because I know there are thousands of families 

who are struggling with the pain of this situation just like I am. 

I sit here before you today on behalf of all of us and hope for some 

victory. My daughter Courtney is here with me today available to 

answer any questions after my testimony. 

So I just wanted to say that I fought relentlessly to save Ryan’s 

life, but when addiction is present, it is like spinning your wheels 

to try to keep up with their compulsive behavior. I believe the 

science that says addiction is a disease and it is not a moral failure. 

As my written testimony details, my son was easily able to obtain these medications from doctors. He didn’t get his pills from my 

medicine cabinet. Once I realized he was getting medication 

through prescriptions and not on the streets, I thought I could stop 

it. He was an adult by this time, and HIPAA privacy laws made 

it difficult for me to communicate my concerns about him abusing 

pills to his doctors but that did not stop me. I was able to get my 

foot in the door more than once. However, my concerns were mostly 

ignored and Ryan still continued to receive OxyContin many times 

for something as simple as a backache. In some cases, even when 

doctors stopped prescribing OxyContin, they still prescribed other 

narcotics that a person with a history of drug addiction should 

never have had. 

In the last 13 months of Ryan’s life, I documented seven pages 

of medical records for visits to doctors, urgent care and emergency 

rooms. There were six near-death overdoses that always resulted in 

a 911 call and hospitalizations, once for 8 days in a lockdown facility. It was a life-or-death struggle for Ryan many times, and we 

lived in fear. 

I saw my son’s addiction progress rapidly once he became addicted to OxyContin. I believe that was the result of the aggressive 

off-label marketing practices of Purdue Pharma. He was never a 

candidate to receive such a powerful, addictive narcotic, and I feel 

he might be alive today if he had not discovered OxyContin. He 

made several attempts to get off the powerful opiate OxyContin but 

did not make it longer than 30 to 90 days at a time. 

After my son’s death, I had the opportunity to discuss all the 

careless mistakes made by the HMO that provided his care. I was 

told in that meeting that they were not aware of the dangers of 

OxyContin at the time my son was receiving it. They were told it 

was safer than other pain medications including methadone, morphine and fentanyl. That confirmed everything I had read regardVerDate Aug 31 2005 10:04 Nov 08, 2012 Jkt 037690 PO 00000 Frm 00097 Fmt 6633 Sfmt 6633 F:\112-00~1\112-03~1\112-39~3 WAYNE
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ing lawsuits and Purdue Pharma, and now my family was a victim 

of their misleading practices. 

In general, Kaiser Permanente, which was the HMO in our county, claims it was not aware of the abuse of prescription drugs taking place among our youth. I was quite surprised hearing that because I thought that if I knew, surely they should have known. I 

then realized how important it was to figure out a way to bring 

awareness of the situation to the medical community as well. I believe that this lack of understanding contributed to my son’s death. 

In addition to the fact that they continued prescribing him narcotics after they knew he was an addict, I feel that prescription 

education is so important. Ryan’s addiction to OxyContin resulted 

in a felony conviction for altering a prescription at a pharmacy. He 

was obtaining prescriptions from many sources at the time that 

could have been averted if a prescription monitoring program was 

in place. Some of those drugs ended up on the streets. Ryan basically became a drug dealer to support his addiction to OxyContin. 

It was unbearable to see what was happening to my son, at what 

lengths addiction will take a person to. 

So in closing, I would like to say I will not stop fighting for my 

son in his memory. As a result, I have joined with some mothers 

to create an organization to fight this epidemic. Our goal is to 

make a difference and to try to save lives by bringing awareness 

to as many people as possible. So I appeal to those of you in this 

room today from the bottom of my heart to help me make a difference. 

I thank you all so much for being here, and I would like to request that each of you reach out to other Members of Congress, 

your colleagues, friends and family to spread the word about this 

epidemic, and please be open-minded and learn all you can. Together we can make a difference. Thank you. 

[The prepared statement of Kathy Creedon follows:] 

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Mrs. BONO MACK. Thank you, and Courtney. I appreciate your 

being here to take questions at the end if we have them, but we 

will go to Ms. Rovero for your 5 minutes of questioning. 

STATEMENT OF APRIL ROVERO 

Ms. ROVERO. Chairman Bono Mack and Ranking Member 

Butterfield and members of the subcommittee, thank you so much 

for having me here today. 

On December 18, 2009, just a week before Christmas, my husband and I received the devastating and inconceivable news from 

a Tempe Police Department detective that our youngest son, Joey 

Rovero, had had been found dead by friends in his apartment off 

campus near Arizona State University, where he attended college. 

Over the next few days, as we worked to get his body returned 

home to California, where we live, and funeral arrangements made 

so we could bury him the day after Christmas, a story began to unfold that we were completely stunned by. 

We learned that Joey had been invited by a couple of students 

from ASU that he knew to travel with them on a 6-hour journey 

from Arizona to Rowland Heights, California, on December 9th, 

which was just 9 days earlier than his death, to visit a doctor who 

was well known for freely prescribing narcotic medications. All 

three students walked into this doctor’s office together after the 6- 

hour drive and all they all walked out a short time later with prescriptions in hand. Joey’s prescriptions, the first time she had ever 

seen him and after just a $75 payment to her, cash, and an X-ray 

that showed no problems in hand for him, was prescribed 90 30- 

milligram tablets of Roxicodone, 90 350-milligram tablets of Soma 

and 30 2-milligram tablets of Xanax. He and his friends were directed to a pharmacy that was at least 35 miles away from this 

doctor’s office. They drove there together and all of them had their 

prescriptions filled with absolutely no questions asked. We have 

since learned that both the doctor and the pharmacy had been 

under investigation for at least 2–1/2 years before Joey died. The 

DEA has since revoked her registration. The medical board has 

moved to revoke her license, and that is in process, and criminal 

prosecution is expected for Joey’s death, among several others for 

this doctor. 

Joey had never been previously treated for any of the conditions 

that were cited in his medical record by the doctor as the basis for 

the prescriptions that he received that day, and there was absolutely no indication that she counseled him on how dangerous 

these medications could be if they are misused or abused, especially with alcohol. So again, just 9 days after he saw her, he was 

dead, and that was after partying with friends in a college, a typical college setting, wee into the morning. Joey went to sleep and 

he simply didn’t wake up. 

The coroner’s report indicated that he died from low levels of 

Xanax and moderate levels of Roxicodone mixed with alcohol. His 

level of alcohol was .013. So he didn’t have huge amounts in his 

system. The medical examiner indicated that none of the individual 

ingredients were lethal but all of them in combination were. So it 

was the polymix that was the problem. 

103 

Joey was due home for winter break the day after he died, and 

the Christmas we expected to share with him never happened. Instead, we somehow managed to get through the most awful week 

of our lives. Stunned, shocked and grieving, we picked out a 

gravesite, coffin and clothes for Joey to be buried in. I had to write 

an obituary for a young man who had not had time to develop the 

lifetime achievements that he should have been able to cite. 

Through it all we struggled to understand how this could have 

happened to him, how our perfectly normal family could have been 

dealt such a blow. There are really no words that can adequately 

describe what my husband, Joey’s brother and all of the other 

members of our family have experienced with his death. He was 

my husband’s only biological child, and his brother is now left with 

no sibling. As his mother, I truly feel as though a part of me is 

gone and just ripped away from me forever. Our lives were irrevocably changed the night that he died. 

Joey wasn’t a troubled young man. I want you to know that. He 

was a senior at ASU just 5 months away from graduating. He was 

a gifted athlete and a good student, even making the dean’s list at 

ASU in the fall of 2008. He worked every summer. He made 

money. He spent it wisely. He had a loving and caring relationship 

with all of his family members. He had tons of friends all over the 

country, and over 200 of them appeared at his funeral to support 

us and to honor Joey. His life has affected them also dramatically. 

Unfortunately, tragedy struck once again 9 months to the day 

after my son’s death when one of his two college roommates shot 

and killed himself in front of his girlfriend after a heavy night of 

drinking and prescription drug abuse. This problem has just continued to manifest itself in that college environment. There have 

been six young men that have died over the course of the last year 

at that university alone. 

In addition to that, as we have heard today, in Florida we lost 

seven people a day, and over 32,000 people a year die from adverse 

reactions to medications, so something simply has to be done with 

this epidemic. 

It is extremely important to me that I do whatever I can to make 

a difference. We formed our National Coalition Against Prescription Drug Abuse, and I speak everywhere I possibly can to parents, 

students, educators and community leaders about this problem. 

One thing that I wanted to point out that hasn’t been mentioned 

today. I have a whole list of recommendations, many of them have 

been talked about today. I think the one that I really want to make 

sure is mentioned is that the pharmaceutical industry has been allowed over time to expand its influence over virtually every facet 

of American life using its near-unlimited financial resources to influence the FDA and other governmental agencies, our educational 

research facilities, our legislators, unfortunately, and most alarmingly, our physicians and other medical providers. They are influencing medical research, drug trials and are compensating doctors 

to prescribe medications they want to become their next blockbuster drug. The spider web of influence needs to be dismantled. 

Thank you very much for having me here today. 

[The prepared statement of Ms. Rovero follows:] 

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Mrs. BONO MACK. Thank you, Ms. Rovero. 

Mr. Harrison, you are recognized for the 5 minutes, and please 

do try to keep an eye on that red light for me. 

STATEMENT OF DAN HARRISON 

Mr. HARRISON. Thank you, Chairwoman Bono Mack, Ranking 

Member Butterfield and distinguished members of Commerce, 

Manufacturing and Trade Subcommittee for giving me this opportunity to speak before you today. I am very honored to be here. 

My name is Dan Harrison. I am a tribal member of the 

Muskogee Creek Nation of Oklahoma. I currently reside in Palm 

Springs, California, for the past 20 years. I worked as a structural 

ironworker and achieved apprenticeship status. In September of 

1995, I took a fall on a construction site. My fall not only resulted 

in a severe back injury but led to a life of addiction. 

After injuring my back, I went on disability for a couple of 

months, then finally went to an orthopedic surgeon, and I was told 

that I would need to have surgery which could result in never 

achieving 100 percent mobility. I chose not to have the surgery and 

developed my own solution of physical therapy and pain medication. After 90 days, I stopped going to physical therapy and started 

drinking to intensify the effects of the pain medication. 

As the days went on, my drinking and opiate use increased and 

my life started spiraling out of control. During this time, my wife 

and I separated, and I shared custody of our two daughters. In 

1999, I remarried and soon after my third child was born. This all 

occurred while I had severe dependence on opiates and alcohol. The 

drugs are what got me through the day. I never had to go back to 

the doctor’s office after my initial injury. I developed such a strong 

relationship with the doctor that I needed only to call and they 

would refill my prescription with no questions asked. I would go 

into local emergency rooms where the doctor would see me and 

wave me back for regular pain injections. I rarely had to resort to 

the streets for my medications. Depending on what type of narcotic 

I wanted and the method of administering it resulted in which doctor I would call. 

In October of 2008, I decided I wanted to fight for full custody 

of my daughters. I felt that the mother was not caring for them the 

way I felt they should be cared for. I decided to call Child Protective Services. After the investigation, they were removed from the 

mother’s care. When the caseworker showed up unannounced at 

my home, I had several cabinets full of prescription medication. 

When I was confronted, I admitted to the recent use of OxyContin, 

Vicodin, morphine, Lortab, Demerol, Dilaudid and marijuana. 

After hearing myself admit to the amount of drugs in my system 

and seeing the caseworker’s response, I knew it was time to make 

a change. The only way I would ever get custody of my daughters 

was to get help. I entered the Family Preservation Court, otherwise 

known as Family Dependency Treatment Court. The Family Preservation Court applies the drug court model to child welfare cases 

that involve an allegation of child abuse or neglect related to substance abuse. The Family Preservation Court seeks to do what is 

in the best interest of the family by providing a safe and secure environment for the child while intensively intervening in the treatVerDate Aug 31 2005 10:04 Nov 08, 2012 Jkt 037690 PO 00000 Frm 00117 Fmt 6633 Sfmt 6633 F:\112-00~1\112-03~1\112-39~3 WAYNE
112 

ment of the parents’ substance abuse and other comorbidity issues. 

This approach also results in better collaboration between agencies 

and better compliance with treatment and other family court orders necessary to improve child protective case outcomes. 

Since graduating from the program, I have learned that there 

are 2,500 drug courts including over 300 family dependency treatment courts in the United States. I am humbled to know that now 

over 120,000 addicted people a year have the opportunity for treatment and restoration in these courts, and I hope that somebody 

they are available to everyone who needs them. These courts have 

been proven to cut up to 40 percent of the crime rate and produce 

up to $27 for every dollar invested. 

When I first entered the Family Preservation Court, I had not 

accepted my problem. I was a little uneasy with myself or calling 

the CPS since the investigation turned on me. However, after my 

intake and sharing my history with the family preservation counselor, I realized how bad things had gotten. Through the Family 

Preservation Court, upon counseling and obtained guidance in educating my daughters about the addiction, I participated in parenting courses that taught me to effectively communicate with my 

children, how to create healthy boundaries. I was given support by 

my counselors and peers throughout my struggles with the reunification process. 

In 2010, I graduated from the Family Preservation Court. Today 

I am thankful that I called the CPS. Without their intervention, I 

would not be here today. Family Preservation Court has helped me 

realize I needed to get help for myself as well as my family. As a 

result of completing the program and completing other parenting 

courses, I have vowed to work diligently with the program and CPS 

side by side to work to do some outreach work for the ones that 

are still suffering from prescription drug use in the local community as well as the tribal community in southern California. 

I thank you for allowing me to come here and share just a little 

bit of my story. I realize today that I am a miracle that sits here 

because of my addiction and going through the process of my recovery, I realized how serious this epidemic is today. 

So thank you for inviting me here today to share my story. I am 

very humbled by that. Thank you very much. 

[The prepared statement of Mr. Harrison follows:] 

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Mrs. BONO MACK. Thank you, Mr. Harrison. 

Dr. Boyd, you are recognized. 

STATEMENT OF CAROL BOYD 

Ms. BOYD. Thank you. Thank you for inviting me today. My comments draw on my research that is primarily funded by the NIH, 

among other sources. I have been studying this for the past 10 

years. 

You have heard today that over the past 15 years, prescriptions 

for controlled medications have nearly doubled for adolescents and 

young adults, and these come from office visits, from ER visits and, 

significantly in this age group, from oral surgeons. And once the 

youth have the pills in their hand, they are at risk for diverting 

them. Approximately 10 percent of adolescents in a given year have 

diverted their pain medicine. Fifteen percent have diverted their 

stimulant medications. And like other researchers, we find that 

girls are more likely to divert by loaning and giving and boys are 

more likely to divert by selling. There are also socioeconomic differences among these adolescents. 

Approximately 10 percent of all youth will divert their pills to 

their parents. Overall, one in six adolescents with legal prescriptions will be approached in a given year to divert their medicines, 

and in some cases, they will be asked to rent them. It is usually 

stimulants in this age group that are being diverted but not exclusively. We have found that the more elite the school and the more 

elite the university, the more likely diversion is to occur, and again, 

it is often stimulants. This is not to say that opiates are not the 

problem either, though. 

Motives to divert as well as to use diverted medications are wide 

ranging, and it should not be assumed that the motives always involve getting high. Indeed, motives are one of the reasons that this 

problem is so difficult to prevent. So I would like to share with 

three cases from our own studies, and they highlight what we 

found in our research. 

The first one is a 16-year-old teen. She is an honor student. She 

was going to homecoming. She had a new boyfriend. Four hours before the event, she got a migraine headache, and she went to her 

mother and her mother gave her one of her own hydrocodone tablets that she had leftover from her hysterectomy. The teen took it, 

went to the event. When I interviewed her, she had had a great 

time and she did not use hydrocodone again. 

The second case, a 15-year-old boy attends an elite high school 

and he is having trouble getting his work done. His best friend has 

a prescription for Adderall and keeps it on the dresser in the 

house. And when his friend leaves the house, his friend takes the 

Adderall. When I talked to this young man, he said well, you know, 

everyone in my school is using it, everyone uses it to study. 

And then in the third case, this is a high school girl. She did 

have a history of alcohol abuse. She was given an oxycodone tablet 

from her girlfriend, who had also gotten it for oral surgery. She 

wanted to experiment to see what it does. Now, this is a girl that 

also was abusing alcohol. She crushed and snorted the pill and she 

found herself continuing to use what she called Oxy when she 

wanted to party with her friend. 

120 

Now, these cases represent what we have found in our research. 

First, diversion in this age group usually occurs among family and 

friends. Two, there are gender differences. Three, it usually involves one primary prescription and it is often from oral surgeons 

and dentists. Four, the diverted medicine is often started for the 

purpose of self-treatment so that you see youth thinking that they 

are going to use it for a headache or that they are going to study 

harder but then once they start using it, they have it available to 

them. And finally, the controlled medications are readily available. 

They are advertised on television. We do advertise controlled medications on television with direct-to-consumer marketing. And they 

are not stored properly nor are they disposed of, and I hear this 

time and again from youth. 

The adolescent girl that was in my case three is the one that is 

at the absolute highest risk. She is a poly-drug user and she is 

using for recreational purposes. It is these sensation-seeking youth 

that our data find have the biggest problems and are at the greatest risk for drug addiction and death. 

Most social scientists end their talk by saying we need more 

data, and I am going to tell you that as well. It is difficult to understand why a country such as ours has data from 2006. We need regional data. We need national data that has more nuance, that 

tells us the complexity of the problem. 

But policymakers can also do something. The FDA has recently 

stipulated that medicine bottles need to carry the schedule on 

them. I called my son, who has a prescription for Adderall, before 

I came here today and I said did you pick up your prescription bottle, and he said yes, and I said, well, what about the labeling, did 

it look different. No, he said, it doesn’t look any different. I said 

come on, Joseph, look, see if it looks different; oh, yes, maybe. This 

isn’t enough. I have a prescription that tells me on the back not 

to use it with grapefruit juice. These prescription bottles need to 

be clearly labeled that it is unlawful to share the medication, that 

they need to be stored correctly, and how they need to be disposed 

of. 

The solution to this problem lies in the recognition that it is far 

more complex than actually street drug use, and it is going to require cooperation with pharmaceutical companies, health care providers, families, young people and policymakers. Thank you. 

[The prepared statement of Ms. Boyd follows:] 

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Mrs. BONO MACK. Thank you. 

Dr. Arria. 

STATEMENT OF AMELIA ARRIA 

Ms. ARRIA. Chairman Bono Mack, Ranking Member Butterfield, 

members of the subcommittee, thank you for this opportunity to 

testify on the problem as it manifest among our Nation’s youth. I 

come at this issue as a researcher at the University of Maryland 

and the Treatment Research Institute in Philadelphia, but I am a 

mom too. 

Since 2003, with my dedicated staff, I have led the College Life 

Study, a NIDA-funded study of more than 1,200 college students. 

Consider our findings regarding non-medical use. By the fourth 

year of college, 13 percent used a tranquilizer, 23 percent an analgesic and 30 percent a stimulant without a prescription. We 

found that more than one-third with prescriptions shared or sold 

their medications, usually to a friend. Most commonly diverted are 

stimulants such as Adderall with a 62 percent diversion rate. And 

individuals who divert prescription drugs are typically non-medical 

users themselves. 

Let me sharpen the focus on this particular aspect of the problems, stimulants. They are widely available and attractive to students with high task demands, especially those experiencing academic difficulties. There is a popular assumption that taking stimulants non-medically confers an academic edge and is therefore 

beneficial. Headlines referencing smart drugs perpetuate the notion 

that non-medical prescription stimulant use increases academic 

performance. Scientific evidence tells us quite the opposite. It is not 

the academically successful students who use them but the unsuccessful ones. We know that non-medical users compared to nonusers are more likely to be dependent on alcohol and/or marijuana, 

skip class more frequently and spend less time studying, and 

digging even deeper, we see that these academic problems are related to heavy drinking and marijuana use. What the research 

shows is that non-medical prescription stimulant use is an unsuccessful shortcut, an attempt to compensate for declining academic 

performance and is a red flag for an underlying alcohol or drug 

problem. 

What can policymakers do about prescription drug abuse? The 

single best thing is to tighten the chain of custody that ultimately 

governs supply. For example, put in place better prescription monitoring programs, reform physician dosing practices and create timely surveillance databases. National data are often old and Statelevel data are not even available to researchers. 

The prescription drug problem has complicated the landscape of 

existing drug threats. It does not occur in isolation. Individuals 

who use prescription drugs non-medically are very likely to be 

heavy drinkers and/or illicit drug users. Therefore, in addition to 

deal with this devastating symptom, we must redouble our efforts 

to develop innovative solutions to the root issue, that is, the larger 

public health problem of drug use and addiction in the United 

States. 

What specific strategies should be proposed? Today is recommend 

two things regarding prevention and intervention. One, modernize 

159 

the Nation’s infrastructure for early detection. We can identify 

those who are at highest risk for drug problems, just like knowing 

who is at risk for other chronic health conditions, with an approach 

that involves standardized assessments, early intervention and promotes teamwork between parents, physicians and educators. We 

can put these young people back on track to fulfill their potential. 

To this end, NIH research has yielded valuable information about 

risk and resiliency, the interplay between genetics and the environment and the natural history and course of addiction. Effective solutions to this enormous public health threat will require continued 

funding for NIH research. 

Number two: connect the dots between drug use and academic 

problems. This link cannot be ignored any longer. Making this connection loud and clear will get the attention of parents who want 

more than anything else to see their child succeed. Tacit approval 

by parents and students of underage drinking as normative and 

college as a 5-year party, especially when there are stimulants 

drugs as a last resort, is completely misguided by regrettably an 

all too common notion. Similarly, we must engage the leaders of 

our education system who are concerned about the high school 

dropout crisis and less than optimal college graduation rates. They 

must recognize the very real and contributory role of drug use to 

poor academic achievement. Sustaining our economy and navigating future challenges will require a clear mind and a sharp 

focus, which is inconsistent with underage drinking, excessive 

drinking, illicit and non-medical prescription drug use. 

Again, thank you for shedding light on this continuing public 

health problem and allowing me to contribute to the discussion on 

solutions. 

[The prepared statement of Ms. Arria follows:] 

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Mrs. BONO MACK. Thank you. I thank you all the panelists very 

much. Certainly the parents who are hurting, I thank you for your 

advocacy and your passion turned towards helping others. 

Dr. Boyd, the statistics I am looking at completely dispute what 

you are saying. As I look at the Drug Abuse Warning Network statistics as published by SAMHSA, you said that stimulants are the 

problem and you also say that opiate addiction has doubled. Did I 

not hear that correctly? 

Ms. BOYD. No, that prescriptions for controlled medications for 

young adults and adolescents—I think this is what you are referring to—has nearly doubled since 2007. 

Mrs. BONO MACK. Now, this is not specific to adolescents, but 

when I look at these numbers for the increase of emergency department visits, now, old data, but from 2004 to 2009 stimulants all together, again not specific to adolescents but I would think the 

trend would be similar, 20,490 admitted to ERs in the year 2004. 

That increased to 25,889 by 2009, a 5,000-person increase over 

those years, while oxycodone and combinations thereof, 41,701 in 

2004. One would think that the crisis is similar, that that would 

double, but in fact it actually increased to 148,449. So you spent 

the bulk of your time talking about stimulants but I am not aware 

particularly, and I am sorry I don’t have the data here, but would 

you say that the trend line for stimulants and fatalities for stimulants is similar to opiates and OxyContin? 

Ms. BOYD. No, I wouldn’t, and actually I did not intend to give 

the impression that I was mostly talking about stimulants actually. 

When I was speaking of the controlled medications, I was speaking 

of the four schedules and that for instance, 10 percent in our sample had diverted their pain medication where 15 percent had diverted stimulants. 

Mrs. BONO MACK. Let me jump to Ms. Creedon here and even 

to Mr. Harrison, and thank God that you are here as a recovering 

addict. I am so proud of your courage. Thank you for being here. 

And to Kathy Creedon, this is the scientific community and you 

guys have lived it in the real world. Is this just diversion from the 

simple places they see? Ms. Creedon, in your testimony, I wish you 

had gone on a little bit more. You talk a great deal, and you mentioned you have seven pages of documentation that show the runaround and what they call the smurfing, the great lengths your son 

went to that had nothing to do with your medicine cabinet. Would 

you be willing to submit your seven pages and 72 entries of medical 

history? Would you be able to submit those things for the Congressional record so we can take a look at all of that? But are you hearing on the real street side of what is really happening out there in 

California and the homes? Is it paralleling what the scientists are 

saying here? 

Ms. KATHY CREEDON. That the drugs are coming from parents’ 

medicine cabinets? Is that the question? 

Mrs. BONO MACK. Perhaps I just—I am a little on edge. It almost 

seems that you act as if the 16-year-old honor student was given 

hydrocodone, Dr. Boyd, and the teen went to the event, she had a 

great time but she never used hydrocodone again. So it seems to 

downplay, and you are acting as if the diversion is, well, Mom gave 

it to a 16-year-old, she had a great time at a party, and I just take 

168 

issue with that because this is a mother who never, ever dreamt 

of doing such a thing. 

Ms. BOYD. Absolutely, but speaking as a social scientist, this is 

also happening so that when we look at the data on diversion, we 

see all kinds of diversion and we see that also parents are role 

modeling, share medications that are controlled. The mother 

shouldn’t have had extra hydrocodone. 

Mrs. BONO MACK. OK, but Ms. Creedon, you had no 

hydrocodone, you had no oxycodone. Can you speak a little bit 

about the great lengths your son went to that had nothing to do 

with this? You are like Ms. Rovero and Mr. Bauer, a loving parent 

doing your best to raise a teenager, or young Ms. Creedon. 

Ms. COURTNEY CREEDON. If I can speak to this, I mean, I think 

the reputation certainly is out there, and we have heard a lot of 

that today that I guess there were some statistics floating around 

that most people get these drugs from their parents’ medicine cabinets, but in our case, that did not happen. We never had any of 

these drugs in our house. My mother never condoned using drugs. 

I mean, when we do submit these records, I mean, Ryan went out 

of his way to visit every doctor imaginable and finagle every aspect 

of the system to make this work, and surprisingly, it wasn’t that 

difficult. So it is kind of hard for us to sit here and hear people 

talk about I guess parent responsibility when really I think the bigger issue is responsibility or rather irresponsibility of the medical 

community in that none of these drugs came from our home. All 

of these drugs that Ryan used and the drugs he died from were obtained legally from licensed physicians. 

Mrs. BONO MACK. Thank you. I have to yield now to the ranking 

member, Mr. Butterfield, but we will have a second and third 

round of questioning. So Mr. Butterfield is recognized. 

Mr. BUTTERFIELD. Let me thank the chairman for convening this 

very important hearing today. Those of us on this side of the aisle 

are also acutely aware of the pervasive problem that we have with 

prescription drug abuse, and so the hearing today is very timely 

and I want to thank the witnesses for their testimony. 

In my prior life, I was a trial judge in North Carolina. I did that 

for 15 years, and so I have seen and heard heart-wrenching stories 

for many years over my career, and I want to extend my personal 

condolences and concern to those families who have been directly 

affected. 

I want to just ask one or two questions. I won’t belabor this unnecessarily but let me start this way. Prescription drug abusers do 

so for a variety of reasons, and I think we recognize that today. 

There are many reasons that contribute to this problem. Some people use them recreationally, some seeking their euphoric, relaxing 

or energizing effects. Other people with or without a prescription 

use them inappropriately seeking to alleviate minor pain and treat 

a perceived illness or even to manage stress. Still other people use 

prescription drugs for their intended purpose but obtain them without a prescription. 

To Dr. Arria and Dr. Boyd, do we have data in percentage terms 

which demonstrate either for the population as a whole or for high 

school- or college-age individuals why prescription drugs are being 

169 

used? In other words, for what reasons by percentage do young people decide to take prescription drugs without a prescription? 

Ms. ARRIA. The percentages vary by class of prescription drugs, 

so for stimulants, I would say about three-quarters of people who 

use stimulants take them to increase concentration, to study and 

the scenario sort of plays itself out that I explained where they are 

having academic difficulties. Only a small percentage of them will 

crush stimulants to get high. On the analgesic side, many, many 

more, a higher percentage, probably about 80 percent, will use 

them to get high and a very small minority will use them because 

of curiosity reasons or for other reasons. And for the tranquilizers, 

we see a lot of self-medication going on where there might be an 

underlying mental health issue. So it varies by class, and that is 

for the college age-population, young adult populations. We do not 

have that level of data at the national level. The national survey 

on drug use and health does not collect that level of information 

for us. 

Ms. BOYD. And I studied 12- to 17-year-olds so it is a younger 

group, and they are less likely to use any drugs, the 12-year-olds 

and 13-year-olds, so you see some differences. We also see differences by drug class, and they mimic much of what Dr. Aria said 

with the exception being the opioids where disproportionately the 

younger the child with the opioid, the more likely they say they are 

treating pain. Once they get older so that now they are into 11th 

and 12th grade, now when they are using diverted opioid medications, they are using it to experiment, to get high, to help them 

sleep, but that may be because they are using stimulants or they 

are drinking or partying, but so it would be for sensation-seeking 

or recreational reasons. 

Mr. BUTTERFIELD. Can we quantify what percentage of users 

snort as opposed to crushing the medication? What percentage are 

snorting it? Do we know? 

Ms. BOYD. Of 12- to 17-year-olds? 

Mr. BUTTERFIELD. Well, your age group, yes. 

Ms. BOYD. Relatively few are snorting it, and it depends by 

grade. Twelve-year-olds and 13-year-olds are not snorting it. We 

see about 5 to 10 percent snorting it by the time they get into high 

school. 

Mr. BUTTERFIELD. What about combining it with alcohol? 

Ms. BOYD. They all combine it with alcohol. 

Mr. BUTTERFIELD. That is a common—— 

Ms. BOYD. Absolutely. Our data show that any youth that is 

using the opioid products to get high or to sensation seek or for recreational purposes are using other drugs as well, and they are also 

using other prescription medications. 

Mr. BUTTERFIELD. Would that be the same in the older age 

groups as well, Dr. Arria? 

Ms. ARRIA. What we find is that there is always a history of excessive drinking or a history of marijuana involvement, and in 

some cases they are using it at the same time concurrently during 

the same session. For instance, in our data, 88 percent of the nonmedical prescription drug users had a history of marijuana use in 

the past year. 

170 

Mr. BUTTERFIELD. So there are similarities between the 12 to 17 

and the 18 and above? 

Ms. BOYD. There are, and particularly when you get to 16-, 17- 

and 18-year-olds. The younger ones, which I am also studying, who 

are in middle school, they do look different. 

Mr. BUTTERFIELD. Well, let me thank you and thank all of you 

for your testimony. I yield back. 

Mrs. BONO MACK. Thank you, and I do ask unanimous consent 

that the information that I requested from Ms. Creedon be allowed 

to be included in the record. No objection? OK. So ordered. 

Mrs. BONO MACK. Dr. Arria, you keep mentioning the history, 

the history, the history of use. It is my belief as a mother who just 

got through high school that the powerful nature of these painkillers that our kids do not have a chance. Can you speak to the 

adolescent brain, specifically what does happen when they get that 

tablet of OxyContin? Can you speak also to a pharm party and explain what that is? 

Ms. ARRIA. Sure. I think it is very true that the addictive potential of opioid analgesics trump what we are talking about when we 

see marijuana, other drugs. So what really appears to be the issue 

is that because it is more typical for alcohol and marijuana to be 

used at younger ages, there are some people who are more predisposed to using substances. We know that. And the adolescent 

brain is more set up to take risks naturally, and so that combination of being an adolescent and having a propensity for addiction 

sets up a course where you get involved with alcohol and marijuana and then it exposes you to drug-using peers. Like I said, you 

begin to lose interest in other things, you get involved in prescription drugs and then you get a very, very highly addictive substance 

and that is what you are talking about when they don’t stand a 

chance. So if they have a propensity for addiction plus they are in 

this age of adolescence—— 

Mrs. BONO MACK. I have no Ph.D., but I beg to differ that if they 

have a predisposition to addiction, because I believe that every 

human being—— 

Ms. ARRIA. I stand corrected. 

Mrs. BONO MACK [continuing]. Has the potential to be addicted. 

Ms. ARRIA. One hundred percent of people have some propensity 

for addiction. 

Mrs. BONO MACK. I am sorry. Can you repeat that? 

Ms. ARRIA. One hundred percent of people are at risk for addiction if they are exposed to addictive substances. 

Mrs. BONO MACK. And then an adolescent then? 

Ms. ARRIA. An adolescent would be even more so because of their 

risk-taking behaviors. 

Mrs. BONO MACK. But risk-taking, a white pill to them is a lot 

less risky than meth? 

Ms. ARRIA. Well, what we find is that in terms of, we have done 

studies on perceived risk and the risk of medications falls in between marijuana and cocaine, so they don’t see it as less risky than 

marijuana. They see taking prescription drugs medically or nonmedically as more risky than marijuana but less risky than cocaine, so that is where it falls. 

171 

Mrs. BONO MACK. Briefly, let me just lead you to the answer that 

I want to hear on another question, pharm parties. It is my understanding, is it not true, that kids now go to parties, throw bunches 

of pills into a bowl and grab whatever they can and swallow it to 

be risky? 

Ms. ARRIA. We have heard of that happening. We are not sure 

how often it happens. What we do know is that the variety of drugs 

used is much—there is much more variety of different drugs used 

on the same occasion than there were years ago. That is what we 

know now. 

Mrs. BONO MACK. Thank you. 

Mr. Harrison, how helpful now is the medical community? If you 

walk into a pharmacy, do you have the ability to tell your pharmacist I am a recovering addict, please don’t prescribe my drug of 

choice to me or help me if I do? Do you have that ability? Are they 

helpful to you now? 

Mr. HARRISON. I went through a process of a second back surgery 

with a 12-month sobriety, and it was difficult for me to have them 

administer more intravenous drugs to me because I was going 

through recovery, but I haven’t yet attempted to gain any access 

since my recovery, so I haven’t attempted to talk to any doctors 

that I have dealt with in the past. Them knowing the severity of 

my injury, in the past, like I said, I had built a relationship with 

them and I see them from time to time in the community, and so 

access was real easy. But since my recovery, 30 months in recovery, 

and I haven’t yet attempted to go back. 

Mrs. BONO MACK. Well, congratulations on your 30 months. 

Mr. Bauer, are you finding a good avenue for your advocacy and 

making a difference out there? 

Mr. BAUER. Yes. 

Mrs. BONO MACK. Good answer. Nice, short and sweet. OK. I will 

yield to Mr. Butterfield for the next 5 minutes. 

Mr. BUTTERFIELD. Thank you very much, Madam Chairman. 

During one of the earlier panels—and I apologize for not being 

here. I forewarned the chairman that I had another commitment 

this morning and I could not resolve. But during one of the panels 

this morning, a lot of time was devoted to discussing monitoring 

programs. I believe databases are an important tool that should be 

in our toolbox, but we need to treat the non-medical use of prescription drugs with many different tools, with multiple tools and 

treat it as a public health issue, not just a law enforcement issue. 

For example, we need better education of patients and parents and 

friends and doctors and dentists and every person in society. 

Dr. Boyd, in your testimony you mentioned better labeling as one 

of those tools. Can you describe what you would envision to be on 

a label and would this be on all prescription drugs or just those 

that are the most risky if diverted? 

Ms. BOYD. Well, I am also a nurse and I would like to see better 

labeling on all medications, but let me direct my attention to the 

controlled medications that are more likely to be diverted and 

abused. I would recommend that we label them that it is unlawful 

to distribute them. Many, many of the kids that I interview do not 

know, and parents do not know, that mother of the girl going to 

homecoming, she didn’t know she was doing something illegal. 

172 

They should know it. It should be labeled on the bottom. There 

should also be directions on how to dispose of extra medicine that 

is left in the bottle so it is not sitting in the medicine cabinet. And 

finally, not only should they know where to dispose of it and that 

it is unlawful to distribute it but they should also know that it has 

addictive potential and abuse potential. Many medications I have 

gotten have been labeled more fully than the medications that are 

controlled. 

Mr. BUTTERFIELD. All right. Let me come to the other end of the 

table. Ms. Creedon, aside from labeling—and I like Dr. Boyd’s assessment of this—but aside from labeling, what can we do to increase public awareness of prescription drug abuse? We have got 

to become more proactive so other families do not have the tragedy 

that you have experienced. What can we do? 

Ms. KATHY CREEDON. You know, that is a really good question. 

I don’t know the answer yet but I intend to hopefully be able to 

make a difference by this organization that I have started and our 

goal is to reach out, first of all, to students in high schools, middle 

school, college age, the parents, and I really would like to reach out 

to the medical community as well because that was a specific problem in my son’s, well, that led up to his death. In these seven 

pages, I document it, if I could just take a minute, in the beginning 

where my daughter and I had a face-to-face meeting with the director of the medical facility where we said to him, Ryan has an addiction problem, and like I said, because of privacy laws, we were not 

able to speak about certain things, you know, because of breaking 

laws. But he did tell me that he would go and speak to the physician that Ryan had an appointment with 2 days later. That conversation apparently never took place, and I just feel that if he 

would have taken our conversation seriously coming from a family 

member of Ryan’s history of drug abuse, that could have stopped 

the other six pages of his hospitalizations and everything else that 

went on. So for me particularly, I feel that the medical community 

doesn’t take addiction seriously because maybe they are just not 

aware, you know, of what a few pills can do to somebody. In my 

son’s case, it led to his death. 

Mr. BUTTERFIELD. What about public service announcements on 

TV channels that are watched by young people? 

Ms. KATHY CREEDON. That is one of the things that we hope to 

be able to do. 

Mr. BUTTERFIELD. MTV and BET and some of the other channels. 

Ms. KATHY CREEDON. Absolutely. There are some things already 

being done directly to young people on the Web sites and things 

that they listen to about the dangers of prescription drug abuse. 

Mr. BUTTERFIELD. We need to do it and we need to do it repetitively. 

Ms. KATHY CREEDON. Exactly. 

Mr. BUTTERFIELD. One thing we have learned in Congress, if you 

say something over and over and over again, people will listen and 

sometimes believe it. 

Ms. KATHY CREEDON. And that is what I read in all the educator 

material that I have been researching lately is that it does have 

to be repetitive and so it would almost mean being present on a 

173 

high school property on a weekly basis just over and over telling 

them the dangers of the drugs before they go to a party on Friday 

night. 

Mr. BUTTERFIELD. Thank you. Thank you again. I yield back. 

Mrs. BONO MACK. All right. Thank you. We will do 5 more minutes and then we will conclude the panel and move on to the next, 

unless you would like another five, I am certainly fine with it. 

Mr. BUTTERFIELD. We are going to have votes in about an hour. 

Mrs. BONO MACK. Dr. Boyd, back to you. Labeling—my understanding through the years of my research on OxyContin that actually the label is what turned kids on to the ability for the misuse. 

I think that labeling is not going to be the answer. I don’t know 

how old your son is, but I believe that it goes back to me to the 

DEA and the FDA and the supply chain and figuring out how this 

stuff is getting out there and why we are taking back hundreds of 

pounds of this stuff, whatever the astronomical number is. It has 

got to be beyond labeling. 

Let me just jump to Ms. Creedon again. Again, your testimony 

is terrific, but you spoke about the medical community, your frustrations with them, but since Ryan’s death you have worked with 

the medical community and the doctors overseeing the HMO, and 

it is my understanding that they did learn a lot from you and that 

they have agreed to change their prescribing practice for such powerful painkillers. Is that true, and have you followed up on that, 

that you are able to actually educate in your community, your 

HMO, and get a change? 

Ms. KATHY CREEDON. Yes, that is true, and I was very happy 

that they were receptive to hearing the information. I printed out 

a lot of information from the Internet and shared it with them, and 

in fact, the medical director told me that he took the information 

that I gave him and presented it in front of a staff meeting that 

they had, and they in fact after my meeting made a policy within 

their organization that covers approximately 3,000 physicians and 

over 300,000 members that those physicians could no longer prescribe OxyContin for the patients unless they had fourth-stage cancer and they had tried everything else. So I feel that was a huge 

victory that the education that I gave them made that change, and 

I haven’t been able to follow up with the outcome. I intend to do 

that, but I don’t know right now if that is still happening. 

Mrs. BONO MACK. I congratulate you on that, and it goes to Ms. 

Rovero, in your testimony you say the same thing. You say that 

your son had never been treated for any of the conditions listed on 

the doctor’s record as the basis for her prescription for the powerful 

painkillers. Were you surprised by how easy it was for him to get 

access to those medications? 

Ms. ROVERO. Not only surprised, I was shocked. I had never 

heard the term ‘‘pill mill.’’ I had not heard about dirty doctors. This 

last year has been a complete education for me. Shocked, absolutely shocked, and I have learned that that is the case throughout 

the country. I talk now to parents all over the place, California to 

Florida, and it is happening. There are so many unscrupulous doctors out there that are giving it out, they are in a pill mill kind 

of environment, but it is not just those doctors, it is also those that 

are really well meaning but they are not really well educated about 

174 

pain management treatment. I have been told, I don’t know if it 

is true for sure, but I have been told that doctors get less pain 

management training than veterinarians do, and that is horrifying 

to think about, but if it is true, my gosh. 

Mrs. BONO MACK. Would you agree with that statement, Dr. 

Boyd, Dr. Arria? Do you know about the level of training that physicians do get before they can prescribe these things? 

Ms. ARRIA. I know it has gotten better but I know that I can 

speak to the addiction medicine side. They really are not given 

proper training at the graduate medical education level on addictive disease. 

Mrs. BONO MACK. Dr. Boyd? 

Ms. BOYD. I agree with that. It is just inadequate. 

Mrs. BONO MACK. Thank you. And I will just use my last minute. 

I think we agree with Ms. Creedon, Ms. Rovero, on trying to limit 

the scope on when it is prescribed. I think that is something we 

can push for in Washington. But I really just want to thank you 

all very much for your commitment, your advocacy to this, and I 

don’t know where it is going to go. I am frustrated last night in 

my research to see that there was a Senate hearing in 2002 that 

is very much like the one we are holding today. I think that is frustrating, and I think we are failing. It is a tough time for budget 

cuts and we all have questions on how we spend our money, but 

we can do a better job and I think the American people want an 

effective government, and in this case, it is not being effective. 

So I look forward to working with each and every one of you, and 

if you had another five, I am willing to yield to the gentleman. If 

not, we will take a quick recess and seat the next panel. Thank you 

very much. 

[Recess.] 

Mrs. BONO MACK. First up will be Sean Clarkin, Executive Vice 

President of Partnership for a Drug-Free America. Also joining us 

is General Arthur Dean, Chairman and CEO of the Community 

Anti-Drug Coalitions of America. Then we will have Dr. Coster, 

Senior Vice President of the Generic Pharmaceutical Association. 

Our fourth panelist is Kendra Martello, Assistant General Counsel, 

Pharmaceutical Research and Manufacturers of America. Also testifying, Michael Mayer, President of Frank Mayer and Associates. 

And our sixth witness is Patrick Coyne, Registered Nurse, testifying on behalf of the Oncology Nursing Society. 

Welcome, everyone. Thank you much for being here today. I 

think you know the drill, 5 minutes, green, yellow, red. In America, 

we generally know what that means. So just please make sure you 

press the microphone to turn it on, and Mr. Clarkin, you are recognized for 5 minutes. 

175 

STATEMENTS OF SEAN CLARKIN, EXECUTIVE VICE PRESIDENT AND DIRECTOR OF STRATEGY, THE PARTNERSHIP AT 

DRUGFREE.ORG; ARTHUR T. DEAN, CHAIRMAN AND CEO, 

COMMUNITY ANTI–DRUG COALITIONS OF AMERICA; JOHN M. 

COSTER, PH.D., R.PH., SENIOR VICE PRESIDENT, GOVERNMENT AFFAIRS, GENERIC PHARMACEUTICAL ASSOCIATION; 

KENDRA MARTELLO, ASSISTANT GENERAL COUNSEL, PHARMACEUTICAL RESEARCH AND MANUFACTURERS OF AMERICA; MICHAEL MAYER, PRESIDENT, MEDRETURN, LLC; AND 

PATRICK COYNE, R.N., M.S.N., CLINICAL DIRECTOR, THOMAS 

PALLIATIVE CARE UNIT, VIRGINIA COMMONWEALTH UNIVERSITY MEDICAL CENTER, ON BEHALF OF THE ONCOLOGY 

NURSING SOCIETY 

STATEMENT OF SEAN CLARKIN 

Mr. CLARKIN. Good morning, Chairman Bono Mack, Ranking 

Member Butterfield, members of the subcommittee, thank you for 

inviting me to testify about the problem of prescription drug abuse 

and the diversion of prescription medicine. 

The abuse of prescription medications, legal substances of tremendous benefit if used appropriately, is the single most troubling 

phenomenon on today’s drug landscape. According to the 2010 

Partnership Attitude Tracking Study, the PATS study, one in four, 

25 percent of teens, report taking a prescription drug not prescribed for them by a doctor at least once in their lives and more 

than one in five teens, 23 percent, has used a prescription pain reliever not prescribed for them by a doctor. 

Why have we as a Nation not been able to reduce this highly 

risky behavior? There are several reasons, many of which we have 

already heard today. The first is ready access. These substances 

are readily available to teens in their own medicine cabinets and 

the medicine cabinets of friends and family, and very often they are 

available for free. Nearly half, 47 percent, of teens in our PATS 

survey say that it is easy to get these drugs from parents’ medicine 

cabinets, and more than a third say it is available everywhere. 

Another reason is low perception of risk, the low perception of 

risk that is associated with abusing prescription drugs. Partnership 

research shows that less half of teens see great risk in trying prescription pain relievers such as Vicodin or OxyContin that a doctor 

did not prescribe for them. Low perception of risk coupled with 

easy availability is a recipe for an ongoing problem. 

The third reason that we have heard a lot about, especially from 

Dr. Boyd, is the motivation to abuse. We have traditionally thought 

of teens abusing illegal drugs and alcohol either to party or to selfmedication for some serious problem or disorder, adolescent depression, for example. But our research, like Dr. Boyd’s, shows that 

teens appear to be abusing these drugs in a utilitarian way, using 

stimulants to help them cram for a test or to lose weight, pain relievers to escape some of the pressure they feel to perform academically, tranquilizers to wind down at the end of a stressful day. 

Once these substances have become integrated into teens’ lived and 

abused as study or relaxation aids, it may become increasingly difficult to persuade teens that these are drugs are unnecessary or 

unsafe when taken without a prescription. 

176 

The fourth reason, and this is a particular focus of the partnerships, is the lack of parental activism in prevention of this behavior. Parents who are usually our most valuable ally in preventing 

teen drug use find it hard to understand the scale and purposefulness with which many of today’s teens are abusing medications, 

and it is not immediately clear to these parents that the prime 

source of supply for abusable prescription drugs may well be their 

own medicine cabinet. Many parents themselves, moreover, are 

misusing or perhaps abusing prescription drugs without a prescription. In research that we did in 2007, 28 percent of parents said 

that they themselves had used a prescription drug without having 

a prescription for it, and 8 percent of those parents said that they 

had given their teenaged child a prescription drug that was not 

prescribed for them. 

Finally, the reason we have not been able to reduce teen abuse 

of prescription medications is that our efforts as a Nation have 

been inadequate, at least to date. There simply has not been sufficient public attention or resources dedicated to this threat. The 

backdrop to all of this is that the national drug prevention infrastructure has been eroding for the past years as the budget for the 

National Youth Anti-Drug Media Campaign has shrunk significantly, the Safe and Drug-Free Schools and Communities State 

Grant has been eliminated, and changes have been proposed to the 

state prevention and treatment block grant that could put prevention funding in jeopardy. With dwindling resources, it is impossible 

for government to be able to mount the kind of effort that is necessary. 

We know that if there is, when there is a well-funded effort to 

educate parents about the dangers of prescription drug abuse, we 

can increase awareness and we can make a difference. In the first 

half of 2008, the Office of National Drug Policy’s National Youth 

Anti-Drug Media Campaign devoted $14 million with which the 

media match was a $28 million effort to a parent-targeted campaign aimed at raising awareness about the risks of medicine 

abuse and motivating parents to take action. The campaign actually in terms of parents’ perceptions of the problem and intent to 

take action was demonstrably successful. This shows that a major 

public education campaign can help to turn the tide on this entrenched behavior. The media campaign’s funding is in jeopardy 

and may even be eliminated in the coming year, so we can’t assume that that campaign will be around to deliver this message. 

The private sector will need to help finance a campaign of the magnitude necessary to change the attitudes that underlie this behavior. 

While the partnership is grateful for the unrestricted support we 

have received from a number of pharmaceutical companies, if our 

Nation is going to reduce teen abuse of prescription medication, we 

need to step up efforts dramatically. We need a sustained, multiyear effort funded by the pharmaceutical industry, the generic drug 

manufacturers and other key stakeholders to first support a major 

independent paid media campaign alerting consumers to the risks 

of abusing medicine and the importance of safeguarding and safely 

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tising and pointing viewers towards an objective and comprehensive online prevention resource. Second, we need to educate and enlist prescribers, pharmacists and other health care professionals. 

Third, we need to educate policymakers so that we can promote 

policies that will help reduce both the supply of and the demand 

for prescription drugs of abuse. And finally, implement an evaluation tool that would measure and hold this program accountable. 

In conclusion, at the partnership we believe that the abuse of 

prescription medications, legal substances of great benefit when 

used properly, is the single most troubling phenomenon on today’s 

drug abuse landscape. We appreciate the time and the attention 

that the subcommittee is giving to raising awareness and looking 

for ways to reduce the abuse of prescription drugs in our country. 

The Partnership at Drugfree.org stands ready to work with the 

subcommittee on this and other substance abuse matters. Thank 

you very much. 

[The prepared statement of Mr. Clarkin follows:] 

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Mrs. BONO MACK. Thank you, Mr. Clarkin. 

General Dean, you are recognized for your 5 minutes. 

STATEMENT OF ARTHUR T. DEAN 

Mr. DEAN. Chairman Bono Mack, Ranking Member Butterfield 

and other distinguished members of the subcommittee, thank you 

for the opportunity to testify today on behalf of Community AntiDrug Coalitions of America, CADCA, and our more than 5,000 community coalitions nationwide. I am pleased to provide you with 

CADCA’s perspective on the complex problem of prescription drug 

abuse. 

CADCA has been on the front lines addressing prescription drug 

abuse for nearly 10 years. We have hosted town hall meetings, developed publications and toolkits for coalitions, and produced television programs on this subject. In 2009, we were fortunate enough 

to conduct a rally with over 1,000 community leaders on Capitol 

Hill to raise the awareness of over-the-counter as well as Rx abuse. 

CADCA recognizes that the misuse and abuse of prescription drugs 

is a multidimensional problem that demands comprehensive, coordinated solutions at all levels, local, State and national. Population-level changes in substance abuse including prescription drug 

abuse can be achieved by a comprehensive, data-driven approach. 

This approach mobilizes key community sectors that work together 

to educate, reduce access and availability, and change perceptions 

as well as social norms. Where this infrastructure is in place, communities have successfully prevented and pushed back against a 

variety of drug problems such as marijuana, methamphetamines, 

K2 and the misuse and abuse of prescription drugs. 

The Drug-Free Community, DFC program is the best example of 

a comprehensive community-wide approach being taken to scale 

nationwide. Since 1998, the DFC program has been a central bipartisan component of our Nation’s drug reduction strategy. A recent 

evaluation of the program found that youth drug, alcohol and tobacco use are significantly lower in DFC-funded communities than 

in communities without a DFC coalition. 

CADCA trains DFC grantees and other community anti-drug 

coalitions to execute seven evidence-based strategies to effect community change for drug use. Coalitions across the country are implementing these strategies, and these strategies range from raising awareness to changing policies, and they are achieving measurable results and reducing local prescription drug abuse rates. 

In the interest of time, I would like to share just one example 

from Caribou, Maine. The Aroostook coalition used a multisector 

approach to identify prescription drug problems and to craft a strategic action plan to address them. The coalition did the following: 

one, they implemented a comprehensive social marketing campaign; two, they provided training to health care providers about 

proper prescribing; three, promoted and funded a prescription drug 

take-back program; and four, created a monthly mailer for health 

care providers that lists individuals charged with prescription 

drug-related crimes in their communities. As a result of this datadriven multisector approach, the coalition achieved significant outcomes. Through the coalition’s effort, the county has Maine’s lowest 

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187 

dents. Similar coalition examples are highlighted in my testimony, 

and I would invite those to your attention. 

CADCA’s primary message today to this committee is that community coalitions are evidence-based and effective and should be 

utilized as a major component of any prescription drug prevention 

strategy. We recommend that the coalition model be implemented 

in concert with a number of other key approaches. For example, 

CADCA supports the expansion of effective prescription drug monitoring programs to ensure adequate coverage in every State. The 

data from these programs can also help identify hot spots and appropriately direct the attention to other resources. We need enhanced education opportunities for training for medical and dental 

professions. We also need increased awareness and education about 

the danger, proper storage and disposal of drugs. We support enhanced opportunities to make prescription take-back programs routinely available. We strongly support increased law enforcement to 

remedy such things as pill mills. Our nation needs to embrace and 

enhance all these strategies. We need to expand the number of 

DFC-funded communities. And finally, we need to increase training 

at the local level so that more communities can effectively address 

this major public health and safety threat. 

I thank you for the opportunity to testify before you today and 

applaud you for your great work. Thank you. 

[The prepared statement of Mr. Dean follows:] 

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Mrs. BONO MACK. Thank you, General, and we are honored that 

you are here, and I thank you for your service and that you came 

under the wire, because there is one person I couldn’t gavel down, 

and that would be you, sir. 

Mr. DEAN. And thank you for your great support and on a continuing basis. We appreciate it very much. 

Mrs. BONO MACK. Thank you. I look forward to our continued 

work together. 

Dr. Coster, you are recognized for 5 minutes. 

STATEMENT OF JOHN COSTER 

Mr. COSTER. Thank you. Good morning, Chairwoman Bono Mack, 

Ranking Member Butterfield, Congressman Lance, members of the 

subcommittee. I am John Coster, Senior Vice President of Government Affairs at the Generic Pharmaceutical Association and a licensed pharmacist. On behalf of GPhA and our member companies, 

thank you for calling this hearing and for the opportunity to testify. 

Let me begin by giving some background on the role of the generic drug industry in the United States. About 75 percent of all 

prescriptions are filled with generic medications, although that percentage does vary by therapeutic class. We are proud that our industry helps make high-quality, safe, effective prescription medications more affordable for millions of Americans while saving the 

health care system billions of dollars each year. 

GPhA’s member companies manufacture FDA-approved generic 

versions of brand-name drugs in all therapeutic categories including prescription painkillers. We are as concerned as the members 

of this committee when medications that are made to improve lives 

or alleviate pain are abused. We believe that address this issue, as 

you have heard from the previous witnesses, will require a continued coordination among Federal and State agencies, State, local 

and Federal law enforcement, health professionals, drug manufacturers, pharmacists, patients and their families. Because it is a 

multifaceted problem, it requires a multifaceted solution. 

As we work together to shape public policy to end the misuse of 

pain medications, we must recognize that the overwhelming majority of individuals including millions of seniors and cancer patients 

do rely on these important drugs for their proper pain treatment. 

We are absolutely committed to the safe and reliable manufacturing and delivery of generic drugs. 

As an industry, we have invested millions of dollars into technologies and delivery systems to help assure that our products 

reach their destinations safely and securely. For example, with respect to opioid medications, the DEA has a closed system of distribution to prevent diversion. Our industry works with the DEA 

to assure that these products do not fall into the hands of abusers. 

For example, the DEA administers drug allotment and accountability systems to assure against the loss of diversion of controlled 

substances. 

Recent studies suggest that the problem of prescription drug 

abuse stems not from drugs that have escaped legitimate supply 

chain or been obtained illegally through the black market but instead from those that were legally prescribed and available in the 

212 

home. Why are these medicines sitting in medicine cabinets? 

Shouldn’t patients have already taken them? It is not uncommon 

to find many medicine cabinets in America are stocked with unused prescription drugs. Some of these may be for mild conditions 

such as allergy while others may be unused medications that were 

prescribed to treat the discomfort of a surgery. Many Americans 

have no recourse to return these unused medications, especially 

controlled substances, because Federal law prohibits the transfer of 

controlled substances from an ultimate user to anyone other than 

law enforcement. This will soon change as DEA implements the 

Safe and Secure Drug Disposal Act, which will permit ultimate 

users such as patients with excess controlled substances in their 

medicine cabinets to return them to DEA registrants such as willing pharmacists so they can be destroyed. 

What has our industry been doing to help address this problem? 

In general, we have tried to support efforts that are dedicated to 

raising awareness to the dangers of prescription drug abuse as well 

as the need to properly dispose of unneeded or unwanted prescription medications. We think education is a key component to this. 

For example, we support efforts such as the American Medicine 

Chest Challenge, which is a community-based public health initiative with law enforcement partnership to raise awareness about the 

dangers of drug abuse. We are pleased to let you know that we will 

be partnering with PhRMA to produce a public service announcement that will promote the upcoming DEA Take Back Day on April 

30th, which we hope will be as successful as the one from last fall. 

We are also a board member of NCPIE, the National Council on 

Prescription Information and Education, a broad-based coalition on 

addressing raising awareness about prescription drug abuse. For 

example, NCPIE most recently developed a college resource kit to 

help educate students about the dangers of prescription drug misuse. 

In addition, over the last few years our industry companies have 

focused efforts in this area by joining with the brand-name industry, patient groups and the FDA on working on a REMS program 

for long-acting and extended-release opioid medications. REMS are 

special programs that are used by FDA to help prevent adverse 

outcomes in patients. At this point, I don’t believe the FDA has implemented that program yet. 

Madam Chairwoman, we applaud you for the countless hours you 

have devoted to raising awareness about this issue and the great 

work you have done. With the cooperation of physicians, law enforcement and others, we can expand education efforts, keep our 

supply chain safe and secure, and help to ensure that patients and 

family members are not alone in this fight. We thank you for holding this hearing, and I would be happy to answer any questions 

you may have. 

[The prepared statement of Mr. Coster follows:] 

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Mrs. BONO MACK. Thank you, Dr. Coster. 

Ms. Martello. 

STATEMENT OF KENDRA MARTELLO 

Ms. MARTELLO. Good morning. Thank you, Madam Chairman 

and distinguished members of the subcommittee, Ranking Member 

Butterfield and Congressman Lance. My name is Kendra Martello 

and I am pleased to offer this testimony today on behalf of the 

Pharmaceutical Research and Manufacturers of America, or 

PhRMA. PhRMA’s members represent America’s leading pharmaceutical research and biotechnology companies. Last year, our 

members alone invested over $49 billion in discovering and developing new medicines. Industry wide, research and investment 

reached more than $67 billion last year, a record. 

The prescription medicines our members research and develop 

are life-saving and life-enhancing medicines that allow patients to 

live longer, healthier and more productive lives when used appropriately and as intended. It is important as we consider the nonmedical use of prescription medicines that we also balance the need 

to maintain patient access to these medicines for legitimate medical use. 

We believe addressing the public health problem of prescription 

drug abuse is a shared responsibility. It requires a comprehensive, 

consistent and sustained approach and commitment from a wide 

range of stakeholders including prescribers and pharmacists. No 

one manufacturer, brand or generic, recognizing that approximately 75 percent of the prescriptions are for generic medicines, no 

one trade association and no one stakeholder group is solely responsible for implementing a solution that will truly be effective. 

We all must work together to achieve a common goal, and PhRMA 

and our member companies are committed to being part of the solution. 

An important part of our educational message surrounds the appropriate use of medicines, which can reduce health care costs 

overall. Data also show that the majority who misuse or abuse prescription medicines do obtain them from a friend or a family member. We believe that education can have a significant impact in 

helping to inform the public and reducing the overall rates of prescription drug abuse. We have developed four simple messages as 

part of our education effort on this important issue. 

First, take your medication exactly as prescribed. Second, store 

all medicines in a safe manner out of the sight and reach of children and adolescents in particular. Third, don’t share your medicines with anyone including friends or relatives. And fourth, 

promptly dispose of any unused medicine in a safe manner, either 

through the household trash or an appropriate take-back program 

such as the one administered by the DEA. In fact, to help further 

this last message, PhRMA partnered with the U.S. Fish and Wildlife Service and the American Pharmacists Association in 2007 to 

create the Smart Disposal Program, which educates consumers 

about how they may safely dispose of most medicines through the 

household trash. 

PhRMA and our member companies have also undertaken significant educational efforts regarding prescription drug abuse. For 

222 

example, we have recently worked with the Washington Health 

Foundation and the State Attorney General to develop education 

for college students and with Dare America to help educate students in grades 5 through 12. We also believe specific educational 

efforts must be targeted towards prescribers and pharmacists and 

could help them to detect and refer for treatment those who may 

be abusing prescription drugs. 

Other ideas that could have a significant impact on reducing the 

rate of non-medical use of prescription drugs: first, increase the use 

of and improvements to State prescription drug monitoring programs which can be an important tool in preventing and detecting 

abusers and referring them for treatment. Second, reauthorize 

NASPER, which provides grants for these State monitoring tools 

and which is legislation that PhRMA has supported. Third, increase penalties for and enforcement against pill mills, medicine 

diverters and those who go outside the legitimate medical supply 

chain including rogue Internet drug sellers. Fourth, work with FDA 

and others to facilitate the development of medicines to treat addiction and mechanisms to make medicines less susceptible to abuse. 

And finally, work with the DEA as it develops regulations to allow 

ultimate users and long-term care facilities to return controlled 

substance for disposal. 

In conclusion, prescription medicines when used as prescribed 

are critical to improving and extending patient health. However, 

when they are misused or abused, they can be dangerous and even 

deadly. No one solution to this public health problem exists. Education is of critical importance and it is a key first step but we 

must not stop there, and all stakeholders have a role to play in 

helping to develop solutions. We are committed to working with the 

subcommittee, members of Congress and other stakeholders on this 

important public health issue. Thank you. 

[The prepared statement of Ms. Martello follows:] 

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Mrs. BONO MACK. Thank you. 

Mr. Mayer. 

STATEMENT OF MICHAEL S. MAYER 

Mr. MAYER. Madam Chair, Ranking Member Butterfield and Mr. 

Lance, I appreciate the opportunity to appear before you today. I 

am here today representing MedReturn. MedReturn is a subsidiary 

of Frank Mayer and Associates, an 80-year-old family-owned company in Grafton, Wisconsin. Our core business is designing and 

manufacturing in-store displayers, merchandisers and interactive 

kiosks for Fortune 500 companies. 

Our involvement in the issue of prescription drug abuse stems 

from the commitment to provide a safe, secure, sustainable and environmentally friendly way to help law enforcement agencies and 

communities collect unwanted or expired prescription medication 

and over-the-counter drugs. 

The genesis of MedReturn began over 3 years ago when I challenged the associates in my company to research and develop new 

ideas. The challenge was called WITT, Wish I’d Thought of That. 

As we began investigating the prescription drug disposal issue, we 

quickly became aware of the management of prescription medication and drugs that sit unused or expired in our medicine cabinets. 

We began researching and looking for existing take-back programs 

and realized there was no consistent method or program available. 

Over a 2–1/2-year period, we developed, prototyped, presented, tested, improved and produced the MedReturn drug collection unit. 

Noting the importance of education, we incorporated a sizable 

graphic panel that States and communities can customize. 

We launched MedReturn at the International Association of 

Chiefs of Police conference in October 2010. To date, our drug collection has been placed in 50 police and sheriffs departments across 

11 States. We helped implement only the second county-wide ongoing drug collection program in the United States. 

Attached statements from law enforcement agencies confirm the 

positive response of their communities to sustained drug collection. 

Lieutenant Tim Doney of the Medford, Oregon, Police Department 

notes usage of their program is so heavy, they are emptying the 

collection unit at least 4 days a week. Other e-mail feedback we 

have received illustrates the demand for permanent medicine return programs. Sheriff David Peterson of Waushara County, Wisconsin, reports collecting 200 to 250 pounds of medication in 3 

months, and Lieutenant Wayne Strong believes the Madison, Wisconsin, Police Department has collected 230 pounds in that same 

time frame. 

What started as an effort to supplement our core business has 

quickly evolved in a passionate desire to be a smart part of the solution to the prescription drug abuse problem. We have devoted 

and continue to devote significant amounts of time and money to 

let State and local law enforcement agencies and community 

groups know we are available to answer inquiries. We know the 

DEA is working toward finalizing regulations that implement the 

Secure and Responsible Drug Disposal Act of 2010. We have talked 

with hundreds of law enforcement officers. Many of them are asking us how to implement their programs. Others believe the collecVerDate Aug 31 2005 10:04 Nov 08, 2012 Jkt 037690 PO 00000 Frm 00242 Fmt 6633 Sfmt 6633 F:\112-00~1\112-03~1\112-39~3 WAYNE
237 

tion and disposal process is too complicated. Others insist on recording and inventorying all collected medications and others don’t 

realize the scope of the problem. 

We believe a lack of understanding may be a deterrent to establishing a permanent take-back program. We also find a varied interpretation of what constitutes safe disposal. Some departments 

accept pills in a bottle while others want pills placed in plastic 

bags. Others will hold the collected contents until the annual Take 

Back Day. One officer admitted he collected the drugs but then 

flushed them down the toilet. Ideally, we would like to refer potential users of MedReturn to a central resource that outlines Federal 

and State requirements and best practices. 

At MedReturn, our vision is a sustainable, nationwide program 

as widely available as plastic, glass and paper recycling are today. 

By our calculation, there are some 30,000 communities that could 

benefit from a take-back program. We are in the process of seeking 

corporate or foundation partners that might speed this process. 

We appreciate the amount of attention prescription drug abuse 

is receiving from Members of Congress and the Administration. We 

hope you will continue to consider the challenges of those who want 

to establish a sustainable drug collection program at the grassroots 

level. We stand ready to serve as a resource in any way that is appropriate. Thank you. 

[The prepared statement of Mr. Mayer follows:] 

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Mrs. BONO MACK. Thank you, Mr. Mayer. 

Mr. Coyne. 

STATEMENT OF PATRICK COYNE 

Mr. COYNE. Good morning, Madam Chair and distinguished 

members of the subcommittee. It is a great honor that I testify 

today regarding pain management and the potential implications 

for patients in need of pain relief from diagnosis to survivorship. 

My name is Patrick Coyne. I have been a clinical nurse specialist 

for over 25 years, focusing on pain management and symptom control, typically in cancer patients. I am the Clinical Director of the 

Thomas Palliative Care Services within the Massey Cancer Center 

at Virginia Commonwealth University in Richmond. In my role, I 

care for individuals on a daily basis who are dealing with life-limiting diseases and significant issues with pain. The patients I care 

for are from all walks of life, living in both urban and rural areas 

throughout the Commonwealth. I also teach in the schools of nursing and schools of medicine in our university and beyond. Today I 

represent the Oncology Nurses Society, ONS, the largest professional oncology group in the United States composed of more than 

35,000 nurses and other health care providers. 

I would be naive not to recognize that the problem of opiate diversion is a very severe one and can destroy both patients, families 

and communities. More must be done to treat the significant issue. 

However, what about those patients who live daily with intractable, unrelenting pain? Daily, I encounter patients who will not 

see their next birthday and often travel hours to see someone within our institution for appropriate analgesia because their local 

health care provider is uncomfortable with prescribing the medications the patients need or fearful that their license may be revoked 

for using too much opiate pain medication. 

This population of patients is frail, dealing with countless issues, 

which I hope I never have to, and often has no voice. I hope to be 

their voice and ensure their comfort. I also wish to support their 

privacy so that nobody needs to know about their illness unless 

they choose to release this information. 

The challenges within pain management are many. Individuals 

respond differently to different medications including oxycodone. 

Many clinicians receive far inadequate training in prescribing analgesics, assessing pain and other treatment options and have false 

concerns regarding the role of analgesics. Certain areas in this 

country have limited resources for managing pain well. We know 

adequate pain management as demonstrated in several studies can 

increase both survival and quality of life for patients with life-limiting diseases. Caregivers often suffer from depression and financial impact when pain is poorly controlled. Pain is a serious and 

costly public health issue. Unmanaged pain is a tragedy. What 

really seems to be the tragedy is this patient population may suffer 

because of those conducting illegal activities. 

Pain management is challenging in any population. Cancer patients fear pain as do their families, but what of cancer survivors 

who suffer daily in pain but are disease-free? Consider those individuals with pain from poor cardiac output, sickle cell disease or 

burn injuries as examples of just a few populations of patients who 

251 

may be at risk without the availability of certain opiates. Addiction 

and misuse of analgesics is exceedingly rare in patients in pain yet 

they may carry the burden and suffer the decisions made by others. 

All discussion about the issue of opiate pain medications needs 

a balanced exploration of the risks but also the benefits of the 

medications when used appropriately. Limiting a pain medication, 

any medication, might take a very safe option away from countless 

patients living with moderate or severe pain. Education of prescribers is clearly needed to better assess pain and implement appropriate treatment options but limiting options may ruin many individuals’ lives. 

I have treated many patients with oxycodone, OxyContin and 

other analgesics, mostly cancer patients who have not tolerated 

other medications or did not get adequate relief from other opiate 

or non-opiate pain medications. Patients and their families need 

better education and support regarding the safe and appropriate 

use of, storage and disposal of medications. The needs of countless 

patients suffering in pain need to be part of this and any discussion. 

I want to thank you for your time and commitment regarding 

this exceedingly important subject. I have devoted my life to pain 

management and I fear that many patients I care for may suffer 

if poor decisions are made regarding pain management, and I welcome your time and questions. Thank you very much. 

[The prepared statement of Mr. Coyne follows:] 

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Mrs. BONO MACK. Thank you to all of the panelists for your expert testimony. 

Mr. Coyle, first of all, I applaud you in your efforts and think 

that we share the same goals. My father was suffering from the 

last stages of cancer just a couple of years ago, and I watched him 

go through it, so I appreciate what you see in a clinical setting. But 

at the same time, I have seen people suffering from opiate withdrawal, so I too care about those people and the pain that they suffer and the life of living with that addiction. Once you are an addict, as you know, you are an addict for the rest of your life. So 

hopefully we can continue to work to make sure that the people 

who you need to treat are treated to the best of your ability and 

we can also keep the drugs out of the hands of the bad guys. 

And it goes to Ms. Martello. I keep hearing this reoccurring thing 

that it is coming from friends and family and medicine chests, and 

I can’t believe that you all are serious when you think that is the 

big problem. You know, just this week there is an article about another prescription drug sting with 15 arrested in San Diego, California. Now, I will grant that they were arrested because they had 

prescription pills that they didn’t have prescriptions for but they 

also had cocaine, methamphetamine and other street drugs, but 

can we take our head of the sand and quit acting like it is all 

grandma’s medicine chest and admit the fact—and let me just go 

to Dr. Coster. 

You are a licensed pharmacist. In 2008, the Partnership for a 

Drug-Free America or Drugfree.org’s president, Steve Pasierb, he 

said in a Reuters interview, and I quote, ‘‘OxyContin is pharmaceutical heroin. There is really no difference between the two.’’ Do 

you care to explain the difference pharmacologically between 

OxyContin and heroin, how far off it is? 

Mr. COSTER. To be honest, Madam Chairman, it has been so long 

that I have been in pharmacy school, I would probably get it wrong 

if I did it, so if you like, we can provide you an explanation after, 

but at this point I probably wouldn’t be able to do it. 

Mrs. BONO MACK. Well, it is my understanding, it is one molecule off. I mean, that would be a fair characterization, and certainly you can submit that to me in writing later, but would you 

say that OxyContin and heroin the way they are consumed by the 

human body, the only difference is the delivery mechanism? 

Mr. COSTER. You know, again, I wouldn’t be able to comment on 

that, you know, from a pharmacological perspective. I wouldn’t 

want to give you any incorrect information or inaccurate information, so again, if you like, I would be happy to provide whatever 

I can in writing after the hearing. 

Mrs. BONO MACK. Well, it is my belief and my contention that 

they are pretty darn near the same, but to both you and Ms. 

Martello, you keep using ‘‘underadherence’’ and ‘‘medication noncompliance’’ and those terms in your testimony. When you talk 

about the problem with underadherence and noncompliance, are 

you lumping in therapeutics, antibiotics, other drugs into that category? Can you really say that there is a problem that people are 

not taking all 30 days of OxyContin when they are prescribed it? 

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Ms. MARTELLO. I think appropriate use of medicines can go a 

long way to helping patients improve their health conditions, and 

as I said in my testimony—— 

Mrs. BONO MACK. Including 30 days of OxyContin? 

Ms. MARTELLO [continuing]. This is a shared responsibility. This 

is something that I think as we have heard throughout the testimony this morning, there are a variety of stakeholders that have 

a role to play. 

Mrs. BONO MACK. Now, let me get back to this simple question. 

Are you saying that it is for the patient’s benefit that they take 30 

days’ worth of painkillers like OxyContin? 

Ms. MARTELLO. I think health care professionals are on the front 

line of this every day, and I think part of the educational effort 

that we can engage in—— 

Mrs. BONO MACK. No, this is a yes or no. And to Dr. Coster too, 

this is a yes or no. 

Mr. COSTER. I mean, I can give you a personal experience if this 

helps. I had surgery a couple years ago, and when I left the physician said here is a prescription for, I can’t remember if it was 30 

or 50, for OxyContin, and I went to get it filled, and he said if you 

need them, take them. So I guess he thought that in my case I 

might need two or I might need, you know, a week’s worth. So I 

think, and again, not to justify how these drugs are used, but some 

people, I guess some physicians feel like I will give you this quantity, and if you need them, take them, if you don’t, they don’t really 

tell them what to do with them. So I don’t know if it is a yes or 

no answer but in terms of a personal—— 

Mrs. BONO MACK. No, the question is, is extending the life, extending the quality of life—you are lumping this in, it seems to me, 

with therapeutic drugs or antibiotic or something when you talk 

about underadherence of drugs. 

Mr. COSTER. Again, in terms of like if you are taking a blood 

pressure medication where you absolutely have to take it every day 

or a cholesterol medication—— 

Mrs. BONO MACK. But we are not focused on those drugs today. 

Mr. COSTER. No, I know that. 

Mrs. BONO MACK. But we keep saying underadherence, underadherence. 

Mr. COSTER. Again, I am not a prescriber, but in the case of pain, 

oftentimes you get prescribed a quantity of medication because a 

physician doesn’t know, for example, how you are going to tolerate 

a certain procedure. He might say you might need for 5 days, you 

might need these for 10 days. Again, I am not justifying this. I am 

just saying as a pharmacist who has seen a lot of patients come 

in and fill prescriptions for pain where the patient says I may not 

need all these or why the doctor did give me all these, you are 

trained to tell the patient that the physician probably gave these 

to you because he is not sure how many you are going to actually 

need. 

Mrs. BONO MACK. My time has expired, but we will come back 

to that, and I am sure Mr. Mayer is very appreciative of the overprescriptions. 

Mr. Butterfield, you are recognized for 5 minutes. 

Mr. BUTTERFIELD. Thank you, Madam Chairman. 

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As we have heard, 70 percent of non-medical prescription drug 

users get those drugs from family or friends. It can be given to 

them, it can be sold. They can actually unfortunately steal it from 

others. We also know that the family medicine cabinet is bulging 

with unused and no longer needed medicines. Disposing of these 

medicines properly must be a priority and we must work to reduce 

their negative impact on the environment. When people do not 

have a safe place outside of the home where they can dispose of 

their unused drugs, they typically flush them, causing them to ultimately end up in our waterways. 

Question: I understand that a number of communities have created take-back days in which medicines are safely collected by law 

enforcement. Also, the Secure and Responsible Drug Disposal Act 

sponsored in the House by Mr. Inslee of Washington will allow 

more people and places to collect these unused medicines. This 

question is for Mr. Clarkin. Does the partnership that you represent have any examples of times when a take-back operation 

works particularly well? 

Mr. CLARKIN. Not specific instances in specific communities, but 

we first of all support the whole take-back program that the DEA 

has spearheaded in the most recent take-back initiative, I think it 

was pointed out earlier was terrifically successful in terms of the 

quantities of drugs that were actually brought back and safely disposed of, and we look forward to supporting the DEA at the April 

30th take back. 

Mr. BUTTERFIELD. Thank you. 

Next to General Dean. Thank you for your service to our country. 

What branch were you a part of? 

Mr. DEAN. The U.S. Army. 

Mr. BUTTERFIELD. Ever stationed at Fort Bragg? 

Mr. DEAN. [Inaudible.] 

Mr. BUTTERFIELD. All right. And thank you for that. According 

to reporting by the North County California Times—I almost said 

North Carolina—the North County California Times a couple years 

ago, military doctors wrote service members nearly 3.8 million prescriptions for painkillers up from less than 900,000 10 years ago. 

The Defense Department estimates that abuse of prescription 

drugs in the military is double that of the general population. First 

of all, do you agree or disagree with that, that military drug abuse 

is more and probably twice as much? 

Mrs. BONO MACK. Excuse me. General, would you please turn 

your microphone on? 

Mr. DEAN. I agree that the military has a significant problem 

with this issue. I don’t have the exact statistics on it. 

Mr. BUTTERFIELD. But you have no reason to disagree with that 

statistic? 

Mr. DEAN. I have every reason to agree with that. 

Mr. BUTTERFIELD. And it appears that one study in 2009 even 

found that 20 percent of Marines had abused prescription drugs, 

mostly painkillers, at some point in the previous year. Our active 

service members face significant anxiety overseas and many live 

through pain every day when they are on duty, but if they develop 

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low them back home to their civilian life, and I have seen it all of 

my life. 

General, what should the Administration do with regard to training veterans hospitals to be on high alert for this type of abuse? 

Mr. DEAN. I think it is a multifaceted approach that needs to be 

taken in order to assist our military members and their families 

and the communities that they reside in. I have had some discussions, my organization has, with the Army. I have another meeting 

scheduled with them in the very near future to address just this 

issue of helping them be more holistic in their approach of dealing 

with this issue that is not only soldier focused but also for the family members as well as the other civilians as well. 

Mr. BUTTERFIELD. Are there other programs geared to prescription drug abuse by veterans? For example, veterans may receive 

health insurance from the Federal Government. Are the insurers 

instructed to be on the lookout for abuse and not simply for the 

sake of law enforcement but really to help the veteran? 

Mr. DEAN. The answer is yes. I have a board member who runs 

the VA substance abuse center, the big VA center in Atlanta, Dr. 

Karen Drexler, and the VA has programs but the resources and the 

number of people that they have in my opinion—I am not speaking 

for the VA—needs to be expanded and there needs to be greater 

information provided and there need to be greater educational programs, but do they have the programs, yes, but my understanding 

would be that there needs to be a substantial enhancement in 

those programs. 

Mr. BUTTERFIELD. Thank you. Thank you, one and all. I yield 

back. 

Mrs. BONO MACK. Thank you, Mr. Butterfield. The chair recognizes Mr. Lance for 5 minutes. 

Mr. LANCE. Thank you very much, Madam Chair, and good afternoon to you all. I find this testimony very interesting. I don’t have 

the honor of representing Fort Bragg but I do represent the district 

in the United States that has more medical and pharmaceutical 

employment than any other district in this country, and certainly 

this is an issue in the district as well as across the country. 

To Dr. Coster or to Ms. Martello or to both of you regarding the 

risk evaluation and mitigation strategy at the FDA, based upon 

your expertise, do you feel that it has contributed to the mitigation 

of prescription drug diversion and has there been any unforeseen 

consequence such as access issues for patients? 

Ms. MARTELLO. When we look at policies in this area, certainly 

balancing the need between legitimate patient access and ensuring 

that the product’s benefits continue to outweigh its risks is an important public health consideration and I think those are the issues 

that are currently being grappled with. The FDA has a variety of 

tools in its arsenal to make sure that the product’s benefits continue to outweigh the risks of any product. 

Mr. LANCE. Dr. Coster? 

Mr. COSTER. Yes, sure. It is an excellent question, Congressman. 

There is so much focus and attention that has been placed on this 

program, and even though it has not yet been fully implemented 

by the FDA, I think just by the attention it has received, it has 

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scribe and patients on what they do in terms of taking these medications, but I agree with Ms. Martello that any program put in 

place like this should assure that it doesn’t interfere with the appropriate prescribing of these medications, the appropriate dispensing of them and that patients in pain are able to get them, and 

I think the agency itself is struggling with what that right balance 

is right now for these extended-release and long-acting opioid products. 

Mr. LANCE. Thank you. 

And to Ms. Martello, you state, and I agree with you, that you 

do not want to see barriers to patient access for needed prescription medicines. You highlight one potential barrier could be unnecessarily restrictive drug control regulations and practices. Could 

you give us in a little greater detail what you mean by that? 

Ms. MARTELLO. I think health care providers play a pivotal role 

in helping to ensure that patients have access to the medicines that 

they need and so we would want to have health care providers and 

pharmacists frankly to be part of this conversation to help ensure 

that they can work with patients and counsel them on medication 

management and using medicines appropriately as prescribed. 

Mr. LANCE. Thank you. 

And to General Dean, thank you, sir, for your service to our Nation. Have you seen greater abuse given the fact that we now have 

military operations in the field in both Iraq and Afghanistan and 

has there been a tracking of this in relationship to other times 

when we have had our military personnel in combat situations? 

Mr. DEAN. Well, as you know, I have been retired for a few years 

so I am giving you information from my perspective and not from 

within the Department of Defense, but clearly the protracted wars 

that we have been in and the extensive number of severely wounded soldiers and other member of the armed forces have contributed 

to an increased number of them needing and benefiting over a long 

period of time from these medicines, and as a result of that, it is 

clear, and my friends have told me, that there is an increasing 

number of them who unfortunately are now abusing them and they 

are trying to find ways to combat that. Just recently, we had an 

officer as senior as a three-star general admit that he was addicted 

to pain medicine. So it is an issue. I am not actively involved in 

it now. I am looking to work with the military services to help 

them build some procedures that would get at training and education around military bases that would help combat this, but it is 

a significant issue. 

Mr. LANCE. Thank you very much. And Madam Chair, I yield 

back my remaining 4 seconds. 

Mrs. BONO MACK. Thank you for your generosity. I recognize myself for 5 minutes again and say that it is so unfortunate, General, 

that we are hearing that this is truly carrying over into our troops, 

and it really makes a huge punctuation point on how important it 

is that we are doing this here today, so I thank you for your testimony and for being here. 

Quickly, just to point out, thought, that the FDA does not currently have a REMS program for long-acting and extended-release 

opioids, so it is not currently in place, and I am wondering how 

long it will take for them to do it and how many deaths will it take 

262 

for them to do it, and I am curious, you know, fen-phen was taken 

off the market really quickly. If either one of the two pharmaceutical reps can explain to me why fen-phen would have been removed from the market or some of these drugs that are so quickly 

and what the difference is between that and these opioids that are 

now up to tens of thousands of deaths a year. 

Ms. MARTELLO. It would be inappropriate for me to substitute 

my judgment for that of the independent scientific expert agency, 

the FDA, which evaluates the safety and efficacy of all marketed 

medicines, and so from my perspective, I think it would be inappropriate for me to comment on that. 

Mrs. BONO MACK. OK, fine. Then let me use my time with somebody who can actually comment, if that is all right. 

Mr. Clarkin, any of you, can you explain to me why the abusive 

opioid drugs because a problem so quickly, the trend lines screaming up there, anybody who is out there in the field in the real 

world? 

Mr. CLARKIN. I think there is probably a combination of factors, 

and clearly supply has been a factor. I think the environment of 

marketing, direct-to-consumer marketing in the pharmaceutical industry, has expanded the abuse of prescription drugs not just prescription opioids. 

Mrs. BONO MACK. In fairness, I have never seen an advertisement ever for OxyContin. 

Mr. CLARKIN. That is correct, but my point is, that the direct-toconsumer advertising, and I think there is fairly robust literature 

on this, is creating a sense of a reliance on medicine to address a 

variety of different ills and so we see in our research, which I mentioned, and Dr. Boyd sees the same thing, an increasing reliance 

on the part of teens, at least, to be addressing not just to self-medicate or recreate with these substances but to address life management issues, and I think that is linked in some measure, not entirely but in some measure, to aggressive marketing. 

Mrs. BONO MACK. Thank you. Does the partnership have any explanation just from an observing standpoint why rogue pharmacies 

specialize in hydrocodone versus oxycodone or other controlled substances yet the pill mills specialize in oxycodone instead? Has anybody figured out that discrepancy? 

Mr. CLARKIN. I don’t have an answer for you on that. 

Mrs. BONO MACK. Anybody? No? OK. Mr. Mayer, the take-back 

program, what do you see as the key features of a successful, always available program? 

Mr. MAYER. Local community support. Education is going to be 

the biggest key. Letting the communities, the public know that 

there is a sustainable take-back program within their community. 

The program that we put together, the county-wide program which 

is in our county actually was a combination of news media and 

support from local newspapers but it was also putting flyers in the 

pharmacies, letting individuals know when they pick up their prescriptions that they can dispose of unused, expired at the local law 

enforcement agencies. 

Mrs. BONO MACK. Terrific. Thank you. 

Mr. MAYER. Education is the key. 

263 

Mrs. BONO MACK. OK. Dr. Coster, when you see the statistics 

and graphs that Governor Scott presented earlier showing the disproportionate share of drugs dispensed from Florida and national 

statistics on drug diversion, do you think that the DEA and FDA 

quota system needs to be reevaluated in light of the high percentage of diversion, particularly in Florida? 

Mr. COSTER. Well, I know the way the quota system works now. 

It is based on a combination of factors both in terms of what the 

data show in terms of demand, FDA data and other data that feed 

into DEA and then DEA then determines how much our individuals manufacturers can make. You know, in terms of the situation 

in Florida, it sounded like part of the issue down there was that 

they didn’t have a prescription monitoring program which hopefully 

that will deter some of the abuse. But we are happy to talk with 

the committee and the DEA about whether the system needs to be 

recalibrated. 

Mrs. BONO MACK. Let me just back that up. I am sorry. I am 

down to my last 15 seconds. You just said the quota is based upon 

the demand? Isn’t that the problem here? If anybody wants it, then 

they are allowed to make it. That is the simple—that is it. That 

is the way you just explained it. 

Mr. COSTER. Well, again, I am not intricately familiar with how 

the FDA determines its actual quotas so I just gave you a broad 

overview, so as I said, maybe it is time that that whole system is 

looked at again in terms of how those quotas are determined based 

upon what is happening in the State. 

Mrs. BONO MACK. Thank you, Doctor. 

Mr. Butterfield, you are recognized. 

Mr. BUTTERFIELD. Thank you. 

Let me drill down on prevention for just a moment if I can. If 

we can prevent abuse, we know we can save millions of dollars 

and, more importantly, we can save many, many precious lives. As 

prepared by the Office of National Drug Control Policy, the 2010 

National Drug Control Strategy called for Federal, State, and local 

entities as well as non-governmental partners to seek earlier intervention opportunities in health care. One of the opportunities that 

the strategy highlights is working with physicians to achieve consensus standards on opiate painkiller prescribing. 

Mr. Clarkin, I am going to go back to you. What do you believe 

are the best ways to seize this opportunity? How specifically should 

stakeholders unite around consensus standards? For example, 

should task forces or working groups that include doctors, nurses, 

pharmacists and others be created? What role can the partnership 

play in such a process? 

Mr. CLARKIN. I think we have heard a lot today pointing to the 

need for prescriber education, first of all, on appropriate prescription of opioids and other medications. One of the measures that the 

partnership supports is the explicit linkage of education of prescribers to their DEA registration renewal every 3 years, so I believe that is an important piece and one that Director Kerlikowske 

also cited when he spoke here earlier. I think the dialog too between health care professionals, whether they are prescribers or 

pharmacists, the dialog between those health care professionals 

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ful of the risks of abuse, the risks of addiction, and I know one of 

the pieces that is under discussion as part of the long-term opioid 

REMS and one that the partnership supports is the adoption of effective prescriber-patient agreements at the point of prescription so 

that the patient very clearly understands the risks. First of all, 

there is a screener so that the doctor is aware if the patient indeed 

is particularly susceptible to addiction but the patient is also aware 

of the risks of abuse, the risks of addiction and the need to effectively safeguard meds and dispose of them appropriately. 

Mr. BUTTERFIELD. Perfect timing. We have just been called to the 

floor. You heard the buzzer. I am going to have to yield back. 

Thank you. 

Mrs. BONO MACK. I thank the gentleman. And does the gentleman from—— 

Mr. LANCE. I do not, Madam Chair, have any more questions. I 

yield to you. 

Mrs. BONO MACK. I thank the gentleman for yielding back, and 

I believe that we should wrap this thing up. 

Before I do, I would like to ask unanimous consent that these 

four items that we have previously discussed with the minority be 

included in the record. 

Mr. BUTTERFIELD. No objection. 

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Mrs. BONO MACK. I thank the gentleman. And we also have 

statements from members who are not on the subcommittee that 

will be submitted for the record without objection. 

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Mrs. BONO MACK. I just wanted to say that as we wrap things 

up today, I want to thank all of our panelists as well as my colleagues and their staffs for their time and their commitment to this 

critically important issue. 

If 30,000 Americans died every year from food poisoning, Congress would take action. If 30,000 Americans died from pesticide 

exposure, Congress would take action. And if 30,000 Americans 

died in airplane crashes every year, trust me, Congress would take 

action in a huge way. So why are the victims of prescription drug 

abuse treated differently? I don’t have an answer, but I encourage 

everyone here to help us find one. 

I remind members that they have 10 business days to submit 

questions for the record, and I ask the witnesses to please respond 

promptly to any questions they receive. Again, I thank you all and 

I look forward to our work together in the future. 

The subcommittee hearing is now adjourned. 

[Whereupon, at 12:35 p.m., the subcommittee was adjourned.] 

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Æ 


76303.274