U.S. GOVERNMENT PUBLISHING OFFICE

31–521 PDF WASHINGTON : 2018

COMBATING THE OPIOID CRISIS 

HEARING 

BEFORE THE

COMMITTEE ON OVERSIGHT 

AND GOVERNMENT REFORM 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

NOVEMBER 28, 2017 

Serial No. 115–101 

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

( 

Available via the World Wide Web: http://www.govinfo.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 

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 

Stacey E. Plaskett, Virgin Islands 

Val Butler Demings, Florida 

Raja Krishnamoorthi, Illinois 

Jamie Raskin, Maryland 

Peter Welch, Vermont 

Matt Cartwright, Pennsylvania 

Mark DeSaulnier, California 

Jimmy Gomez, Maryland 

SHERIA CLARKE, Staff Director 

WILLIAM MCKENNA, General Counsel 

SARAH VANCE, Healthcare, Benefits, and Administrative Rules Subcommittee Staff Director 

MICHAEL KOREN, Professional Staff Member 

SHARON CASEY, Deputy Chief Clerk 

DAVID RAPALLO, Minority Staff Director 


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C O N T E N T S 

Page 

Hearing held on November 28, 2017 ...................................................................... 1 

WITNESSES 

PANEL I 

The Honorable Chris Christie, Governor of New Jersey 

Oral Statement ................................................................................................. 5 

Written Statement ............................................................................................ 10 

PANEL II 

Mr. Richard Baum, Acting Director, Office of National Drug Control Policy 

Oral Statement ................................................................................................. 43 

Written Statement ............................................................................................ 46 

Dr. Leana Wen, Health Commissioner, Baltimore City Health Department 

Oral Statement ................................................................................................. 57 

Written Statement ............................................................................................ 59 

Dr. Caleb Alexander, Co-Director, Center for Drug Safety and Effectiveness, 

Johns Hopkins Bloomberg School of Public Health 

Oral Statement ................................................................................................. 83 

Written Statement ............................................................................................ 85 

APPENDIX 

‘‘The Opioid Epidemic From Evidence to Impact’’ October 2017 submitted 

by Dr. Alexander can be accessed here: https://www.jhsph.edu/events/ 

2017/americas-opioid-epidemic/report/2017-JohnsHopkins-Opioid-digital.pdf ................................................................................................................... 104 

Representative Gerald E. Connolly Statement for the Record ............................ 105 

Letter of November 21, 2017, from Association for Behavioral Health and 

Wellness submitted by Mr. Cummings .............................................................. 107 

National Healthcare for the Homeless Council Statement for the Record submitted by Mr. Cummings .................................................................................... 110 

Response from Mr. Baum, Office of National Drug Control Policy, to Questions for the Record .............................................................................................. 114 

Response from Dr. Wen, Baltimore City Health Department, to Questions 

for the Record ....................................................................................................... 115 

Response from Dr. Alexander, Johns Hopkins Bloomberg School of Public 

Health, to Questions for the Record ................................................................... 117 


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COMBATING THE OPIOID CRISIS 

Tuesday, November 28, 2017 

HOUSE OF REPRESENTATIVES, 

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

Washington, D.C. 

The Committee met, pursuant to call, at 12:42 p.m., in the Chevy 

Chase Auditorium, Johns Hopkins Hospital, 1800 Orleans Street, 

Baltimore, MD, 21287, Hon. Trey Gowdy [Chairman of the Committee] presiding. 

Members present: Representatives Gowdy, Grothman, Palmer, 

Comer, Cummings, Norton, Clay, Lawrence, Raskin, and Welch. 

Also present: Representatives Sarbanes and Ruppersberger. 

Chairman GOWDY. Thank you, Governor, thank you, Mayor Pew, 

thank you, Johns Hopkins for pardoning the inconvenience of having a Committee of Congress come, and appreciating the seriousness of the issue that brings us here. The Committee will come to 

order. Without objection, the Chair is authorized to declare recesses 

at any time. I am going to break from protocol a little bit because 

we are in Mr. Cummings’s hometown, and because he cares so passionately about this issue, we are going to recognize you first for 

your opening statement. 

Mr. CUMMINGS. Thank you very much, Mr. Chairman, and I 

want to first of all, take a—just to mention one thing that is so important to me, Mr. Chairman, and to the members of this panel. 

I cannot come into this hospital without saying thank you to 

Hopkins for saving my life, and spent 60 days here this summer, 

a lot of it in this building. And so I want to thank—I see a lot of 

white coats out there and others, but pass the word. I thank you 

for what you have done for me and my family. 

I want to begin by thanking Chairman Gowdy for calling today’s 

very important hearing, and for bringing the Oversight Committee 

to Baltimore. I also thank my colleagues for coming to Baltimore, 

and certainly my colleagues who represent Baltimore along with 

me as Dutch Ruppersberger and John Sarbanes. I thank you for 

being here. 

I have been in Congress now for 20 years and I have been 

through and seen a lot of field hearings. I have never seen as many 

members attend any field hearing since I have been in Congress. 

I believe today’s remarkable turnout reflects the fact that the 

opioid crisis is truly a national emergency that does not discriminate based on politics. It affects the red states and blue states, and 

every state in between. So I am extremely grateful that the Chairman agreed to my request to bring the Committee to—on the road 

to investigate the devastating effects of this very difficult problem. 


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I also want to thank Dr. Miller and Johns Hopkins for your 

warm welcome and your hospitality. The work that you do makes 

a huge difference in our community and around the globe. I also 

thank our esteemed guests, Governor Hogan and Mayor Pew, for 

joining us. We are honored to have you in our presence. And of 

course, I thank our witnesses, Governor Chris Christie, Commissioner Wen, Dr. Alexander, and Mr. Baum. Thank you for testifying and for all that you are doing to help us combat opioids and 

save lives. 

A year and a half ago at our Committee’s first hearing on this 

issue, I warned that so many people were dying in communities 

across America and that we could no longer ignore this emergency. 

Today, the Centers for Disease Control and Prevention estimates 

that more than 64,000 Americans died from drug overdoses in 

2016, an increase of more than 20 percent over the year before. 

To put this in perspective, the death toll from drug overdoses last 

year alone was higher than all U.S. military casualties in Vietnam 

and Iraq wars combined. Every 20 minutes someone does from an 

opioid overdose. If today’s hearing lasts for two hours, half a dozen 

families will have lost a parent, a sibling, or a child to opioids. We 

have the reports. We have had years of talk. Now it is time for action. The American people are looking for us to take action. They 

are looking to the President and the Congress, and they are asking 

what are you going to do? 

Governor Christie and the other members of the President’s 

Commission on Drug Addiction have given us an excellent blueprint for action with dozens of recommendations. Now it is up to 

us, Republicans and Democrats, Federal, State, and local officials, 

researchers, policymakers, doctors, drug companies, health providers on the ground, and families of the faith communities. We 

need to work together to end this epidemic. 

There are some things that we can do right now to help prevent 

addiction and save those who already have this disease. For example, we can ensure that every single person who needs naloxone 

has it. The Commission’s report highlights the importance of equipping first responders with naloxone, including police officers, fire 

departments, and public health officials. But here is a challenge. 

Drug companies have continued to hike the price of this 45-yearold drug and communities have been forced to ration it. In September, I led 50 Members of the House of Representatives in sending a letter urging President Donald Trump to negotiate lower 

prices for naloxone, just as the Commission recommended. Unfortunately, we never received a response. The President should act now 

to ensure that naloxone is available at a reasonable price wherever 

and whenever it is needed. 

We also need to ensure that every affected person has access to 

effective treatment. According to the Commission, and I quote, 

‘‘Today, only 10.6 percent of youth and adults who need treatment 

for substance use disorder receive that treatment.’’ Only 10 percent. There is simply no way to end this crisis if 90 percent of those 

affected are not being treated if we do not act now. To do this, we 

need funding. 

Last month, President Trump declared this epidemic a public 

health emergency, but he did not propose any additional funding 


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to combat it. We cannot fight this epidemic without funds equal to 

the challenge we face. This is a sad but stark truth. 

So finally, we must recognize and acknowledge the many factors 

that put people at risk: woefully inadequate support for our children and our vulnerable residents, worsening economic inequality, 

lack of opportunity, and profound disparities in the criminal justice 

system. We cannot solve this crisis until these risk factors are addressed. 

With that, Mr. Chairman, again, I thank you for convening this 

critical hearing, and I look forward to the testimony and taking action on it, and I ask, Mr. Chairman, with unanimous consent, that 

Representatives Ruppersberger from the State of Maryland and 

Representative Sarbanes from the State of Maryland be permitted 

to sit in with the Committee and participate in this hearing today. 

And with that, I yield back. 

Chairman GOWDY. Without objection, welcome to our colleagues. 

I also want to thank the Johns Hopkins community for taking such 

great care of our friend and colleague over the summer. You sent 

him back stronger than ever, so thank you all for whoever had a 

role in that. You didn’t send him back quite that strong, but you 

sent him back stronger than ever. 

Governor Christie, Governor Hogan, recent past and present governors have witnessed the most devastating drug epidemic in our 

Nation’s history. Since 1999, more than half a million Americans 

have died from a drug overdose, and the epidemic is escalating. 

Over the span of nearly 20 years, the death toll has quadrupled 

with the emergence of even more potent drugs and an ever-expanding online marking for illicit distribution. 

Today, drug overdoses kill more Americans than gun homicides 

and car crashes combined. That is a staggering reality. Two out of 

three daily deaths from drug overdoses in the United States involve an opioid, a class of drugs commonly prescribed to relieve and 

manage pain. And actually, over 33,000 Americans died from an 

opioid-related overdose in 2015, which is an 11 percent increase 

from the year before. 

In South Carolina where I come from, Greenville and 

Spartanburg Counties in particular, suffered more than 100 opioidrelated overdoses in 2015, and while the numbers in the upstate 

of South Carolina are fewer when compared with cities like Baltimore, behind every number and every statistic is a life with loved 

ones and friends and potential and aspirations. We have a tendency to use numbers in government and in our line of work, but 

the victims aren’t numbers. The victims are fellow human beings 

ravaged by the consequences of drug addiction, including the abuse 

of prescription painkillers. 

We are a remarkable country of progress and innovation, community and charity. We can cure diseases that past generations lived 

in fear of. We can put people on the Moon and we can split atoms. 

Yet we are struggling with how to respond to this epidemic. I guess 

we need to start with how did we get here? There are more illicit 

users for these drugs, and there are illicit users for these drugs and 

there are licit users for these drugs. One is unlawful, of course, the 

other is legal, but with the potential for abuse and misuse remaining. 


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Physicians have a role to play for certain. These drugs are not 

available legally without a prescription. What are the pharmaceutical alternatives? Is there overprescribing? Is there sufficient 

information shared with patients to avoid misuse and abuse? 

Frequent exposure and easy access to painkillers has led to dependency and tolerance, which drives those with a substance abuse 

disorder to intensify doses or methods with out without the help of 

a physician. Addiction to prescription painkillers is growing exponentially. On the illicit side of the equation, the level and actors 

are diverting high potent pills to the black market to be laced with 

heroin, resulting in drugs so lethal they have been called Gray 

Death, a term used to describe the high risk associated with every 

single injection. Opioid-related overdoses are now deadlier than the 

HIV–AIDS epidemic at its peak, more insidious that the cocaine 

base, cocaine powder epidemic that predated it. 

So there are a plethora of questions to be asked, such as whether 

we are being as effective as possible in the diversion of these highly 

toxic substances? I actually like doctors. I happen to be the son of 

one. But, I also prosecuted doctors. And I want to make sure the 

DEA and DOJ are effectively going to the source of prescriptions 

issued outside the course of a professional medical practice. Is HHS 

monitoring insurers, placing pricier but less addictive opioids out 

of reach for patients with acute pain? Are states regulating socalled sober homes, which can move vulnerable patients in and out 

of treatment, typically for profit? These are the questions our Committee and the American people want answers to. The health and 

safety of our communities all across the Nation are at risk. Although almost everything seems capable of being reduced to political exercise in our current environment, I genuinely hope that this 

epidemic is above that. I hope it is about protecting those susceptible to addiction and punishing those fueling the epidemic. Death, 

especially among the premature—especially the premature death of 

a young life has no political or ideological bet. Victims are victims. 

Perpetrators are perpetrators. Addiction is addiction. Heartache is 

heartache. 

The issue, to me, comes down to those of good conscience earnestly seeking a solution and those of a malevolent conscience bent 

for profit off of other people’s addiction and pain. It is not just the 

deaths that devastate our families and communities across the 

healthcare system; it is also the disease of addiction that is permeating and threatening in some places within our country the very 

fabric of those communities. 

At the same time, pain is real. It is real for a homebuilder in Mr. 

Cummings’ district or mine with immense back pain who can’t otherwise get out of bed in the morning without his physician-prescribed pain medication. 

So how do we solve this epidemic? There is a prevention aspect, 

there is a treatment aspect, there is an education aspect, there is 

an enforcement aspect, there is a punishment aspect, and there is 

an oversight aspect. In March, the President signed an Executive 

Order creating a Commission consisting of governors and attorney 

general mental health advocates, and a professor of psychobiology 

to recommend policies for the Federal response to this epidemic. 

Earlier this month, the Commission finalized recommendations for 


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how the Federal Government can help states and stakeholders 

tackle the evolving crisis and stave off emerging threats. Today, we 

will have an opportunity to highlight the report, and in Baltimore, 

and appropriately so. We will also examine Baltimore’s state and 

Federal partners and how they can assist with and learn from the 

efforts that are occurring here. The devastating statistics may 

leave us feeling like we have just left the start line, but our country 

is resilient and we have resources. We have compassion. I think we 

have the commitment to win this battle with opioid and opioid addiction. 

Chairman GOWDY. So I want to thank all of our witnesses. Governor Christie, you are the governor of the great State of New Jersey. As I mentioned to you in the ante room, you are also a former 

United States attorney, so you are uniquely well-suited and we 

cannot thank you enough, not just for your presence today, but for 

your willingness to undertake this vitally important responsibility 

and role, and with that, you are recognized. 

PANEL I 

WITNESS STATEMENTS 

STATEMENT OF THE HONORABLE CHRIS CHRISTIE, 

GOVERNOR OF NEW JERSEY 

Governor CHRISTIE. Thank you, Mr. Chairman. Ranking Member 

Cummings, thank you for your work in this area, and thanks to all 

members of the Committee for inviting us today. 

As the Chairman mentioned, in March the President asked me 

to chair his Commission on Opioid and Drug Addiction in our country. We worked together to name a bipartisan group of people to 

join that Commission. I think that is an important place to start. 

I can tell you, as the Chairman referenced in his remarks and Mr. 

Cummings in his, I am acutely aware as a Republican governor in 

the State of New Jersey that there is much that divides political 

dialogue in our country right now that makes it very difficult for 

us to get things done. This cannot be one of them. 

I read the obituaries that are happening regularly in our state, 

and in none of the obituaries do they designate whether the person 

that died was a Republican or a Democrat. They are a son or a 

daughter, a husband or a wife, a mother or a father. And so I hope 

that what we try to do in the Commission and this Committee is 

trying to do today will help to rise—give this problem the ability 

to rise above the partisanship that we have in our country today. 

It is true, this is the greatest and broadest public health epidemic of our lifetime. Everything else pales in comparison to the 

breadth of this problem. It is everywhere in America. One hundred 

seventy-five people are dying per day, which for someone who 

comes from where I come from, the most powerful analogy is that 

this means that we have a September 11 every two and a half 

weeks. Every two and a half weeks. 

Now I want to ask all of you and ask this Committee, if we had 

a terrorist organization that was invading our country and killing 

175 of our citizens every day, what would you be willing to pay to 

make it stop? We don’t ask that question in this country, and the 

reason we don’t ask this question, in my view, is because we still 


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believe that this addition is a moral failing. We are making moral 

judgments on the people who are suffering and dying, and we are 

making moral judgments on their families. 

Every time I go to a drug treatment center in my state and I ask 

someone who is in the midst of treatment, tell me your story. Within the first two minutes, they say to me but Governor, I am from 

a good family. And my response to that is why would you think I 

would think otherwise? The reason why they believe that is because the stigma that is attached to this disease each and every 

day makes people believe that they have to defend their very upbringing, their performance as parents, their role as a child. That 

somehow we believe that this is a choice. 

I would love to see a show of hands in this audience of who has 

not made a bad decision in their life. Usually works. The fact is, 

we all have. Many of us in this room are fortunate that bad decision was not to abuse opioids or heroin, because if it had been, we 

might be in a very different judgment position than some people 

are today. Addiction is a disease. It is a chronic disease, and it 

needs to be treated as such and viewed as such. That is why I am 

proud the President declared this a national public health emergency. 

Now, as Mr. Cummings mentioned, we need to fund the Public Health Emergency Fund, which by my last check was at $66,000. 

I don’t think that is going to make it, everybody, in combating this 

problem. We need to fund the Public Health Emergency Fund to 

make sure that the Administration has at their disposal the resources that they need to implement the recommendations that the 

Commission has made. 

We had lots of discussion in the opening remarks about the role 

of physicians and healthcare providers in all of this. Let me be very 

clear. This is a drug epidemic that did not start on the corners of 

Baltimore or the corners of my hometown in Mendham. They started in doctor’s offices and in hospitals across this Nation. And while 

some of it, as Chairman Gowdy implied in his remarks, are done 

by folks who have bad intent, most of these done by folks who have 

no intent. Why do physicians and healthcare providers have no intent on this issue? Because they are not educated on this issue. 

Broadly across our country in medical schools in every state in the 

union, we are not educating our future doctors and nurses, dentists, on the dangers of these drugs. 

We grant DEA licenses to write prescriptions for these drugs 

without requiring continuing medical education on opioid addiction 

and how it can lead to heroin addiction. I, as a lawyer—a recovering lawyer, but a lawyer nonetheless—I have to—even as governor today, I have to take continuing legal education every year 

to maintain my license. And I’m not practicing. How is it that physicians can have a DEA license and not be required to have continuing medical education on this very problem when 64,000 people 

died last year? The Commission recommends that we do that. And 

if you don’t believe that limits on opioid prescription length as an 

initial prescription work, with exceptions, obviously, for people who 

are terminal from cancer and in hospice. 

Let me tell you what is happening in New Jersey just since we 

put a five-day limit on opioid prescriptions beginning on March 1 


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of this year. Opioid prescriptions in New Jersey are down 15 percent from March to October, and the number of pills are down 20 

percent that have been prescribed in just that seven-month period 

of time. Those restrictions work, and they should be instituted in 

every state across this Nation, and that is also in the report. 

I want to commend the President for granting waivers to states 

now for the old-fashioned, antiquated, and ridiculous IMD restriction, Institutes of Mental Disease. It says that if there is any hospital healthcare provider that has more than 16 beds, 16, that 

those folks cannot be reimbursed for the federal share of Medicaid 

because they are a state psychiatric hospital. What that means is 

there are literally thousands of beds that could provide the treatment that Chairman—that Ranking Member Cummings recommended in his remarks that could begin to take that 10.6 percent number up significantly, but are not opened because of this 

antiquated waiver. States have been asking for this ability to waive 

this for years. I commend the President for ordering that to be 

done, and tomorrow in New Jersey, the head of CMS will be coming to New Jersey with me to announce that New Jersey has received a waiver, and that hundreds of beds will open within the 

next six months for people who need drug treatment. And these are 

folks who are the neediest in our society, those folks who qualify 

for Medicaid. 

We need to increase physician education across the Nation, and 

we need to decrease the influence of the pharmaceutical industry 

on that education. See, right now most doctors only get their education from the very companies that are producing the pills that 

they want them to prescribe. 

Now as Chairman Gowdy said, I am a former prosecutor, and 

that makes me a little bit skeptical, and I am from New Jersey, 

which makes me completely cynical. And so what that tells me is 

if the only education physicians are getting are from those people 

who want them to prescribe these pills, and then in 2015 259 million prescriptions for opioids were written in this country, enough 

to give every adult in this country their own bottle of 30 pills, 259 

million. We are four percent of the world’s population, and we consume 85 percent of the world’s opioids. If you don’t think that that 

is where this problem started, listen to the CDC who says that four 

of every five new heroin addicts began with prescription opioids. 

We need to have alternatives to opioids, because as the Chairman said, pain is real for many people in this country. But that 

is what pharmaceutical companies should be spending their money 

on, not on paying doctors to write more prescriptions for opioids. 

And so that is why we as a Commission brought together Dr. 

Francis Collins, the head of NIH, and all of the executives of the 

major pharma companies in this country in New Jersey and got 

them to agree to a partnership where they will now work with NIH 

to come up with two different solutions to this problem. First, more 

non-opioid painkillers to be put on the market and be affordable, 

and second, more alternatives to medication-assisted treatment for 

those who are already addicted. Right now we have three in this 

country. There should be more. 

Those pharma companies said they have 43 different compounds 

among them that could address either or both of these issues. If 


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they are not moving forward, we need NIH to be the accelerant for 

moving them forward, and I would urge this Committee to look at 

additional funding for NIH specifically for that program to make 

sure that we work in partnership with the pharma companies to 

get these things to market, along with the FDA, as quickly as possible. If people have an alternative to opioids, both the physicians 

who prescribe these things for pain, and the consumer who wants 

to avoid addiction, to have non-opioid alternatives, that would be 

enormously helpful in stemming the tide here. 

The insurance companies play a large role in this as well. Now 

as a governor, I get folks all the time saying to me well, why don’t 

you change the regulation of insurance companies to make sure 

that they are covering drug treatment, so that middle class folks 

in our country who have employer-provided health insurance can 

get treatment, when right now most of them do not. And I say well, 

remember this. Only 30 percent in my state of the health insurance 

policies, employer-based health insurance policies, are regulated by 

the State of New Jersey. Seventy percent are regulated by the Federal Government under ERISA. So we say why doesn’t the Department of Labor step in? Well, they don’t have the authority to do 

it. Under the statute that Congress passed in the Mental Health 

Parity Act, they do not allow the Department of Labor to fine an 

insurance company or an employer who is not treating mental 

health and addiction with parity, and they do not allow the Department of Labor to investigate individual insurance companies. They 

must go employer by employer. How ridiculous is that? 

We urge the Congress and the Commission to give the Secretary 

of Labor both the authority and the responsibility to fine insurance 

companies that are not treating addiction with parity to all other 

diseases, and to give the Secretary of Labor the authority and the 

responsibility to be able to investigate insurance companies directly, and not have to go employer by employer by employer, when 

we know that we have a number of very large insurance companies 

in this Nation that cover thousands of employers. As a former prosecutor, I can tell you, one robust investigation is a lot easier to 

staff than 2,000 little ones, and much more effective. 

Lastly, and then I will leave it for questions, because I can go 

on for a long time. Drug court is a very important part of this. We 

need alternatives to incarceration. We have put forward in New 

Jersey the largest criminal justice reform in the last two years of 

any state in America, and one of the things we have done is institute drug court in every county in our state. 

What does it mean exactly? When you come in, not as a dealer, 

not as a violent actor, but as a non-violent possessor, an addict, you 

are now in New Jersey required by law to go to drug court and you 

are diverted to treatment, not to jail. Now if you don’t take your 

treatment seriously and the judge decides that you are not utilizing 

the opportunity that is being given to you, they will then send you 

to jail. But you are going to get a chance first to go to treatment. 

We should have drug court, and the Commission recommends this 

as well, in every federal district in this Nation. One judge in every 

federal district committed to dealing with the drug problem in this 

country, to diverting people into treatment and to giving those families and those addicts who are suffering from this disease hope 


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and opportunity to get better. I am a former prosecutor. I am all 

for jailing people who profit from this poison, and I am in favor of 

putting them in jail whether they are standing on a street corner 

in any town or city in this country, or whether they are standing 

in a hospital or in a doctor’s office. If you run a pill mill and you 

have a physician, you should go to jail just as soon as this drug 

dealer on the corner should go to jail, but we will not solve this 

problem by incarcerating addicts. And we must get them the treatment that they need to be able to have the tools to recover. 

In New Jersey, we have now been the first state in the country 

to convert a state prison into a drug treatment facility, and so now, 

state prisoners who are in their final year of incarceration who 

have a demonstrated drug problem transfer from a standard state 

prison to the state prison treatment facility that we have on the 

property of Fort Dix in New Jersey run by a certified addiction 

treatment company that works in conjunction with our Department 

of Corrections to give people the tools to deal with their addiction 

before they leave prison, so that when they get back on the street, 

we lower their chance for recidivism. All these things are in the report recommended for states and the rest of this country. We are 

proud of Governor Baker, Governor Cooper, Attorney General 

Bondi, Congressman Kennedy, and Professor Madras who joins me 

on the Commission and worked in a completely nonpartisan manner to make these recommendations to the President, and I hope 

that the members of Congress work with the President and hold 

the Administration and each other responsible for getting something done on this issue. 

Thank you, and I am happy to take questions. 

[The prepared statement of Governor Christie follows:] 


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Chairman GOWDY. Thank you, Governor Christie. I will now recognize the gentleman from Maryland for his questions. 

Mr. CUMMINGS. Thank you very much, Mr. Chairman, and thank 

you, Governor Christie. I want to—and as I said to you before the 

hearing and now, an excellent report. 

I want to talk about naloxone a little bit. I had a situation, Governor, where not very long ago I was at an event for the Maryland 

Legislative, my caucus, and I walked outside coming out of the 

event and somebody just dropped a man right in front of the hotel. 

And I said well what’s going on? They said well this happens all 

the time. We see people who may be at a party and they don’t 

know—the person has an overdose and they don’t know what to do. 

And I use that as an introduction with regards to naloxone, because of course, as you well know, it has been—it is a drug that 

has been used to save lives with regard to overdoses. And in your 

report, you are saying—this is what you said. Price increases of the 

various forms of naloxone continue to create affordability issues, 

preventing state and local governments, as well as community organizations from stocking naloxone at the levels necessary to rescue more people from the overdose. Is that correct, Governor? 

Governor CHRISTIE. That is true, sir, yes, and what we recommend in the report is that governments, starting with the Federal Government, should band together to use their purchasing 

power to make bulk purchases of naloxone at lower prices, and 

then there is no reason why—we do this in many other areas of 

bulk purchasing, whether it is through the GSA, as you know, or 

through other entities, to be able to do this. And there is no reason 

we shouldn’t be able to do this with naloxone. 

And one of the things we are doing in New Jersey, which we are 

also recommending in the report, is co-prescribing. When you are 

a physician, you prescribe an opioid, to prescribe at the same time 

naloxone to go to the home, because some of these overdoses are 

not intentional. They are accidental. Someone is in severe pain, 

thinks well if two pills every four hours is good, four pills might 

be better. So it is not just for the person who is suffering from addiction, it is also for the person who unintentionally misuses this, 

to have naloxone available in the home so that—in an easy form 

so that the folks who live with them, if they have an overdose like 

the one you mentioned outside the hotel, it is—in its nasal form 

now it is very easy. It is two pushes of a button. One in one nostril, 

push the button, one in the other nostril, push the button, and you 

save a life. 

Mr. CUMMINGS. You know, our health commissioner will be testifying in a few minutes. It is one who has been very strong, Dr. Wen 

here in Baltimore. You know, but the thing that I think bothers me 

so much about naloxone is that the price was jacked up, I mean, 

big time, when—at the very time when first responders and others 

were trying to get it because they saw the effectiveness of it. 

Did you have discussions with any of the manufacturers or drug 

companies with regard to naloxone? 

Governor CHRISTIE. We did not in terms of the pricing issues—— 

Mr. CUMMINGS. Okay. 

Governor CHRISTIE. —Congressman. What we did, though, talk 

about was the concept of bulk purchasing and their willingness to 


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consider the idea of bulk purchasing lowering prices. And so we did 

talk about that with the manufacturer—with a few of the manufacturers, and that is why we urged it in the report. We believe it is 

something that can be done, and that these manufacturers recognize. And the Commission emphasized to them their social responsibility. 

Mr. CUMMINGS. And that negotiation recommendation that you 

just talked about was in—I noticed it was in the interim report, but 

I didn’t see it in the final report. 

Governor CHRISTIE. This is some confusion. The way the Executive Order was written, Mr. Chairman, was that the President 

wanted first an interim report and then a final report. They should 

not be read as mutually exclusive, they should be read together. 

And so if there is, I think, 56 recommendations in the final report, 

there is nine in the interim report. We have made 65 recommendations. So the nine interim recommendations remain fully enforced 

and in effect and should be added to the final report. So—— 

Mr. CUMMINGS. Good. Well I am glad you clarified that. I 

thought you just kind of changed your mind. 

Governor CHRISTIE. No, sir. I think you know me well enough to 

know that changing my mind would be a difficult thing. 

Listen, I reminded the White House on a regular basis, and you 

need to know this. 

Mr. CUMMINGS. My last question—— 

Governor CHRISTIE. This was our report. 

Mr. CUMMINGS. My last question is this. Have you discussed this 

report at length with the President? In particular, have you discussed this naloxone recommendation? 

Governor CHRISTIE. Yes, I have discussed it with—— 

Mr. CUMMINGS. And which response did you get? 

Governor CHRISTIE. I did not—let me fully answer this, sir. I 

didn’t—we have discussed the report at length. I have not discussed the specific pricing issue of naloxone. My conversation with 

the President was more on how important it was for all law enforcement officers and first responders to have it, but we did not 

get into the pricing part of it in my conversation directly with the 

President. But I have had that conversation with other members 

of the Administration. 

Mr. CUMMINGS. Thank you very much, Mr. Chairman. 

Governor CHRISTIE. Thank you, sir. 

Chairman GOWDY. The gentleman from Maryland yields back. 

The gentleman from Wisconsin is recognized. 

Mr. GROTHMAN. Sure, a couple questions. 

This is really a horrible thing, and I think it is a very publicized 

problem and it is still underpublicized. Did you look at other countries who perhaps did not have the opioid problems we have? I was 

in Taiwan like 10 years ago and they had almost no problem. 

Could—I think England has a big problem. Could you comment on 

the criminal justice systems and how they deal with possession or 

sale of opioids in other countries? 

Governor CHRISTIE. Yeah, we didn’t look at it from a criminal 

justice perspective. What we looked at it from was an availability 

perspective, and the biggest difference we see between our country 

and the others is the extraordinary overprescribing of these drugs. 


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We believe that part of it was caused by the Federal Government, 

quite frankly, with this, you know, pain as a vital sign requirement 

where everybody who leaves the hospital has to have the smiley 

face, you know, on their lack of pain. And the hospitals were evaluated on this basis, and so what was going on was hospitals were 

like heck, if we are going to be evaluated on this basis, you are 

going to leave with no pain, and the best way to leave with no pain 

is to give you a whole bottle of Percocet and get you taking it. 

And so the difference is the way at the very base of this problem 

we are dealing with the availability of this medication. 

Mr. GROTHMAN. Okay. Do you know anywhere where I would 

even be able to get access to how they treat possession or sale of 

opiates in other countries that don’t have this problem? 

Governor CHRISTIE. Sure. We—and the Commission can be very 

helpful in that regard, because we dealt with a lot of other countries on those issues but not on the particular one you are talking 

about. But we would be happy to help. Could you get your staff in 

touch with ours? We would be happy to help. 

Mr. GROTHMAN. Yeah. Next question I have, what percentage of 

people who are arrested for opiates, heroin or whatever, are addicted and what percentage are just using it? 

Governor CHRISTIE. I don’t know the exact numbers, Congressman. What I will tell you is that the rate of addiction in terms of 

the amount of time that it takes someone to get addicted to these, 

according to the CDC, is as little as three days. So if you have a 

predisposition to this, within three days of your use you could become addicted. Which is why the CDC says their recommendation 

is to limit prescriptions to no more than three days on initial prescription, because they think beyond three days you can become addicted. 

Mr. GROTHMAN. Have you talked to anybody who—when you talk 

to people who are arrested for heroin, do they say they were addicted in one or two days? 

Governor CHRISTIE. I will tell you that this young woman—yes. 

The answer is yes, and I have spoken to literally hundreds of people across my state in treatment centers about this who say that 

the time for addiction is very brief. I will tell you that young—one 

young woman who is part of our public advertising campaign on 

this issue in New Jersey, it is a young woman who suffered an injury, knee injury. She used her first bottle of pills. This young 

woman, who was a college graduate, cheerleader in college, went 

out, had her first job, and she was addicted within the first week 

that she was on these drugs. She went from being employed, having her own place to live, supporting herself, to within 60 days having lost her job, moved out of her apartment, and was living on the 

streets of Atlantic City in New Jersey and prostituting herself to 

get heroin. 

Mr. GROTHMAN. Okay, I will give you one more question because 

I don’t see—normally, as you know, on these Committee hearings 

have a clock, but I don’t—in Vietnam, as I understand, heroin was 

somewhat widely used, and something has been said about how 

quickly it was not used by the troops once they got back in the 

United States, which would be a little bit inconsistent with the 

idea that heroin is always addicting. Can you comment on that? 


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Governor CHRISTIE. Yeah, I don’t think anything is always addictive to anybody. I don’t think it is always addictive, sir. I think 

there are people, as we know, who use prescription opioids and 

some who use heroin who use it and can use it recreationally and 

not become addicted. So I think we have to be very careful about 

using the phrase always or never in this context, because you are 

dealing with human beings who have different genetic backgrounds 

and make-ups, different psychological make-ups, and different 

physiological make-ups, and I think any of the physicians who are 

here at Johns Hopkins would tell you this is what makes what they 

do an art, as well as a science. 

And so no, there is no always on this, sir, but what I would tell 

you is that when CDC says that four out of every five heroin addicts start with prescription opioids—and we are talking about the 

same compound—this is something that is lethal in terms of its 

ability to become addictive. 

Mr. GROTHMAN. I will give you one more question. 

Governor CHRISTIE. Sure. 

Chairman GOWDY. The red light—if you are wondering where the 

lighting system is, it is right there in front of the Governor. Although I am in such a charitable mood, if you do have one more 

short question, emphasis on short. 

Mr. GROTHMAN. Sure. One of the questions—or one of the things 

on treatment is, of course, some people feel that treatment is frequently ineffective. Could you give us your opinion on what constitutes ineffective treatment or how we can avoid ineffective treatment? 

Governor CHRISTIE. Well what constitutes ineffective treatment 

is anything that’s not evidence-based. And so we should not be operating theoretically here, and there is no reason to because there 

is sufficient information across this country in the medical community about what works and what doesn’t, and medication-assisted 

treatment works for most people who try it. The fact is, though, 

that the way to make sure the ineffective treatment isn’t happening is through the state regulatory bodies who regulate the Departments of Health across this country need to be very vigilant 

about regulating what happens in treatment centers. And there are 

places in this country where you have a lot of fallacious treatment. 

I don’t want to be the first to shock you and say that there is 

fraud in all different areas of our country when there is money to 

be made. That does not discount the value of treatment. What it 

does is it increases the need for regulatory bodies and prosecutors 

to go after those people who are ripping off people by giving them 

false hope and fake treatment. 

Chairman GOWDY. The gentlelady from the District of Columbia 

is recognized. 

Ms. NORTON. I thank you very much, and I want to thank you, 

Mr. Chairman, and the Ranking Member for this very important 

hearing, and I want to thank you, Governor Christie, for coming 

and for your very forthright report which minces no words. 

The last Congress and the last Administration did come forward 

with a billion dollars, but we have seen no slowing in this epidemic. Indeed, my own district, which is not considered one of the 


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most serious districts, the District of Columbia, tripled in this 

opioid crisis in just two years. 

This notion of a national emergency versus a public health emergency has emerged, and I note, Governor Christie, that the report 

indicated that this was a national emergency. Is that not the case? 

Governor CHRISTIE. Well no, what the report indicates is we believe it is a national emergency that can be addressed one of two 

ways, either through the calling of a public health emergency 

under the Public Health Safety Act, which was our preferred method, or on the declaring of an emergency under the Stafford Act. 

Ms. NORTON. Now which—and why did you prefer one to the 

other? 

Governor CHRISTIE. Because of who would administer the funds. 

If it is under the Public Health Safety Act, the funds will be administered by the Department of Health and Human Services. If it was 

under the Stafford Act, it would be administered by FEMA. Having 

had a little experience with FEMA during a small storm in New 

Jersey, I would just tell you that I don’t believe, based on my experience, that FEMA would be necessarily the best folks to administer these funds, and that the folks at Health and Human Services 

would be better. That is why we made that. We gave the President 

an alternative because our—we felt our job was to present alternatives, but I can tell you that my recommendation to the President was to do it under the Public Health Safety Act so the funds 

would be in the Public Health Emergency Fund; therefore, administered by folks who I think—no apparent disrespect to FEMA— 

that would have a greater sense of expertise on how to deal with 

this issue at HHS rather than at FEMA. 

Ms. NORTON. You know, I can see that bureaucratic difference 

may make a difference otherwise. 

Governor CHRISTIE. Especially if you are a governor who dealt 

with FEMA, it makes a big difference. 

Ms. NORTON. You—the region—this region where we are now, 

Maryland, Virginia, the District of Columbia, just had a summit on 

this issue. Governor Hogan has declared a national emergency or 

a state emergency here. I am trying to find whether the declaration 

of a national emergency would encourage Congress to, in fact, come 

forward with farther funding that you indicate that you thought 

was necessary. I mean, your remarks were replete with versions of 

funding one way or the other. You asked at the beginning of your 

testimony what would we pay a terrorist, for example, who invaded 

our country and making that analogy to what opioid has done. You 

have called in your testimony for funding the Public Health Emergency Fund for funding, NIH, but we sit here and Congress is, 

frankly, lost focus here. In fact, we are not sure whether the government is going to be kept open and therefore, nobody is thinking 

about this issue. 

Would declaration of some kind of emergency force this back to 

the front burner of the Congress of the United States, which has 

not funded anything since last Administration funded $1 billion in 

additional funding for this emergency? 

Governor CHRISTIE. Well with all due respect, I think if Congress 

needs different wording to focus its attention, then we need—— 

Ms. NORTON. Then what would you suggest? 


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Governor CHRISTIE. —a new Congress because if you can’t tell 

from 64,000 Americans dying a day that this is an emergency because the President did it under the Public Health Safety Act as 

opposed to Stafford Act, then I would say to members of Congress 

on both sides of the aisle that you need to reassess from a Governor’s perspective what you are doing. And I recognize the billion 

dollars that the last Administration, the last Congress put in. Let 

me put that into some context of what is needed. 

In New Jersey this year, in New Jersey, we are spending $500 

million. 

Ms. NORTON. Of their own money? 

Governor CHRISTIE. Yes, state money, $500 million. And so I am 

not, quite frankly, impressed with a billion dollars from the Federal 

Government for the Nation, when the State of New Jersey is dedicating from—in a $34 billion budget, we are dedicating half a billion dollars just to increasing availability for opioid treatment, 

training, naloxone. All of that is being supplied by the state to localities. 

Now we need help from the Federal Government, and I want to 

be clear about the public health emergency. It is a national emergency. It is just two different ways of doing it. Whether it is under 

the Public Health Safety Act or the Stafford Act, and my recommendation was the Public Health Safety Act to keep this away 

from people who don’t know about this problem. There is confusion 

about all this, and you want to see real confusion? Let’s put FEMA 

in charge of naloxone. As somebody who was, you know, waiting for 

blankets and food and water in Sandy, I don’t want to be waiting 

for FEMA to give me naloxone. 

Ms. NORTON. Thank you very much. 

Governor CHRISTIE. Thank you. 

Ms. NORTON. I see the red light. 

Governor CHRISTIE. Thank you, ma’am. 

Chairman GOWDY. The gentleman from Alabama is recognized. 

Mr. PALMER. Thank you, Mr. Chairman. 

Is this on? 

Chairman GOWDY. There you go. Now we can hear you. 

Mr. PALMER. Is the clock started now, or did it—— 

Mr. CUMMINGS. It just started. 

Mr. PALMER. No, or did it start after my colleague turned on the 

microphone? 

Chairman GOWDY. I would ask me to—yes, I am restarting. Look 

into the Iron Bowl and how upset you are. 

Mr. PALMER. Don’t go there. 

Governor CHRISTIE. It is worth at least 15 seconds. 

Mr. PALMER. All right. I just wanted to go back to something 

that was brought up by my colleague from Wisconsin about heroin, 

and as an initiator versus the over-prescription of painkillers. And 

what we found is that in opioid addiction as initiated by painkillers 

like oxycodone and hydrocodone has actually gone down from 42.4 

percent for oxycodone to 27.8—I mean, to 24.1 and from 42.3 percent for hydrocodone to 27.8, but in terms of heroin as an initiator, 

it has gone from 8.7 percent in 2005 to 33.3 percent in 2015. So 

I think we are on two tracks here, Governor, that I think that the 


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medical community has to address, but also the law enforcement 

community has to address. 

Governor CHRISTIE. Oh, no question. 

Mr. PALMER. There needs to be a tandem effort. 

Governor CHRISTIE. Right, the report talks about that. There is 

no question that we need to make sure that enforcement against 

those—I think I said this in my opening statement, that as a 

former prosecutor, enforcement against those who are profiting 

from the poison that they are spreading throughout our communities has to continue, and has to continue aggressively. And so I 

don’t think there is any—there is no reason you can’t chew gum 

and walk at the same time. The fact is that we also need to acknowledge that treatment as a part of what our overall spend is 

across the national government and state governments is a fraction 

of what we spent on enforcement. 

And so I want the three-legged stool to operate. I want there to 

be education prevention, interdiction, and law enforcement and 

treatment. But right now, the prevention education part of the 

treatment part are shorter legs of that stool, and as long as that 

continues, we are going to continue to have this problem. But you 

will not find me being opposed to stricter enforcement. I am 

against those who are profiting from this, but we must draw a distinction, in my view, between those who are profiting from it and 

committing violent acts in support of it, and those who are addicted, and without those other elements. Those people I think, in 

the criminal justice system, need to be dealt with differently than 

those who are profiting from it. 

Mr. PALMER. I also think we need to look at this in a holistic 

manner. There is—I don’t know anyone who doesn’t know someone, 

either a friend who has a family member who hasn’t lost someone 

to an opioid overdose. It crosses every boundary that you can think 

of: race, gender, income level, profession. But one of the interesting 

things is—that doesn’t get talked about is family structure. When 

you take a look at that, 68 percent of the population is either married or widowed. Yet that only represents 28 percent of the overdose deaths. Whereas the never married and divorced population is 

about 32 percent, but they represent 71 percent of the opioid 

overdoses. 

I would like to see us do a deeper dive into that to start looking 

at the ages in those categories, but I think that has got to be part 

of the discussion is the overall breakdown of the family and how 

that has contributed to this. 

Governor CHRISTIE. You know, I think as a father of four, married for 31 years, I believe we are doing something right, at least, 

we are trying to. But I also want to be very careful about this as 

well, because there are plenty of folks who are in the situation I 

am who wind up having children who wind up addicted. And so 

there is—part of what we said in the report is there is not one silver bullet to fix this problem. There just isn’t, and whether it is 

treatment or interdiction, so I think all of those things have to be 

considered and looked at as part of what is leading our country to 

consume 85 percent of the world’s opioids with four percent of the 

population. So something happened all across our country that is 

encouraging this. But there is no question that all those things 


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have to be things that are considered, but I don’t want to mislead 

anyone that there is one silver bullet to fix this, because there is 

not. 

Mr. PALMER. Well—— 

Governor CHRISTIE. I am confident of that. 

Mr. PALMER. —for my own personal experience, one of my children’s classmates, a tremendously talented young African American artist died of an overdose, and then one of my board members 

of the think tank that I ran, I literally sat in their living room with 

them while the local authorities removed the body of his son in his 

bedroom who had died. 

My last point, Mr. Chairman, if I may, is taking a look at the 

drugs prescribed through Tricare and through the VA. I have gotten information from different people about the tremendous numbers of drugs and—that are sent out that these people don’t need. 

This is a huge issue in Alabama. It gets back to where we started— 

or where I started with the overprescribing of medicine. If you 

would like to address that? 

Governor CHRISTIE. That is a large part of the diversion problem, 

right, so that that is why we have advocated in the report and it 

is happening, and it is a good partnership with the private sector 

as well. Places like Rite-Aid and Walgreens and other major national pharmaceutical—pharmacy chains that are setting up kiosks 

in all their stores for people to safely dispose of these unwanted or 

unused medicines. A lot of times what happens is that a young 

man or young woman in their own home, their parents get a prescription for this. They don’t use the entire prescription and it 

stays there, and they decide heck, I might as well try this. Or 

worse, they take it out and they go to sell it because there is great 

value on the streets for this. 

So the over-prescription of this in every way impacts this crisis 

in an enormous extent, and that is people who overuse it themselves, and it is also people who are—don’t use it but don’t know 

how to get rid of it safely, and as a result it winds up hanging 

around and is available for diversion to either other users directly 

in their home or to be sold outside of the home. 

Mr. PALMER. Thank you, Mr.—— 

Governor CHRISTIE. I do want to mention one other thing, if I 

could, on the VA. We took a field visit as a Commission to the 

Louis Stokes Veterans Hospital in Cleveland, and they are doing 

some extraordinary things in lowering the opioid use by veterans 

with alternative therapies and other ways to deal with this issue 

with our vets, and we versed in the report that Secretary Shulkin 

expand that throughout all the veterans hospitals for the very reason you talked about. There are a lot of these vets who know they 

don’t want to take this stuff, but are in real pain from the war 

wounds that they have suffered defending our country, and they 

are coming up with alternatives that are really helping the veterans community in Cleveland, and we think would help the entire 

country. 

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

Chairman GOWDY. The gentleman from Missouri is recognized. 

Mr. CLAY. Thank you, Governor Christie, for your testimony 

today. You know, while we have made critical gains in coverage as 


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a result of the ACA, we still have work to do. We need to make 

sure that they ACA’s parity requirement, which requires that insurance benefits for our mental healthcare be comparable to those 

for physical healthcare. I guess that is why you recommend that 

the DOL must have authority to investigate insurance companies. 

Let me quote the report. It says ‘‘The Commission found that 

there are commercial insurance barriers to Medicaid and assisted 

treatment, despite the fact that such treatment is evidence-based 

and largely successful.’’ Would you agree that all insurers, both 

public and private, should work to remove barriers? 

Governor CHRISTIE. Sure, and that is the law in the country. I 

mean, this is the frustrating thing. Congress passed the Mental 

Health and Addiction Parity Act, but for reasons that are beyond 

me, gave the Executive Branch no ability to enforce it. And so we 

are—I don’t want to be, again, New Jersey cynical, but we are 

counting on the goodwill of the insurance industry to cover this 

treatment that is required, but there is no penalty for not doing it. 

So my view is as a former prosecutor, the law should be followed, 

and if Congress’s will and the President’s will at that time is to 

make sure that mental health and addiction is treated with parity 

and physical ailments, then the law should be enforced. 

Mr. CLAY. So we need to put more teeth in the—— 

Governor CHRISTIE. You got it. And listen, we had Secretary 

Costa at a hearing of the Commission, and he asked for this authority. He said if you give me this authority, I will use it. And 

Chairman Gowdy I think knows that Secretary Costa is also a 

former U.S. attorney who served with me during the Bush 43 Administration. I know Alex well and I am convinced that somebody 

with his background and experience as a prosecutor in Miami on 

this issue will be very, very aggressive if the tools were given to 

him, and I urge Congress to give him the tools. 

Mr. CLAY. Thank you for that response. I represent the State of 

Missouri and I am proud of a lot of things, but one issue that I am 

not that proud of is that we have a patchwork for a PDMP in Missouri. It may go by county or by city, but it is not really statewide 

and it is not effective. Talking to law enforcement in Missouri, they 

tell me that it is really becoming pill mill, and that is an attraction 

for users as well as physicians who want to make profit off of that. 

Tell me how is Missouri—how do they compare to the rest of the 

Nation as far as being a PNA problem for law enforcement? 

Governor CHRISTIE. It pains me to say this to you, sir, but it is 

the worst state in the Nation. 

Mr. CLAY. Yeah. 

Governor CHRISTIE. It is the only state in the Nation without—— 

Mr. CLAY. No, I appreciate—— 

Governor CHRISTIE. —a comprehensive—— 

Mr. CLAY. We need to be critical of our state. 

Governor CHRISTIE. It is stunning to me that there is a state in 

this Nation any longer that doesn’t have a comprehensive prescription drug monitoring program, and that they are not sharing that 

information with their neighbors. We know there are people who 

go from state to state to be able to fuel this addiction, and one of 

the—not only effective law enforcement tools, but it is also an effective healthcare tool predominantly for our physicians. They can use 


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the PDMP, be able to see when someone comes in presenting with 

symptoms that might induce them to prescribe, but if they go the 

PDMP and see that this patient has had a dozen, two dozen, three 

dozen from other doctors prescriptions for this, they can stop adding to the problem then. 

So Missouri is a state that is the sole outlier on this issue, and 

one that is damaging the health and the safety and welfare, in my 

view, of the people of Missouri. 

Mr. CLAY. And I appreciate hearing that, and I will make the effort with our legislature and governor to reinforce it and tell him 

how much we need to get our act together. 

Governor CHRISTIE. Yes, sir. 

Mr. CLAY. Final question. HHS and CMS now get down to the 

tough work of implementing some of your Commission’s report, and 

I understand that hey are calling for states to apply for waivers 

from the IMD exclusion. New Jersey and Utah just got a waiver 

approved, but as I understand it, CMS has insisted that waivers 

are budget neutral, so CMS is asking for states to fund—to find 

cuts elsewhere in underfunded behavioral health systems to pay for 

SUD treatment and residential settings. To me, that doesn’t reflect 

the urgency of this epidemic. 

Can you talk to us about how New Jersey dealt with it? 

Governor CHRISTIE. Yeah, I think that we are finding areas—and 

this is part of, I think, each governor’s responsibility, is to find 

places within the Medicaid program where spending is not being 

effective. And so I think it is a good start. I think once we become 

convinced at the state level that we have done what we need to do 

in terms of cost savings, that then the Administration is going to 

have to make the next decision, which is to lift budget neutrality 

requirements from it. 

You will notice in our report we do not ask for a waiver of IMD 

with budget neutrality, we just ask for a waiver of IMD exclusions. 

That is our ultimate recommendation, but I can tell you in New 

Jersey that governing is about choosing, and I do believe that given 

the level of this crisis, I can make the choices as governor that are 

necessary to make those beds available almost immediately. But 

there will come a moment when you are cutting into bone and not 

fat, and when that happens, then I think the broader IMD exclusion is something without budget neutrality that needs to be considered by the Administration. 

Mr. CLAY. Thank you for your responses. My time is up. 

Chairman GOWDY. The gentleman from Kentucky is recognized. 

Mr. COMER. Thank you, Chairman Gowdy, and Governor 

Christie, thank you for being here today to discuss the growing crisis of substance abuse in our country. 

The opioid epidemic is a particular challenge for my State of 

Kentucky where overdose deaths rose by 12–1/2 percent last year 

alone. I appreciate your work as chairman of the President’s Commission on Combating Drug Addiction, and look forward to working 

together to make progress on this issue for all the American people. 

My first question is I would like to discuss the issue of fentanyl, 

which accounted for nearly half of the overdose deaths in Kentucky 

last year. Can you briefly discuss the Commission’s findings and 

recommendations related to this especially lethal drug? 


KING-6430 with DISTILLER
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Governor CHRISTIE. Yes. Fentanyl and carfentanil is what will 

take this crisis to its next geometric explosion, because the 

strength of fentanyl and carfentanil is so beyond normal street heroin that the first usage of it can lead to death, and often does. It 

is so lethal that law enforcement officers who come to crime scenes 

where this is have to be careful in terms of the way they deal with 

the crime scene so they don’t contaminate themselves and wind up 

overdosing. And in the report, we make it very clear that this is 

a Chinese problem, and we have urged the President and the Secretary of State to make this a priority with the Chinese and the 

negotiations that they are undergoing right now. China is where 

most of the fentanyl and carfentanil is coming from, sometimes— 

more times than not, we found—and this is why we recommend an 

increase in border security, not just at the Mexican border, but 

with the United States Postal Service. The United States Postal 

Service is delinquent in stopping these drugs. These drugs are 

being mailed in to the United States, and as are with the other carriers like FedEx and UPS and others, we are not having the level 

of enforcement that we need. 

And to your point before, Congressman, you know, this is one of 

those areas where I think we need to be able to step up our efforts 

at the Postal Service and at DOJ through the DEA to make sure 

that we are stopping this stuff from coming into the country, but 

we also need to make very clear to the Chinese that this is an act 

of war. You are sending this into our country to kill our people. 

There is no other purpose for this drug. This drug will kill people, 

and any foreign country, in my view, who is wilfully allowing this 

to be done is committing an act of extraordinary aggression on our 

country and it needs to be met with the right type of diplomatic 

response by the Administration and the Secretary of State, and we 

have urged that in the report. 

Mr. COMER. And I appreciate the work that you have done, along 

with the Administration, on seeing a recent crackdown in the Chinese manufacturers, and look forward to working with the Committee to see what more we can do through the Internet and postal 

systems to try to prevent that. 

My last question, through legislation like the 21st Century Cures 

Act, Congress has worked to provide more support and flexibility 

to states who are on the frontlines of this battle. From your experience as governor, as well as your work on the Commission, what 

advice do you have for Congress on how best to support state and 

local efforts to combat opioid epidemic both now and over the long 

term. And I know you mentioned the billion dollars didn’t go very 

far when you divide it up among the 50 States, but as you know, 

we are in a financial crisis as well in this country so what advice 

do you have for Congress? 

Governor CHRISTIE. Well first off, I think if this battle is going 

to be won, it is going to be won with the Federal Government and 

the state governments acting as partners, but with the state governments taking the lead. We are the ones who are on the ground, 

and as you said, the problem in Kentucky is different than the 

problem in New Jersey, and the problem here in Maryland is different than the problem in Missouri. These are state circumstances 

depending upon all the different ways that you go about enforceVerDate Nov 24 2008 15:52 Nov 02, 2018 Jkt 000000 PO 00000 Frm 00031 Fmt 6633 Sfmt 6633 H:\31521.TXT APRIL

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ment in your state, the ways you go about treatment in your state 

and its availability. So our view is that there is—there should be 

accountability block grants that block grants should be sent to the 

states for dealing with this crisis, and that Congress should be demanding accountability in return for the block grant. If I am given 

a block grant as a governor, and I say in New Jersey the best way 

for me to spend this money is X, and it will show a decrease in 

deaths, if I show that decrease in deaths, I should continue to get 

my funding. And if I don’t, my funding should be reduced. To force 

me as a governor to be accountable for what I am doing. 

With all due respect to Congress, you know, it is a very difficult 

job to be able to determine individual programs that are necessary 

and effective in all 50 states, and so I really believe we have to 

trust the governors. And because I don’t believe this is a partisan 

issue, I don’t think there is a Republican or a Democratic way to 

combat this. So I think part of this is going to have to be a leap 

of faith between Congress and the governors to be able to sit down, 

and I really do believe that if Congress is serious about doing 

this—and the President—they need to sit down with the governors. 

They all come to Washington in February. I won’t be there, but the 

rest of them will be. And the fact is that we need to sit down and 

say listen to the governors as to what they need and Congress then 

needs to make demands on the governors and say okay, if we are 

going to be partners in this and we are going to help you fund this, 

then what accountability measures are you willing to give us so 

that we can be accountable in the financial situation we are in, 

that this money is being spent in a way that is effective to save 

lives? And that should—in my view should be the determining factor. If that number, that 64,000 continues to go up, we are failing. 

When it starts to go down, we are succeeding. 

Mr. COMER. Well thank you, Governor, and I yield back. 

Chairman GOWDY. I have not gone yet either, so let me share 

this with my colleagues. We want to be a good steward of the Governor’s time. We also want to be a good steward of the next panel’s 

time, so to the extent we can get it done before the red light comes 

on, that would be great for everyone. 

And with that, I would recognize my friend from Michigan, Ms. 

Lawrence. 

Ms. LAWRENCE. Thank you, Mr. Chairman and Ranking Member 

Cummings, and thank you, Governor, for being here. 

You know, there is a saying that in government, if you want to 

know my priorities, follow my budget. Many of the organizations 

receiving funding through the Community Mental Health Block 

Grant through the Substance Abuse and Mental Health Services, 

and these fundings provide the wraparound services. We are talking about the access to the drug, but those of in this room and 

those who have been on the ground with this know putting those 

services to transition and nurture a person out of addiction back 

to a healthy life, training, rehabilitation, case management, comes 

through the Substance Abuse and Mental Health Services. 

Unfortunately, the House Appropriation bills which we will vote 

on this month proposes cutting funding for the Community Health 

Mental Health Services Block Grant by $141 million, and our 

President’s budget proposed cutting it by 116. Now the CommisVerDate Nov 24 2008 15:52 Nov 02, 2018 Jkt 000000 PO 00000 Frm 00032 Fmt 6633 Sfmt 6633 H:\31521.TXT APRIL

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sion—and I read your report. Thank you for it, but you strongly 

recommend and urge Congress to do their constitutionally delegated duty and appropriate sufficient funds. It is—being in Congress and being a former mayor and being in local government, sir, 

being held accountable for my budgetary decisions, I find I am perplexed how we can have this Commission have—you being appointed, doing all this work, yet still what we do in our budget 

would just cut the legs from under this program. 

I need you to know in your leadership and in your recommendations to this bipartisan body, this agenda of this budget that cuts 

the thing that we are saying that we are so passionate about—we 

have statistics. I wanted to say in Michigan we have enough drugs, 

like you said, in the United States to give every person in the State 

of Michigan 1.8 prescriptions, 1.1 prescriptions, which is 84 opioid 

pills for every resident in my state. That is how many prescriptions 

we write. 

So—but if we really want to make a difference, if they live, we 

want to get them off of it. So I need you to comment on that. 

Governor CHRISTIE. Well yes, and I think we are very clear in 

the report. We believe there needs to be a greater financial commitment at all levels of government to this problem. 

Now, you know, the fact is there are lots of other things that we 

can do as well and should be doing that won’t cost us anything, so 

increased medical education, increased requirements of continuing 

medical education for DEA licensees. There are a lot of good things 

we can do that don’t, but please, what we said in the report, we 

mean, which is that we do not sufficiently fund these programs 

now and we also recommend in the report that there needs to be 

an evaluation of all the different programs, and you just mentioned 

one of them, and there are literally dozens and dozens of programs 

we looked at that are being funded. How effective are they? I can 

tell you that GAO did two reports during the Obama Administration that said that these programs were not being effective in stemming the tide. We know that from the sign that is behind all of 

you, the number of deaths. 

So I think there are a couple of things that need to be done. One 

is to—for us to hold ourselves accountable for all the good ideas we 

have had in the past. Some of them were good and some of them 

weren’t. Let’s reevaluate it and reassign that money to places that 

we think can be effective, and then there is going to have to be additional funds given. And I—we made that very clear. I made it 

clear to the President in my direct conversations with him, and 

every member of Congress who has asked me about this, I have 

said there is no avoiding having to increase funding to deal with 

this problem. The question is how and you guys get to make that 

call. 

Ms. LAWRENCE. Mr. Governor and to the panel, we often hear the 

thing of repeal and replace the Affordable Care Act, and I equate 

that to you having a Cadillac and you don’t change the oil or you 

don’t rotate the tires, and then when the car doesn’t operate, you 

say that the car is inefficient and you just throw it away. 

The Affordable Healthcare Act is—provides essential health benefit services that actually directly go to the mental health parity 

part, but all we talk about is repeal and replace, and I don’t know 


KING-6430 with DISTILLER
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if you are comfortable talking about this, but I am very comfortable. It is a time for us to have real discussion on this. We talk 

about the lives that we are losing, and we are so compassionate 

and our hearts break when we read the obituaries, but we must 

do the work. And I want to be that voice in the room while we are 

talking about this, the action that needs to be taken needs to happen. It is not good enough to get a Commission together, write an 

excellent report, if you don’t fund it. If you don’t look at the Affordable Healthcare Act that had those essential services that we are 

saying eliminate, how are we going to get to where we need to go? 

Thank you so much. My red light is on. 

Governor CHRISTIE. One thing I would just quickly in response 

to that say to you is we need to remember that no matter—my position on the Affordable Healthcare Act is pretty clear over time, 

but I won’t get into all of that. I will just tell you this. The Affordable Healthcare Act insures a fraction of the number of people that 

private health insurance in this country insures, and yet, Congress 

is not permitting mental health and addiction parity to be enforced 

for them. And so, you know, the fact is that we have tens of millions of Americans who work hard every day and are able to obtain 

health insurance through their employer and pay for a good part 

of that as well, and they are not getting the benefit of the law and 

parity either. 

And so I don’t think it is just in talking about the Affordable 

Healthcare Act, we are not enforcing that as the Affordable 

Healthcare Act. We are not enforcing that as to private insurers. 

You want to talk about a feel good piece of legislation, okay, the 

Mental Health and Addiction Parity Act is a feel good piece of legislation, because when all you do is ask would you please do this, 

and if you don’t, there is no penalty, we know what happens in 

those circumstances. 

And so I think we have to have even a broader discussion about 

it, because it is not just for those people who are covered now 

under ACA, it is also those people who have been covered under 

private insurance for a very long time who are not getting the benefit of that law that is now a decade old. We have not been enforcing that law since the day we passed it. So it seems to be we got 

to have an even broader discussion that I think includes all of that. 

Ms. LAWRENCE. We have to do the work. 

Governor CHRISTIE. Right. 

Chairman GOWDY. Professor Raskin? 

Mr. RASKIN. Mr. Chairman, thank you. Governor Christie, again 

welcome to Maryland. I want to, first of all, salute you for the passionate intensity of your leadership of this Commission and the 

way that you have clearly absorbed all of the lessons of it in a powerful way. And I also want to thank you for the comprehensive nature of the recommendations that are in the report, which have— 

which include messages for us in Congress, and I very much take 

your point about empowering the Secretary of Labor to act, and I 

hope that is one of the things that will come out very concretely 

from today’s session. But also, there are a whole series of recommendations across the Federal Government, the Department of 

Education, the Department of Justice, the National Highway Traffic Safety Administration, HHS, and so on. 


KING-6430 with DISTILLER
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So I know you are a big Bruce Springsteen fan. Who is the boss 

now? In other words, who is in charge of implementing all these 

recommendations across the Federal Government and being the 

leader and making sure that these things comes to fruition? 

Governor CHRISTIE. Well first and foremost, the President has to 

be the leader. He is the person who empowered this Commission, 

and he is the leader of the Executive Branch of government and 

it is his responsibility under the Constitution to make sure that the 

laws are duly executed. So the buck stops with the President of the 

United States, and I am confident that the President is serious 

about this effort and will put the resources that are necessary to 

do it. 

Mr. RASKIN. Can I just follow up on that point? So I was following your work very closely. You came out with the Commission 

report on November the 1st, I think it was. It was just—— 

Governor CHRISTIE. Yes, it was. 

Mr. RASKIN. —earlier this month. Did you come down and have 

a session with the President and his advisors about everything that 

is in this report and talk about what the next steps are? 

Governor CHRISTIE. Yes, sir. 

Mr. RASKIN. Okay, and what came of that meeting? I mean, has 

he appointed—is there an opioid crisis czar in the White House 

now? 

Governor CHRISTIE. Not to the best of my knowledge. 

Mr. RASKIN. Should there be one? 

Governor CHRISTIE. Listen, I think as a governor, you know, the 

czar I think sometimes gets a little overplayed. I think the fact is 

the President needs to give direction to his new HHS Secretary. 

Because if you look at the recommendations, you are right that 

they are all across government. That is why at every one of the 

Commission hearings, we had the Deputy Attorney General, we 

had the Secretary of HHS until there was a change there, and then 

the Acting Secretary. We had Secretary of Labor. We had the Secretary of Veterans Affairs. All of those individual cabinet officers 

I think need to be empowered to take the section of the report that 

is theirs and report back to the President on what they are doing 

on a regular basis to implement it. 

Mr. RASKIN. But you—but as a governor, you also know if everyone is responsible, no one is responsible. 

Governor CHRISTIE. The President is responsible. 

Mr. RASKIN. Okay, well—— 

Governor CHRISTIE. It is—— 

Mr. RASKIN. —with no respect to the President then, I mean, we 

have tweets about people kneeling during the playing of the National Anthem. We have tweets about who got the Americans out 

of China from shoplifting charges. I haven’t seen any tweets about 

the opioid crisis, and I don’t see the kind of passionate intensity 

of leadership that we need to deal with what you described as the 

equivalent of a 9–11 every two weeks in the United States of America. 

Governor CHRISTIE. Well let me respectfully say this. Before this 

President, you didn’t see a national Commission on this problem. 

This problem didn’t just start on January 20 of 2017. This problem 

was building for years before this, and neither President Obama 


KING-6430 with DISTILLER
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nor President Bush empowered a national Commission to come up 

with recommendations, put absolutely no restrictions on that national Commission on what restrictions—what recommendations I 

could make. This President is the President who has declared a national emergency. This President is the one who has begun to grant 

IMD waivers. This President is the one who is taking the leadership on this. 

So listen—— 

Mr. RASKIN. I am just asking about constructively moving forward—— 

Governor CHRISTIE. But that is—— 

Mr. RASKIN. —how do we make sure that—you know, there are 

dozens of recommendations in here. How do we make sure that 

they actually get into practice at every level of government? 

Governor CHRISTIE. Well there are a few ways. First of all, the 

President of the United States is the Chief Executive and he should 

require of those men and woman who serve in the Cabinet offices 

that he has appointed them to that are covered in this report to 

report to him on the progress they are making in implementing the 

report. I don’t think that requires another person sitting in the office in the executive office building, you know, sending out emails, 

with all due respect. I, as a governor, I hire cabinet people. Those 

cabinet people are supposed to run those departments and I think 

that is what the President is going to require of them, but more 

importantly, what they have seen is that this President is the first 

President who has elevated this to this level, and he deserves great 

credit for that. And I know it is very fashionable right now in lots 

of different corners to be critical of all those different things, and 

I have been critical of some of it myself, but I don’t believe it is 

right at this moment in time to be critical of the President’s efforts 

in this regard, and he will be held to account for what he produces. 

But I would also say that Congress has to step up as well, and 

this is not just the President’s responsibility, but every person sitting up here and every other member of the 535 of you know about 

this problem. You didn’t need my report. Our report gives you some 

good recommendations, but what you know is that people are dying 

in your district every day. And so I would say what are members 

of Congress doing as well to demand that this be done? If that happens, then there will be a cacophony in that city which will force 

action from both the Executive and the Legislative branch. 

Mr. RASKIN. Thank you, Mr. Chairman. 

Chairman GOWDY. Gentleman from Vermont, Mr. Welch. 

Mr. WELCH. I will try to be quick in light of your admonition. 

Number one, Governor Christie, greetings from Governor 

Shumlin. He gave the State of the State in 2014 where it was totally dedicated to opiate crisis, and I remember many of my colleagues wondered why in the world would you do that, and then 

started acknowledging that this is a huge problem in their states. 

Second, we need concrete actions. There is bipartisan concern 

about this issue. There is bipartisan conflict about spending on just 

about anything. But you outlined some concrete things we could do. 

For instance, if we can’t appropriate money, which I would be in 

favor of, many people here would be, we can at least deal with the 

drug company rip-offs, and you acknowledged that cost increase 


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that is really becoming an enormous burden on our local communities that are on the frontlines of trying to address this. 

So my—I want to ask you this question and then I will stop. The 

ideal outcome here is that Congress would step up and find the 

areas where we can act that it would make a difference, like addressing the cost issue, like the prescription issue. And my question to you is what would be your advice to this Committee, knowing that we are divided on many issues, but we have a common 

concern about this horrible scourge in our communities. What are 

the three things you would recommend for us to do? 

Governor CHRISTIE. You know, you are asking me to take 65 recommendations and boil it down to three. I am pretty good, but I 

am not that good. 

I would just tell you this, that the first thing we need to make 

sure we do on the supply side is to nip this fentanyl and 

carfentanil problem in the bud. If we don’t, 64,000 is going to look 

like the good old days. And so our interaction with the Chinese on 

this needs to be unequivocal, and our ability to invest in making 

sure that we are stopping this as best we can from coming into our 

country is going to be enormously important, because fentanyl and 

carfentanil is going to make heroin and prescription opioids look 

like child’s play. 

Secondly, I would say that the issue of education of our medical 

community, and I include the pharmaceutical companies in this, 

about the danger of these drugs and having a real national conversation on the cost benefit of using these drugs has to happen. 

With this many deaths—and I understand pain is real and the 

Chairman is right in his recommendation on that, that we need to 

deal with those folks who need to get to work every day and suffer 

from chronic pain, but I can tell you we are losing that fight. We 

are losing that fight because that homebuilder can’t go to work if 

he is dead. And so, you know, we need to try to have a conversation 

about that with our medical community and get them more tuned 

to the fact that this is killing people. 

Third, I would say we have to fund greater treatment in this 

country. We just have to. And so if you made me come down to 

three, I would say fentanyl and carfentanil and the interaction 

with the Chinese and our own law enforcement has to be strengthened, and our communications with the Chinese on this has to be 

unequivocal and see it as an attack on our country and its people. 

Secondly, we need to work on medical education because our medical community is not educated enough at this time on this issue 

across the country, and that is why we also recommend things like, 

you know, distance, you know, treatment of folks who are in rural 

areas, can’t get to a physician, being able to do that stuff in different ways is very important to do. And then lastly, we have underfunded treatment in this country and we need to make treatment more available to folks. I think it was as Member Cummings 

said in his remarks quoting the report, ‘‘When 10.6 percent of the 

people who need treatment are getting treatment, we need to do 

better.’’ And I think if you maybe boiled down 65 to three, I would 

go with those three. And I am sure when I leave, I will kick myself 

for not having picked a different one. 

Mr. WELCH. Thank you very much. 


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Mr. CUMMINGS. Yield? 

Mr. WELCH. I yield back. I yield to—— 

Mr. CUMMINGS. Just one question. I told the Chairman just a 

moment ago that this is one of your finest moments, and I really 

mean that. And I got to ask this question, because I think it is critical. 

How can you, Governor, with your passion and your full understanding and embracing of this issue, how can you help us bridge 

the gap between Republicans and Democrats so that we can get 

something done on this? And I mean—I don’t mean to put you on 

the spot, but I mean, it is a critical moment. And when you just 

said what you said about fentanyl, we got to do something, and you 

seem to have pulled it all together and come out with a very balanced report so that we can be effective and efficient, and that is 

all. 

Governor CHRISTIE. Well I appreciate the opportunity. I don’t feel 

burdened by it at all, by your question. 

The fact is that I will play any role that leaders of both the Congress and Administration want me to play as a private citizen in 

49 days to be able to continue this fight. Mr. Cummings, this is 

something that began to be passionate for me in 1995 when as a 

local county official, I was brought to a drug treatment center in 

my county for adolescents, and I saw what was going on there. And 

the priest who started this treatment facility said to me at the end 

of my visit, Chris, this is something you are going to want to be 

involved in for the rest of your life. Now in 1995 I was 32 years 

old. The rest of my life seemed a lot longer than it does right now, 

but I said to him Father, with all due respect, I mean, why am I 

the one being involved in this the rest of my life? And he said because you just walked out of a place where God makes miracles 

happen on Earth. 

And from that moment on, Mr. Cummings, I have been hooked 

on this problem and on saving lives. And so you can see what happened in New Jersey. I have worked as a Republican governor 

every one of my 2,920 days with a Democratic legislature, and with 

broad majorities, yet the package that we have done on this twice 

has passed overwhelmingly bipartisan majorities. And I gave my 

State of the State in 2016 on this with a package of reforms to insurance, to pharmaceutical companies. All things that are difficult 

things to do, they passed within 30 days and were signed. 

I am happy at any time, sir, at the encouragement of the chairman or of you to come and speak and meet with anyone and to use 

my relationship with the President, which goes back 15 years, to 

encourage people to say this is the new water’s edge in our Nation’s 

conversation. We have to end the politics here. We have to compromise with each other. There are going to be some things that 

people on my side of the aisle are going to have to vote to fund that 

they may have some concerns about, and there is some flexibility 

and trust that folks on your side of the aisle may have to give to 

governors that you are not normally accustomed to doing. But I 

think I can speak to that directly, and you have my word that I 

will not only speak out and continue to speak out publicly, but I 

am cool with every role you two gentlemen want me to play in 

helping you to do this, and the President knows I that I feel exactly 


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the same way. And I am one of the folks who has known him for 

15 years, so when he needs to hear some truth, he comes to New 

Jersey not just to play golf. Let’s put it that way. 

Chairman GOWDY. Gentleman from Maryland is recognized. 

Mr. SARBANES. Thank you, Mr. Chairman, and thanks for the opportunity to sit in on the hearing today. Governor, thank you for 

your testimony and thank you for the report of the Commission, 

which I think is outstanding and has a myriad of very positive recommendations that we need to—probably need to prioritize so that 

we can make forward progress. But I think a lot of the building 

blocks are there. 

We are very proud of the efforts here in Baltimore that our 

health commissioner, Leana Wen, who we will hear from shortly, 

has undertaken that healthcare providers, institutions like Johns 

Hopkins and others, are undertaking to change the trajectory on 

this. It is obviously a heavy lift. But these recommendations will 

help. 

I want to echo Congressman Cummings’ concern about making 

sure that naloxone is available in a way that it should be and there 

is not price gouging going on around that. I think that does need 

a closer look. I was able—and I want to thank you for the recommendation around co-prescribing of naloxone. We were able to 

get included in one of the bills that was passed last year, the Comprehensive Addiction Recovery Act, a proposal for demonstration 

project on co-prescribing of naloxone, to examine best practices 

around that, your recommendations, in a sense, are running along 

side that in a very positive way, so we thank you for that. 

My question is this. I would imagine that you don’t think yet 

that the sense of urgency that needs to be in the country around 

this issue is there, but it is changing. And as I move around in my 

district—and I am sure this is the experience of others—not only 

are you hearing about these tragedies that raise your awareness, 

but you are also hearing people say things like, you know, I went 

to my doctor the other day. I went to the dentist, and they gave 

me a prescription for this Oxycontin or something like that, and all 

I really needed was Tylenol. So patients are starting to step back 

from this, so something is getting to them. There is beginning to 

be a level of public awareness around this. 

When will you look at the situation, based on your experience 

and being involved with this Commission, and what will you see? 

What will be the indications to you that the level of urgency is 

where it needs to be among policymakers that the level of education and awareness out in the public is where it needs to be? Is 

it PSAs coming across the airwaves in a way that matches, you 

know, election time in a swing election somewhere? Is it the President getting a briefing every Monday morning on what the status 

is with all the steps that are being taken with respect to addressing this crisis? What are the indicators that you are looking for to 

say to yourself we are starting to get it here? 

Governor CHRISTIE. That is a really good question, Congressman. 

Thank you. 

So I have been asked this before. Someone in their remarks, I 

forget which member said it, talked about this epidemic being in 

greater numbers of deaths now than the AIDS crisis at the peak 


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of the AIDS crisis in the mid-1980s. I was alive then, and a young 

adult, and here is what I think. Were are the marches? 

See, I remember the AIDS epidemic and I remember marches in 

every major city in this country, and in Washington, D.C., with 

people marching to say the government must do something to find 

a way to stem the deaths. In this crisis, there are many, many, 

many more people impacted than were impacted in the AIDS crisis, 

yet we have no marching. And I will tell you that I think we will 

have seen that we have begun to remove the stigma of this disease 

when the people who are impacted are willing to show their face 

and march and demand from their government a response. And I 

believe they don’t march today because they are ashamed to march, 

because they don’t want to be identified—I am not talking about 

everybody, but I am talking about mass numbers. They don’t want 

to march. They don’t want to be identified as this having happened 

in their family to their loved one. And I think that that is why we 

recommended a national advertising campaign beyond PSAs. 

I will tell you, in New Jersey in this year, we will spend $50 million on an advertising campaign in my state to remove stigma and 

to let people know how to get treatment, $50 million of state 

money. And the reason we are doing it is because I don’t want people to be stigmatized anymore for this and to avoid treatment and 

avoid asking for help and avoid demanding that there be something 

done about this. 

I will tell you one quick story. My mother was an addict. She was 

addicted to nicotine. She began smoking when she was 16 years 

old, and she smoked for 55 years and she tried everything that she 

could to quit, and she couldn’t. And when she inevitably, it seemed, 

was diagnosed with lung cancer at the age of 71, nobody said to 

me well, your mother was smoking for 55 years. She has known 

since 1964 that it could cause cancer. She is getting what she deserved. No one said that. People said oh, we are so sorry for your 

mom. What can we do to help? Let’s recommend doctors or treatments, that she go to this hospital or that hospital. We are praying 

for you. They came and visited her. They consoled her. They encouraged her. And I felt no shame in telling people that my mother 

had lung cancer and that her lung cancer was caused by smoking. 

I want to ask you, sir, if my mother was a heroin addict, would I 

have done the same thing? And would all those people have come 

to her aid and recommended treatments and help? Would my dad 

have been willing to ask for that? 

I will know that we are at the brink of the urgency to this when 

those barriers go away, when people march to demand that Congress and the President and their government along with our private sector find treatments to treat people who are addicted and 

to find ways for them not to get addicted in the first place by alternative medicines. I will believe it when people are marching and 

showing their faces. And when that happens, we will know that we 

are on our way to a solution, and that is why I firmly believe in 

my heart and I believe the stigma is causing death every day, almost as much as the drug is itself. 

Mr. SARBANES. Thank you. I yield back. 

Chairman GOWDY. The gentleman from Maryland is recognized. 


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Mr. RUPPERSBERGER. Yes. Thank you, Chairman Gowdy and 

Ranking Member Cummings, thank you for having this hearing in 

Baltimore. It is such an important area, and to all our members 

on both sides of the aisle, welcome to Baltimore. 

Governor—and I want to acknowledge Dr. Wen, who has done a 

lot in the Baltimore area. 

Governor, I think you are at the right place at the right time. 

You were in local government. You were a prosecutor. You managed a major jurisdiction. That is kind of my life, local government 

and managing a jurisdiction, except I am in Congress and you are 

a governor. And I really appreciate the fact that you have made 

this one of your highest priorities. When you leave office, probably 

it will dominate your life for a while. 

Now there are a couple suggestions that I do have, though, and 

to make sure that we pull all this together. The first thing when 

you have a major crisis, you have got to identify the problem, and 

I think these hearings—we understand it with the deaths throughout the country, it is a national issue. It is not just in urban areas, 

rural areas, everywhere. But the part that I am interested in—I 

am an appropriator, and you know, one of the issues that we have 

to deal with is clearly money, and you know, we have to have that. 

There has been a lot of money put into this. There are other areas 

as far as treatment and drug—doctors, nurses, treatment centers, 

all those types of things. But I know in your report, which is a good 

report—I haven’t read it, but I have heard and I have been briefed 

on it. There are a lot of recommendations, and when you have that 

many recommendations, you have to pick priorities. But I think for 

us to get to the level—those of us who are appropriators, we are 

going to have to find out what your recommendations are for 

money, especially from the Federal Government. We have to have 

a number, and I would hope that your Committee or your staff on 

your Committee to start putting together a report. 

The second thing is there is no question you said that Congress 

maintains the power of the purse. But in this situation, the President who has within his power as President to free up funding as 

well. And I am glad the President has made this a priority, but everything in life you have to have follow through. And what your relationship—I didn’t know you knew the President for 15 years, that 

is even better—and with your tenacity, with your experience in all 

the areas that I talked about, I would like to know what your plan 

would be to work with his advisors, his Administration, to make 

sure we find out where we are as far as the money. 

Our governor, and I praise him, has—Governor Hogan has dedicated $10 million per year for the next five years to fight this epidemic. I think other governors throughout the country need to do 

that too, whether Republican or Democrat. And this is not a partisan issue. If there is anything that is partisan, this can’t be the 

case. 

So my question to you is, first thing, can you decide what the recommendations would be as far as funding is concerned? When we 

find that number, we will work with you. I will pledge to work with 

you as other appropriators, Democrats and Republicans, to find a 

way to get Congress to fund this issue and also to get the President. 


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You know, Congresswoman Brenda Lawrence made a comment 

about certain cuts that are already there, so if the President has 

made this such a high priority, we are going to have to influence 

it. We are going to have to find a way to get him to make this a 

high priority to go forward in what we need to do. 

Governor CHRISTIE. Sure, a few things. I think when you say the 

Commission or my staff, I want to be clear. My staff is sitting right 

over there. My chief of staff in the governor’s office was the main 

staffer. We were not given staff on this. We had some support from 

ONDCP, but I will tell you that the work that you see in that report is the product of the Commissioners, and so we did not get 

into an amount of money, and quite frankly, I didn’t think it was 

our province to do that. We laid out the priorities that we believe 

are very important, and we believe that every one of those are important priorities. 

Now I know from personal experience that governing is choosing, 

but the choosing now needs to be done by the President and the 

Congress, not by an unelected Commission. We have laid out all 

the things that we think need to be done in both near term and 

long term. Now I really believe it is up to the leadership of the 

Congress and the President, along with the appropriate Cabinet 

members, to sit down and to say how do we implement this plan? 

How do we want to do that? And I don’t think—listen. I have done 

this stuff as a governor, but no one elected me to do this. And I 

really believe that all of you are the ones who have both the authority and the responsibility to do it. I am happy to identify the 

problem and identify solutions and bring a practical opinion to it, 

but I don’t believe it is my realm to talk about how much. 

Mr. RUPPERSBERGER. I respect you, what you have done, but you 

are the man and if you can’t do it, nobody can. 

Governor CHRISTIE. I am going to have you call my wife and tell 

her that. 

Mr. RUPPERSBERGER. You have the expertise, you are an advocate, you have committed. But if you don’t have the money, it is 

not going to work. 

Governor CHRISTIE. I agree with you. 

Mr. RUPPERSBERGER. So we need you to be not only the advocate, 

we need you to be the lobbyist. We will work with you. We will— 

I will—Democratic and Republican staff, I guarantee you on the 

Appropriations Committee on the House will come together. But we 

need your expertise and your advocacy, especially when it comes to 

this President. 

Governor CHRISTIE. Sure. Listen, I—as I said to both Mr. 

Cummings and Chairman Gowdy, I am and will continue to be 

available to all the folks on this Committee and other members of 

Congress who care passionately about this issue to give you my advice, my counsel, my opinions, and to be an advocate. I am going 

to continue to be an advocate no matter who is in the Congress, 

no matter who is in the White House. I have been an advocate on 

this issue for 22 years. I am going to continue to be an advocate 

on this issue because in my heart, I believe that the most important role of government is to protect the health, safety, and welfare 

of its citizens. And this is right at the core of that, so—I don’t know 


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if I like the phrase lobbyist that you threw in there at the end, but 

I will certainly be—— 

Mr. RUPPERSBERGER. Persuader. 

Governor CHRISTIE. Yeah, I will be an advocate for this and I 

have been an advocate with the President all along, and I will continue to be. 

Mr. RUPPERSBERGER. My time is up, but my staff—I want to 

reach out to your staff to find a way how we can start working on 

the numbers. 

Governor CHRISTIE. Excellent. 

Mr. RUPPERSBERGER. That is end game. 

Governor CHRISTIE. I look forward to it, sir. 

Chairman GOWDY. Gentleman from Maryland yields back. Governor, I want to thank you on behalf of everybody for—not just for 

being here and sharing your perspective today, but for the hard 

work the Commission did. 

I go last when it comes to questioning, and I want you to—while 

we appreciate the audience that is here, they would be the upper 

echelon in terms of engagement and education. I want you to think 

of broader audience, broader jury, our fellow citizens that have 

heard about the epidemic, perhaps someone close to their family 

has been touched by it, but they don’t live and breathe it every day. 

As I listened to your opening, you can put physicians, I guess, 

in one of three categories. The vast majority of physicians are incredibly well-intentioned and they are well trained and they are 

well educated and they do it the right way for the right reasons. 

And then you have a group that is equally well-intentioned, but 

they lack the education on it, and you made reference to continuing 

legal education, continuing medical education. There is that group, 

and I don’t know how big it is. Our perspective is swayed by being 

prosecutors. There is that group that is profiting from people’s addiction, and I don’t see the diversion cases being prosecuted like I 

did in olden days. Am I missing it? Did you all find it? 

Governor CHRISTIE. No, I don’t think you are missing it. I do 

think that there has been over the course of the last decade or so 

a de-emphasis on that priority, and I think it is a mistake. It is— 

I often think, Mr. Chairman, that folks believe that to emphasize 

one issue is to deemphasize another. 

So in New Jersey, for instance, we have done broad criminal justice reform that has lowered our prison population more than any 

state in the country. During my time as governor, we have closed 

two state prisons. Yet our crime rate is down significantly in our 

state. That doesn’t mean that I don’t want to see my attorney general continuing—and he has—to continually aggressively pursue 

the drug dealers in our state who are killing our people. 

I think that sometimes justice departments, which we have both 

been members of, think that if you are in favor of criminal justice 

reform, you can’t be in favor of aggressive prosecution of criminals. 

Or if you are in favor of aggressive prosecution of criminals, you 

can’t be for criminal justice reform. I don’t believe that, and I think 

as governor it has taught me even more than as a prosecutor, the 

Federal Government, in my view, over the last decade has dropped 

the ball on these cases. And I think that it is contributing—not 

causing, but contributing to the problem that we have today. And 


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that is why I am not in favor of shortening the leg on the stool of 

enforcement interdiction. We need to continue to do that and do it 

aggressively. I have shared that opinion with General Sessions, 

and I believe he understands that piece of it. But that message has 

to get out to the U.S. attorneys, and that can only come from the 

attorney general and the deputy attorney general. You and I both 

know, and when you were a U.S. attorney, it is kind of like being 

the captain of a ship out at sea, you know. Sometime the radio 

works from the shore, and sometimes maybe you can’t hear it quite 

as loudly. We need to make sure the radio is working on this one, 

and that U.S. attorneys are not given an option, but are given a 

directive from their boss, the Attorney General of the United 

States, that these are important cases to do. That doesn’t lessen 

our commitment to providing more treatment. It doesn’t lessen our 

commitment to confronting the Chinese on what they are doing and 

using our foreign policy tools in addition to law enforcement in 

doing that, and it doesn’t mean that we don’t believe that education 

and prevention are really important. We didn’t talk about that 

today, but let me say in conclusion here, from my perspective that 

if we don’t start talking to our children in the middle school about 

this issue, we will lose them. And it is frightening to me as a father 

to think that my 11 and 12-year-old daughter or son needs to be 

spoken to about this issue in stark terms, but they do. 

And we can’t do it anymore. I saw from the Department of Education they were very proud. They showed me when I first came 

to—oh, we have this new pamphlet that we are going to be giving 

out in schools on this issue. And I looked at it and I said so listen, 

it is a great pamphlet. I read it. There is a lot of good information. 

I said if my kids got this pamphlet, it would go in their backpack. 

By the end of the school year, it would be all the way at the bottom 

of their backpack, and they would never read it. Because if it is not 

on here, they don’t read it. We need to modernize the way we are 

educating our children. We should be demanding of companies like 

Google and Facebook who are such predominant players in communication today to our young people, that they step up to the plate 

and start educating our kids on the things that we need to do. 

So what I am saying to you is we have dropped the ball in my 

view in the last decade since I have left the Justice Department in 

2008 in doing these cases. We need to do them to slow the supply, 

but we also need to make sure that we are doing those other things 

as well. And this is the bipartisan nature of it, and I believe that 

Mr. Cummings agrees with this as well. We have got to get rid of 

our old barriers on this issue, to think that if you are for one thing, 

you must be reflexively against the other, and vice versa. We can 

do both and we must do both. And there are people of goodwill and 

great experience who are ready to help to do this, and I hope that 

they are called upon to do it, and I count myself as one of them, 

and I will allow myself to be called upon to do it. 

And so I think you make a very good point, Mr. Chairman, and 

I think we need to make sure that we don’t get caught in the trap 

of mutual exclusivity. It is a trap that will lead to failure, and failure we can’t afford. 

Chairman GOWDY. Well I want to finish up with drug courts, because we agree on that. If you want to not only have your own life 


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change, but see other people’s lives change, attend a graduation for 

a drug court. That graduation ceremony will be with you for the 

rest of your life. And I want to mention one kind of a niche issue 

there at the end. I also want you to address what barriers did you 

find, if any, for the pharmaceutical alternatives, non-habitual aiding, non-addictive pharmaceutical alternative. What are the barriers to either having them researched, developed, or to market? 

Governor CHRISTIE. They don’t believe they are going to be profitable. I think that is the single biggest barrier to it, and that is 

why I believe bring NIH in as a partner to be a fair broker of the 

compounds and say which ones are most effective, and let’s move 

those most effective ones to the front of the line and allow them 

to go to market, and let’s see how it goes. 

What I say—and listen, you know that New Jersey has more 

pharmaceutical companies than any state in the country, and so I 

am very sensitive to the importance of the pharmaceutical industry, the role that they play in our country as an economic driver, 

in addition to being a healer. And I am an advocate for the pharmaceutical industry. But what I reminded my friends in the pharmaceutical industry is they have a social responsibility that goes 

along with that, and that to stand by and not develop these compounds purely on the basis of concern about profitability is to, in 

my view, walk away from part of your social responsibility as a corporate citizen in this country. 

Now NIH needs, I think, to be a fair broker in all this so that 

the right compounds get the right money spent on them to develop 

them, but what I heard from them was the biggest concern was an 

issue of—with the R&D money that they have available, is this the 

best way to spend that money for our shareholders? And that is an 

absolutely legitimate fiduciary concern that they need to have 

under our laws and our system of—our economic system, but they 

also have a social responsibility as well. 

And so what I would say and what we did say to pharmaceutical 

companies is would you trust NIH to be a fair broker on, say, okay, 

all 43 of these compounds don’t need to be developed, but these five 

have real potential to be non-addictive pain relief and/or great 

medication assisted treatment to help those who are already addicted. And the pharmaceutical companies at that meeting in New 

Jersey agreed to submit their compounds to NIH. What we need 

to make sure of now is that NIH has the funding to make sure that 

they complete that job. If they do—I know Dr. Collins is really committed to this. If they do, we are going to get some of those compounds onto the market, and that is going to help significantly. Because I know physicians would much rather prescribe a pain reliever that is non-addictive but effective, rather than one that is 

addictive. 

Chairman GOWDY. You mentioned though the phrase social responsibility—this will be my last point. 

In addition to being a colleague, one of my favorite colleagues in 

the entire body, Peter Welch, is also a former public defender, and 

his clients would have been incredibly fortunate to have him. In 

South Carolina, I saw sometimes in the state system, public defenders would opt for straight probation as opposed to drug court 

because it was easier. Now that is not in their client’s best interest. 


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Their client will remain an addict. But they are right. Straight probation is easier than drug court. How do we develop around the 

grant strategy in sending the defense attorney, the public defender 

to encourage their client to go get help as opposed to just being on 

probation for the next 12 months and remaining an addict? 

Governor CHRISTIE. Well let me tell you, in New Jersey what we 

did was we took away the option. You don’t have the option of probation anymore. Your option is this: go to treatment or go to jail. 

Now when given that option, it is kind of the gentle encouragement 

I am known for, Mr. Chairman. You know, it is—and where a lot 

of people absolutely opposed that, said how dare you do that. If 

they are not ready, they shouldn’t go. I said I have never met an 

addict who is ready. I have never met an addict who is ready. I 

have done interventions. I have never seen a—I had a great friend 

of mine who sat there and argued with me that I was wrong that 

he was addicted, he didn’t need treatment. He was fine. Well he 

is dead now, and the fact is I have never met an addict who was 

ready. 

So I think one of the things that you could work on from a grant 

structure perspective is to say that we want to encourage those 

programs that don’t give an option, that your option—you don’t 

have a probation option, because I know. I know exactly what you 

are talking about. That was happening in my state before we 

passed this law. Now defense attorneys have a really easy equation 

to give their clients. You can go to drug court and go into treatment, or you can go to state prison. And what we are finding is 

most people are choosing treatment. And even when they don’t 

think they are ready and what has happened—you talked about 

drug court graduations. The miracle of those drug court graduations is, in my mind, not the young men and women and older men 

and women that I am sitting with on stage, it is looking out in the 

audience at their families. Their lives are hopeful again. Their eyes 

are lit with joy for the restoration of a life that they initially 

brought onto the earth, and which they had almost given up on. 

So from my perspective, the drug court and why I advocate it for 

every federal district in this country is because I have watched it 

change lives, and so have you. And there is no reason—even 

though there are fewer cases on the Federal Government than 

would be appropriate than on the state level, there is no reason 

that we should have our federal prisons filled with people who 

would be better off being treated, for themselves and for us as a 

society. Because the recidivism rate, as you know, for drug court 

graduates goes down significantly, and that is what we all want 

anyway. We would much rather spend less money on corrections, 

on BOP, than we would on other issues that are confronting our 

country in a time of limited resources. If we can lower the prison 

population like we have done in New Jersey and close two state 

prisons in eight years—I defy you to find any other state in America that is closing state prisons with a decline reduction, and it is 

because we are treating folks who have this problem like they have 

a disease, not like they have a moral failing. 

Chairman GOWDY. Well thank you for your passion and your expertise, and I know Mr. Cummings would want to thank you also 


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as we transition from your panel to the next panel. Thank you on 

behalf of all of us. 

Governor CHRISTIE. Mr. Chairman, thank you very much. Mr. 

Cummings, thank you for inviting me. 

Mr. CUMMINGS. Mr. Governor, thank you very much. Just one 

thing being our good colleague from Maryland, Mr. Delaney, has a 

phrase that I wish I had invented. He said ‘‘The cost of doing nothing is never nothing.’’ And you have given us a broad blueprint, 

and now we have got to act. Thank you very much. 

Governor CHRISTIE. Thank you, sir. I appreciate that very much. 

[Recess.] 

Chairman GOWDY. The Committee would like to welcome our second panel of witnesses. We have Dr. Richard Baum, Acting Director of the Office of National Drug Control Policy; Dr. Leana Wen, 

the Health Commissioner for the Baltimore City Health Department; and Dr. Caleb Alexander, Co-Director of the Center for Drug 

Safety and Effectiveness at Johns Hopkins Bloomberg School of 

Public Health. 

Welcome to you all. I am not going to swear you because I didn’t 

swear the first witness, so I will violate Committee rules there and 

hope that nobody knows that I have done it. We are going to call 

on you sequentially for your opening statements. To the extent possible, I will limit those to five minutes, just understanding that we 

have the full body of your opening statement in the record, and 

then we will—once Dr. Alexander gives his opening statement, we 

will then recognize the members for their questions. 

With that, Dr. Baum, you are recognized. 

PANEL II 

STATEMENT OF RICHARD BAUM 

Mr. BAUM. Well I thank you, Mr. Chairman, Mr. Cummings. 

Thanks so much for inviting me and for the Committee, I am really 

honored and pleased to be here in Baltimore for this important 

hearing. 

You are all familiar with the problem we face because you see 

it in your districts. This epidemic knows no geographic, political, 

socioeconomic, or racial bounds. We are very mindful of the fact 

that your constituents share heartbreaking stories with you about 

the loss of too many of our country’s sons and daughters. ONDCP 

is committed to working with you to turn this awful crisis around. 

This truly is the worst epidemic in American history. 

As has been referenced in earlier testimony, we have seen over 

60,000 drug overdoses in 2016, mostly caused by opioids such as 

heroin, illicit fentanyl, and prescription pain medications. Now listen, fentanyl is being added to heroin, cocaine, and other drugs, increasing their lethality. It is often being pressed into counterfeit 

prescription pills, complete with fraudulent manufacturer logos. We 

are not getting enough people with addiction into evidence-based 

treatment. Our whole system through response to overdoses and 

other outreach efforts has to be faster to go out and find the people 

that need help. Once people go through detox or treatment, they 

need ongoing recovery support, as well as help with sober housing 

and employment so they can fully rebuild their lives and reVerDate Nov 24 2008 15:52 Nov 02, 2018 Jkt 000000 PO 00000 Frm 00047 Fmt 6633 Sfmt 6633 H:\31521.TXT APRIL

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integrate into society. We also need to ensure that law enforcement 

agencies have the tools they need to reduce the drug supply and 

disrupt and dismantle the drug trafficking organizations that 

threaten the safety and health of our people. 

The Administration is working hard on multiple fronts to address 

this crisis. As you know, President Trump has been vocal about the 

drug crisis, both during the campaign and since taking office. When 

the President established the Commission, he directed it to look at 

additional actions the government can take to address this epidemic. ONDCP was tasked with providing policy and administrative support to the Commission. I had the honor to serve as the executive director of the Commission, and ONDCP staff contributed 

their expertise and time to assist the Commission with its work, 

totaling more than 5,500 total staff hours. On November 1, the 

Commission released its final report, which included 56 recommendations, as Governor Christie just described. The recommendations have now been circulated to all the agencies in the 

Administration for careful consideration. I am glad to say that the 

Administration is already working on a number of them. 

President Trump declared the opiate crisis a national public 

health emergency as the Commission recommended in its interim 

report, and he has mobilized the entire Administration to address 

the crisis. HHS has announced a proactive policy to allow states to 

waive the decades-old ban on Medicaid reimbursement for patients 

receiving inpatient treatment at facilities with 16 or more beds, 

known as the IMD exclusion. Utah and New Jersey have already 

received approvals under the new policy, and we hope to have 

many more requests for waivers in the coming months. 

In terms of reducing the availability of these illicit drugs, the Administration has also taken a number of steps. We are working 

with the Chinese government to reduce the flow of fentanyl and its 

add-alongs to the United States. This includes getting additional 

advanced electronic data from China on packages mailed into the 

U.S. This summer, DOJ took down the dark web marketplace, 

AlphaBay, and other sustained actions like this over time will reduce trade over the Internet that has been threatening the health 

of our citizens. 

The Heroin Response Strategy, which is an initiative of our 

ONDCP-run HIDTA program, is bringing law enforcement and 

public health together to quickly respond to overdose at the local 

level, and to increase law enforcement and—efforts. And the FDA 

is working to make prescription opioids safer and lend the effort to 

remove the opioid medication Opana extended release from the 

market, since it was frequently being diverted and abused. 

The Administration has provided significant resources to address 

this crisis. For fiscal year 2018, the President proposed a $28.7 billion drug budget overall, including $10.8 billion for drug treatment. 

This year, we have already sent $800 million out to states for intervention, treatment, first responders, prescription drug monitoring 

programs, and recovery services. The President has requested $500 

million additionally to help states expand access to opioid treatment in the fiscal year 2018 budget. And at ONDCP, as you know, 

we are developing the Trump Administration National Drug Control Strategy, which will be out early next year. So we are using 


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all the tools in the toolbox to make headway against this enormous 

problem which is affecting every state and many of your constituents in some way, shape, or form. 

I have not yet had the privilege to visit South Carolina as acting 

director, but I have visited Anne Arundel and Cecil Counties in 

Maryland and I have seen how people in these communities are 

coming together to address this crisis at a local level. This is a critical part of our country’s response to the epidemic. 

As I said, this crisis is unlike anything we have seen before and 

have been working hard to address it, but we have a lot more to 

do. I thank Governor Christie and the Commission for their recommendations which will help to this end. I also want to thank the 

dedicated ONDCP career staff for so skillfully supporting the Commission’s work. And I thank the Committee for holding today’s 

hearing on this important matter, and I look forward to more discussion and dialogue. Thank you very much. 

[The prepared statement of Mr. Baum follows:] 


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Chairman GOWDY. Thank you. Dr. Wen? 

STATEMENT OF LEANA WEN 

Dr. WEN. Chairman Gowdy, Ranking Member Cummings, thank 

you for calling this hearing in our city of Baltimore where today, 

two residents will die from overdose. 

Our aggressive approach to this epidemic has three pillars. First, 

we save lives by making the opioid antidote, naloxone, available to 

everyone. Not only have we equipped paramedics and the police, I 

issued a blanket prescription to all 620,000 residents. Since 2015, 

everyday individuals have saved the lives of 1,500 people. But our 

city is out of funds to purchase naloxone, as Congressman 

Cummings mentioned, forcing us to ration and make decisions 

about who can receive this antidote. And at the time of a public 

health crisis, it is unconscionable that we are being limited in our 

ability to save lives. 

Second, we aim for on demand addiction treatment, because the 

science is clear that addiction is a disease and treatment works. 

But nationwide, only 1 in 10 people with addiction get treatment. 

Imagine if only 1 in 10 patients with cancer get chemotherapy? 

As an emergency physician, I see patients coming to the ER all 

the time asking for help, but I tell them they have to wait weeks 

or months. My patients have overdosed and died while they are 

waiting, because our system failed them. Here we are starting a 

stabilization center, which is the beginning of a 24/7 ER for addiction and mental health. We are expanding medication assisted 

treatment, which is the gold standard for helping people to recover 

from opioid addiction. 

Third, we reduce stigma and prevent addiction. Treating addiction as a crime is unscientific, inhumane, and ineffective. That is 

why our public health and public safety agencies collaborate closely, including to pilot law enforcement assisted diversion where individuals caught with small amounts of drugs are offered treatment 

instead of prosecution. Recognizing that it has hurt people who 

hurt people. We are working to prevent the next generation of addiction by addressing trauma and providing mental health services 

in our schools. 

My written testimony has point-by-point analyses of the President’s Commission’s recommendations, and I agree with many of 

them, but they do not go nearly far enough in four areas. 

First, the Commission did not identify substantial additional federal funding. We on the frontlines know what works, and we desperately need new resources, not repurposed funding that will divert from other critical priorities. These funds should also be given 

directly to communities of greatest need. Cities have been fighting 

the epidemic for years, and we shouldn’t have to jump through additional hoops. Competing for grants and having funding passed 

from the states to cities will cost time and many more lives. 

Second, the Commission failed to advocate for taking on necessary steps to expand health insurance. One in three patients 

with addiction depend on Medicaid. If Medicaid were gutted and 

they were to lose coverage, many more would overdose and die. 

Other patients on private insurance could find themselves without 

treatment if addiction is no longer required to be part of their 


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health plan. It is estimated that ACA repeal could result in three 

million people losing access to addiction treatment. Block grants 

should not replace insurance coverage, because no disease can be 

treated through grants alone. 

Third, the Commissions’ recommendations did not guarantee access to treatment for addiction. Medication-assisted treatment reduces the likelihood of death, incidents of other illness, and criminal behavior. At the very least, medication-assisted treatment 

should be the standard of care for all treatment centers, and we 

can go further. If doctors can prescribe opioids that lead to addiction, why shouldn’t hospitals all be required to treat this disease? 

Fourth, the Commission ignored evidence-based harm reduction 

practices. In Baltimore, needle exchange has resulted in the percentage of individuals with HIV from injection drug used decrease 

from 63 percent in 1994 to seven percent in 2014. Our programs 

are staffed by people in recovery themselves who help patients connect to treatment. 

Here in Baltimore, we know what works. We need support from 

the Federal Government in three ways: number one, urgently allocate additional funding to areas hardest hit by the opiate epidemic; 

number two, directly negotiate with the manufacturers of naloxone 

so that communities no longer have to ration; number three, protect and expand insurance coverage to get to on demand treatment 

for the disease of addiction. 

Here in Baltimore, we have done a lot with very little. We can 

do so much more if we had more resources, and I urge Congress 

to commit these resources so that we can save lives and reclaim 

our futures. 

I thank you for coming to our city and for calling this hearing. 

[The prepared statement of Dr. Wen follows:] 


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Chairman GOWDY. Thank you, Dr. Wen. Dr. Alexander? 

STATEMENT OF CALEB ALEXANDER 

Dr. ALEXANDER. Good afternoon, Chairman Gowdy, Ranking 

Member Cummings, and members of the Committee. I appreciate 

the opportunity to speak today. 

I am a practicing primary care physician and co-director of the 

Johns Hopkins Center for Drug Safety and Effectiveness at the 

Johns Hopkins Bloomberg School of Health. My research focused 

on identifying political and policy solutions to the opioid epidemic, 

but as a practicing physician, I also know the power of stories to 

compel action, and I would like to share with you a brief one now. 

In 2011, Judy Rummler lost her son Steve from an overdose. I 

work with Judy on policy reform and I asked her if I could share 

his story. She said, I am always happy to share Steve’s story if it 

helps the cause. Steve’s journey began like so many with a lower 

back injury that led to chronic opioid use and subsequent addiction. 

Years before his death, he wrote presciently of opioids, ‘‘At first 

they were a lifeline, and they became a noose around my neck.’’ 

Steve tried as best he could to get well and he didn’t want to die, 

but he ultimately succumbed from an overdose after discharge from 

a rehab facility. Now, Judy keeps a picture of Steve along with a 

note, ‘‘If love could have saved you, you would have lived forever.’’ 

Steve’s story, and his family’s resolve to ensure that other families don’t have to experience what they have, is a reminder to me 

of what is at stake here, and of the loss that so many have endured. 

During the past year, my colleagues at Johns Hopkins and I 

have reviewed hundreds of scientific studies and other data points 

on the epidemic. Last month, we released this report, ‘‘From Evidence to Impact’’, that has been provided with my written testimony, and that synthesizes the field and provides recommendations to address the epidemic. Ranking Member Cummings, we 

were so honored that you participated in the release of this report. 

In the remainder of my time, I would like to highlight two points 

regarding how the Commission’s report can best drive change. First 

the Commission’s findings provide a comprehensive framework for 

action. Simply put, the science is the science, and the Commission’s 

report gets it right. It is based on evidence and lines up closely 

with our own appraisal in most areas. For example, both assessments agree that providers should be required to use prescription 

drug monitoring programs, that the CDC’s guidelines should be 

standard practice nationwide, and that high quality evidencedbased addiction treatment should be available on demand. 

In my written testimony, I make specific recommendations regarding steps Congress can take, such as passage of the Prescription Drug Monitoring Act of 2017, and I also highlight areas where 

the Commission might have increased the comprehensiveness or 

impact of their review. 

Second, as we have already heard urged by some of you this 

afternoon, it is now critical for the Administration to develop a 

strategy to support the implementation of its recommendations. It 

is one thing to say we are going to send a man to the moon, and 

it is totally a different thing to have a plan in place to do so. In 


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my humble opinion, the Commission’s two most important recommendations are that we need to reduce over-prescribing and provide high quality evidence-based treatment for addiction upon demand, although I think reducing the supply of fentanyl in the 

country is a very close third. 

But I am left asking the questions that some of you may be, 

which is what specific steps is the Federal Government going to 

take to reduce, for example, opioid over-prescribing? What resources are required? Which agencies are responsible? What 

timeline will be followed? And how will we know when we have 

been successful? In short, we urgently need an implementation 

plan, and this Committee could support this effort by asking for 

and reviewing such a plan for the Commission’s most important 

recommendations. This Committee can also exercise oversight capacity to ensure that other federal agencies act on the Committee’s 

recommendations. 

Esteemed representatives, we are missing more than half a million Americans from overdose that should be with us today, people 

like Steve Rummler and so many others. Incredibly, more deaths 

from opioids are expected in 2017 than ever before; yet as we look 

to 2018, there are reasons for hope. Providers are increasingly 

using safer and more effective treatments for pain. There is growing awareness that addiction is a disease and treatable, and more 

Americans are living fulfilling lives in recovery. Communities are 

increasingly mobilized, demanding affordable naloxone, reliable access to addiction treatment, stronger FDA regulation, and coordinated federal action. This is a fixable crisis, but not without an implementation plan to accompany the Commission’s recent recommendations. 

Thank you again for the opportunity to testify. I look forward to 

your questions. 

[The prepared statement of Dr. Alexander follows:] 


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Chairman GOWDY. Thank you, Dr. Alexander. The gentleman 

from Maryland is recognized. 

Mr. CUMMINGS. Thank you very much, Mr. Chairman. 

Dr. Wen, on June 18, 2017, the Baltimore Sun published an article on naloxone entitled ‘‘Baltimore City Running Low on Opioid 

Overdose Remedy.’’ The article stated that ‘‘The city has about 

4,000 doses left to last until next May.’’ You were quoted in that 

same article as stating that, and I quote, ‘‘We are rationing. We are 

deciding who is the highest risk and giving it to them.’’ How many 

doses of naloxone does the city have left now, and is that number 

adequate to meet the city’s needs? 

Dr. WEN. Thank you, Congressman. We—I have people—— 

Mr. CUMMINGS. And who are the highest priority people? 

Dr. WEN. The highest priority individuals that we allocate this 

lifesaving medication to are the individuals who are clients of our 

needle exchange plan. These are individuals who we know are actively using drugs. 

Now, I will say that we do not in any way condone drug use, but 

we do believe in saving someone’s life. If it is a question of preventing the spread of hepatitis and HIV we need to do that, and 

if someone had died today, there is no chance for them to get into 

treatment tomorrow. So for 11 unit of naloxone given out on the 

needle exchange plan, one unit is used to save someone’s life. 

Now I don’t know how many medical advances there are out 

there that have a number needed to save someone’s life as 1 in 11. 

I have to answer your question. I have about 8,000 units left between now and July of 2018. Now we are grateful for the work of 

our state. Clay Stamp is here from the state. They have been gracious in providing additional funding for naloxone once they saw 

the need in Baltimore City. But if I got 8,000 more units today, I 

could distribute them all by this weekend, and then we can calculate how many more lives are going to be able to be saved. That 

is the very definition of rationing. In the middle of an epidemic, I 

shouldn’t have to be forced to decide who gets to carry a medication 

that could save their lives or their family’s lives. 

Mr. CUMMINGS. So how many doses do you need? I mean, let 

me—to adequately distribute enough to be effective? In other 

words, what is your goal? 

Dr. WEN. I want—— 

Mr. CUMMINGS. What would be your goal amount? 

Dr. WEN. I would like for everyone in our city to carry naloxone 

in their medicine cabinet or their first aid kit. Imagine if we had 

the remedy—if Ebola had hit our city or some other horrible contagious illness were to hit our city, we would want to make sure 

that every single person carried the antidote. I have community 

members, neighborhood faith leaders calling me every day asking 

for naloxone. Why shouldn’t it be available everywhere in every 

public place in a way that we have defibrillators available in public 

places? 

Mr. CUMMINGS. Now that Baltimore Sun article in February of 

this year said, and I quote, ‘‘The price of a popular injectable 

version jumped 500 percent in the past two years, and the cost of 

a nasal spray used in Baltimore has increased nearly 63 percent.’’ 


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One auto-injector can now cost about $4,500 for just two doses, is 

that correct? 

Dr. WEN. That is correct. 

Mr. CUMMINGS. So Dr. Wen, what formulation of naloxone is 

your office using? I mean, what do you—— 

Dr. WEN. We use nasal Narcan, which is manufactured by a company called Adapt Pharma. It is one of the FDA-approved versions 

of the medication, and we would hope that in this epidemic the 

Federal Government can directly negotiate the price so that we can 

get this at a much discounted one. 

Mr. CUMMINGS. Some kind of way—we have spent a lot of time 

dealing with this issue of drug pricing and over-drug pricing, and 

it seems sad—and this is my conclusion—that a lot of these price 

hikes are about greed, not about cost of research, R&D, but greed. 

And at the same time, we know that we have something here that 

works. 

Are there other things coming down the pike that you know of 

that might be just as effective as naloxone? Have you heard of any 

of those things? 

Dr. WEN. I have not. There are very few antidotes available in 

modern medicine. This is one of them. Naloxone is on the World 

Health Organization’s list of essential medications. It is available 

by the pennies in other countries. 

Mr. CUMMINGS. By the pennies? 

Dr. WEN. In other countries. 

Mr. CUMMINGS. Wow. Thank you very much. 

Chairman GOWDY. The gentleman from Wisconsin. 

Mr. GROTHMAN. First question for all of you, on the break I ran 

into a woman down here—it was very interesting—who had a relative who had been through treatment dozens of times, which kind 

of obviously means that treatment doesn’t always work. I would 

like you folks to comment on percentage-wise how often in your experience in programs you deal with treatment works, and what distinguishes the programs that treat—that are successful and those 

programs that are not successful? And also, what percentage of admissions do you expect to be successful with regard to treatment? 

Dr. ALEXANDER. Well I could begin and say that there is no question that opioid use disorders are really, really serious, and the individuals that have opioid addiction remain with a lifelong vulnerability to the products, and this is one the reasons that it is so important that we reduce the overprescribing of prescription opioids 

in the first place. 

Mr. GROTHMAN. They only give me so much time. Can you tell 

me percentage-wise in the treatment programs you are familiar 

with, percentage-wise how many times people go into treatment, 

percentage-wise how often are they successful? 

Dr. ALEXANDER. I don’t—— 

Dr. WEN. The data that I have seen are about 40 to 60 percent 

rate of recovery, recognizing that addiction is a complex disease 

and that we need to be ready for people whenever they want to go 

into treatment. 

Governor Christie had mentioned that he had not met people 

who were ready for treatment. I meet them all the time, and the 

problem is that we need to be ready for people at that moment, not 


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have them wait weeks or months, and then recognize that relapses 

are part of recovery because that is the nature of the disease. 

Mr. GROTHMAN. So you expect a treatment program to be successful half the time? Whether it is half the time of a heroin addict 

or an opiate addict goes in, they will never do it again? Is that 

what your expectation is? 

Dr. WEN. They may not be successful that first time, but they 

may be successful that second time, and recognizing that there are 

forms of treatment that are evidence-based and some that are not, 

and so we need to be promoting these evidence-based treatments 

which include medication-assisted treatment. 

Mr. GROTHMAN. Well just when you get on the Internet, it implies that, you know, these are wildly unsuccessful, that is why I 

am asking. 

Mr. BAUM. Yeah, I just want to add to that. It is true that relapse rates are a challenge, but I think that if we move away from 

this sort of isolated episodic treatment model to an ongoing, continuing care, we can drive down relapse rates. Sometimes we have 

a detox program that is separate from an inpatient that is separate 

from ongoing recovery supports, and we have to stop doing it that 

way. The system has to evolve to have ongoing recovery support so 

that relapse rates are driven down. 

And just in summary, I would say we shouldn’t accept the level 

of relapse rates. I think we can drive them lower if we work harder 

and work smarter. 

Mr. GROTHMAN. Okay. I asked Governor Christie and I will ask 

you as well. Some of you made about the fact that heroin was fairly 

apparently common in Vietnam. I don’t know. And when people 

came home, almost all the troops stopped using heroin. Could you 

comment on that? 

Mr. BAUM. Yeah, it is a very interesting point in history. In Vietnam was when they had the first drug testing program, and people 

weren’t cleared to go home from Vietnam until they tested negative 

for drugs. And so there was—people in Vietnam were highly motivated to get home. They had to step using drugs, they had to test 

negative, and then they went home. 

I mean, I do—I don’t dispute the point that you changed the environment and you changed the behavior, but it was also part of 

a program to test people and to encourage them to get off heroin 

before they came back. 

Dr. WEN. Part of it, too, is why it is that people are using drugs? 

Part of it may be overprescribing because of treating physical pain, 

but people are also treating other types of pain too. We know that 

the same communities facing high rates of overdose are also facing 

poverty and homelessness and unemployment, and in order for us 

to break that cycle of addiction, we also have to be addressing 

those underlying factors and helping those communities thrive too. 

Mr. GROTHMAN. Okay, you are touching on something that I 

think Governor Christie wanted to stay away from, but do you find 

that sometimes family background is a correlation with abuse? 

Mr. BAUM. I mean, I think that there is evidence that people on 

all walks of life and all type of background, of every level of wealth 

and every racial group are affected by the drug problem. 


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Mr. GROTHMAN. That goes without saying, but I mean percentage-wise. 

Mr. BAUM. No, I think if you look at the percentage breakdown 

by socioeconomic group there is a little bit of variation, but really, 

everyone is being affected by this problem. Everyone with the disease of addiction needs and deserves treatment and ongoing recovery support. 

Mr. GROTHMAN. Okay, that is it. On to the next. 

Chairman GOWDY. The gentleman yields back. The gentlelady 

from the District of Columbia is recognized. 

Ms. NORTON. I think you can hear me now. 

I think it is fair to say that both Democrats and Republicans underestimated the standing of the Affordable Healthcare Act until 

the most recent election where we saw governor-to-be—governor 

elect Northam win an election and the polls say that a lead indicator was the Affordable Healthcare Act, and they don’t even have 

that in Virginia. People apparently are very, very afraid for their 

healthcare, and they chose that election, which is considered a kind 

of herald election for the coming elections to express themselves, 

even though they knew that Northam would have a hard time getting them the Affordable Healthcare Act. 

So I—my question is about what role the Affordable Healthcare 

Act can play or is playing in this crisis? I know that Governor 

Christie indicated that the Affordable Healthcare Act, unlike, by 

the way, the plans that many Americans have, does require that 

substance abuse be afforded in the same way as other healthcare. 

That is an important gain for healthcare in the United States, at 

least for those who have the Affordable Healthcare Act. One of the 

figures that interested me was the one on Medicaid expansion and 

who, in fact, has benefitted from it? It appears that 3 in 10 nonelderly adults with substance abuse disorders nationwide get Medicaid expansion. It says to me it is being used by the very people 

that we are discussing here today. 

So I need to know from you, perhaps Dr. Wen, Dr. Alexander, 

what you think would—what you believe would occur if, in fact, 

those states that have Medicaid expansion—this is one of them, 

New Jersey, Governor Christie’s state, is another—suppose that 

was no longer available? What would that do to the crisis under 

discussion here this afternoon? 

Dr. WEN. More people would die. Because of Medicaid expansion, 

1.6 million people who have substance abuse disorders are now 

able to have access to treatment. Prior to the ACA, one-third of the 

individual market plans did not cover substance abuse disorders, 

and for people who have the disease of addiction, there is no margin of error. If you are to take away their treatment today, their 

only option may be to overdose and die. And so studies have shown 

that it will take $180 billion over a decade to provide healthcare 

to those who lose coverage. 

So back to the point that Ranking Member Cummings made that 

the cost of doing nothing isn’t nothing, we are spending that money 

anyway. We are spending the money now on medical costs and cost 

of incarceration. We can choose to invest it in treatment instead. 

Ms. NORTON. Is the Affordable Healthcare Act being used to prevent opioid addiction and not simply to intervene once it occurs? 


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Dr. WEN. We need to do a lot more when it comes to prevention, 

including stopping the overprescribing of drugs, stopping the trafficking of drugs, but also, things like investing in nutrition, in family literacy, in home visiting. All those things also help to boost 

family structure and reduce poverty, which ultimately also reduces 

addiction. 

Dr. ALEXANDER. I would just add that there are several provisions—although the ACA wasn’t designed for the treatment of patients with opioid use disorders alone, there are several provisions 

within it that have been very important for those seeking treatment for opioid addiction. And that is not just the parity provision, 

but also the requirement that treatments for addiction be considered an essential health benefit. So this is something that—the 

Commission speaks—the Commission’s report speaks to ways that 

there may be insurance barriers to accessing, for example, medication-assisted treatment, but is—does not directly address the role 

of insurance in the first place. And as a colleague of mine has, I 

think, eloquently put it, until you make it easier for patients to access high quality addiction treatment than it is to find their next 

bag of heroin or their next bottle of Oxycontin, they aren’t going 

to flock towards treatment. So it is vital that treatment is expanded. 

Ms. NORTON. Could you give us some insights on why some jurisdictions are so much worse off in this crisis than others? For example, the District of Columbia is a big city. They have taken—they 

have used the Affordable Healthcare Act and done a lot of prevention. The crisis, I think, over the last three years tripled. Are there 

characteristics of a jurisdiction that will predict the opioid crisis 

that you could speak about, Dr. Alexander? 

Dr. ALEXANDER. Well it is an outstanding question, and indeed, 

if you look at maps of the country, county maps, it is stunning the 

variation county to county, both in terms of opioid prescribing as 

well as injuries and deaths from opioids. 

The first point I would make is that these are highly correlated. 

That is, if I showed you plots, you don’t have to have a degree in 

biostatistics to see that there is a very high correlation between the 

volume of opioids that is being prescribed in a given area and injuries and deaths from these products. We do know that there are 

a variety of different state policies and county policies that can 

make a difference in the volume of opioids that are prescribed, and 

in rates of heroin and illicit fentanyl use. 

But I think that there is a lot more that we have to learn, not 

only in why it is so bad in some countries, but also why we have 

seen counties that have had remarkable gains in terms of reducing 

both volume of overprescribing, but also injuries and deaths from 

these products. And state policies like prescription drug monitoring 

programs ensure policies and state policies like caps on the volume 

of prescription opioids that are prescribed, investments that cities 

and states are making and addiction treatment services, all of 

these can play an important role. 

Ms. NORTON. Thank you. 

Chairman GOWDY. Gentleman from Alabama, Mr. Palmer, is recognized. 

Mr. PALMER. Thank you, Mr. Chairman. 


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Mr. Baum, there was a report in the November 2017 Journal Addictive Behavior that noted that there has been a shift in drug— 

opioid abusers first use. According to the report, in 2005 8.7 percent of individuals who began abusing opioids in 2005 began with 

heroin. By 2015, that had changed to 33 percent. Has your office 

been able to determine what caused this shift? 

Mr. BAUM. You know, thank you for the question. I don’t have 

a definitive answer, but I would say that the epidemic continues 

to evolve rapidly. We know—and I won’t repeat what was discussed 

what has caused this epidemic, which was the overprescribing of 

narcotic painkillers. As more people have been using heroin, there 

has been a spread of heroin shared between family members, boyfriends, girlfriends, and others, and so I have seen those reports 

and it is concerning. 

And let me just emphasize, we need to get out the message about 

the incredible lethality of the drug supply. When someone consumes heroin, it could contain fentanyl. It might contain other substances as well. Same with these prescription pills that people buy. 

The drug supply is more lethal than ever before, and really people 

are taking their lives in their own hands when they are using these 

drugs. 

Mr. PALMER. Dr. Alexander, it has been reported that there were 

64,000 deaths in 2016. Is that an accurate number? 

Dr. ALEXANDER. Yes, correct, from all overdoses. 

Mr. PALMER. The information that I have indicates that it might 

be reported—underreported by as much as 20 percent, and each of 

you have touched on this a little bit because the reluctance of family members to have that cited as the cause of death would—is that 

20 percent underreporting—does that—is that real? 

Dr. ALEXANDER. Well I don’t have a—I am not sure of the precise 

degree to which there is underreporting, but there is no doubt you 

raise a very good point. And any underreporting would mean that 

the epidemic is even more worse than the 64,000 number would 

suggest. 

Mr. PALMER. Well that is my point. The epidemic is at a point 

now where it has literally reduced the life expectancy of Americans. 

We—for the first time in I forget how many years, but it has been 

at least a couple of decades, our life expectancy in the United 

States has declined, and there are some studies indicating it is related to the number of people dying from drug overdoses, drug poisoning. 

Dr. ALEXANDER. Yeah, that is correct, and we see manifestations 

in many different sectors of the economy. The labor force—I think 

the Commission’s report did a good job of outlining many of the ripple effects. We have heard about strains on the foster care system, 

and so there are effects manifested throughout. 

And the other point to make is that the deaths are tragic, and 

I know many of you have met with constituents and, you know, 

you’ll never forget those stories and those days, and yet the deaths 

are the tip of the iceberg. For every patient that has died, there 

are dozens or more that have opioid addiction. There are hundreds 

that are experiencing the effects of going to emergency departments or having a chaotic household where someone has an opioid 

use disorder. 


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Mr. PALMER. I want to touch on something my colleague from 

Wisconsin brought up, and that is about the efficacy of the treatment using medication assisted treatment. I think the number—it 

is not effective for about 40 percent of the population. We talked 

a good bit about—but there is another drug out there, Vivitrol, that 

does not give the same impact as opioids. It is not—it is a once a 

month type pill, but it literally requires that people go into withdrawal for—I mean, it takes three to ten days for someone to become clean and use that. Have you used that, Dr. Wen? I guess 

that would be more appropriate to address that to you. 

Dr. WEN. Yes, we believe that all three forms of FDA-approved 

medications, which are methadone, buprenorphine, and naltrexone, 

also called Vivitrol, that all three should be available in all settings 

without there being prior authorization for insurance, without only 

one form being available at some places. Because just like for other 

illnesses, some patients may do well with one medication, some 

may not do well with that medication but may do well with another 

one. And so we believe that all three should be available. And 

methadone and buprenorphine have had a bag reputation because 

they can be abused and misused, but so can many medications. 

And we have to follow the signs and evidence which show that 

medications as a treatment is the gold standard and that it reduces 

illness and death and even criminal behavior. 

Mr. PALMER. I see my time is expired. I appreciate your responses to this. 

I just want to point out, though, this is not a political issue. This 

is—it is, in my opinion, a public emergency and to bring the politics 

into it, I think, is inappropriate. We have seen a major increase in 

deaths from drug overdoses since 2010, so I just want to encourage 

folks to not look at this as a political issue. This is a national crisis. 

I yield back. 

Chairman GOWDY. Gentleman yields back. Gentleman from Missouri is recognized. 

Mr. CLAY. Thank you, Mr. Chairman. 

If we are to be successful, I am a firm believer that we must first 

remove the stigma traditionally associated with drug use. For far 

too long, society has deemed drug users criminals in need of incarceration rather than patients in need of treatment, as we saw so 

clearly during the 1980s and ’90s. 

Dr. Wen, you summarize that change back in January stating, 

and I quote, ‘‘Traditionally, it has been seen that if you have an 

addiction, it is a moral failing. It is a personal choice. Now we are 

calling it a disease.’’ 

Drs. Wen and Alexander, how important is it that we as a society 

are finally recognizing addiction for what it is, a disease? 

Dr. ALEXANDER. Well I think it is vital, and I think we heard this 

question posed which is can you imagine if we told people with diabetes that 10 out of 100 will get treatment or that we told people 

with kidney cancer we will take 100 of you and we are going to 

offer 10 of you the best treatment that we have. And it is when you 

look at settings like that where one realizes the role that stigma 

has. Another very pervasive and under-appreciated point is that all 

too often, we discuss abuse. And I was heartened by the Commissions’ report, the word addiction is throughout. It is in the first 


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sentence, I believe. It is in the title and the charge to the Commission. This is an epidemic of addiction. It is not an epidemic of 

abuse. There is non-medical use that takes place, but for far too 

long, we have suggested that there are sort of two populations of 

individuals. We have the drug abusers that we need to do everything we can to prevent them from accessing the medicine, and 

then, you know, when I was a resident, I was taught that we need 

not worry about the addictive potential of opioids if a patient had 

‘‘true or legitimate pain.’’ And nothing could be further from the 

truth. 

So I think that the issue of stigmas is really front and center, 

and I think that this will take resources of massive scale, really, 

to continue to educate individuals. Who would choose a life of addiction? It is on anybody who has really understood and met somebody that has addiction knows that this isn’t a choice that people 

are making any more than it is a choice of a 10-year-old to have 

Type I diabetes. 

Dr. WEN. We would never say to somebody with diabetes that 

they should go to jail, and if—they should not get treatment in jail, 

but once they return, they should be cured. Which is the type of 

stigma that we continue to put on people and—who have the disease of addiction. 

I think one of the questions I would ask was about the communities that are the most heavily affected. Our community here in 

Baltimore has been affected for decades. This is not a new issue, 

and Congressman Cummings has spoken very eloquently about 

this in many talks past that we owe an apology to generations we 

have incarcerated. And we owe an apology because we knew the 

signs but didn’t speak up then. 

Mr. CLAY. Mr. Baum? 

Mr. BAUM. Thank you, Congressman, for the question. 

Police chiefs and sheriffs, they are doing an incredible job around 

this country. They know the difference between someone who is a 

drug user who needs treatment and someone who is a drug trafficker, a major drug dealer who deserves punishment. It is no question that someone whose criminal activity is limited to buying and 

using drugs should be diverted to treatment. I have been really encouraged with the police diversion that is happening now around 

the country pre-arrest, working very closely with the police assisted 

addiction recovery initiative parry. Over 300 precincts and sheriff 

offices allow you to walk into a police department or sheriff’s office 

24 hours a day and get diverted right to treatment. They do a 

quick intake, they put you in the front seat of the police car, and 

they drive you to treatment. This program is expanding rapidly. So 

we are doing more police pre-arrest diversion than ever before. 

On the other hand, if somebody is selling heroin laced with 

fentanyl to our citizens and causing overdoses that are killing people, that is a serious crime and they deserve prosecution for that. 

So I think we are able to tell the difference between those who 

need to be diverted to treatment and those who deserve prosecution. 

Mr. CLAY. As well as those physicians who turn their offices into 

pill mills. 


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Mr. BAUM. No question there have been some abusive doctors 

who have been incredibly reckless and they deserve prosecution for 

those crimes as well. 

Mr. CLAY. Now not to put you on the spot, but is it—is that the 

official position of the U.S. Department of Justice, or can you share 

with us that—— 

Mr. BAUM. The Department of Justice wants to prosecute traffickers and criminals and those that are killing our citizens with 

these deadly drugs. There is no conflict at all for diversion for 

minor, non-violent offenders for treatment. 

Mr. CLAY. Thank you for your responses, and I yield back, Mr. 

Chairman. 

Chairman GOWDY. Gentleman from Missouri yields back. The 

Chair will now recognize himself. 

Dr. Alexander, you mentioned overprescribing as being one of 

the—kind of the dual things that you would address first. What are 

the causes of over-prescription? Is it a misdiagnosis? Is it a failure 

to consider alternatives? What are the root causes of the over-prescription? 

Dr. ALEXANDER. Well thank you for the question, Mr. Chairman, 

and the Commission’s report discusses these in some detail. And 

here again, I think that they hit most of the high points. Misinformation, as I noted from my own training, when we were taught 

in the late 1990s that we had overestimated the addictive potential 

of prescription opioids. Labeling that is inconsistent with the totality of evidence regarding the safety and effectiveness of these products, and of course, the labeling, as you know, in turn affects the 

ways that pharmaceutical companies can market and promote the 

products. The widespread prevalence of pain and a notion that pain 

needs to be fully abated and that people should, you know, get to 

a zero on a scale of 1 to 10, rather than in many countries, cultures 

where pain is something to be managed. I think many pain experts 

would say pain is something to be managed and lived with, not just 

grin and bear it, but not expect that you are going to be taking 

enough opioids that you get down to a zero. 

There are many, many, many causes that have contributed to the 

overprescribing. 

Chairman GOWDY. Are there certain specialties or subspecialties 

where you have identified where the overprescribing is more prevalent? 

Dr. ALEXANDER. Well it is a terrific question. It would be a privilege to share with the Committee some of our own data and own 

analyses in this regard. The point that I would make is that the 

prescribing volume of opioids is highly skewed so that if you look, 

for example, within primary care physicians, it is a small subset 

of primary care physicians that account for the lion’s share of 

opioids that are prescribed. 

With that being said, these are not primarily rogue prescribers 

that are down on Main Street seeing 300 patients in a day and 

only accepting cash. I think that there is a very important point 

here, and in fact, Governor Christie spoke to it when he said that 

most prescribers that are contributing to this epidemic aren’t doing 

so out of ill intent. They are doing so out of non-intent. So it is important to recognize that while opioid prescribing is highly skewed, 


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that the prescribers that are prescribing in such enormous volumes 

are not necessarily, you know, just flouting any standard of best 

medical practice. 

Chairman GOWDY. Now when you say primary care physicians, 

I am thinking pediatricians, internists, and GPs. What am I missing? 

Dr. ALEXANDER. Family docs, internists are the big two. Pediatricians are lower volume only because fortunately, not many kids are 

prescribed opioids. 

Chairman GOWDY. So we can take pediatricians out of it. Internists—— 

Dr. ALEXANDER. Sure. 

Chairman GOWDY. —or would you—internists and GP—— 

Dr. ALEXANDER. Yeah. 

Chairman GOWDY. —or what used to be GPs, family doctors. 

Dr. ALEXANDER. Um-hum. 

Chairman GOWDY. Two questions in this realm. Has there been 

any analysis of physicians who write prescriptions for opioids after 

a patient has been declined a prescription from another physician? 

In other words, doctor shopping? 

Dr. ALEXANDER. Yeah, that is a terrific question, and here again, 

as with the rogue prescribers, when we look at the data we reach 

a very interesting conclusion, which is that opioid shoppers are exceedingly rare, and almost around the era in importance relative 

to other populations of high risk patients. That is not to suggest 

that it is not vital that we identify and intervene upon opioid shoppers, but there are other populations of chronic opioid users that 

are much higher risk when you look at a population level, a public 

health level than opioid shoppers. And so I am speaking about individuals that are on chronic high-dose opioids and also individuals 

that are on the combination of prescription opioids and 

benzodiazepines. 

Chairman GOWDY. I have a couple more questions. I am going to 

try to fit them in so I don’t violate my own rules. 

In terms of alternatives—well let me ask you this. We can test 

blood pressure, we can test cholesterol, we can check somebody’s 

temperature. How close are we to having a diagnostic test for pain? 

Dr. ALEXANDER. It is, you know, nowhere in our lifetimes would 

be my best guess, and I think it is one of the other factors that has 

contributed to the epidemic because it is really—because pain is so 

inter-subjective. It varies a lot person to person, and it is very difficult—there is no objective test for it. 

This is one of the reasons that I think it is so important that we 

teach the next generation of professionals and those currently in 

practice, there are lots of tools in the toolbox. We don’t need to just 

wait for the FDA to bring new drugs down the pipeline 10 or 20 

years from now. We already have dozens of different treatments, 

both pharmacologic and non-pharmacologic for pain. And I think 

one of the things that is happening with the opioid epidemic is that 

we are shining such a bright light on opioids that we are neglecting 

to consider all of the alternatives that, in many cases, are safer and 

more effective. 

Chairman GOWDY. The gentlelady from Michigan, Ms. Lawrence. 

Ms. LAWRENCE. Thank you. 


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I am going to ask this question to Ms. Wen and anyone else who 

can answer. You spoke about the Baltimore schools having addiction screening. We have approximately, as reported, about 430,000 

foster children in America. I sit on the Foster Care Caucus, and it 

is a high priority for me. Mental health for our foster children in 

that alarming rate they suffer five times more likely from PTSD 

and from trauma. 

With that being said—and we talked about the priority groups 

based on the socioeconomics. Is there any focus on foster children 

as far as education, screening, and support? 

Dr. WEN. That is an excellent question. We know from studies 

that children who experience trauma, which losing their family certainly would be that trauma, or growing up in families with high 

rates of addiction would also be traumatic too, that these children 

have higher rates of addiction themselves. And that is this vicious 

cycle then of poverty, trauma, and addiction, and addiction begins 

to beget addiction too. 

So from our standpoint, we absolutely need to provide services 

for those children experiencing trauma, but critically, we also have 

to provide treatment for their parents and caregivers, because unless we do that, we are going to have issues like we have a tripling 

of the number of children born with neonatal abstinence syndrome. 

Some studies show that 40 percent of neonatal ICU days are because of their—the child being born with and with the opiate addiction themselves. That is a dangerous cycle, and we can stop it by 

providing treatment for the mother, for the parent, for the caregiver. 

Ms. LAWRENCE. I am told by the Department of Human Services 

that the fastest growing contributor to foster children growth in 

America is from opioid addiction, because children are being taken 

away. 

The last thing I want to say is that I did enter a bill that 

would—the Timely Mental Health for Foster Youth, which would 

require all children to be mandated, like they get a physical health 

assessment. They need to get a mental health assessment because 

we know these children have experienced the first level of trauma, 

that is being separated from their family, and I really hope that 

as we continue of targeting and addressing addiction screening, 

that we keep a focus on our foster children in America. 

Thank you. 

Chairman GOWDY. Gentlelady yields back. The Chair would now 

recognize the gentleman from Vermont, Mr. Welch. 

Mr. WELCH. Thank you, Mr. Chairman, and Mr. Gowdy and Mr. 

Cummings, I thank you for organizing this hearing. I think all of 

us should leave this hearing with some significant amount of humility. You know, as I see it, the Federal Government primarily 

has to be a partner to the local communities that are doing all the 

frontline work, and when I look at what you have done here in Baltimore, just the training of the number of people who are capable 

of administering lifesaving medication, a kind of all-in approach 

that the city has taken, and also Johns Hopkins has taken as well. 

Our role, as I see it, is to try to get resources back to the communities so that you can your job, because this appears to me to be 

fundamentally an issue that can only be dressed—be addressed at 


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the very local institutional individual level. I mean, that story, Dr. 

Wen, about your 24-year-old patient was—it really says it all. So 

I want to thank you—all of you, really, Dr. Alexander and Mr. 

Baum. Thank you for your work. 

We are going to have a tough time in Congress on money. You 

need more and when we don’t provide it, our local first responders 

are put in a jam, our police officers, the hospitals. But we can do 

something about the cost of these drugs that have gone way up, 

and it is my hope that this Committee—there has been a lot of interest by many of our members in trying to take practical steps to 

contain the cost. Both Mr. Gowdy and Mr. Cummings have been 

leaders in this. 

What has the cost of these lifesaving drugs, Dr. Wen, done to 

your budget in your health department or in Baltimore? 

Dr. WEN. We have redirected—given the scope of the opioid epidemic, we have redirected funds from other critical programs in 

order to fund this. So we—I have to choose all the time, do we fund 

asthma programs for children, lead poisoning reduction, or do we 

fund the opioid epidemic? And we had to—— 

Mr. WELCH. I will ask all of you. On these drugs like naloxone 

and these others, have the changes that have been made largely, 

in my view, to extend intellectual property protection and allow additional price increases, have they made a significant different in 

the benefit to the lifesaving qualities given to the patient, or is it 

just the higher price? And you can all address that. 

Dr. WEN. Hard to say except that, again, this is available in 

other countries for very little, and I would love to see us get the 

broad access that this epidemic requires. 

Mr. WELCH. Mr. Baum, is that an issue? 

Mr. BAUM. Yeah, I don’t know if that is an issue. I have met with 

all the manufacturers of these medications and talked to them 

about pricing, and they have talked about how if you have insurance, either public or private, they have a very low copayment, 

sometimes—— 

Mr. WELCH. Can I interrupt? 

Mr. BAUM. Please. 

Mr. WELCH. I hear that all the time. 

Mr. BAUM. Yes. 

Mr. WELCH. It is so corrupt. I mean, what is the problem—and 

I am not directing this at you, I am directing it at them. What is 

the problem with being able to go on the internet and finding out 

what it costs without all the convoluted obfuscation that occurs in 

drug pricing? I mean, is that as frustrating to you as it must be 

to practitioners? 

Mr. BAUM. I guess where I am is naloxone saves lives. We want 

everyone who needs access to it to get access to it. I was trained 

on how to use it. I want it out available—— 

Mr. WELCH. What happens when the drug companies hold hostage your desire to save lives with a stick up price that bankrupts 

your operation? 

Mr. BAUM. You know, I think that the story is more complicated 

than that, and they are getting a lot of this product out at discounted prices. I think we need to continue to work with them and 

need to continue to find resources to fund naloxone, because I—— 


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Mr. WELCH. Explain to me why the price has gone up so much 

when it is basically the same product? 

Mr. BAUM. Well I really—I don’t want to speak for the manufacturers, but my understanding is they had a list price but the actual 

price at the retail level that is paid by consumers is much less. 

Mr. WELCH. See, that again is gobblygook, because it is a price— you know, if you went and bought a car and paid $15,000, and the 

same car a year later was $25,000, you would be able to figure out 

that is a $10,000 difference. You can’t figure that out now. 

Mr. BAUM. All I can say is, you know, we are committed to keep 

working to getting naloxone at a fair price. 

Mr. WELCH. Well we would love to work with you. You know, 

President Trump has said that he wants—he said that the pharma 

companies on pricing are getting away with murder. 

And by the way, all of us acknowledge that pharma does fantastic things, life extending and pain relieving drugs. But if the 

price kills us, we are not really getting ahead. So we really need 

the President and all of us to get involved in trying to do legitimate 

things to contain this, in my view, price gouging. 

I yield back. 

Chairman GOWDY. Gentleman from Vermont yields back. 

I want to thank our panel. We have votes back in Washington 

that they expect us to be there for, whether we want to be there 

or not. They expect us to be there. So I want to thank all three of 

you not just for your time and your expertise today, but for the 

dedication of your lives in helping other people. It has been very 

instructive. I think we are—all the members—I want to thank 

again the good folks at Johns Hopkins and the mayor and the governor and Governor Christie, and I want to thank you, Mr. 

Cummings, for being such a phenomenal host to all of your colleagues. 

Mr. CUMMINGS. Again, I want to thank you, Mr. Chairman. You 

didn’t have to do this, but you did, and you made a commitment 

to me right after you became Chairman that you were going to do 

this hearing, and you kept your word. And I really do appreciate 

that. 

And to all of our witnesses and to Johns Hopkins, we thank you, 

and to the members, I want to thank every member. People in the 

audience, this is a little bit of a sacrifice for members to come here. 

I know it is close to D.C., but they literally have to come in earlier 

than they normally would have, probably catch some earlier flights 

than they would have to be with us. And so I want to thank all 

of our members for being here. 

I just have one quick unanimous consent request, Mr. Chairman, 

and that is that the letter dated November 21, 2017, from the Association for Behavioral Health and Wellness be entered into the 

record, and that the testimony of the National Healthcare for the 

Homeless Council be admitted into the record, and it is dated November 28, 2017. 

Chairman GOWDY. Without objection. 

Chairman GOWDY. The gentleman from Alabama looks like he 

seeks recognition. 

Mr. PALMER. We will have the opportunity to submit questions 

in writing? 


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Chairman GOWDY. You may. Let me get to that part of it. 

The hearing record will remain open for two weeks for any member to submit a written opening statement or questions for the 

record. If there are no further questions, no further business, we 

want to thank our second panel again, particularly for your patience in that the first panel was super important, but it also 

maybe went a little bit longer. So we appreciate your patience and 

your expertise and your comity, with a t, with the Committee. 

With that, we are adjourned. 

[Whereupon, at 3:53 p.m., the Committee was adjourned.] 


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