U.S. GOVERNMENT PUBLISHING OFFICE

31–106 PDF WASHINGTON : 2018

LOCAL RESPONSES AND RESOURCES TO CURTAIL 

THE OPIOID EPIDEMIC 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTHCARE, 

BENEFITS, AND ADMINISTRATIVE RULES 

OF THE

COMMITTEE ON OVERSIGHT 

AND GOVERNMENT REFORM 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FIFTEENTH CONGRESS 

SECOND SESSION 

APRIL 11, 2018 

Serial No. 115–76 

Printed for the use of the Committee on Oversight and Government Reform 

( 

Available via the World Wide Web: http://www.fdsys.gov 

http://oversight.house.gov 


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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

Trey Gowdy, South Carolina, Chairman 

John J. Duncan, Jr., Tennessee 

Darrell E. Issa, California 

Jim Jordan, Ohio 

Mark Sanford, South Carolina 

Justin Amash, Michigan 

Paul A. Gosar, Arizona 

Scott DesJarlais, Tennessee 

Blake Farenthold, Texas 

Virginia Foxx, North Carolina 

Thomas Massie, Kentucky 

Mark Meadows, North Carolina 

Ron DeSantis, Florida 

Dennis A. Ross, Florida 

Mark Walker, North Carolina 

Rod Blum, Iowa 

Jody B. Hice, Georgia 

Steve Russell, Oklahoma 

Glenn Grothman, Wisconsin 

Will Hurd, Texas 

Gary J. Palmer, Alabama 

James Comer, Kentucky 

Paul Mitchell, Michigan 

Greg Gianforte, Montana 

Elijah E. Cummings, Maryland, Ranking 

Minority Member 

Carolyn B. Maloney, New York 

Eleanor Holmes Norton, District of Columbia 

Wm. Lacy Clay, Missouri 

Stephen F. Lynch, Massachusetts 

Jim Cooper, Tennessee 

Gerald E. Connolly, Virginia 

Robin L. Kelly, Illinois 

Brenda L. Lawrence, Michigan 

Bonnie Watson Coleman, New Jersey 

Raja Krishnamoorthi, Illinois 

Jamie Raskin, Maryland 

Jimmy Gomez, Maryland 

Peter Welch, Vermont 

Matt Cartwright, Pennsylvania 

Mark DeSaulnier, California 

Stacey E. Plaskett, Virgin Islands 

John P. Sarbanes, Maryland 

SHERIA CLARKE, Staff Director 

ROBERT BORDEN, Deputy Staff Director 

WILLIAM MCKENNA, General Counsel 

BETSY FERGUSON, Counsel 

KILEY BIDELMAN, Clerk 

DAVID RAPALLO, Minority Staff Director 

SUBCOMMITTEE ON HEALTHCARE, BENEFITS, AND ADMINISTRATIVE RULES

Jim Jordan, Ohio, Chairman 

Mark Walker, North Carolina, Vice Chair 

Darrell E. Issa, California 

Mark Sanford, South Carolina 

Scott DesJarlais, Tennessee 

Mark Meadows, North Carolina 

Glenn Grothman, Wisconsin 

Paul Mitchell, Michigan 

Raja Krishnamoorthi, Illinois, Ranking 

Minority Member 

Jim Cooper, Tennessee 

Eleanor Holmes Norton, District of Columbia 

Robin L. Kelly, Illinois 

Bonnie Watson Coleman, New Jersey 

Stacey E. Plaskett, Virgin Islands 


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C O N T E N T S 

Page 

Hearing held on April 11, 2018 .............................................................................. 1 

WITNESSES 

Ms. Amy Haskins, Project Director, Jackson County Anti-Drug Coalition 

Oral Statement ................................................................................................. 4 

Written Statement ............................................................................................ 6 

Ms. Lisa Roberts, Coordinator, Scioto County Drug Action Team Alliance 

Oral Statement ................................................................................................. 24 

Written Statement ............................................................................................ 26 

Mr. Derek Siegle, Executive Director, Ohio HIDTA 

Oral Statement ................................................................................................. 45 

Written Statement ............................................................................................ 47 

Ms. Karen Ayala, Lead Staff, DuPage HOPE (Heroin/Opioid Prevention and 

Education) Task-Force 

Oral Statement ................................................................................................. 55 

Written Statement ............................................................................................ 57 

APPENDIX 

Reprensentative Mark Walker Statement for the Record .................................... 92 

DuPage County Statement for the Record, submitted by Ranking Member 

Krishnamoorthi .................................................................................................... 93 

Gateway Foundation Statement for the Record, submitted by Ranking Member Krishnamoorthi .............................................................................................. 99 

Robert Crown Center for Health Education Statement for the Record, submitted by Ranking Member Krishnamoorthi ..................................................... 104 


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LOCAL RESPONSES AND RESOURCES TO 

CURTAIL THE OPIOID EPIDEMIC 

Wednesday, April 11, 2018 

HOUSE OF REPRESENTATIVES

SUBCOMMITTEE ON HEALTHCARE, BENEFITS, AND

ADMINISTRATIVE RULES

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

Washington, D.C. 

The subcommittee met, pursuant to call, at 10:05 a.m., in Room 

2154, Rayburn Office Building, Hon. Jim Jordan, chairman of the 

subcommittee, presiding. 

Present: Representatives Jordan, DesJarlais, Massie, DeSantis, 

Walker, Grothman, Palmer, Comer, Krishnamoorthi, Norton, and 

Kelly. 

Mr. JORDAN. The committee will come to order. I would ask 

unanimous consent that members not part of the subcommittee can 

participate in today’s hearing. 

We want to thank you all for being here. Thank our witnesses. 

We will do a quick opening statement and we will introduce you. 

I will swear you in and get right to your important testimony. I am 

not even going to read my prepared remarks here. I am just going 

to say we all know how bad this crisis is. 

In 2016, 64,000 Americans died from overdose from an opioid, 

and it has hit certain areas of our country, as evidenced by the people we have here today, in a dramatic way. The ranking member 

came to me a few months ago and said we need to have a hearing 

where we at least continue this conversation about what we can do 

to help improve this situation, and I said that is a great idea, let 

us get folks together and do just do that. So, I want to thank our 

witnesses for being here today. 

I am going to turn it over to the ranking member for some opening comments. And then like I said, we will swear you in and hear 

your important testimony, and then get questions from members on 

the subcommittee and other members who have joined us for this 

important subject matter. So, with that I would recognize Mr. 

Krishnamoorthi for his opening remarks. 

Mr. KRISHNAMOORTHI. Thank you very much, Chairman Jordan, 

for allowing us to have this hearing today on this very important 

topic. I really appreciate your cooperation and the cooperation of 

your staff. And thank you all for traveling from long distances to 

be here today, and thank you to people in the audience as well. 

I asked for this hearing today because opioid addiction is a public 

health crisis that has devastated neighborhoods across Illinois and 


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communities in every State. Local communities are at the front line 

of this crisis, and Congress needs to listen to them. 

Today we will hear from local experts who are addressing the 

horrific impact of opioid addiction and other substance use disorders in Ohio, West Virginia, and in one part of my district, namely DuPage County, Illinois. In Illinois, there are an estimated 

180,000 people with an opioid use disorder. Every single day I feel 

the impact this crisis has on so many of my constituents in 

DuPage, Cook, and King Counties. In DuPage County alone, 126 

patients died of heroin overdoses, and another 108 from fentanyl 

just in the last 3 years alone. I applaud the $3.2 billion in new funding for opioid treatment 

that Congress passed this year, but Chairman Jordan and I need 

to know is the Federal government doing enough about this disease. Is Congress supporting you in the most effective ways possible to address the opioid crisis? We need to know if you have the 

flexibility to respond to opioids because what works in one area is 

not necessarily what works in another. 

We also need to know if you require more resources for prevention, treatment, and rehabilitation of those suffering from substance use disorders. We need to know if law enforcement is going 

after big drug cases and not just arresting addicts. We need to 

know if current law enforcement practices are preventing addicts 

from seeking treatment for fear of legal jeopardy. 

The public health crisis of opioid addiction demands that we are 

committing sufficient resources and that we are spending efficiently and effectively. It is critical to increase the supply and use 

of the highly-effective opioid overdose reversal drug, naloxone, so 

that we can save the lives of those who overdose. We must ensure 

that first responders and others have sufficient supply to prevent 

overdose deaths in their communities. 

I look forward to hearing today about evidence-based prevention 

efforts that have proven effective, including what we know about 

addressing the root causes of addiction, and that is something that 

is especially important to me. I want to know what is working in 

terms of preventing opioid addiction in the first instance. 

I look forward to hearing about effective harm reduction strategies for addicts with children in their household in order to lessen 

the burden addiction put on families. Once addicts do come forward, there must be effective evidence-based treatments available 

to them, and they need to know where and how to find treatment. 

We know that various forms of medication-assisted treatment, or 

MAT, can effectively treat addiction, but current access to such 

treatment is woefully inadequate. Let me repeat that. Resources for 

that type of treatment is woefully inadequate today. 

Recovering addicts should have the tools and support they need 

to both get clean and stay clean. I hear about this problem in Illinois nearly every day. Even when people can get treatment, can get 

into rehab, they and their families still have no support upon release. It is not enough for us to get them clean. We have to keep 

them clean. These people then struggle to maintain sobriety. I hope 

to hear today from our witnesses on ways to solve this problem. 

Finally, Federal spending has to be held accountable. One of this 

committee’s core missions, and I know Chairman Jordan agrees, is 


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to identify and root out government waste, make sure that we are 

not good money after bad. I look forward to hearing today how scientific evidence is being used to ensure that taxpayer dollars are 

being spent efficiently and effectively in local addiction response efforts. 

I hope today’s hearing will provide a constructive conversation 

about what local communities are doing and what the Federal government should be doing to address the opioid crisis and the disease of addiction, and I look forward to working with my colleagues 

on both sides of the aisle to address this public health crisis. Thank 

you so much. 

Mr. JORDAN. I thank the gentleman for his opening comments. 

We will introduce our witnesses. Why do we not start with the 

ranking member? I will let him introduce one of our witnesses who 

is from back in his district. 

Mr. KRISHNAMOORTHI. Thank you again, Chairman. Yes, I would 

like to introduce our distinguished witness, Ms. Karen Ayala. She 

is the executive director with the DuPage County Health Department in Illinois, and she is the lead staff at the DuPage Hope Task 

Force, which she will be talking about today. This addresses opioid 

prevention and education in my district. 

Mr. JORDAN. Thank you. I now recognize the gentleman from, 

even though he is from Kentucky and going to introduce someone 

from Ohio, there is a relationship there. So, the gentleman from 

Kentucky, Mr. Massie, is recognize. 

Mr. MASSIE. As the chairman well knows, there are some good 

people in Ohio. 

Mr. JORDAN. Yeah. 

Mr. MASSIE. But we are always on the lookout for the Buckeye 

Navy coming across the Ohio River there. 

[Laughter.] 

Mr. MASSIE. It is my honor to introduce the next witness. Thank 

you for allowing me to participate in this subcommittee. The next 

witness, Lisa Roberts, is a registered nurse from Portsmouth, Ohio. 

She has been working at their health department since 1989, and 

the City of Portsmouth, as the chairman knows, is located in Scioto 

County, Ohio. 

Drug addiction does not recognize geographic boundaries, and 

the area of southern Ohio, eastern Kentucky, and western West 

Virginia, that tri-State area, has really been hit hard by opioid addiction. It has been the subject of some documentaries. But Lisa is 

at the forefront of fighting this. She helped form the Scioto County 

Drug Action Team Alliance, and she is currently administering the 

Drug Free Community Program in Scioto County, which is in its 

6th year. 

She oversaw Scioto County’s first public health overdose prevention pilot program, and that has been a model for other communities in Ohio as I understand it. But the most remarkable thing 

about Ms. Roberts is my mother was her nursing instructor, and 

she survived by mother’s class, and I know she has been taught 

well. My mother taught me, and so it is an honor to have her testify here today. 

Mr. JORDAN. Thank you, Mr. Massie. Good to have you with us, 

Ms. Roberts. Ms. Haskins is the Jackson County Anti-Drug CoaliVerDate Nov 24 2008 09:23 Sep 04, 2018 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 H:\31106.TXT APRIL

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tion representative from the great State of West Virginia. We are 

glad to have you here with us as well. And Mr. Siegle, who represents the Ohio HIDTA, High-Intensity Drug Trafficking Area 

Program, and we appreciate you being here also. 

If you all would please stand up. We have to swear you in, and 

then we will get right to your testimony. Raise your right hand. 

Do you solemnly swear or affirm the testimony you are about to 

give is the truth, the whole truth, and nothing but the truth, so 

help you God? 

[Chorus of ayes.] 

Mr. JORDAN. Let the record show that each witness answered in 

the affirmative, and there is a clock in front of you that you can 

see it is 5 minutes. If you can keep your remarks within that 5- 

minute timeframe, that is great. If you are a couple of seconds 

over, we are not going to hurt you or anything, and then we will 

just move right down the list. And then, like I said, we will get to 

questions. 

Ms. Haskins, you can go first. 

WITNESS STATEMENTS 

STATEMENT OF AMY HASKINS 

Ms. HASKINS. Good morning, Chairman Jordan, Ranking Member Krishnamoorthi, and esteemed members of the Subcommittee 

on Healthcare, Benefits, and Administrative Rules. My name is 

Amy Haskins, and I am the project director for the Jackson County 

Anti-Drug Coalition and also the administrator for the Jackson 

County Health Department located in West Virginia. It is on behalf 

of our coalition members and the Jackson County Board of Health 

that I want to thank you for the opportunity to testify today regarding the Drug Free Communities Program which is housed in 

the Office of National Drug Control Policy. 

The Drug Free Communities Program is the only Federal prevention program that goes directly to communities to tackle the local 

drug issues. DFC provides training through the institute to enable 

communities to implement substance abuse prevention strategies. 

In our community, DFC provided us with the tools needed to build 

capacity to achieve significant reduction in opioid use and misuse 

despite the State of West Virginia having one of the highest use 

and misuse rates in the country. Not only did we reduce our prescription drug abuse among youth, but we reduced population-level 

rates of youth substance abuse across the board, not just prescription drugs. 

Preventing or delaying substance abuse is the single most critical 

tool in stopping the pathway to addiction and overdose. Research 

shows that for each dollar invested in prevention, between $2 and 

$20 in treatment and other health costs can be saved. Substance 

abuse prevention has historically been under funded and underutilized in combating drug issues, including the current opioid epidemic. 

DFC has allowed our coalition to leverage other funds to provide 

prevention education within the school systems. It has also enabled 

us to respond and to address local trends as they arise. DFC has 

enabled our coalition to work on environmental strategies that creVerDate Nov 24 2008 09:23 Sep 04, 2018 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 H:\31106.TXT APRIL

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ate lasting population-level change and the ability to evaluate 

these changes through data collection. Specifically, we utilize the 

strategies of providing information, enhancing skills, providing support, enhancing access and reducing barriers, changes in physical 

design, and modifying or changing policies. Those environmental 

strategies are laid out in more detail in my written statement provided to you. 

With the training and technical assistance provided through the 

Drug Free Communities Program and ONDCP, our coalition has 

been able to change the environment not only in our community, 

but throughout West Virginia. The destruction of medication from 

static collection sites is a tremendous issue across the United 

States. Our community determined what worked best for us and 

successfully advocated for similar changes across the State. 

The individuality of each community is what makes ONDCP and 

DFC such a marvelous program. Our coalition has significant community-wide involvement from our school system to law enforcement, local business, media, youth-serving organizations, faithbased organizations, healthcare providers, civic organizations, parents, and more than a hundred youth to name just a few. We determine through data collection and assessment what the best plan is 

for our own communities. In fact, looking at the latest PRIDE survey data for Jackson County, 4.7 percent of our 12th graders report 

using prescription drugs in the last year, nearly 6 percent lower in 

use as compared to the national annual use as reported by the 

Monitoring the Future Survey. When looking at that same age 

group and the past 30-day use of prescription drugs, the national 

average is 4.9 percent as reported by the Monitoring the Future 

Survey, while only 1.8 percent of Jackson County 12th graders report using prescription drugs in the last 30 days. 

Since receiving DFC funding, our coalition has been successful in 

reducing 30-day use among our high school students across the 

board. In fact, we have seen a 15 percent reduction in alcohol use, 

13 percent reduction in tobacco use, 8 percent reduction in marijuana use, and nearly 6 percent in prescription drug abuse. The 

DFC Program is a great example of how a very small investment 

of $125,000 per year of Federal funds can inspire a great deal of 

coordinated and steadfast effort at the community level. 

Unfortunately, there is no one-size-fits-all solution to this opioid 

epidemic, but who best to determine what needs to be done to help 

a community than those who live, work, and raise their families 

there? I thank you for providing local communities like Jackson 

County, West Virginia the opportunity and the ability to do what 

is best to keep our children moving forward with positive change. 

Thank you for the opportunity to testify before you today, and I 

am happy to answer any questions you may have. 

[Prepared statement of Ms. Haskins follows:] 


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Mr. JORDAN. Thank you, Ms. Haskins. 

Ms. Roberts, you are recognized for 5 minutes. 

STATEMENT OF LISA ROBERTS 

Ms. ROBERTS. Chairman Jordan, Ranking Member 

Krishnamoorthi, and esteemed members of the Subcommittee on 

Healthcare, Benefits, and Administrative Rules, my name is Lisa 

Roberts, and I am the coordinator for the Scioto County Drug Action Team in Scioto County, Ohio. I have been a public health 

nurse in Portsmouth, Ohio for 30 years. Portsmouth, located in 

Scioto County, is part of the Appalachian region that has been seriously impacted by prescription opioids since the mid-1990s. 

In 2010, Scioto County has the highest prescription opioid distribution rate in Ohio and the highest fatal overdose rate in the 

State at more than double the State average. We also had the highest rate of infants born with neonatal abstinence syndrome and numerous other community problems related to opioid addiction. And 

like so many parents, my own child developed and opioid use disorder at a young and has struggled mightily with this disease 

throughout adulthood. It has been a long and difficult struggle for 

my family. 

In 2010, the county health authorities declared a public health 

emergency, and we formed a coalition. I have been the coalition coordinator since that time. In 2012, Scioto County was awarded both 

a Drug Free Communities Support Program and a High Intensity 

Drug Trafficking Area Program. These two programs work collectively to provide comprehensive supply and demand reduction 

strategies across our community landscape. 

Thanks to the enhanced training, technical assistance, and programmatic support provided by the Office of National Drug Control 

Policy, I have been continuously professionally developed to guide 

this coalition’s work. The combined efforts of these programs have 

resulted in numerous improved outcomes in our population. 

The DFC Program has allowed us to regularly collect and measure youth substance use and behavioral data for the first time in 

our county’s history. This information allowed our coalition to plan 

and implement locally-tailored and evidence-based strategies designed to reduce youth substance use. Since 2013, these biannual 

data sets have documented significant and sustained reductions in 

youth substance use, not only for prescription drugs, but for all 12 

measured substances, including tobacco and alcohol. 

I believe that these outcomes are a direct of the DFC Program 

and the training provided by the required year-long Community 

Anti-Drug Coalition Institute, which teaches coalition leaders like 

myself the essential processes to guide a highly-effective coalition 

capable of achieving these types of successful outcomes. The Institute taught us how to use local data and to implement a combination of evidence-based strategies. These strategies are further detailed in my written statement that you have. 

The opioid epidemic remains one of the biggest public health 

challenges of our time, but public health receives little funding to 

address it. The current structure of the DFC Program under the 

Office of National Drug Control Policy allowed my public health 


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agency to be eligible for this Federal support and to comprehensively address our local public health crisis. 

In addition to improving youth substance use rates, we have also 

seen positive secondary outcomes. Our prescription opioid distribution rates are at the lowest point in a decade, and Scioto County 

no longer leads the State in fatal overdose. Less infants are being 

born opioid dependent, and our high school graduation rates are 

now above the State average. And because we have built a community interfere that supports treatment and recovery from addiction, 

more youth are living in stable homes and more adults are achieving recovery. 

The Federal investment of $125,000 annually provided by DFC 

has allowed our community to organize and work toward a better 

future for our residents and our children. It has also helped us to 

gain additional opioid fighting resources, and these will be sustained into the future through the institutionalization of programs 

and services. In short, this small Federal investment has seeded 

community recovery in Scioto County, Ohio. 

America’s drug problems are extremely complex, dynamic, and 

ever-evolving. ONDCP is uniquely positioned to have a clear and 

broad understanding of these issues and how they can best be addressed through policy. These complexities require that we support 

an agency that has expertise and influence so as to provide national leadership and oversight to these issues. I believe it is critical the DFC Program remain in ONDCP and that this successful 

model is not disrupted. 

In closing, I want to thank the members of the committee for allowing me to testify on behalf of the critical importance of reauthorizing the Office of National Drug Control Policy and its vital 

programs. Because of them, we have been able to improve our community so that future generations of children and families can live 

safe, healthy, and drug free. 

Thank you for allowing me to speak on this important topic, and 

I am happy to answer any questions that you may have. 

[Prepared statement of Ms. Roberts follows:] 


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Mr. JORDAN. Thank you, Mr. Roberts. 

Mr. Siegle, you are now recognized. 

STATEMENT OF DEREK SIEGLE 

Mr. SIEGLE. Chairman Jordan, Ranking Member 

Krishnamoorthi, and distinguished members of the subcommittee, 

I am honored to appear before you today to testify and highlight 

the Ohio High Intensity Drug Trafficking Area Program, or 

HIDTA, and how the program assists localities in addressing the 

opioid problem. 

Today fentanyl and fentanyl analogs account for approximately 

58 percent of unintentional drug overdoses in Ohio. Opioids account for 86 percent of unintentional drug overdoses. Overdose 

deaths have risen 486 percent in the last 13 years from 904 in 2004 

to an expected 5,300 in 2017. We are seeing a rise in the seizure 

of crystal methamphetamine and cocaine being trafficked in large 

quantities by Mexican organizations. Recently, 140 pounds of methamphetamine was seized near Akron, Ohio. 

The foundation of the HIDTA strategy continues to be the co-location of law enforcement personnel in order to increase information and intelligence sharing, provide training, and incentivize participation in uniquely effective drug enforcement initiatives. These 

cooperative efforts support HIDTA’s core mission of disrupting and 

dismantling drug trafficking organizations and money laundering 

organizations. 

The Ohio HIDTA supports traditional drug task forces along with 

highway interdiction, package interdiction, bulk cash smuggling 

units, and fugitive apprehension teams. De-confliction services are 

a key contribution by the Ohio HIDTA for all our law enforcement 

partners. De-confliction prevents blue-on-blue incidents and duplication of efforts. 

In 2017, the Ohio HIDTA de-conflicted 4,200 law enforcement 

operational events and 7,200 subject elements for more than 300 

law enforcement agencies. The Ohio HIDTA participates in the 

ONDCP-sponsored Heroin Response Strategy, or HRS. The HRS is 

designed to enhance public health, public safety, and prevention 

collaboration supported by 10 HIDTAs across 22 states with the 

goal of reducing drug overdose deaths. 

The Ohio HIDTA supports heroin-involved death investigation 

teams in our major metropolitan areas. These teams respond to 

overdose deaths and begin an investigation into the source of the 

drug. In July of 2016, the Ohio HIDTA began to train law enforcement officials throughout the State on an overdose incident form. 

Almost 10,000 overdose investigations have been entered from 42 

of the 88 counties in Ohio, giving investigators the ability to instantly de-conflict information. 

The Investigative Support Center spearheaded efforts to form 

overdose initiative groups within each of these counties. The purpose is to more efficiently link overdose data and enable intelligence support that otherwise might not have been available to 

them. 

The Ohio HIDTA introduced the Overdose Detection Mapping 

Application Program, ODMAP, allowing first responders to report 

fatal and non-fatal overdoses and any administration of Narcan. 


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The incidents were plotted on a map allowing participating agencies to visualize overdoses in near real time. 

The Ohio HIDTA participates in the Domestic Highway Enforcement Initiative promoting collaborative, intelligence-based, unbiased policing on the Nation’s highways. Investigating Support Centers provide analytical help to participating and non-participating 

agencies, many of which do not have analytical support or record 

analysis capabilities. During 2017, the Ohio HIDTA provided in excess of 15,000 hours of free training to more than 1,400 students, 

many who would not be able to attend training without the 

HIDTA. 

HIDTA has become more important as overdose deaths have doubled over the last decade while drug enforcement funding overall 

has declined. Because of the reputation that HIDTA has built for 

bringing individuals together and producing results, HIDTA components are often involved with prevention, treatment, and education 

initiatives. HIDTA executive boards are a key strength to the 

HIDTA program. Ohio HIDTA is managed locally by an executive 

board of 23 Federal, State, and local partners who each have an 

equal say in how their HIDTA prioritizes its efforts. 

As a program, not an agency, HIDTA is viewed as a neutral partner whose goal is to help all levels of law enforcement reduce drug 

trafficking organizations and their effect in our communities. 

HIDTA is best served under ONDCP, who provides leadership from 

a neutral, unbiased, non-competing point of view. ONDCP possesses the expertise and authority to look at the drug problem holistically and set direction across the board. 

Thank you for allowing me this opportunity to testify before you 

today. I look forward to answering your questions. 

[Prepared statement of Mr. Siegle follows:] 


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Mr. JORDAN. Thank you, Mr. Siegle. 

Ms. Ayala, you are recognized now for 5 minutes. 

STATEMENT OF KAREN AYALA 

Ms. AYALA. I am both grateful and humbled for the opportunity 

to speak before you today. My name is Karen Ayala, and I serve 

as the executive director of the DuPage County Health Department. DuPage County is the second-largest county in the State of 

Illinois. In this role, I have witnessed the heroin and prescription 

drug crisis unfold across our communities, and also instructed participation efforts to reduce the impact in our neighborhoods. 

I am, oh, so proud of our nationally-recognized healthcare systems as well as the most recent recognition of DuPage County as 

the healthiest county in Illinois. However, we are now in the 5th 

year of our response to this opioid crisis, and with the framework 

that has recently been developed through the HOPE Task Force, 

which is included in my written documents, I realize that we lack 

the resources needed to fully and successfully address this public 

health epidemic. 

I strongly believe as we are faced with responding to the complex 

needs of residents affected by this pervasive and impressive public 

health threat, we need additional resources. So, first, with the rise 

in direct consumer marketing of pharmaceutical companies, coupled with the efforts of the drug companies to market opioids as 

safe, effective treatments for chronic pain, our culture has developed an unprecedented reliance on these medications, while removing any perceived risk of harm or dependence. 

With that realization, the first opportunity for action by our Federal partners is to review and to restrict the methods that pharmaceutical companies continue to use in order to increase the number 

of users of opioid medications. Until we are able to reduce the number of new users, we are waging a losing battle against this epidemic in our communities and across our country. 

The next opportunity to support our local efforts is to expand the 

critical need for access to effective and evidence-based treatment. 

Integrating behavioral healthcare with primary healthcare ensures 

the best outcomes for individuals with multiple healthcare needs. 

This integrated care, however, requires unrestricted sharing of information between all members of the healthcare team. Currently, 

Federal law, specifically 42 CFR Part 2, prohibits access to substance use disorder treatment, which represents a significant barrier. This regulation prohibits information related to substance use 

disorder treatment to be shared across all members of an individual’s healthcare team. 

Earlier this year, the President’s Opioid Commission identified 

this as an important component to address the crisis across our 

country. We and our DuPage County partners strongly support this 

recommendation and urge immediate action in this matter. 

Expanding treatment to all individuals in need represents a strategic focus of our local efforts. With an increasing number of individuals ensnared in this chronic and lifelong illness, treatment, in 

fact, represents hope and the opportunity to succeed. Currently, estimates indicate that only 11 percent of individuals experiencing 

substance use disorders are actually able to engage in treatment. 


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Expanded publicly-funded treatment opportunities must be 

achieved in communities across our country. Although I recognize 

this is a bold goal, I believe the utilization of existing networks 

that Congress currently funds and established through the federally-qualified healthcare system, the community healthcare system, 

the rural health system, will assure this goal is achieved. 

Funding for this critical expansion of treatment must be allocated to achieve the additional treatment capacity we need in local 

communities today. Public health systems must be equipped to address this crisis and prevent others in the long term. DuPage 

County has been successful through the development of the HOPE 

Task Force multifaceted and comprehensive response plan. I am 

confident that our efforts to develop systems preventing substance 

use disorders, while engaging individuals in treatment and recovery, may serve as a model for other communities attempting to address this goal as well. These efforts, however, must be supported 

with Federal assistance focused on developing new policies that reduce new opioid users coming into the system, easing of restrictions 

preventing the unrestricted flow of information across healthcare 

provider teams, as well as building the capacity through the expansion of treatment services from Federal intervention. 

I look forward to continued partnership with you in these critical 

areas, and I wish to thank you once again for the opportunity to 

share. 

[Prepared statement of Ms. Ayala follows:] 


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Mr. JORDAN. Thank you, Ms. Ayala. I will now go to Dr. 

DesJarlais from Tennessee for the first round of questions. 

Mr. DESJARLAIS. Thank you, Mr. Chairman. Thank you for being 

here to discuss this very important and relevant topic. 

Mr. Siegle—I have a lot of questions for all of you, so if you can 

keep your answers short, that would be helpful—you testified that 

ONDCP’s neutrality is an asset to the HIDTA Program. Can you 

elaborate on that for me? 

Mr. SIEGLE. Yes, the participation and oversight and guidance 

given by the ONDCP versus a traditional law enforcement agency 

is actually a very good benefit. It is neutral. It does not make the 

State and locals feel alienated. It empowers the regional and local 

executive boards to make decisions in their area. And it, I think, 

has increased and continues the increase of the program because 

of the belief that they have a say in the program because it is not 

controlled by one agency. It is controlled and directed by the executive board. 

Mr. DESJARLAIS. Okay. And how does the reauthorization of the 

ONDCP ensure the continued success of the HIDTA Program? 

Mr. SIEGLE. It places the HIDTA Program under ONDCP and 

continue our operation under their coordination, and guidance, and 

funding. 

Mr. DESJARLAIS. How important is ONDCP’s national drug control strategy in shaping the focus of the HIDTA Program? 

Mr. SIEGLE. It is very important, and it kind of goes both ways 

in that the drug problem started at the local or regional level, and 

all those combined feed in to the National Drug Strategy, which 

ONDCP puts together. And by having HIDTA and ONDCP together, they can reach out to the HIDTAs across the country and 

have instant access to all the different drug information at the various, you know, regional areas and cities and levels of law enforcement across the country. 

Mr. DESJARLAIS. Okay. Thank you. Ms. Haskins, the Drug-Free 

Communities Program provides Federal funding straight to the 

local level. How effective is ONDCP, a Federal policy shop, in administering a program geared towards local communities? 

Ms. HASKINS. They are extremely effective. Something that is 

helpful with ONDCP being over the Drug-Free Communities Program is that ONDCP, their focus is substance use and abuse. So, 

there is nothing else that is kind of clouding their focus area. They 

provide us technical assistance whenever it is needed. They help us 

out if we have difficulty with our program officers or project officers 

through SAMHSA. They are there to help kind of connect us and 

help move that process forward. 

Mr. DESJARLAIS. Okay. The DFC Program is required to collect 

and submit data about its coalitions every 2 years. How does this 

data collection share the effectiveness of your coalition? 

Ms. HASKINS. We have to be able to prove that, the $125,000 annually that we receive that we are seeing reduction in use. Without 

that data collection, we are unable to do that. 

Mr. DESJARLAIS. Would it be helpful to collect the information on 

an annual basis? 


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Ms. HASKINS. There are some drug-free communities locations 

that do that. I think that in order to see long-term change, though, 

it is not going to be as effective to do it on an annual basis. 

Mr. DESJARLAIS. What does ONDCP need to improve its data collection, or does it need to improve it in any way? 

Ms. HASKINS. The reports that we have to provide, it is once 

every 6 months. They provide a submission of what we have turned 

into them so that we have an overarching idea of where we are 

moving from and where we are going to. At this point, I would not 

say that there would be anything that would need to be changed. 

Mr. DESJARLAIS. Does your coalition work with the HIDTA Program? 

Ms. HASKINS. We work with some of their officers in West Virginia. We particularly are not a HIDTA county, but all of the counties surrounding us are HIDTA counties. 

Mr. DESJARLAIS. Okay. Ms. Roberts, as Congress appropriates increased funding to tackle the opioid crisis, the need for Federallevel coordination is imperative. How does ONDCP assist your local 

initiatives in preventing and reducing illicit drug use? 

Ms. ROBERTS. ONDCP has helped us tremendously to address 

supply and demand at the local level. Sometimes evidence-based 

practices and best science does not get transmitted to the locallevel area people so much. And so, by allowing us to be exposed to 

forums, conferences, the leadership, the reporting systems, we are 

able to find out what is kind of the cutting-edge types of things, 

science that is being researched at the Federal level. And we are 

able to take that to our local communities then and translate that 

into action at the local level. 

Mr. DESJARLAIS. How does the reauthorization of ONDCP affect 

the HIDTA and DFC grant programs? 

Ms. ROBERTS. Because they are both under the Office of National 

Drug Control Policy, these are their two main programs. Like Mr. 

Siegle said, it is very important that they be led by an agency that 

has very broad understanding. This is an extremely, extremely 

complex and evolving issue. And so, it is very important for an office to be able to look at law enforcement’s concerns, public health’s 

concerns, treatment concerns, and be able to kind of lead and develop policies that do not necessarily hurt another branch or another entity while developing a policy that helps another entity. So, 

it is just very important for them to be able to have a very broad 

picture, and to be able to translate that into information that communities like mine can use at the local level. 

Mr. DESJARLAIS. Okay, thank you all for your responses. I yield 

back. 

Mr. JORDAN. Thank you, Doctor. The gentleman from Illinois is 

recognized for 5 minutes. 

Mr. KRISHNAMOORTHI. Thank you, Chairman, and thank you all 

for your really enlightening testimony. I wanted to first start out 

by saying representatives from three organizations, namely the 

Robert Crown Center for Health Education, the DuPage County 

Board, and the Gateway Foundation, have provided additional testimony for the record about local efforts to combat the opioid epidemic in Illinois. Mr. Chairman, I request unanimous consent that 


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this testimony be made part of the official record for today’s hearing. 

Mr. JORDAN. Without objection, so ordered. 

Mr. KRISHNAMOORTHI. Thank you. 

[The information follows:] 

Mr. KRISHNAMOORTHI. I would like to start, I have several questions, so I ask everyone to please be brief. But, first, I would like 

to start with Ms. Ayala. Thank you again. We are honored to have 

you here today. 

Ms. Ayala, how has the Federal grant landscape shaped the work 

you are able to do with the HOPE Task Force? 

Ms. Ayala: So, it was not part of my comments provided earlier, 

but we have been a recipient of the Drug-Free Communities grant 

for the past 5 years. That, as other members providing testimony, 

has provided us with an opportunity to coalesce a group and really 

provide the framework in which we can develop a more expanded 

approach based in the local communities to meet our needs. 

Primarily the efforts and the funding that we have received from 

the Federal level so far have been around the use naloxone, which 

we greatly appreciate, and it is very much needed within our community. However, one of the opportunities I think that grants such 

as the Drug-Free Communities and the HIDTA model provide is an 

opportunity for local communities to better define where their 

needs lie versus the categorical funding that has been historically 

provided to us. 

Mr. KRISHNAMOORTHI. Got it. Thank you, Ms. Ayala. Ms. 

Haskins and Ms. Roberts, with the Drug-Free Communities grants 

that you have received, could you each just talk about a couple like 

tangible examples of how you use that money to reduce, you know, 

the addiction rates in each of your counties. I was especially interested in Ms. Haskins’ testimony about the reductions pretty much 

across the board. Could you talk about this, the tangible application of the money? 

Ms. HASKINS. Absolutely. The very first year that we began our 

coalition back in 2009, we had had 16 youth die in a matter of 2 

years all pretty much from the same graduating class. So, that is 

pretty difficult for a community to put aside and not recognize that 

we have a prescription drug issue. 

We were able to do a comprehensive public awareness campaign 

to help bring that forward and help kick off some conversation that 

otherwise was not being had in our community. We educated anybody from preschool all the way up to the elderly who participate 

in our senior centers, you know. We had pharmacy students that 

would come in and volunteer their time to go over medications with 

the elderly and let them know what were some of the medications 

that were being taken out of the home, you know, people watching 

mailboxes to take that medication out of mailboxes that had been 

sent through the Postal Service. So, our comprehensive public education strategy was probably the biggest thing that we have done. 

That money has also helped us utilize, like I said, the destruction 

of prescription pills. We have three static takeback locations that 

we advertise constantly. We are a county of 29,000, and we usually 

get about 99 pounds of medication back per quarter. It is fiscally 

difficult to destroy that medication properly, so one of the things 


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that we were able to utilize, only $2,000 of our Federal money was 

to build and purchase an incinerator for our community so that we 

can destroy these pills and it will not be a financial burden on our 

community. We then took that idea and we advocated that that 

needs to take place throughout the State of West Virginia, so, 

therefore, we now have regional incinerators throughout the State 

of West Virginia to help other small communities like our own. 

You know, when you do public education, and you are going into 

the classroom, and you are teaching kids, you are teaching parents 

what to watch for for substance abuse, you are teaching teachers 

what substance abuse looks like so that they can understand, you 

know, when kids are high in the classroom. We have done law enforcement training to train them on diversion because when we 

started seeing pill issues in our county, law enforcement did not 

have a clue. They do not know if it is a blood pressure medication 

or an oxycodone, you know. 

So, those types of trainings were very important, and our DFC 

funding enabled us to do all those of skill building opportunities. 

And that is how we ended up with a reduction across the board 

was all of our educational opportunities that we are able to provide. 

Mr. KRISHNAMOORTHI. Thank you. Can Ms. Roberts answer briefly? 

Mr. JORDAN. Sure. 

Mr. KRISHNAMOORTHI. Ms. Roberts, can you please address the 

question? 

Ms. ROBERTS. Yes, our DFC funding enabled us to do comprehensive strategies across the entire community. And one of the requirements of drug-free communities is that you have very broad 

sector representation. There are 12 sector members that are required to be part of the coalition. 

When we first started our coalition in 2010, we were actually in 

incident command mode, which is a public health military type of 

strategy that is used for an emergency, which we had declared an 

emergency. But we needed to learn to be more strategic and long 

term and have outcomes that were going to last over a period of 

time after the urgency subsided. 

So, sector leaders ended up being very important. One sector in 

particular is a healthcare provider. Our healthcare provider at the 

moment is our health commissioner who is also a Data 2000 

waivered physician, and just the coalition inspired him to become 

a Board-certified addictionologist. 

And so, those strategies allowed us to have access to prescribers, 

the people that are actually writing prescriptions. And so, we were 

able to get into hospitals, and medical societies, and dental societies, and things like that, and tell them about the opioid crisis, 

which they were not aware of at the time in 2010. But also to 

change their prescribing habits, prescribing guidelines, to increase 

their access or utilization of the Prescription Monitoring Program. 

And so, in my written testimony you can see that we are the lowest point since the Prescription Monitoring Program began in terms 

of opioid prescription being written. Thank you. 

Mr. KRISHNAMOORTHI. Thank you. 


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Mr. JORDAN. If you could do just one thing and only one thing, 

what would it be? The single one thing you would do to deal with 

the problem? Ms. Haskins. I am just going to go down the line. 

Ms. HASKINS. I would —— 

Mr. JORDAN. Single most important thing to address the problem 

in your community or communities across the country. What would 

it be? Only one thing. 

Ms. HASKINS. I would have to put in place some type of parameters for the MATs that are in our area, for the Medication-Assisted Treatment programs that are in our area, for the adults. For 

youth, it would absolutely prevention, prevention, prevention. 

Mr. JORDAN. Okay. That sounded like two things. 

[Laughter.] 

Mr. JORDAN. Ms. Roberts. 

Ms. ROBERTS. Well, in terms of the overall, drugs are always a 

symptom of a bigger thing. And so, you know, Appalachia has been 

an area that has kind of been impoverished. And so, I think that 

overall anything that can improve the economy is going to be helpful in the long term. 

But I would have to say at the moment that this is not necessarily being treated like a public health emergency even though 

it has been declared. Whenever there is a public health emergency, 

there is typically a stabilization period where the crisis kind of gets 

contained. And having been through multiple addiction treatment 

facilities with my own child and experienced a gamut of things that 

did not work, my daughter thrives on medication-assisted treatment. But I cannot tell you how difficult that was for me to access 

for her. 

So, I think that I would have to say I would like to see our regulations surrounding medication-assisted treatment be lessened, 

similar to what some of the other countries in Europe are doing. 

People can actually dose on a methadone at a local pharmacy on 

their way to work. I do not have any access to methadone in my 

community. The closest clinic is, like, a hundred-and-some miles 

away. And so, that would be my answer. Thank you. 

Mr. JORDAN. Thank you. Mr. Siegle? 

Mr. SIEGLE. Yes, if I could do one thing, it would be the continuance of HIDTA under ONDCP because, as I stated, it allows us to 

operate efficiently and effectively. And also interface and support 

the prevention and education and treatment sides more effectively. 

For instance, some of the items I mentioned, like ODMAPs, that 

is not just for law enforcement. We developed it for law enforcement, but it is open to hospitals, treatment people, other people, 

public health people to see where the overdoses are occurring. 

Mr. JORDAN. Yep. 

Mr. SIEGLE. And some of the HIDTAs are starting to use that information to forward out to the treatment people to say, hey, we 

have responded to this individual 5 times or 3 times. They have 

been Narcan’d X number of times. You may want to get out and 

talk to these people because they are going to be your next overdose victim. But I think that totality of strategy that ONDCP encompasses allows us as an enforcement program to partner and 

have greater access to the areas and provide assistance in those 

areas. 


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Mr. JORDAN. Ms. Ayala? 

Ms. Ayala: My recommendation would be to integrate and expand access to substance use disorder treatment across the community with a particular focus on individuals who are uninsured or 

under insured using public funding for their care. 

Mr. JORDAN. Do any of you believe that other social welfare, not 

other, but social welfare programs, government programs in our social welfare system I should say. There was a study by Senator 

Johnson’s staff over on the Senate Oversight Committee, and there 

has been some research in this area, that the Medicaid expansion 

is actually in some ways maybe contributed to growing opioid use 

in certain communities. Do you think that is something that should 

be examined and may, in fact, be the case? Ms. Haskins? 

Ms. HASKINS. I will not blame that for the reason that West Virginia has had an increase. 

Mr. JORDAN. I am not saying cause and effect yet, but do you see 

a correlation and potentially cause and effect relationship between 

the Medicaid expansion and the opioid epidemic? 

Ms. HASKINS. I believe it has made it easier for access, yes. 

Mr. JORDAN. Yeah, that is what Senator Johnson’s study indicates. Ms. Roberts? 

Ms. ROBERTS. Ohio is one of the States that did expand Medicaid, and so I can probably speak on that a little bit. However, 

Ohio had a prescription opioid problem before Medicaid expansion. 

What Medicaid expansion —— 

Mr. JORDAN. If I could interrupt for a second. I am not saying 

it did not. I am asking do you as a professional in this area, do you 

think the Medicaid expansion exacerbated an already-existing 

problem? 

Ms. ROBERTS. I think Medicaid expansion helped tremendously 

in terms of the problem because it allowed access. What I see at 

the community level is that it allowed access to addiction treatment for a lot of population that was not able to access it. 

Mr. JORDAN. Do you think welfare reform would be a necessary 

part of actually addressing this overall problem? Reforming our 

welfare policies, incentivizing work, doing different things. You 

mentioned in your comments earlier, Ms. Roberts, that economic 

concerns you think led to this. So, do you think reforming our welfare system would help with this problem as well? 

Ms. ROBERTS. I think that it would be worth taking a look at. 

But, you know, as far as where I am from, there really are not a 

lot of opportunities for people, and so, public assistance is necessary for those people. So, I was speaking more in terms of economic development and opportunities. 

Mr. JORDAN. Ms. Haskins? 

Ms. HASKINS. I would say, I mean, I would agree with that, yes. 

I think part of what would need to happen, though, is with the 

Medicaid expansion, they would need to be able to go across State 

lines to access treatment. 

Mr. JORDAN. I am pushing my limit on time, so I am going to 

recognize Ms. Kelly for her 5 minutes of questioning. 

Ms. KELLY. Thank you, Mr. Chair, and thank you and the ranking member for having this hearing. And welcome to all the witVerDate Nov 24 2008 09:23 Sep 04, 2018 Jkt 000000 PO 00000 Frm 00080 Fmt 6633 Sfmt 6633 H:\31106.TXT APRIL

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nesses. I have another question that I had planned to ask, which 

I still will, but maybe I missed this. 

When you think about your places that you represent, or even if 

you think about nationally, how did this start? Like the majority 

of the people that have opioid addiction or died, how did it first 

begin? 

Ms. Ayala: If I could jump in. Within our community and within 

our research, we work closely with the National Safety Council, 

and what their evaluation demonstrates is that 75 to 80 percent of 

the individuals who are currently addicted to heroin began their 

journey into this complex world through the use of opioids prescribed by their physicians. 

Ms. KELLY. Thank you. 

Ms. Ayala: Or doctors. 

Ms. HASKINS. I would tend to agree with Ms. Ayala. I would also 

say that West Virginia had a very high heroin usage rate, and 

when that balloon started to get contracted on the heroin side, it 

is going to automatically flip over to the opioid side. You know, our 

particular issue in our community was fentanyl way before 

fentanyl was a household name. And that was coming from local 

prescribers. 

Ms. KELLY. Thank you. Anybody else? 

Ms. ROBERTS. I would like to chip in. I am from Portsmouth, 

Ohio, which we ended up with a lot of notoriety for being an area 

that saw the opioid crisis really early. We were making headlines 

back in 2002 in terms of OxyContin. And so, these products were 

marketed heavily in Appalachia, you know? That is why they 

ended up being called ‘‘hillbilly heroin.’’ And so, I would say the 

pharmaceutical company marketing played a role in that, but also 

what we saw was that it became a form of currency, currency in 

an impoverished area where people did not have access to other 

forms of making money. So, I think these things were interrelated. 

Ms. KELLY. I have to be careful. Both the ranking member and 

I are married to doctors, so I have to be careful. 

[Laughter.] 

Ms. KELLY. And my husband is an anesthesiologist. But that is 

what I thought, and when I went to a meeting with my hospital 

where I represent in Illinois, they actually started a program 

where they gave out the medicine to prevent the deaths. But that 

was something they talked about, more education for the prescribers, that that was needed, too. But anyway, again, I want to 

thank you. 

I wanted to talk to you about access to the lifesaving drug, 

naloxone. As you know, it is a drug that reverses opioid overdoses 

and prevents death, and last week the Surgeon General issued the 

first advisory in 13 years calling for expanded access to it. He 

wrote that ‘‘Increasing availability and targeted distribution of 

naloxone is a critical component of our efforts to reduce opioid-related overdose deaths.’’ 

Ms. Roberts, I understand you are a registered nurse, and you 

obviously worked in the public health field for a long time. So, I 

would like to ask you is access to this critical for first responders 

and others working on the ground to save lives? 


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Ms. ROBERTS. Well, as someone who has worked extensively with 

the drug naloxone, I think I can say that it is absolutely imperative, especially at this time when we are having a national crisis. 

But naloxone is a prescription drug, and so, therefore, it is subject 

to all of the rules and regulations that surround a prescription 

drug. In some other countries it is not necessary. It is an over-thecounter drug, and so it is, you know, sold over the counter, it is 

very cheap, and all of that kind of stuff. 

So, it I a little bit difficult to navigate the system sometimes because of the rules and regulations that control it as far as who can 

dispense it, who can, you know, prescribe it, and all of those things. 

So, in Ohio we have actually had to navigate that system for several years, and have managed to be able to get it to a point where 

we are able to have it available at certain pharmacies through a 

corporate protocol. There has to be a licensed prescriber in the loop 

someplace, which makes things a little bit difficult. 

And so, we have been able to get it to where people can get it 

without a prescription by going to a certain pharmacy, and it is 

covered by insurance. However, as far as supplying it to law enforcement and fire departments and these sort of non-traditional 

first responders, the fact that the price does increase frequently, 

you know, really does kind of impede our, we kind of fly by the seat 

of our pants all the time in terms of coming up with the medication. 

Ms. KELLY. Well, and mentioning that, several of my Democrats 

colleagues did write to President Trump in September of last year 

asking that he take action to lower the prices. And this morning 

actually, Ranking Member Cummings sent yet another letter to 

President Trump urging him to adopt his own commission’s recommendation to negotiate lower prices, and ensure that this lifesaving drug is available to all who need it. 

I know my time is over, so thank you. 

Mr. DESANTIS. [Presiding.] Thank you. The chair now recognizes 

the gentleman from Kentucky for 5 minutes. 

Mr. COMER. Thank you, Mr. Chairman. Ms. Roberts and Ms. 

Haskins, I represent a very rural district in Kentucky that has 

been hit especially hard by the opioid epidemic. How have you seen 

the opioid epidemic uniquely affect rural communities? 

Ms. HASKINS. Especially in our community, much like Ms. Roberts said, it is a form of income for a lot of people in a location 

where there are no other jobs. Luckily for us with DFC funding, 

we are able to do some prevention with the children of those families and parents who are using a lot and abusing and selling, helping them create goals, and figuring out that there are some other 

options in life other than utilizing prescription drugs or some other 

form of a substance. 

In particular, we have many of our elementary schools in Jackson County that are seeing difficulties just now with students coming up through the school system. They cannot retain information. 

This is pretty much the first wave of children who are coming 

through the school system from opioid. You know, I mean, they are 

opioid-exposed babies, and they are having difficulty retaining information that is being taught. That is not the fault of the teacher. 

That is not the fault of the school system itself. And we do not 


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know how to deal with these children because they cannot get 

qualified for special ed. They are not learning disordered as far as 

what the school parameters are. So, we are having difficulties even 

with behavior in our school systems. That is probably one of the 

most recent happenings from how it has affected our community. 

Mr. COMER. Right. 

Ms. ROBERTS. In answer to your question, I have seen opioids affect our community in so many negative ways. And so, prescription 

opioids really just sort of landscape. In Appalachia, we had never 

really had a heroin problem. Heroin was a problem that was associated with big metropolitan areas. And so, heroin is now a problem 

in Appalachia, and because of that, you know, we are absolutely 

seeing children who are, you know, having to live in families where 

substance use is a problem. 

However, the Drug-Free Communities grant has allowed as a coalition to address parental substance use because that has such a 

negative effect on children. One of our sector leaders is the juvenile 

court judge, and he actually has started a family drug court to help 

families that are struggling with opioid use disorder so that they 

can retain their children and keep the family intact. 

Mr. COMER. Now, one of the things that Chairman Jordan mentioned with the expansion of Medicaid is that, the question he 

asked was did that make the opioid epidemic worse. And the source 

of most of the opioids in my rural county, according to my law enforcement, from people on Medicaid for which you mentioned, a 

source of income. 

Ms. HASKINS. Absolutely. 

Mr. COMER. And that is something that, you know, you think 

about it, that is being paid for by the tax dollars. That is not coming in from drug cartels. That is coming from citizens in the communities that are getting free prescription drugs and turn around 

and selling them, which is having devastating effects on a community that has already been devastated by the new economy. So, 

that is something that I think we need to look into. 

And do you have any advice on how to prevent that, alternative 

sources of payment? I mean, I do not know. There are certainly 

over prescribing that is going on in rural communities. 

Ms. HASKINS. You know, in our particular community, at this 

point I do not think it is an over prescribing issue. It truly is an 

access issue. We have a needle exchange program that we just 

started in our health department, and I can tell you that most of 

our individuals that come through our program are actually using 

Suboxone, and Subutex, and crystal meth, you know, so, again, access is an issue. 

I think one of the main fixes would be to have some additional 

quality mental health counseling available because right now in 

West Virginia, that is seriously lacking, and I am sure it would be 

similar in Kentucky as well, because until you deal with the root 

of the problem, and, you know, most people will tell you that with 

substance use there is some underlying mental health issue that is 

not being dealt with, they are going to continue to use. 

Mr. COMER. Thank you, Mr. Chairman. I yield back. 

Mr. DESANTIS. The gentleman yields back. The chair now recognizes the gentlewoman from the District of Columbia. 


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Ms. NORTON. Thank you, Mr. Chairman. I particularly thank the 

witnesses who have testified, whose testimony has already clarified 

much for me. 

I want to make sure I know what we are talking about. I think 

it was you, Ms. Ayala, who talked about how people on heroin transition to opioid addiction, one of you did. And I think it is useful 

that we are using what looks like a broad term to describe what 

we are talking about when we hear ‘‘substance abuse,’’ sometimes 

is a term used. But I would like to know essentially what we are 

dealing with. 

One of you indicated, or perhaps it was my colleague, that it was 

called ‘‘hillbilly heroin’’ in his rural area. Well, obviously it is not 

called that in mine. I represent the District of Columbia, and big 

cities are where you had heroin abuse. Now you have something 

else, and it looks like physicians and the medical community is implicated. 

And so, I would like to know exactly what we are talking about. 

When we talk about an opioid crisis, most people will think that 

are prescribed or highjacked medicines. I do not think they understand the relationship to heroin. So, anything any of you could do 

to clarify that I think would be useful for this hearing. 

Ms. ROBERTS. I would like to clarify that. Prescription opioids are 

commonly called ‘‘pain pills, ‘‘pain killers.’’ They are manufactured 

by pharmaceutical companies, and they have some molecular structure that includes morphine. 

Ms. NORTON. Well, I understand that there is a difference between —— 

Ms. ROBERTS. Yeah, okay. 

Ms. NORTON. I am trying to find out how these substances, why 

you find some in some place, some in the others. 

Ms. ROBERTS. Okay. 

Ms. NORTON. Why there is a crossover. Even if you think that 

they are hillbilly heroin in some places, was there any heroin there 

before? 

Ms. ROBERTS. No. 

Ms. NORTON. I do not understand how this got started. I do not 

understand whether it is sectional, whether we need different approaches for different parts of the country since apparently they all 

transition between and across one another. 

Ms. ROBERTS. Molecularly, heroin and prescription opioids are 

very similar, so you can kind of think of them as being interchangeable. When somebody becomes addicted or dependent to prescription opioids, then heroin will fill the same need. It is also 

cheaper. It comes from a different place, so —— 

Ms. NORTON. Heroin is cheaper? 

Ms. ROBERTS. Absolutely. 

Ms. NORTON. Initially opioid has to come from a physician, I 

guess, from a prescription, how does that get to be like heroin so 

they are simply passed all around the community? 

Ms. ROBERTS. Well, prescription opioids come from a physician, 

and they have been used widely for the last 20 years due to some 

changes that took place with something called a pain scale. There 

was a belief that we under treating pain in the United States, and 

so you saw prescription opioids, especially, you know, some very poVerDate Nov 24 2008 09:23 Sep 04, 2018 Jkt 000000 PO 00000 Frm 00084 Fmt 6633 Sfmt 6633 H:\31106.TXT APRIL

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tent ones, come on the market and end up being very liberally prescribed. When I mentioned that —— 

Ms. NORTON. So, they are liberally prescribed. Now, all right, I 

get a prescription. I go around selling that prescription. Is that 

really the only way people are able to market this as a drug? They 

keep going back. Where do they keep getting prescriptions from? 

Ms. ROBERTS. Well, they can find a prescriber that will give them 

the prescription, and so —— 

Ms. NORTON. So, it looks like Congress or somebody needs to do 

something. 

Ms. Ayala: So, if I could just interject. The prescription drug 

monitoring programs that have been established on a State-byState basis have been very successful in addressing the multiple attempts by an individual to go to multiple prescribers and game for 

additional prescriptions. However, the flip side of that is once that 

source is diminished, then that individual tends to turn to street 

heroin both because of the availability as well as the price. So, that 

happens on a system-wide basis, but it also happens on an individual basis. 

Ms. NORTON. Yeah, that is important to understand how that occurs. They become addicted whether with heroin or opioids, and it 

does not matter, they are addicted. Now, Governor Christie of New 

Jersey headed the President’s commission on combatting drug addiction. And I just want to read to you what he said to find out 

what in the world Congress needs to do, because this is a crisis 

that is getting worse. This does not always happen. I mean, there 

was an Ebola crisis. That was very different, but we got a hold of 

it. Swine flu, we got a hold of it. This thing is running away from 

us. 

Governor Christie said, ‘‘One of the most important recommendations in this final report is getting Federal funding, support more 

quickly and effectively to State governments who are the front 

lines of fighting this addiction.’’ Do you believe this is the key to 

quelling the addiction you find in your communities, and I would 

like to have answers from all of you, increased funding from the 

Federal government. 

Ms. HASKINS. Absolutely, increased Drug-Free Communities 

funding because that is letting local communities deal with whatever trends are coming through their communities. It is not a onesize-fits-all answer unfortunately. 

Ms. NORTON. Ms. Roberts? 

Ms. ROBERTS. I would have to agree with Ms. Haskins. DrugFree Communities is extremely important. It does allow you to be 

fluid and to shift your focus when necessary, and the opioid epidemic is a good example of when that has happened. We have prescription opioids, kind of deal with that, took care of that, now we 

have a heroin problem. 

Many Federal grants are very restrictive, and they will say, well 

you can only deal with prescription opioids. So, what do you halfway through when a heroin problem comes? You are kind of stuck. 

And so, Drug-Free Communities is very important because they 

allow us to kind of shift gears midstream when we need to along 

with the HIDTA program, because supply reduction is extremely 

important now, too. 


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Mr. DESANTIS. The gentlewoman’s time has expired. The chair 

now recognizes himself for 5 minutes. 

Ms. Roberts, I wanted to follow up with you. Chairman Jordan 

asked you about the Medicaid expansion. There has been testimony 

before the Congress and some data suggesting that that has fueled 

the epidemic, and I think the argument is, you know, you are expanding to able-bodied adults. The program is not really good for 

long-term quality care and things like that, but it does provide access to the prescription drugs. 

And so, the stats, I think, are 13 of the 15 States with the highest opioid overdose rates are Medicaid expansion States. I think 

your testimony was you think it has helped mitigate the problem, 

not exacerbate it. And so, what is your basis for saying that and 

have you seen data that would substantiate your view? 

Ms. ROBERTS. Well, thank you for the question. So, they are saying that prescription opioids become more liberally prescribed in 

States that expand Medicaid because now people have more Medicaid and have a way to access them. Am I correct? Is that what 

is being said? 

Mr. DESANTIS. And I think, you know, you access it with, I think, 

pretty much no cost to the patient. 

Ms. ROBERTS. Yeah, and there could very well be some truth to 

that. But what I can say about Ohio is that Ohio did not expand 

Medicaid until probably 2014 or 2015. At that time, my county had 

the highest distribution rate in the State of Ohio, so we had plenty 

of opioids before Medicaid expansion. What I saw Medicaid expansion do for Ohio was allow many of the people that we were not 

able to help get access to addiction treatment. So, I think it is just 

probably going to be one of those double-edged swords. 

Mr. DESANTIS. Right, because I think some of the graphs, I 

mean, since 2013, I mean, you have seen, it is noticeable the increase in the Medicaid expansion States. Let me ask you this. Is 

the bigger problem too many prescriptions and abuse of that right 

now, or is a bigger problem the street drugs? 

Ms. ROBERTS. Well, that depends on where you live. 

Mr. DESANTIS. What is your experience? 

Ms. ROBERTS. Well, where I live right now the bigger problem, 

we have seen almost a hundred percent transition to heroin. And 

that happened relatively quickly when the prescription opioids less 

easy to access. We have seen the analog drug fentanyl products 

show up in heroin, and now they are showing up in other illicit 

drugs, such as cocaine and crack. And so, we are starting to see 

our entire drug supply become contaminated with these analog 

drugs that are highly lethal. 

Mr. DESANTIS. Where is that coming from? 

Ms. ROBERTS. Primarily it is coming from China. There have 

been many labs that have been —— 

Mr. DESANTIS. So, China sends it where? 

Ms. ROBERTS. It is a very condensed product. It is very small, so 

it is very easy to send in the postal system. And so, it can be 

mailed to different parts of Canada, driven across the border. It 

can also be mailed to the United States. 

Mr. DESANTIS. Well, I think that is true, and it is interesting, 

they will not use Federal Express or UPS for that because it will 


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be identified. The Post Office has had a tough time. We passed a 

bill recently to try to provide some tools to deal with that, and so 

it does come in the mail, but a lot of it, you know, comes in, you 

know, across the border. And I think that if you look at this crisis, 

it shot up around the same time where we have had a lot of problems at the border. 

And I think that, you know, there are issues with what taxpayers have to shoulder when we do not have a secure border. 

There are issues with the rule of law that are very important. But 

this drug issue is a huge deal, and this garbage is coming into our 

country. And I think the prescription stuff, you know, obviously has 

been an issue, still is. But the prescriptions are going down now, 

and yet this stuff out there is just absolutely killer. 

So, we have got to get a handle on this. And I am all for treatment, I am all for, you know, fighting it on the demand side, but 

you have got to fight it on the supply side as well. There is no way 

you could just let our country just be an open field for this stuff 

and not think that we are going to have some really negative consequences. 

And with that, my time has expired, and I will recognize the gentleman from Wisconsin for 5 minutes. 

Mr. GROTHMAN. Okay. We have a few questions here for the experts. We have heard how much the opioid crisis has gotten, and 

it has gotten much worse. And, of course, you know, we are spending billions of dollars between law enforcement or treatment, or 

whatever. Are there any examples around the country of States or 

large or small municipal areas in which there has been a precipitous drop in the number of deaths caused by opioids that we could 

say these people know what they are doing? Are there any examples of that around the country? 

Ms. HASKINS. I think in Huntington, West Virginia, they would 

be a good example. The health department there started a harm 

reduction program. Their issue is mainly heroin. They have provided thousands and thousands of doses of naloxone, and they have 

seen those drop. 

Mr. GROTHMAN. And how big is Huntington? How many people 

live in Huntington? 

Ms. HASKINS. I would say probably about 70 or 80,000. 

Mr. GROTHMAN. Okay, and do you know what —— 

Ms. HASKINS. That is a large metropolis in West Virginia. 

Mr. GROTHMAN. Okay. Yeah, I know, I got a district like that, 

too. Okay. So, there was not even a reduction in the use of the opiates. It was really just they got the shot to a lot of these people 

in time, right? 

Ms. HASKINS. Yes. But now, as far as reduction and use, I think 

you look at any Drug-Free Communities grantee program recipient, 

and you will see a reduction in usage rates in their areas. 

Mr. GROTHMAN. Yeah, can you give me an example of a city that 

if I look up or call their county, there has been a drop of deaths, 

and it is attributed to a drop in usage? 

Ms. HASKINS. Well, I mean, if you look at Jackson County, West 

Virginia, we have had a drop in overdose deaths among adults and 

specifically youth. 


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Mr. GROTHMAN. Okay. Next question I have in general, one of 

the tragic things about this opioid epidemic is it strikes very good 

families, however we describe ‘‘good families.’’ And it just must be 

shocking for parents who did everything right and have this happen. Nevertheless, I always do wonder about overall statistics on 

family background of people who wind up in this situation. Do we 

have any statistics on that? 

Ms. HASKINS. On family backgrounds? 

Mr. GROTHMAN. Correct. 

Ms. HASKINS. No, but, I mean, science has proven that if you 

have addiction somewhere in your family tree, you are almost —— 

Mr. GROTHMAN. Right. 

Ms. HASKINS.—you know, 50 percent more at risk to have an addiction. 

Mr. GROTHMAN. Right, so we have no —— 

Ms. Ayala: If I could add. 

Mr. GROTHMAN. Sure. 

Ms. Ayala: Most of our information is anecdotal and is geographic and demographic dependent, meaning whatever the representation of the community, that is what we are seeing reflected 

in the overuse and death data. So, for DuPage County, Illinois, the 

vast majority of our overdose reversals occur to young white males 

between the ages of 19 and 29 years old. That also happens to be 

the largest demographic in our community. So, it is absolutely agnostic when it comes to —— 

Mr. GROTHMAN. Well, let me cut you off because I only have so 

much time. It is kind of meaningless if you say the largest demographic has the most deaths. That is kind of expected. What I am 

wondering is are there any studies out there given the sea of 

money we are throwing at this who can give us some statistics on 

family background or parental background and that sort of thing? 

Ms. Ayala: By the time an individual gets to the point of being 

addicted, many times they do not enjoy the support of their family 

regardless of where they started. 

Mr. GROTHMAN. Well, you are not answering my question. 

Ms. Ayala: Okay, I am sorry. 

Mr. GROTHMAN. I am sure that is true. Do we have any statistics? 

Ms. Ayala: We do not. 

Mr. GROTHMAN. Okay. 

Ms. HASKINS. Not that I am aware of. 

Mr. GROTHMAN. Do you think it would be a good idea to get statistics like that given the gravity of the problem? It would be. 

Okay. Next question. One of the benefits of your program is that 

you have flexibility to do different things in different counties, 

right? Can you give me a solid example of how you should one 

strategy in Huntington and a different strategy in another type of 

city, or any city? 

You know, one of the reasons we are talking about this program 

being good is you can adapt locally. 

Ms. HASKINS. Right. 

Mr. GROTHMAN. Which presumably means it is not one-size-fitsall. So, I am looking to kind of give you a softball question in which 

you guys can tell me, you know, we did this in this city and it 


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worked, but it would not have worked in this city where we did 

something else. 

Ms. HASKINS. Well, I can tell you, for example, Huntington, West 

Virginia, they began the harm reduction program. They offer 

naloxone classes once a week. They give out thousands and thousands of doses of naloxone and save lives every day with that. In 

our particular community an hour north of Huntington, naloxone 

would not help in our community with what is being utilized at 

this point because what is being utilized by our adults at this point 

is Suboxone, Subutex, and meth. Naloxone is not going to save your 

life if you are using one of those three things, so. 

Mr. GROTHMAN. I guess are there differences by community other 

than just the type of drugs that are being used? 

Ms. HASKINS. Absolutely, I mean, other than socioeconomic. I 

mean, the way that your communities are structured. We have 

wonderful relationships with our board of education, with our law 

enforcement, with our local city councils and mayors that come together for this issue, whereas Huntington may not have that type 

of partnership with their organizations and their movers and shakers. 

Mr. SIEGLE. In Cleveland, Ohio, the medical examiner has been 

pretty active in putting out statistics and things that he sees. And 

it is kind of back to your question, but he has found that in the 

Cleveland, Ohio area, which is Cuyahoga County, which leads the 

State in overdose deaths, that what he has seen is primarily white 

males in their 30s and 40s. But there is a correlation between their 

education level, and most of them work in the trades. 

And I think when you say they work in the trades, I think that 

is back to the pain pills that started because, you know, their back 

hurt or their something got hurt as they are working on one of the 

construction trades. So, there seems to be a push to educate and 

reach out to those trade unions to help educate their members. 

Mr. GROTHMAN. When I said ‘‘background’’ —— 

Mr. PALMER. [Presiding.] The gentleman’s time has expired. 

Mr. GROTHMAN. Okay. 

Mr. PALMER. I now recognize myself for questions. I want to 

point out, I want to ask Ms. Haskins, you talked about children 

with learning disabilities or other issues —— 

Ms. HASKINS. Yes, sir. 

Mr. PALMER.—or children and parents who are addicted to 

opioids. Have you seen any disparity demographically between children of people who are enrolled in Medicaid versus children who 

are not enrolled? Is there a greater population of children with 

these issues who are from homes where the parents or parent are 

on Medicaid? 

Ms. HASKINS. I would have to look at the school system for that, 

but just anecdotally from what we hear in our community and from 

my observation, a large number of the children that are in that situation are certainly parents who are either uninsured or on Medicaid. But having said that, we also have a lot of children who are 

being raised by grandparents whose parents are very financially 

well off, and able to provide whatever it is that they want, but because of their addiction, they are living with family members. 


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Mr. PALMER. I understand, but the point, and you verified and 

it is consistent with the data that I have seen. There was a CDC 

study in Washington State that showed persons on Medicaid are 5 

to 7 times more likely to die an opioid-related death than someone 

not on Medicaid. It also said that the opioid prescription rate 

among Medicaid enrollees is at least twice the rate for persons on 

private insurance. So, you would naturally look at that data and 

conclude that some of the issues that you brought up about children having these learning disabilities would disproportionately 

come from households where they are on Medicaid, and I think 

that is a real issue with this. 

Mr. Siegle, Ohio enrolled more than 700,000 adults in the expansion of Medicaid, and is now seeing unprecedented problems with 

opioid addiction. As a matter of fact, last year Ohio was on pace 

to have more opioid-related deaths than the entire United States 

did in 1990. That is one problem. I also want to know if you have 

also seen more trafficking of opioids that drew Medicaid enrollees. 

Mr. SIEGLE. I do not know if I have any basis or statistics to support that one way or another. Most of the HIDTA funded counties 

in Ohio are centered in the major population areas. We only have 

one task force that operates down in Portsmouth in a rural area. 

And so, most of what I see coming from our interdiction efforts and 

enforcement efforts are in the larger metropolitan areas, and we 

are in 17 of the 88 counties, 14 of the 88 counties in Ohio. So, in 

those rural counties I really do not have a basis. 

Mr. PALMER. Well, it would not be rural versus urban. It is more 

are people getting prescribed opioids and then selling them. There 

are a number of issues here that are related to this —— 

Mr. SIEGLE. We are—we are —— 

Mr. PALMER.—but we are seeing this across a number of programs where there is trafficking, whether it is a SNAP benefit card 

or opioids that someone got as a result of a Medicaid prescription. 

Mr. SIEGLE. We are interdicting less pills and seizing less pills 

than before. Most of what we are getting now is the fentanyl, and 

it has actually overtaken heroin. So, if you want to make a correlation, I do not know if you can, between less pills and more people 

on Medicaid getting pills. But we are seeing and seizing less pills. 

Mr. PALMER. Well, you mentioned fentanyl. It was recently reported that there were three people arrested who enough fentanyl 

to kill everybody in Toledo. In my district, there was a gentleman 

arrested who had 38,000 lethal doses of fentanyl that he bought on 

the dark web and paid for it with bitcoins. But, Ms. Roberts, you 

were talking about it is produced in China. I would also add that 

the North Koreans are doing this. 

I was in a field hearing at Johns Hopkins Hospital with the 

former governor of New Jersey, Chris Christie, and I asked him if 

we had gone from a war on drugs to a drug with drugs, and that 

the 70,000 or so people who have died from overdoses, are they casualties of this war. But it is interesting to me that when you talk 

about how it gets into the country, it comes in the mail, but it is 

largely coming across the border. And you only mentioned the Canadian border, and perhaps that is because Ohio shares a border 

with Canada. 


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But I do think that this is the real issue of border security, and 

a lot of people lose sight of this, that we are in a war with drugs, 

and it is coming across the border. And the fentanyl issue I think 

is something that we are going to have to address outside of just 

drug policy because it is lethal. Any comment on that, Mr. Siegle, 

in your efforts? 

Mr. SIEGLE. I would agree with you, it is coming across the border, and some of that is coming from China to Mexico and then up. 

And there is also a strong belief that the Mexican drug cartels are 

starting to produce their own fentanyl and transporting it up. But 

fentanyl, heroin, cocaine, all the major drugs are coming up from 

the south of border into Ohio and most of the HIDTAs. There is 

very little activity from other parts of the world. Some of the East 

Coast still see some from the Asia part of the world, but most of 

it is coming up through Mexico, at least in the Ohio HIDTA. 

Mr. PALMER. One last issue here, Ms. Ayala. I raised this question in the field hearing as well about the fact that hospitals have 

quality surveys that they provide for their patients, and one of 

those was on pain management. And when you are tying the Federal government’s reimbursement rate to the hospitals or to physicians based on the outcomes of these quality surveys and you include pain management, that creates an incentive to over prescribe. 

And I think we cannot address this whole issue of opioids without 

addressing that. 

And it is my understanding, and I hope they are doing this, that 

beginning of the first of this year, they removed that as one of the 

criteria. Do you have any information about that? Any of you know 

anything about that? Have you seen any changes in that? 

Ms. Ayala: That is my understanding as well from our own Senator Durbin’s staff. That is our understanding. The issue, however, 

is still with patient satisfaction. It may not be directly tied to pain 

management, but if I went to the doctor with the expectation of 

getting an opioid prescription and I left without one, then my satisfaction in general is going to be decreased. So, I think that your 

point is right on, and we need to do additional kinds of analysis 

around those policies. 

Mr. PALMER. I would like to thank the witnesses again for appearing before us today. Are there any other members? You wanted 

to ask? I recognize the gentleman from Illinois for one question? 

Mr. KRISHNAMOORTHI. Two questions. 

Mr. PALMER. Two questions. 

Mr. KRISHNAMOORTHI. Thank you, Mr. Chair. Okay, two final 

questions. One is a very, like, tangible question based on what I 

have been hearing, which is I think each of you have kind of developed a program or strategy that was effective in combating the crisis. If there is one thing that you could share with the rest of the 

communities who are paying attention to this hearing or the others 

who are paying attention, what would it be? Like, what would be 

the most effective thing that you did in kind of dealing with the 

opioid crisis in your community? 

Ms. HASKINS. I would say looking at data, analyzing and figuring 

out exactly what the root of the problem is. 

Mr. KRISHNAMOORTHI. Okay, thank you. Ms. Roberts? 


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Ms. ROBERTS. I would say learning how to think strategically in 

long term, such as what is taught at the Community Anti-Drug Coalition Institute which we went to, which changed the way that we 

dealt with this all together. And the importance of data in being 

able to monitor, and, like Mr. Siegle said, live monitoring. You 

know, data that is a couple of years old is not real useful. So, I 

would say that Drug-Free Communities actually taught us how to 

do all of those things. 

Mr. KRISHNAMOORTHI. Great. Mr. Siegle? 

Mr. SIEGLE. I think the bringing of all the levels of law enforcement together, but also developing those systems that I talked 

about from ODMAPs to the intake form, and the sharing of information back out to all aspects of fighting this battle, the prevention, education, treatment, and enforcement. And I think the one 

area that we all tend to, I do not want to say ‘‘overlook,’’ but I 

think is part of the prevention side is education. And, you know, 

what are going to do with future generations to look at the information we give them to process, and the training, and the educations in school to prevent this from happening down the road I 

think would be important. 

Mr. KRISHNAMOORTHI. Got it. Ms. Ayala? 

Ms. Ayala: I believe that it is two parts. So, the opportunity to 

discuss with our residents that issues of substance use disorder in 

the terms of public health and overall health of the community 

have probably been the most profoundly liberating aspects of our 

work. The other is to acknowledge that infrastructures for substance use disorder treatment is extremely limited. 

Mr. KRISHNAMOORTHI. Well, that transitions to my last question, which is, you know, the 2018 omnibus package appropriated $3.2 

billion to address the opioid crisis. We are still trying to figure out 

exactly how that money is going to get spent. But at least in my 

understanding, I do not think it is going to be directed so much to 

DFC, Drug-Free Communities, or the HIDTA programs, more to 

certain treatment programs, which is also a huge unmet need as 

well. But, I mean, what is your kind of impression of the amount 

of money that was appropriated, and, you know, what are some of 

the unmet needs that we really need to address that maybe we are 

not addressing even in this package. Ms. Haskins and just down 

the row. Very briefly, please. 

Ms. HASKINS. You will never be able to treat your way out of this 

problem regardless of how much money you throw at it. So, unless 

you continue to fund and at additional funding levels, unless you 

continue fund prevention —— 

Mr. KRISHNAMOORTHI. Right. 

Ms. HASKINS.—you will never have enough money for treatment. 

Mr. KRISHNAMOORTHI. Right, thank you. Ms. Roberts? 

Ms. ROBERTS. I would have to agree with Ms. Haskins. It has 

been typical for a long time for most of the money to go towards 

these sort of downstream crisis problems and less money to go towards preventing them in the first place. And I think that is one 

of the reasons why we are seeing this crisis now. 

Mr. KRISHNAMOORTHI. Thank you. Mr. Siegle? 

Mr. SIEGLE. I would agree also, prevention. You know, also we 

cannot arrest our way out of it. We cannot treat our way out of it. 


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And I think we need to avoid getting those people at that level because we have lost them by that point. 

Mr. KRISHNAMOORTHI. Thank you. Ms. Ayala? 

Ms. Ayala: And although I absolutely agree and support everything that has been said, I also do not think we can ignore this 

large population that now find themselves ensnared in the chemical dependency. And so, I would say we have some obligation as 

a civil society to address their needs. 

Mr. KRISHNAMOORTHI. Thank you. Thank you, Mr. Chair. 

Mr. PALMER. I would just add I agree with all four of your responses on that, and just add this, and it is in regard to the Medicaid expansion. I think we cannot ignore this, that there has been 

a dramatic increase in addiction in the States that have expanded, 

and that we are better off, as each of you said, directing Federal 

funding on prevention. We cannot ignore the addiction issue either, 

that we have go to deal with it. But I think that we have also got 

to recognize that there is a problem, that we have created a problem with the expansion. And, you know, my previous career was 

with a think tank. Part of that was engineering, and one of the 

things that we fundamentally understood is you cannot solve a 

problem until you properly define it. 

With that, again, I would like to thank the witnesses for appearing and for your testimony. The hearing record will remain open 

for 2 weeks for any member to submit a written opening statement 

or questions for the record. 

[The information follows:] 

Mr. PALMER. If there is no further business, without objection, 

the Subcommittee on Healthcare, Benefits, and Administrative 

Rules stands adjourned. 

[Whereupon, at 11:37 a.m., the subcommittee was adjourned.] 


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Æ 


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