▶ 0:14:43>> the special committee on aging will come to order. Over the last decade we have lost hundreds of thousands of american lives to drug overdoses. It is happening in every community and across every state. None of us have been spared by the carnage left by this crisis. We have all heard the heartbreaking stories of families who have lost children, parents, and siblings to fentanyl and other opioids. Fighting the crisis has been an incredible challenge.
▶ 0:15:10The precursors of these drugs come from communist china and are bought by the people drug cartels to make deadly opioids like fentanyl. These cartels then traffic these drugs over the border and into our communities where they poison and kill tens of thousands of americans every year. Thanks to the hard work of our governors, state attorneys general, sheriff departments, police departments, from 2022 to 2023 we saw a drop in overdose deaths from people aged 15 to 54.
▶ 0:15:40That is good news what shows we have more work to do. While overdose deaths in the U.S. dropped for people between the ages of 15 and 54 we saw deaths increase from 22 23 for americans ages 55 and older after seeing an increase in the 55 and older age group in 2022. In 2023, more than 29 thousand americans aged 55 and older died from an opioid overdose. That is 80 seniors dying from opioid overdoses every day. Think about it this way.
▶ 0:16:10You need two hours we will spend together today, six people 55 and older will die. Every overdose is preventable. Every single one of those nearly 30,000 lives of older americans lost could have been saved. While we have all heard the heart wrenching stories of children and young people lost to the opioid crisis, the stories that have been largely untold are those about the devastating impact this crisis of having on american seniors. That includes not only the horrible deaths I just talked about but the toll of being a caretaker.
▶ 0:16:45I know we will hear firsthand today about that from ms mateer. This is an american issue and congress must act now pick last year I was proud to have my bipartisan anti-fentanyl act signed into law.
▶ 0:17:06It was a bipartisan success because it exposed how behind parts of the federal government were when it came to fighting the opioid epidemic and stopping the deadly fentanyl deaths killing thousands of our fellow americans. In 2019 study from the government accounting office found drug guidance had not been updated in 20 years. That is unacceptable.
▶ 0:17:33Now that the law cbp is required to update policies once every three years including drug interdiction guidance are up-to-date. These are the kind of commonsense policies we need to get done here in washington. Seeing the and fentanyl act come into law makes me more optimistic we can get things done and I have more ideas to combat the opioid crisis. Last week I introduced my opioid act. This bipartisan bill is one step we can take to fight this epidemic here and now.
▶ 0:18:04We will provide better insight. Local law enforcement agencies are on the front lines of this crisis. This would provide additional grants to support law enforcement and communities with high rates of overdoses and make federal agencies collaborate on this problem. And my opioid act will stop the bad practices of stealing money for the budget to provide additional grants to support law enforcement and communities with high rates of overdoses and make federal agencies collaborate again.
▶ 0:18:35I'm oso proud -- naloxone literally stops in overdose in its tracks. That is why each june 6 we do a national naloxone day to educate people on the life-saving drug capabilities of something so simple to carry.
▶ 0:18:57I also have several other pieces of legislation on this issue including national fentanyl awareness week resolution and more. This is by no means all we can do but it has to start somewhere. I am optimistic. I know it might seem like there is not a clear path forward but if we keep fighting every day we can make a change. I look forward to hearing your testimony and working with my colleagues on the next step to fight this issue.
▶ 0:19:26I now want to recognize ranking member kirsten gillibrand.
▶ 0:19:31Sen. Gillibrand: Thank you. There is no community in this country that has escaped the impact of the opioid crisis. Substance use disorders are growing at an alarming rate in the united states. Broadly, 48.5 million people aged 12 or older have a substance use disorder in the past year.
▶ 0:19:53Sen. Gillibrand: While older adults tend to use substances at lower rates than other age groups, 4.6 million people aged 65 or older had a substance use disorder. In the past year, fatal drug overdoses decreased nationally. And while the numbers vary significantly between states, we have the tools to continue reducing overdose deaths to reduce the trend in states where this is not the case.
▶ 0:20:18Sen. Gillibrand: We know that expanding the availability and affordability of treatments and harm reduction policies like universal access to naloxone are strategies that work. We need to make a multifaceted approach that includes a law enforcement and criminal justice element that prayed -- places a larger emphasis on public health and social policies. We cannot fully address the opioid crisis if we are not also adjusting prevention and access to affordable treatment.
▶ 0:20:48Sen. Gillibrand: It is why protecting medicaid is so critical. Medicaid is the primary care for substance use disorder treatment, and any cuts to the medicaid program would devastate our ability to solve this crisis. Another critical piece of the puzzle is the impact of drug use on the whole family.
▶ 0:21:07Sen. Gillibrand: More than 2.5 million children are currently being raised by grandparents or relative or close family friend over time where grandparents are forced to become family caregivers because of the opioid crisis. I co-lead a bipartisan supporting families through addiction act which would provide support to the families of people receiving treatment for substance use disorder.
▶ 0:21:34Sen. Gillibrand: Congress must do a better job of tackling this crisis holistically. I hope to work with my colleagues in the future to develop policies that take every aspect of this crisis into account, from providing necessary a book safety tools, to making sure those with substance use disorder have access to affordable, evidence-based treatments. I look forward to today's hearing and I look forward to hearing from our witnesses who can speak to the opioid ecosystem and how we can truly combat the opioid crisis.
▶ 0:22:06Chair Scott: Thank you. I would like to welcome our witnesses here today. Before I introduced them I would like to ask each of you to be mindful of our limited time together and keep opening statements to five minutes. I would like to welcome sheriff dennis lemma who serves as the chair on florida's statewide council on opioid abatement created to enhance the development and coordination of state and local efforts to abate the opioid epidemic and support the victims and families of this crisis.
▶ 0:22:36Chair Scott: Sheriff also serves as a member of the victorious voice foundation which does amazing life-saving work to help prevent overdoses by raising awareness of naloxone, a revolutionary drug to stop an overdose in his tracks, as well as educating people about the dangers of drugs. I have worked with the foundation for two years to introduce national naloxone awareness day resolution and was happy to see had passed to raise awareness of this important opioid tool.
▶ 0:23:04Chair Scott: It has been an honor to work with them to get naloxone into more schools and help them partner with school districts so these parents can talk directly to students about the dangers of fentanyl. I've also had the pleasure of working with the sheriff for years on these important issues. Thank you for being here.
▶ 0:23:25Mr. Lemma: Good afternoon chairman scott, ranking member gillibrand, and distinguished members of the special committee. Thank you for the opportunity to testify on the devastating crisis of overdoses and fentanyl poisonings in our country. It is an honor to present a proven strategy from florida, one that can be replicated nationwide.
▶ 0:23:46Mr. Lemma: Chairman scott, your leadership starting with your time as florida'sovernor when you and attorney general bondi took action to shut down pill mills served as a model for the country. Senator gillibrand, your efforts through the legislative efforts have been crucial in this fight. I would also like to recognize senator ashley moody, who as florida's attorney general, provided invaluable leadership in the fight against this epidemic.
▶ 0:24:13Mr. Lemma: Her vision and dedication inspired my own focus on this issue which requires both law enforcement and clinical understanding. I serve as the elected sheriff of seminole county, florida in the orlando metropolitan area. Seminole county is the fourth most densely populated county in the state. And despite its affluence, we are not immune to the devastating effects of this crisis. Simply stated, this epidemic does not discriminate.
▶ 0:24:43Mr. Lemma: It affects citizens from all backgrounds and demands comprehensive solutions. In my nearly 33 years of law enforcement, I have come to believe the greatest responsibility of any civilized society is to protect and preserve human life. Overdose death has tragically become a leading cause of death for individuals aged 18 to 45. In 2022, the average life expectancy of a U.S. citizen decreased partially due to the rise in overdose deaths.
▶ 0:25:13Mr. Lemma: To effectively combat this crisis, we need a holistic approach that includes prevention, treatment, advocacy for life-saving interventions, and a strong emphasis on law enforcement strategy that aggressively goes after the drug dealers who are dealing deadly doses of narcotics in our communities. Prevention remains a critical tool in the process. Through focused education and awareness, we can equip individuals with the knowledge to avoid addiction before it ever starts.
▶ 0:25:42Mr. Lemma: Prevention also requires ensuring the highest level of access to opioid antagonists like narcan, a life-saving medication that can immediately reverse the effects of an opioid overdose. In florida we have made great strides in expanding access to these antagonists and they have saved countless lives. Treatment is equally important in breaking the cycle of addiction.
▶ 0:26:07Mr. Lemma: Medication assisted therapy combined with cognitive behavioral therapy has proven to be effective in helping individuals recover from substance use disorder in both clinical and correctional settings. Data collection also plays a critical role in combating this epidemic. We need to gather and analyze overdose data at all levels. By understanding overdose trends, we can better allocate resources and target enforcement efforts.
▶ 0:26:34Mr. Lemma: However, accountability for drug dealers is absolutely crucial if we are going to put an end to this epidemic. We must ensure that those who distribute fentanyl and other illicit substances like the emerging trend of street-level xylazine, are held fully responsible for their actions, whether there is an associated death or not. Too often overdoses are treated as accidents when in reality they are crimes.
▶ 0:26:58Mr. Lemma: In florida, we have passed legislation with harsher penalties for those drug dealers whose actions result in fatal overdoses. While at the same time we have created criminal laws to hold drug dealers accountable for the individual overdoses that we bring people back to life with. Drug dealers cannot be let off easily and the law must hold these individuals accountable to the fullest extent.
▶ 0:27:26Mr. Lemma: We cannot ignore the illicit drug trade, particularly from cartels, which still pose a threat to our country. Securing the border and preventing fentanyl from entering our country is critical to minimizing its availability in reducing deaths. This crisis must unite us all regardless of partisan lines, because it impacts every community across the country.
▶ 0:27:50Mr. Lemma: In conclusion, we must adapt a holistic strategy that includes prevention, treatment, improved data collection in the strictest accountability for drug dealers. This strategy works. Build safer communities and ultimately save lives. Utilizing this strategy in seminole county, we have achieved a 29% reduction in overdoses and a 42% reduction in fatalities in 2024 alone.
▶ 0:28:17Mr. Lemma: While we have seen this reduction, we know that the hard work still lies ahead. Thank you for having me here today and I look forward to addressing your questions.
▶ 0:28:25Chair Scott: Thank you. I would now like to recognize jim justice to introduce our next witness.
▶ 0:28:35Sen. Justice: Let me say this. Gregory duckworth, you are an incredible man and you have done incredible work and it is an honor for me to introduce you. But I just have to say this. I said this earlier today. Can you just imagine west virginia, how hard west virginia was hit? It was unimaginable in every way. We had to have people who really stepped up.
▶ 0:29:06Sen. Justice: People who were superstars. This man is a superstar. He is 27 years a veteran of the state police and absolutely a superstar in every way. With all that being said, let me tell you a story very quickly. Babydog and I go through a lot of drive-through windows and maybe we shouldn't go through that many. But just the other day we were going through the drive-through window at arby's.
▶ 0:29:34Sen. Justice: And I looked up and the car right in front of me had amber and a cross, and 1993-2023. When we made it to the window to pay for our food and the car had left and they paid for our food. We tried to run them down. We finally, through a lot of different ways, through the state police, found them. Amber had played basketball for me as a coach.
▶ 0:30:04Sen. Justice: So many situations to where all of a sudden, a drug takes a life. It is happening all over the place. Greg, I mean this with all in me. It is an honor to introduce you. You have done great work with our foundation in west virginia. You have absolutely been just what I have just said. You have been a superstar because you care. And I am really proud to introduce you. Thank you so much, Mr. chairman.
▶ 0:30:35Mr. Duckworth: Thank you very much. Chairman scott, ranking member gillibrand, and my fellow west virginia senator justice and other members, thank you so much for having me here today. It is truly an honor. I spent my law enforcement career in the heart of the opioid epidemic in an area once known as the coalfields.
▶ 0:31:01Mr. Duckworth: Today I want to share first-hand experiences on how this crisis is devastating families, affecting our aging population, and where we must focus our efforts going forward. In 2012, a 17-year-old reported to the police that her father and two younger siblings were missing. She had already lost her mother, who under the influence of oxycontin, had wandered into the highway and was fatally struck by a truck.
▶ 0:31:29Mr. Duckworth: During the missing person investigation, police found that her father was lured into a trap by an oxycontin dealer who owed him money. Hendrix, his girlfriend, and the two youngest children were ambushed and murdered and their bodies were discarded as if they were worthless. A decade later, cheyenne herself died of an opioid overdose, leaving behind three small children. Entire families are being erased by addiction.
▶ 0:31:59Mr. Duckworth: This is not just a crisis of individuals, it is a crisis of generations. Children and grandparents are forced back into parenting and communities crumble. The story involves a single mother in her early 30's with four children, a nine-year-old, a seven-year-old, and three-year-old twins. For years she lived with her mother who helped care for the children. Recently she moved into her own place, a single wide trailer within walking distance of her mother's home.
▶ 0:32:28Mr. Duckworth: At night she would take the twins home while leaving the older children with their grandmother, who would ensure they got to school the next morning. The twins were described as full of life and radiating joy as much as three-year-olds do. 190 mother put the twins to bed and by the time she checked back on them again they were deceased. Autopsies revealed multiple drugs in their systems including lethal amounts of fentanyl. The neglect was so severe, their rigor mortis had already set in before she realized what had happened.
▶ 0:32:59Mr. Duckworth: The children's grandmother had already lost her husband to cancer and she is fighting for custody of the remaining children but has been unsuccessful. She is however allowed to see them with the help of child protective services. The mother is currently in jail awaiting trial on two counts of child neglect resulting in death. The burden on our seniors in west virginia, one in seven children lose their parents to overdose or incarceration by the age of 18.
▶ 0:33:28Mr. Duckworth: With the highest rate of neo-nato absences syndrome, many of these children have medical and developmental challenges. Grandparents who thought they are retiring are now primary caregivers. They face physical strain in raising young children at advanced age, financial hardship, many struggled to meet basic needs. Emotional toll, raising children while still grieving the loss of their own. Many of this is off the record to avoid the foster care system.
▶ 0:33:58Mr. Duckworth: They don't receive financial or legal support either. The west virginia first foundation is supporting grand families and the aging population and I am proud to serve on a board of the west virginia first foundation and to be part of this organization that is making a real difference in our communities. The foundation is committed to addressing the full impact of the opioid epidemic including the burdens placed on west virginia's aging population. Recognizing that addiction is not just affecting the individual but entire families.
▶ 0:34:29Mr. Duckworth: The foundation is dedicated to supporting grandparents raising grandchildren by providing resources and assistance to child advocacy and youth prevention programs. We recognize the crisis did not end with one generation and it continues to ripple out words. By investing in solutions as supports a full family systems, the foundation is helping to break the cycle of addiction and ensuring grandparents raising grandchildren are not left to struggle alone.
▶ 0:34:57Mr. Duckworth: Where we must focus having served on the front lines of the epidemic I believe our response must be comprehensive. Treatment access, prevention and education, recovery support, grand families and child advocacy, and of course economic recovery. We must fix some of the systemic failures as well. The underreported overdose deaths, inconsistent narcan used documentation, and recovery homes miss classifying overdoses.
▶ 0:35:25Mr. Duckworth: In closing, I believe we have to restore hope and substance use disorder is our enemy. It is destroying the very core of the american way, god, family, and self. We must ensure the love of the church, reunite families, and emphasize the importance of family values, can bring back support systems that give people a sense of self-worth. The crisis is more than just statistics. These are real people.
▶ 0:35:52Mr. Duckworth: If there is one thing I want you to take away from today, it is behind every number, there is a human being. Thank you.
▶ 0:35:59Chair Scott: Thank you, commissioner. I would like to recognize ranking member jell-o brand.
▶ 0:36:08Sen. Gillibrand: I want to introduce elizabeth mateer, a grandparent who has been raising her grandson for more than a decade due to his parents opioid use disorder. Thank you so much for sharing your story with us today. You may begin.
▶ 0:36:28Ms. Mateer: Thank you for holding this important hearing and for inviting me to share my perspective. My name is elizabeth mateer. I am a grandmother raising my grandson due to the impact of opioids. I also volunteer as a generations united grand voice caregiver advocate. When my grandson was born I had no idea that my life would change forever. I did not know the baby was suffering with neonatal abstinence syndrome.
▶ 0:36:58Ms. Mateer: I also had no knowledge about opioid use disorder. So at first I did not identify and understand the harsh reality that both parents were addicted to painkillers. When we learned of the mom's opioid use my husband and I intervened and arranged for her to be admitted. To a treatment facility. Suddenly we had a baby. Although we were very relieved and hopeful for the future, we had no crib, no diapers, no baby clothing, no formula, and no idea where to start.
▶ 0:37:29Ms. Mateer: 10 days later I would receive a phone call that mom was leaving treatment. We would not hand our infant grandson back to parents who were using. Fear drove us to find an attorney who obtained emergency custody, but a few weeks later the parents cheated a drug test and we were ordered to return the baby. Why do judges misunderstand opioid addiction and the risk in placing children with parents who are in active addiction?
▶ 0:37:57Ms. Mateer: The cycle of staging interventions and arranging for admissions to treatment continued. Early on one interventionist told me to be prepared to keep my grandson long term because this would go on for a long time. Each relapse was a crushing blow and each time the recommended length of inpatient treatment increased. The staggering cost for some treatment facilities included $30,000 deposits for admission and $10,000 a month. I constantly battled with the insurance company.
▶ 0:38:28Ms. Mateer: Opioid addiction is like none other. It takes a person's soul and turns them into someone you do not recognize. We were desperate to save both mom and baby. The stress of living in this opioid created crisis landed me in the hospital with pneumonia in both lungs. While we were trying to help our grandson's mom get treatment we were fighting a custody battle with the father who was still in the throes of opioid addiction. Our legal fees exceeded $85,000.
▶ 0:38:58Ms. Mateer: The court was permitting supervised visits that were actually not being supervised. We worried every time we went to court. The court halted visitation privileges when we learned the father had been charged with child endangerment of another child under his supervision. Six months later he died of a heorin overdose. When I told my then-4.5-year-old grandson that his father died, the first question he asked was, will I still be able to live with you?
▶ 0:39:29Ms. Mateer: I've found that working for and caring for a child was harder than raising my own children. I had to lose my job. My relationships disappeared. Friends stopped inviting me to social events. I felt isolated as my husband traveled for work. The stigma of addiction that the child I raised could not raise their child made me feel ashamed. No one knocks on your door with a lasagna in hand to comfort a family in this kind of crisis.
▶ 0:40:00Ms. Mateer: My clergy never called. Depression set in and I wondered how I would go on. By the grace of god, our grandson's mother has been clean for a long time. Our relationship is challenging because her son, now 13, wishes to remain in our home. During the years of battling her addiction he just grew up. This is his community, his home where his pets live, where his school is, where his friends are.
▶ 0:40:25Ms. Mateer: My husband delayed retirement so we could provide for our grandson and it is nothing like we envisioned driving the middle school carpool and hosting the baseball team picnic. We have to stay healthy so we can be there for our grandson. The staggering number of grandparents who care for their grandchildren, often without any support, is one of the least recognized populations impacted in the opioid crisis.
▶ 0:40:51Ms. Mateer: Grandparents and other relatives who stepped forward to keep children out of foster care and safely with family save taxpayers more than $4 billion a year. The child welfare system would collapse if grandparents did not take in these children. Any grandparent raising a grandchild could use financial help. I urge you to consider these recommendations. Encourage states to distribute opioid settlement to help children and caregivers. Promote peer support.
▶ 0:41:21Ms. Mateer: Being part of the grand voices network has been a godsend to me. I was once told that opioid addiction in a family is like pouring acid on it. Expand the number of mental health providers with expertise and grant families. When we enrolled in medicare our grandson lost their health insurance. Expand health care coverage options so grandparents have coverage for the children they are raising.
▶ 0:41:49Ms. Mateer: Allow grandchildren who are in a legal already in ship of their grandparent to qualify for social security survivor benefits if the grandparent dies. Snap can be a lifesaver. I urge you to protect this program. Continued support for kinship navigator support for kinship navigator programs or kinship navigator programs that nship navigator programs that provide information about community- based services. I cannot imagine what my grandson's life would have been like in foster care with strangers. Grandparents are committed to protecting children in their care, but we need help.
▶ 0:42:19Ms. Mateer: Thank you.
▶ 0:42:22Chair Scott: Thank you. Go ahead.
▶ 0:42:28Sen. Gillibrand: Thank you. Our next witness is Dr. malik burnett, medical director of several opioid commitment treatment programs. Dr. burnett also serves as vice chair for the committee for the american society of addiction medicine and oversaw naloxone distribution for the state of maryland. Thank you for being here Dr. burnett. You may begin your testimony.
▶ 0:42:54Dr. Burnett: Esteemed members, I thank you for inviting me to participate in this critically important hearing. My name is Dr. malik burnett, I am a board-certified addition specialist in maryland.
▶ 0:43:12Dr. Burnett: Today I am testifying in my capacity as vice chair of acm, a national society representing over 8000 physicians and clinicians who specialize in the treatment and prevention of addiction. I want to talk about baltimore and it's forgotten generation older adults born between 1951 in 1970, particularly older blackmon.
▶ 0:43:38Dr. Burnett: In in my city one of three drug overdoses that has come from this -- they are among the deadliest health threats they face pretty many of these men have struggled with addiction for years but today there is no margin for error. A single relapse can leave them at the mercy of a lethal dose of fentanyl or other synthetic drugs.
▶ 0:44:00Dr. Burnett: While addiction is a treatable medic disease it is also one of the most complex in medicine that involves interactions among genetics, and left experiences. Solutions to our nations crisis can be equally complex and interconnected. Approaches are important to public safety. But they yield little net benefit if demand-side interventions remain inaccessible.
▶ 0:44:27Dr. Burnett: Drug cartels can quickly replace synthetic drugs with little overhead. The good news is evidence-based addiction treatment works and reduces by 80%. I personally witnessed hundreds of lives transformed by addiction treatment.
▶ 0:44:48Dr. Burnett: They restore their marriages, rejoin the workforce, leave criminal activity, improve their mental and physical well-being, reunite with children and escape the grasp of drug cartels. We are fortunate to live in a time when effective evidence-based treatment exists for opioid use disorder and yet tens of thousands of people in the U.S. continue to die from opioids annually. How is this possible? The people who need these treatments to most are not getting the care they need when they need it.
▶ 0:45:16Dr. Burnett: In fact it is this treatment gap that has barely budged for the last decade. We will not end the opioid epidemic until the treatment is easier to get then opioids. For many americans, especially in rural areas, this treatment is impossible to find.
▶ 0:45:38Dr. Burnett: People with addiction awfully experience a brief window of time between desiring treatment and experiencing painful withdrawal symptoms, symptoms cheap fentanyl can temporarily stop in an instant. But easier access to addiction treatment cannot happen without is substantially larger workforce including more addiction specialist physicians, increasing funding for psychiatry fellowships and encouraging more physicians is surely needed to ensure every community has high quality
▶ 0:46:08Dr. Burnett: Addiction treatment. Federal law must be amended to allow these addition specialist to ascribe methadone for opioid use disorder that can be dispensed from community pharmacies. Only about 2000. They are lacking in about 80% of U.S. counties. Methadone has been caught in bureaucratic red tape for nearly 50 years. Allowing states to regulate without undue federal restriction could lead to the innovation needed in opioid treatment in america.
▶ 0:46:40Dr. Burnett: Yet continuing -- connecting individuals to treatment is not enough. They must also be able to afford care. Medicaid and medicare are major insurers, making it essential these fiscal mechanisms facilitate rather than hinder access. Many clinicians and opioid treatment programs do not accept medicaid, largely reflecting the program's administrative burdens and low reimbursement rates. Congress should increase medicaid rates to change this equation.
▶ 0:47:09Dr. Burnett: Medicaid and medicare must also cover the full continuum of addiction care. Medicare does not cover non-hospital-based residential addiction treatment. This must change. Furthermore assurance of equal reimbursement for mental health and addiction care must be strengthened for parity violations and incentivizing straight regulators to be more robust in their enforcement. Stigma towards addiction is arguably the most difficult area to address as it is so entrenched in society.
▶ 0:47:37Dr. Burnett: Even when people recognize they have a problem with drugs or alcohol, they are often too embarrassed or scared to talk to their physician about it. The federal government should stop wasting money on incarcerating people for nonviolent drug offenses and recognize addiction is a disease and not a moral failing. People already in the criminal legal system also need better access to addiction treatment.
▶ 0:48:00Dr. Burnett: Congress should eliminate the exclusion requirements and federal funding for prisons and jails contingent upon treatment to ensure taxpayer money is not wasted on a revolving door of incarceration. Thank you for the opportunity to share my perspective and extra tease today.
▶ 0:48:16Dr. Burnett: One thing is clear about america's opioid ecosystem, whether it is funding and training more addiction specialist, ensuring access to methadone, closing medicare coverage gaps, avoiding harmful custom medicaid, congress owns this. Let's work together to save lives. Thank you and it look forward to answering your questions.
▶ 0:48:36Chair Scott: Thank you. I cannot imagine trying to stay up with them as a parent as my daughter and son-in-law have to do. Finally I would like to introduce Dr. bradley stein, director of the rand usc shaper opioid policy center and senior physician policy researcher at the rand corporation. Dr.
▶ 0:49:03Chair Scott: Stein has worked extensively. Thank you for being here.
▶ 0:49:09Dr. Stein: Thank you. Thank you for inviting me to share insights on combating the opioid crisis which is increasingly impacting other americans. I am a policy researcher at rand and direct an nih funded research center devoted to better understanding the effectiveness of opioid-related policies.
▶ 0:49:34Dr. Stein: I'm also a practicing child psychiatrist in western pennsylvania where I see how opioid addiction devastates families. The toll of the crisis extends far beyond fatal overdoses. It affects millions of americans, not just older adults fighting to maintain their own recovery. Also those spending their life savings to pay for adult children addiction treatment or raising. Today I will focus on three topics relevant to this committee.
▶ 0:50:02Dr. Stein: What escalating rates of opioid use disorder among older adults imply for health care. How upstream strategies of better product paying management can help prevent opioid misuse. And the social toll of grandparents raising grandchildren due to parental addiction. Opioid use disorder rates have tripled among medicare beneficiaries the last decade.
▶ 0:50:24Dr. Stein: The rapid increase poses significant challenges to our health care system which is not adequately prepared to address the unique needs of this population, who often have conditions that can complicate diagnosing and treating like dementia or chronic pain. Primary care providers that clinicians at the heart of treating our older adults often lack training or confidence in managing opioid use disorder. Meanwhile, few addiction specialists are equipped to handle the complex medical needs of older patients with conditions like dementia.
▶ 0:50:54Dr. Stein: This mismatch leaves many older adults with opioid use disorder without adequate care, especially in rural areas experiencing acute clinician shortages. The american population is aging but currently most clinicians treating chronic disorders in older adults don't have expertise in substance use disorders. And substance abuse experts treating older adults who have addiction usually have little experience in treating chronic disorders in the elderly.
▶ 0:51:21Dr. Stein: Only with concentrated efforts in federal investments will be clinical workforce caring for the elderly be prepared to efficiently and effectively treat individuals with opioid use disorder and disorders like dementia. And chronic pain is even more common than dementia, affecting 36% of those over 65. Efforts to reduce -- many individuals with chronic pain don't receive non-opioid treatments leaving many without adequate pain management options.
▶ 0:51:51Dr. Stein: Some clinicians now avoid prescribing opioids altogether even when they are clinically appropriate, leaving patients to suffer or turn to illicit opioids for relief. Expanding access to non-opioid pain management is essential to address this gap and can help prevent new opioid use disorder cases. Acupuncture, rehabilitative exercise, therapeutic massage, can all reduce alliance on opioids and improve quality of life for individuals with chronic pain.
▶ 0:52:25Dr. Stein: However, insurance coverage is often inconsistent or limited, and high out-of-pocket costs often make these non-medication therapies less affordable than opioids and provider shortages can make this care hard to find. Congress can help by considering incorporating non-opioid therapies for chronic pain and value-based insurance designed to enhance affordability and ensure these insurances are fully covered by medicare.
▶ 0:52:48Dr. Stein: Also consider expanding existing loan forgiveness programs let the national health services core to include providers trained in nonmedication therapies to ensure we have an adequate workforce in the future. Finally, as we heard, the opioid crisis has far-reaching -- an estimated 2.6 million grandparents are raising grandchildren, often becoming informal caregivers when parents struggle with addiction or succumb to overdose.
▶ 0:53:19Dr. Stein: Doing so often entails significant emotional and financial burdens as grandparents working to keep their family together delay retirement or take on new expenses like housing or childcare. These older adults deserve better support. Better support systems, expanded access to respite care, and kinship navigator programs, and information to help them raise children affected by parental substance abuse and trauma. Yet informal caregivers come outside the child welfare system often don't receive such support.
▶ 0:53:51Dr. Stein: Despite the vital role these individuals play in providing stability for so many children. Congress can help support these families by expanding access to respite care and affordable childcare through programs like head start or alongside the child abuse prevention act. It can seek to ensure grandparent caregivers have access to benefits such as health insurance for children and navigate programs. Whether they participate in the program or not.
▶ 0:54:23Dr. Stein: It is important we support the development of educational resources tailored specifically for grandparents, stepping up to raise children affected by parental substance use disorders. Supporting grandparent caregivers not only strengthens families but also reduces long-term social costs associated with parental addiction.
▶ 0:54:42Dr. Stein: There is no simple solution to the opioid crisis but health care reforms, improving non-opioid chronic pain management, and better supporting families at -- affected by addiction will help keep families together and ensure our health care system is better prepared to meet the diverse needs of older americans. Thank you again for this opportunity and I look forward to your questions.
▶ 0:55:04Chair Scott: Thanks all of you for being here. Now we will start going to some questions. We will start with senator tuberville.
▶ 0:55:20Sen. Tuberville: I spent 40 years coaching and in all those 40 years I saw the correlation between family and some kind of addiction. There is direct correlation. If we don't figure out something to do with family in this country and get back to mom and dad and discipline and responsibility, we are going to have a tough time and continue to have a tough time.
▶ 0:55:44Sen. Tuberville: Also, I saw over the years, I would bring young men into my football teams and of course we are their mom and dad for four years and we would bring in doctors. The first part of my career, we had a few that were on insulin for sugar, diabetes or something. But my last 10 years they were very few that were not on adderall or ritalin for attention deficit.
▶ 0:56:13Sen. Tuberville: Kids are over prescribed by doctors for some reason. Do you see a direct correlation between over-the-counter drugs or prescription drugs that lead to addiction?
▶ 0:56:30Dr. Stein: This is a question science this -- scientists have been looking at. And so far it suggest there is not a direct relationship between children receiving these medications and later addiction. But it is also important to recognize that we do recognize there is a relationship between mental health disorders and children generally or in adults and substance use disorders.
▶ 0:56:54Dr. Stein: I think that some point that recognizing that there is this relationship and individuals may have both mental health disorders and substance use disorders. It is important that not only why we are focused here for substance use disorders, to try and address the substance use crisis more generally without recognizing how many of those individuals also suffer from mental health problems.
▶ 0:57:25Dr. Stein: It suggests we are trying to fight that battle with one hand behind our back.
▶ 0:57:26Sen. Tuberville: Do you think we need to rollback the prescription of childhood drugs, of what I was just talking about a few minutes earlier?
▶ 0:57:34Dr. Stein: Sir --.
▶ 0:57:38Sen. Tuberville: Are we over drugged at young age, is what I am asking.
▶ 0:57:45Dr. Stein: That is beyond the research I am currently involved in. As a clinician, it is important we need to make sure we are using medication and other therapies appropriately and that means making sure that individuals who are not being treated and may benefit receive them, and also that we are not providing medications to children or adults who may not benefit from them.
▶ 0:58:07Sen. Tuberville: Thank you. Mr. duckworth, how have states like west virginia used state funds to fight back against epidemics?
▶ 0:58:17Mr. Duckworth: That is a great question.
▶ 0:58:25Sen. Tuberville: How is that funded?
▶ 0:58:27Mr. Duckworth: Opioid settlement money. The executive director was not hired until may of 2024. So between may and september, it took a lot getting the homework done, the staff hiring. We put an initial opportunity grant together that went out for applications in september. So by the end of december we have committed over $20 million.
▶ 0:58:54Mr. Duckworth: Most of it at this point has went to youth prevention and child advocacy. I think we would all agree the hidden epidemic of our seniors is not so hidden anymore. So I can anticipate in the future having a lot more funding going towards the grandparents raising money for seniors.
▶ 0:59:18Mr. Duckworth: To answer your question on the short-term, child advocacy and prevention, education, is where it went recently.
▶ 0:59:25Sen. Tuberville: Do you think there is anything you use we can do on a federal level to help more from this program?
▶ 0:59:31Mr. Duckworth: I think senator scott is on the data sharing education. Data sharing is important for law enforcement. It is so important. I hope we can see that come together.
▶ 0:59:45Sen. Tuberville: Thank you. We have heard a lot about how children are able to purchase drugs which are often laced with fentanyl. There is this god-awful stuff where you can go into one of these convenience stores and by. All of it is made in china which are some reason it is allowed to be sold here in this country.
▶ 1:00:08Sen. Tuberville: What can we do here in washington to curb practices and raise awareness to parents about things that kids are able to buy?
▶ 1:00:16Mr. Lemma: Hank you for the question and you are spot on. The chinese created this epidemic. Illicit substances. Now we have seen the most recent numbers, 50% of the pills made in clandestine labs or somebody's dirty bathrooms contain a lethal dose of fentanyl. That is down from 70%.
▶ 1:00:43Mr. Lemma: Seven out of 10 people were likely to die with a pill that was manufactured in its listed environment. But we see these trends. It was just yesterday we were talking about methamphetamine, mdma, roof fees. Then things got confusing for americans with designer drugs where they would walk in and elicit chemists would stay one step ahead of what the dea would approve as illegal and we would clean the shelves off.
▶ 1:01:15Mr. Lemma: I think we have that under control now. There is no longer a problem in this country of overprescribing. Clearly you have to have your head in the sand to realize that we have a problem that is down at the border with mexican chemists picking up recurs or chemicals from china and learning how to process this. But education is so important. That is why when we talk about greater access to it will be led into agonists, the most significant thing we can do to prevent people from having a drug overdose is never starting.
▶ 1:01:46Mr. Lemma: But many of us remember nancy reagan saying just say no. Just say no works incredibly well if you never started. When people have started on a regiment we have to give them access to science-based, medical-based treatment therapy combined with cognitive therapy and not just do that for the person on the journey. Make sure family members and loved ones and in partnership with is this is and corporations.
▶ 1:02:12Mr. Lemma: Private companies have a big role to play in that because many people who are on this journey are actually going to an environment. Whether they are going to a public school system or that kind of environment or they are going to work. Somebody is formally supervising them and when they first see the signs of it it is important to not only say something, but know what resources are available and stay current with the current trends. Lastly, we all are member the program dare, which was incredibly successful.
▶ 1:02:42Mr. Lemma: But dare had nothing to do with what the challenges are of our kids today. Sexting, texting, cyber bullying, vaping, all of these things have to be incorporated in education for k-12.
▶ 1:03:01Sen. Gillibrand: Senator kim, would you like to take time?
▶ 1:03:06Sen: Kim: thank you. Ms. mateer, I want to say how grateful I am that you took the time to come up here and share your personal story. It is so important that we talk human about the difficulties that are faced.
▶ 1:03:28Sen: I will be honest with you, I have heard a lot of stories about the opioid crisis but I have not heard as much about the challenges that it puts upon grandparents. I thought that was very powerful. I don't know if you have this offhand, but you are talking about numbers and figures in terms of how much in some ways is being saved by grandparents stepping up. But is there an actual figure in terms of the estimated number of grandparents in this situation right now?
▶ 1:03:57Ms. Mateer: Thank you for the question. To my knowledge according to what generations united has at their fingertips, the grandparents taking care of their grandchildren saved $4 billion a year.
▶ 1:04:12Sen. Kim: Do we have a sense of how many grandparents are in this situation?
▶ 1:04:16Ms. Mateer: Yes we do. I know there are around 2.6 million children in our country being raised by caregivers other than their parent. And of those, the majority of them are being raised by grandparents. There is a website that has statistics for every state. I think it is grand families.org.
▶ 1:04:43Ms. Mateer: Where I am from in pennsylvania, I know there are over 250,000 grandparents -- or children in pennsylvania being raised by other caregivers. And it does show you the grandparent statistics. The problem is a lot of these are unreported and not part of the system. So there are probably many more than we know about.
▶ 1:05:05Sen. Kim: That stands to be something this committee could try to look into. As Dr. stein was saying, we want to make sure that support is available to all. We don't want bureaucracy getting in the way or regulations getting in the way of getting support out to those that need it. Thank you for illuminating me on this and I will continue to follow-up with you and others.
▶ 1:05:36Sen. Kim: Both in terms of the caregivers, but Dr. burnett, what I have come to stand as not to see challenges of caregivers, but that we as a nation right now are not resourced in terms of the workforce needed to address both from a practitioner standpoint and more broadly against other types of addiction related specialists. So what can we do at the federal level to try and increase that sense of workforce to make sure we can rise up to the magnitude of this challenge we face?
▶ 1:06:05Dr. Burnett: Thank you for the question. One thing I would say we can do is reauthorize a couple different programs. One called the substance use treatment and disorder act repayment program.
▶ 1:06:21Dr. Burnett: It is a great program that provides loan reimbursement for providers and clinicians up to $250,000 to work in mental health professional shortage areas or in places where the overdose rate is greater than three times the national average.
▶ 1:06:39Dr. Burnett: There is another program that currently exists that could be reauthorized that provides fellowship support for addiction medicine and addiction psychiatric fellowship programs to be able to increase the number of these types of providers. Currently we are at about half the capacity estimated to be needed to address and treat the current substance use disorder need.
▶ 1:07:02Sen. Kim: One thing you raised is the challenge providers need to engage with medicaid and you are suggesting may be increasing the rates to try to get more providers on board. We are having a debate here in congress and the senate about medicaid right now. I just want to hear from you, what do you think would happen if we saw cuts to medicaid? What would happen are as a nation?
▶ 1:07:31Dr. Burnett: Medicaid is vital for us to be able to take care of patients with substance use disorder. 80% of the patients in micronic allies medicaid. If we were to cut medicaid funding it would significantly reduce our capacity to be able to fight the addiction crisis fundamentally.
▶ 1:07:52Sen. Kim: Thank you. Without I yield back.
▶ 1:07:56Chair Scott: Senator justice.
▶ 1:07:59Sen. Justice: Thank you so much. I am going to be very official. I'm going to call greg Mr. duckworth but I have, two questions. The first question is about our aging. Of course you have seen the crisis on both sides, from the law enforcement side and from the community advocacy side.
▶ 1:08:28Sen. Justice: What does this particularly affect -- how does this particularly affect the aging population in west virginia?
▶ 1:08:35Mr. Duckworth: Thank you for that, senator. It starts with a grandparent raising their grandchildren. So if a grandparent is raising a grandchild, we have lost a generation out of their family tree. So the senior is mourning the loss of their child and raising their grandchildren. But it is not just grandparents, it is great great parents and great aunts and uncles.
▶ 1:09:07Mr. Duckworth: It is like the floods and fires. Everything it touches, it destroys. It starts with the babies being born with addictive opioids or in west virginia we have a large amount of babies being born addicted to suboxone. We have neonatal absence issues and the seniors mourning the loss and raising children. 40% to 50% in west virginia are raising their grandchildren.
▶ 1:09:37Sen. Justice: I hope everyone heard that. The magnitude of the percentage in west virginia of grandparents raising their grandbabies. It is terrible, that is all there is to it. I have said this over and over and over. But I said this. I said if we don't really get a handle on this it will cannibalize all of us. We must get a handle on it.
▶ 1:10:08Sen. Justice: There is so much more we can do. I have one more question, and it is just this. I would like you to talk about the ways we can see hope restored. When it really boils down to this level of crisis, what really keeps our west virginia families even going? Greg, we started with jim's dream and then we went to jobs and hope, and we made a dent.
▶ 1:10:41Sen. Justice: But there has got to be a lot more dents. That is all there is to it. I said so many times in life that you will never get out of the hole until you know where you are in the hole, and the hole in this situation is bad. That is all there is to it.
▶ 1:11:04Sen. Justice: I just think that we have got to give people all across this land, if not all across the globe, hope, optimism, a chance to be better. Absolutely this situation has got to have every single one of us arm in arm pulling a rope together. We can do it, but that is exactly what we have got to do.
▶ 1:11:29Sen. Justice: So tell me your thoughts real quickly on how do we address this terrible crisis and give hope to our west virginia families.
▶ 1:11:39Mr. Duckworth: Thank you for that. In my mind the treatment centers and the detox centers, they do a fine job for that 30 days and then our addict gets released from either jail or a recovery home and there is nowhere to go except back where they came from.
▶ 1:11:58Mr. Duckworth: So there is a piece of this in the economic development part of creating jobs so that when these folks get detoxed or they have hope for a job or something that can support their family, that is where we lack sometimes is a place for them to go either when they get out of jail -- the overdose rates are highest when someone first gets out of jail or a treatment program and they don't have a recovery center to go to or somewhere different than where they came from and they just go back to the community they were into start.
▶ 1:12:30Sen. Justice: That is exactly what we tried to do with jobs and hope. What I will tell everyone is this. We know we have to have treatment. And we know we have to have sympathy to bring people back. But these people have got to have a job. They have to have training. They cannot be trained on a pickup truck how to drive a dump truck. They have to have real-life training. And we have to spend dollars to be able to do that.
▶ 1:12:58Sen. Justice: I thank y'all so much for being here.
▶ 1:13:00Chair Scott: Senator alsobrooks.
▶ 1:13:07Sen. Alsobrooks: Thank you to each of our witnesses. Baltimore ravens are dying from overdose at a rate never seen before in a major american city, with the number of deaths quadrupling over the last 10 years. Their frequency of overdose deaths in senior homes has likewise increased more than 340 people have died in baltimore senior housing complexes in recent years.
▶ 1:13:32Sen. Alsobrooks: Black men aged 55 to 74 lead drug fatalities over all other demographic groups in the city, a death rate that is 20 times that of the rest of the country. Yet this administration is working to slash funding for research, treatment, and our public health workforce.
▶ 1:13:54Sen. Alsobrooks: Nearly one in 10 employees at the substance use and mental health services administration known as samsa wer as part of the government wide cuts, cuts at sam's threaten continued access to essential mental health and substance use services including crisis supporting suicide prevention. Samson is another federal agency based in maryland. I would like to stop -- start with Dr. burnett.
▶ 1:14:25Sen. Alsobrooks: Thank you for the work you do every day and I just want to ask you, how will public health efforts be impacted I this administration slashing the federal workforce at sam's the and leaving a skeleton staff worsening the situation on the ground in baltimore?
▶ 1:14:47Dr. Burnett: I can answer definitively and talk about my experience working out of the maryland department of health and how samsung funding was -- samsa funding was critical. Samsa funding supported a lot of our naloxone distribution statewide.
▶ 1:15:16Dr. Burnett: This would significant leaker tail our ability to provide it across the state of maryland and I'm sure that is true for many other states and it is particularly true in states that have not expanded medicaid. Samsa funding provides integral prevention support but treatment support in places where patients don't have access to medicaid. Funding from samsa can get community health programs so people can get access to medication. It is very critical funding.
▶ 1:15:47Dr. Burnett: Sen. alsobrooks it is really shocking, but the new york times recently reported that dealers are targeting senior apartments in baltimore. Yet health officials have done little targeted outreach to older people. What more can be done on the ground to help address the pattern of deaths among low income seniors and to stop honorable communities from being prayed upon?
▶ 1:16:13Dr. Burnett: I see that every day in baltimore. Where we were, I have a senior living facility just down the street from our treatment program and we have taken steps toward partnering with the senior community to talk about treatment and recovery.
▶ 1:16:30Dr. Burnett: The population of seniors experienced opioid treatment in the years before major reform took place, so they have a very negative perception of opioid treatment, very strong stigma towards medications for opioid use disorder.
▶ 1:16:50Dr. Burnett: There has to be education to bring those individuals back into treatment, and it requires partnerships and peer recovery support services going into these homes to talk about what recovery looks like and being able to access medications and reduce the sigma -- reduce the stigma associated with opioid use disorder.
▶ 1:17:09Sen. Alsobrooks: There was a question to address at least part of this, but also, would you speak to the importance of supports for seniors who are caring for children impacted by the opioid crisis and how does keeping families together reduce the trauma experienced by these children?
▶ 1:17:28Dr. Burnett: Was the question for me?
▶ 1:17:30Sen. Alsobrooks: That is for anyone who can answer.
▶ 1:17:36Dr. Burnett: I am happy to take the question. In my clinic, one of the things that we really look for in terms of people's capacity to recover is their connection to community and having family support. Sometimes people come into treatment and they are by themselves, don't have any social support systems, so it is critical toward your recovery process if you have people that can help you through the process.
▶ 1:18:03Dr. Burnett: It is a long one, much more than the 30 day timeframe, and it is critical that you have family members, especially if you are an older generation or caring for younger individuals. That is important, that community-based experience is critical to being able to help people get into recovery because a large percentage of people who suffer from opioid use disorder are disconnected.
▶ 1:18:31Dr. Burnett: They are suffering from trauma, they don't have any resources or places to turn to, so they take drugs to cope with their isolation. Being able to bring them back into the community, whether through faith-based organizations, nonprofits, all of that is critical.
▶ 1:18:48Sen. Alsobrooks: Thank you.
▶ 1:18:49Chair Scott: Senator mccormick.
▶ 1:18:51Sen. Mccormick: Thank you for hosting this important meeting on such an important topic. Good to see some fellow pennsylvanians on the panel. Thank you for being here today, to talk about such an important issue. 4000 pennsylvanians died last year from fentanyl. About 100,000 nationally. This is a crisis of historic proportion.
▶ 1:19:19Sen. Mccormick: I was in cambria county a couple years ago and I talked to a woman describing a family member who died of fentanyl poisoning, and the devastating effect on her family. I asserted to make these visits and would say who among you has been affected by fentanyl? Almost half the people in the audience put their hands up, either their immediate family or their friend group was affected by fentanyl. We have to get our hands around this.
▶ 1:19:43Sen. Mccormick: Of course it's a problem that begins at the southern border, primarily with the prefectures from china and then it goes out to a network of drug dealers and cartels in the united states. My first question is for you, sheriff lemma. Is there any gaps you see in the way various law enforcement bodies coordinate and any insight you could give us on what we can do better?
▶ 1:20:10Sheriff Lemma: Thank you for the question, and I think that first, there were gaps and we are raining them in right now. There is potentially some confusion and need for deconfliction between the law enforcement agencies that worked under the department of homeland security and those that worked for main justice. I suspect that those problems are going to be cleaned up pretty quickly.
▶ 1:20:41Sheriff Lemma: I do think that deconfliction is important not only between federal agencies but between local and state. There are platforms and relationships and task forces that are a huge benefit to the country. What we can do better, I think more of what we are witnessing right now. We are witnessing a bipartisan effort to focus on things that move beyond politics, and find a way to at least tackle what we agree on.
▶ 1:21:10Sheriff Lemma: I think through that process, we should build chemistry and camaraderie and when we look at what works, we cannot lose focus , treatment and access to prevention programs and access to lifesaving opioid antagonists like narcan and generic versions. All of those things are incredibly important. But the bad guys have to go to jail.
▶ 1:21:40Sheriff Lemma: The cartels are a big part of this. They are a threat to this country. We have to be incredibly aggressive about that, and unfortunately many overdoses or poisonings across the country are being treated as accidental tragic events. Every person who has dealt from those dealers is likely to experience a similar fate. I recently had some conversations with incoming attorney general pam bondi.
▶ 1:22:07Sheriff Lemma: Our association has had the same conversations and I think we are going to see a lot of great progress. More of this is good.
▶ 1:22:15Sen. Mccormick: Thank you. Mrs. mateer, you are a fellow pittsburgher. I think your grandson is extremely blessed to have your support. It must be emotionally taxing and financially challenging, but it sounds like you are making it work.
▶ 1:22:34Sen. Mccormick: Unfortunately, as senator justice was saying, many grandparents, hundreds of thousands across the country -- any advice you would offer to families going through a similar situation, ticket really grandparents faced with a similar set of challenges?
▶ 1:22:47Mrs. Mateer: The best advice I can offer is to join some sort of a peer to peer support group. That has been my lifesaver. Because of my advocacy with grand voices, I connect with grandparents raising grandchildren across the country , in the tribal nation and everywhere and that is where I get my mojo, because we support one another and we understand one another.
▶ 1:23:12Sen. Mccormick: Thank you. Sheriff, one more question. You talked about collaboration and common data. Common data is an important part of the unified effort. Any commentary on the quality of the data and anything in particular that congress could do to ensure common data standards and availability to combat this?
▶ 1:23:35Sheriff Lemma: We have a lot of great things going on and congress has been responsible for those things, the elimination of the x waiver. We should take on permanently scheduling xylazine. Many states have moved down that path. We are seeing the deadly substance end up mixed in substances and a growing problem across this country but it is still not scheduled at the federal level.
▶ 1:24:03Sheriff Lemma: What is incredible he frightening about xylazine, -- incredibly frightening about xylazine, it eats the skin away and is nonresponsive to opioid antagonists. These numbers we are presenting across the country would absolutely decline or the drug dealer would move down the path to move into that business if we don't tighten up on that. One last thing is looking at that scheduling of that, and then making sure that we have programs that work.
▶ 1:24:37Sheriff Lemma: Operation overdrive is a dea program that has shown great success, data tracking. 37 cities across the country was the last report. It should spread out to the unincorporated counties that those major municipalities are in. I think that data collection and od maps is a great effort to expand research, data collection and allow us to let science move the path.
▶ 1:25:03Sen. Mccormick: Thank you.
▶ 1:25:03Chair Scott: Thank you senator mccormick. Senator warren.
▶ 1:25:09Sen. Warren: Thank you for holding this hearing. It is an important topic and I appreciate the care with which you treat this issue. Since 2017, the opioid epidemic has taken the lives of nearly half a million americans. Their families and so many more people around this country need congress to come up with some real solutions.
▶ 1:25:37Sen. Warren: For example, I know that chairman scott and I agree on the need to close a trade loophole that lets china ship fentanyl precursors into the country uninspected, and it's time to put a stop to that. But as we sit here today, president trump and congressional republicans are working hard to advance budget legislation that would make the opioid epidemic worse and not better.
▶ 1:26:06Sen. Warren: They have proposals to cut over $800 billion from medicaid, the largest single payer of substance use disorder services in the entire country. And why? So they can fund tax cuts for billionaires. Let's be clear about this.
▶ 1:26:27Sen. Warren: Slashing medicaid funding, either through per capita caps or back door cuts like work requirements in an area that already has work requirements would mean ripping away health care from millions of vulnerable americans, including about one million people right now who are getting treatment for their opioid addiction. Dr. burnett, you've worked on the front lines of the opioid crisis.
▶ 1:26:55Sen. Warren: You have helped countless people overcome addiction. I want to thank you for your work and express my admiration for that. But tell me in this budget space, what percentage of your patients rely on medicaid for their treatment?
▶ 1:27:09Dr. Burnett: I would say about 80% of my patients rely on medicaid for treatment.
▶ 1:27:14Sen. Warren: In other words, medicaid as I understand it is not just one option for how people get treatment. It is the backbone of the entire system for treating opioid addiction. Is that fair?
▶ 1:27:32Dr. Burnett: That is a fair comment.
▶ 1:27:34Sen. Warren: And yet republicans are talking about gutting that system to the tune of nearly a trillion dollars. I would like to look at a deeper level about what those cuts would actually mean for our country's battle against the opioid crisis.
▶ 1:27:54Sen. Warren: Two of the policies proposed by house republicans are capping medicaid payments to states and imposing redtape like additional work requirements. Dr. burnett, can you talk for a minute about how those changes would affect access to treatment if they were put into law?
▶ 1:28:16Dr. Burnett: Absolutely. The kaiser family foundation has a study that talks about the work requirement issue. 92% of people on medicaid are either working or involved in some sort of part-time or full-time work. The work requirements situation just at a lot of administrative burdens, resulting in many people getting kicked off of medicaid.
▶ 1:28:42Sen. Warren: I want to make sure we say that again. What proportion of people are already subject to work requirements?
▶ 1:28:47Dr. Burnett: 92%.
▶ 1:28:50Sen. Warren: So adding more work requirements on top of this has what impact?
▶ 1:28:54Dr. Burnett: It would certainly increase the administrative burdens of keeping people on medicaid.
▶ 1:29:01Sen. Warren: And what is the cost?
▶ 1:29:02Dr. Burnett: They would lose access to their addiction treatment.
▶ 1:29:07Sen. Warren: So more people fall by the wayside. That was the arkansas experiment as I recall.
▶ 1:29:11Dr. Burnett: That is correct.
▶ 1:29:14Sen. Warren: What about capping the funding?
▶ 1:29:16Dr. Burnett: Capping the funding would create two problems. It would definitely curtail the amount of choice that patients have a look to to the types of addiction treatment they have and capping the funding would also create a network app -- adequacy problem because more providers would disenroll, so patients would not be able to access treatment close to where they live.
▶ 1:29:39Sen. Warren: We don't have to speculate on what the consequences would be. In states expanding medicaid, treatment for opioid addiction increased over four times faster than in states that refused the expansion. Meanwhile, republican states that imposed so-called work requirements did not actually increase employment because that was never the point. Instead, opioid overdoses went up and access to treatment went down.
▶ 1:30:12Sen. Warren: There is no denying the critical role that medicaid plays in fighting the opioid epidemic. Cutting that program is not just cruel. It is totally backwards in what we are trying to accomplish. Might I ask one more question Mr. chairman? Thank you. Dr. burnett, I want to ask about something you have done scholarly work on.
▶ 1:30:36Sen. Warren: You've written extensively about the positive effects of investing in treatment and how that ultimately lowers costs down the line, so that if you cut the investments for treatment, like cutting medicaid, the question is, is that going to save any money?
▶ 1:30:56Dr. Burnett: As I said in my testimony, people who experience treatment are much faster to return to work and be productive members of society and ultimately not be a burden on the social safety net. It would actually be more detrimental to cut medicaid funding in terms of the amount of expenditure that states and public dollars would be needed.
▶ 1:31:22Sen. Warren: So this treatment gets people back to work, fewer trips to the emergency room. Long we save money by making these investments. One study found that for every patient treated with medication for opioid addiction, the government saves up to $100,000 over the course of that person's lifetime. Let's be clear. The budget cuts the republicans are proposing are not about saving money.
▶ 1:31:48Sen. Warren: If republicans wanted to save money, they would be expanding treatment to folks that claim -- that they claim they want to represent, rather than ripping it away so that we can bankroll tax cuts for billionaires. Families and communities across this country are counting on us to deliver real solutions to the opioid epidemic, not play politics and I won't stop fighting for that. Thank you very much. Thank you Mr. chairman.
▶ 1:32:17Chair Scott: Senator moody.
▶ 1:32:20Sen. Moody: Thank you senator scott. I've always been impressed in the great state of florida. You've always dug into the details and cared about things that were harming floridians and this committee hearing is a perfect example of that. You saw how it was affecting seniors. I don't know how that isn't abundantly clear, and I love that you were the one that highlighted this.
▶ 1:32:48Sen. Moody: When we say -- the largest bulk of the number of people we lose to overdose death, those are often our parents. They are our parents, in this country and I am so grateful, Mrs. mateer that you are here and willing to share your story and your experience.
▶ 1:33:09Sen. Moody: I am certain it informs everyone and raises awareness that those parents, when they fall victim to addiction and that affects not only the children but the generation before them, and I appreciate you being here. So much of what we did in florida addressed -- and some of that went to helping caregivers and family members of those addicted.
▶ 1:33:38Sen. Moody: I think it is a false narrative and shortsighted to say that we have to stop incarcerating drug traffickers. In fact, sheriff lemma is a leader in our state. I have probably supported him to oversee not only how we are tackling this problem, but how we are expending the resources that our office recovered going after pharmaceutical companies, distributors, pharmacies for the opioid epidemic itself.
▶ 1:34:06Sen. Moody: He now helps overseas -- oversee sponsor spending. Number one, you have to put the peddlers of this poison, the traffickers of opioids, synthetic opioids like fentanyl, behind bars because they will do violence to our communities by selling them lethal doses of opioids or synthetic opioids.
▶ 1:34:33Sen. Moody: To call that nonviolent is a shortsighted and I think if we do not take them out of the communities, they will continue to create daughter after son after mother after father falling prey to this, and that is step one. I'm so proud of law enforcement efforts in florida. We led the nation in fentanyl seizures. We are focused on that. We have dedicated resources to that, funding law enforcement, making sure they were focused on that and had the resources to go of -- to go after those traffickers.
▶ 1:35:03Sen. Moody: You can say honestly, we cannot arrest our way out of this crisis. That is true. But we cannot stop going after the people who peddle poison indiscriminately, that our children and mothers and fathers are taking. That has to be the first step. Going after the cartels and everyone helping them spread this is number one.
▶ 1:35:25Sen. Moody: After that, we broke it down into how do we make sure that narcan is available to family members, caregivers, readily available, and we pushed it to our first responders. We are leading the national rate in decreasing the number of deaths we are seeing every year and I am so proud of that statistic.
▶ 1:35:49Sen. Moody: Past that, we want to make sure that people can receive treatment, good treatment, treatment that is proven successful with few rebounds, and has done so with science-based methods. I agree that is the case.
▶ 1:36:09Sen. Moody: The problem is I think a lot of money -- because this is such a problem and we are trying to fix it and tragically we often try to fix these things by shoving money at the problem and not doing a very efficient and intelligent way of distributing that. What would you say, sheriff lemma, is the independent body that rates these substance abuse providers?
▶ 1:36:32Sheriff Lemma: First I want to thank you for your leadership. It was your work that inspired many of us to go down the path in the first place and I think it is so incredibly important.
▶ 1:36:46Sheriff Lemma: I also think that for the first time in recent history, the stars have aligned and the funds have been made available because of the work of attorney generals in various states and candidly, I think that if you cannot explain what you did last week, you public don't have that important of a job. When we talk about health care, it is incredibly important and these programs are incredibly important. Medical based treatment, therapy is the gold standard for treatment.
▶ 1:37:16Sheriff Lemma: Greater access to naloxone. When it comes to the drug enforcement, connecting the dots, making these things work together, there has to be a sensible strategy because many of the cartel members that are selling drugs, some of them are not even legal citizens anyway. It creates a challenging dilemma. We have boards and committees.
▶ 1:37:41Sheriff Lemma: In the state of florida we have an opioid abatement settlement team that you lead when you were attorney general and it has these checks and balances for 20 qualified counties that have populations of over 300,000 people and a comprehensive strategy to make sure that all of the checks and balances are in place.
▶ 1:37:59Sheriff Lemma: Followed by organizations like the department of children and family in various states that work for the managing entities that already hearing to the gold standard of making sure there are checks and balances and people who are responsible for the money at a local level are held accountable to make sure that they are doing the right thing.
▶ 1:38:18Sheriff Lemma: We don't want patrol cars and fire trucks and water treatment plants because as big pharma created this by saying proper use of oxycontin, the patient was less than 1% likely to become addicted and the world said that's not true. The money should go to enrich programs that help those individuals and families.
▶ 1:38:36Sen. Moody: Thank you. Dr. stein, one of the things as attorney general, it was heartbreaking to see so many people in florida and across our nation dying so I was very hands in and I am shocked to know that there wasn't a directory that people could go to in the moment when they were ready to get help, that had reputable proven quality assured treatment, with
▶ 1:39:07Sen. Moody: Beds available. I ultimately ended up speaking with -- thankfully florida was supportive, shatterprooftreatmentatlas.org. It was one of the first republican states that was pushing something like that because you know when someone is ready for treatment, you wanted then, right now but you don't want to put it somewhere where they are just going to take your money and churn them out.
▶ 1:39:36Sen. Moody: Is there an independent body that is ranking the success of these treatment services that are grasping all the grants and the funding from federal or state government or even recovery settlements?
▶ 1:39:50Dr. Stein: Thank you for the question. I think it is an incredibly important issue. This is a topic that has come up over a long time. In terms of helping people find the places that can offer them the best treatment, because as you point out, when someone needs treatment, you need to connect them now. You have a window of opportunity.
▶ 1:40:15Dr. Stein: I am not aware of any organization that does this routinely in the type of way that I think many families look for. There is certainly an organization that has done tremendous work in this area and I think it has been a leader many people look to and support the work they done -- they have done and that certainly is helpful.
▶ 1:40:39Dr. Stein: One is sort of identifying places that are providing good evidence based care, cognitive behavioral treatment.
▶ 1:40:52Sen. Moody: I don't want to get off track. To your knowledge, is there an independent organization that rates the quality of these drug treatment facilities?
▶ 1:41:02Dr. Stein: To my knowledge, the organization that comes closest right now is shatterproof. But I am not aware of anything.
▶ 1:41:11Sen. Moody: There is probably very limited attention or resources given to something like that before we are handing out aliens and billions of dollars -- handing out billions and billions of dollars.
▶ 1:41:25Dr. Stein: I certainly think that is one area that needs attention.
▶ 1:41:29Sen. Moody: Would necessarily be a helpful filter. Thank you.
▶ 1:41:35Chair Scott: Senator kelly.
▶ 1:41:39Sen. Kelly: Thank you Mr. chairman. Dr. stein, and everyone who is appearing here today, thank you for being here. It is a very important topic. Dr. stein, we know based on the conversation with senator moody, seniors are rather vulnerable when it comes to opioid use disorder.
▶ 1:42:07Sen. Kelly: The number of adults who need treatment for this have tripled between 2000 and 2020. A study recently found that opioid use disorder costs $4.3 billion each year for newly diagnosed medicare beneficiaries.
▶ 1:42:31Sen. Kelly: If you think about not just newly diagnosed beneficiaries, but all edit care beneficiaries and you extrapolate that $4.3 billion each year to the size of the medicare population, it looks like the treatment for this could be in the tens of billions of dollars. Dr. stein, I think we can stop addiction before it starts for many of these individuals that wind up in treatment.
▶ 1:43:02Sen. Kelly: I have a bill that would improve access to non-opioid pain medication for seniors who are on medicare. My bill would make sure that seniors aren't paying more for a non-opioid pain reliever than they would pay for an opioid. Dr.
▶ 1:43:22Sen. Kelly: Stein, do you think addressing that financial barrier is important, to ensuring folks have alternatives and aren't put on the pathway to addiction?
▶ 1:43:35Dr. Stein: Thank you for the question. I think multiple steps such as making sure there are not financial barriers, to allow adults who could benefit from non-opioid management of their pain and decreased use of opioids would help to decrease the risk for opioid use disorder. I absolutely believe the barrier is one .2 address.
▶ 1:44:06Dr. Stein: I also think we need a sufficient workforce providing these treatments that are available. We need to make sure --
▶ 1:44:14Sen. Kelly: What would that workforce look like? It is just a decision for a doctor to say I have these two options. I have a non-opioid pain reliever that costs x out of topic -- out of pocket. You might be on a fixed income as a senior, this is a choice we are going to have to make, but what is the workforce beyond that?
▶ 1:44:38Dr. Stein: I think non-opioid medications is one option but there are also options that can help people. Therapeutic massage, acupuncture, does it work for anyone? We need to make sure that we have sufficient individuals, so that is an option for the doctor you're talking about, that it is not just opioid -- but I've got three options, what works best for you or your family?
▶ 1:45:07Dr. Stein: Aching sure that medicare reimburses those services. Non-pain management for chiropractors is limited to back pain but there are other things in their scope of practice that might be relevant. The financial barrier is one, it is critically important. Getting the care they need for the pain to reduce the risk of a pure deduction.
▶ 1:45:38Sen. Kelly: So the barrier extends beyond the cost of the medication. Do you have a sense for how many folks wind up on opioids because they can't afford a non-opioid pain medication?
▶ 1:45:53Dr. Stein: I do not.
▶ 1:45:56Sen. Kelly: Does anyone know of any studies that have been done? I'm trying to get a sense of my legislation and if we were to implement this, how big of an impact it would have. Do you think reducing the price of the non-opioid pain reliever would result in less people addicted to opioids?
▶ 1:46:16Dr. Stein: I think options that allow elderly, like non-opioid medication treatment, to better control their pain are all things -- the less elderly exposed to opioids, the more likely we are going to be reducing those cases.
▶ 1:46:34Sen. Kelly: Dr. burnett, it seemed like you wanted to comment.
▶ 1:46:38Dr. Burnett: When we are talking about chronic pain management, noting modal -- multimodal is critical. Dr. stein highlights this point in that you are actually only limited to pharmaceutical options a lot of the time relative to pain management, so coverage for the physical and occupational therapy, being able to get into people's homes to improve their living environments and having people going and making those evaluations and changes in addition to aqua therapy,
▶ 1:47:11Dr. Burnett: Acupuncture, all of these alternative and company and re-strategies would be instrumental to improving -- complement re-strategies would -- complementary strategies would be instrumental to avoid people getting addicted.
▶ 1:47:26Sen. Kelly: Thank you.
▶ 1:47:27Chair Scott: I was -- I run a large hospital company for a long time and then I was governor of florida and any issue, I think all of us have stories that we believe, some sort of treatments, some sort of something is going to save money down the road and if you believe that, you jump at it.
▶ 1:47:55Chair Scott: Nobody, nobody comes with an analysis and nobody wants to take the risk. At times I had hundreds of thousands of employees and some of my companies and people would come and say if he would do this test, it would cost x dollars and cost multiples of that in health care. Who wouldn't do that? I said I'll do it.
▶ 1:48:24Chair Scott: I will double what I pay you, but you take the risk. Now wait a minute. We aren't in that business. We are going to take the risk. That is the issue you have on all of these programs. Nobody wants to go through what Mrs. mateer is going through. Everyone wants to do what you're talking about, some program. Nobody comes with data. Nobody comes with data and no one is willing to take the risk, on any program.
▶ 1:48:56Chair Scott: Whether it is a medicare program, medicaid program. It makes it so difficult to say I am all in for doing that because there is no data. Nobody was willing to take the financial risk. I've never been in the insurance business, but you would think if you are in the insurance business and someone came to you and you can really prove that they can save money by providing this service or this drug or whatever it is, they would jump at it.
▶ 1:49:27Chair Scott: For whatever reason, it doesn't happen. I always ask -- the biggest thing I ask is are you willing to take the risk? Are you willing to take the risk that it is going to save money and if you are, people should jump at that but nobody does. Sheriff lemma, can you talk about your community for a second? You are not in a big downtown area. You are more of a suburban and rural area.
▶ 1:49:54Chair Scott: How is an area like that, most people in this country would think you don't have drugs in that area. This is sort of the heartland of america. How does it happen in an area like yours?
▶ 1:50:05Sheriff Lemma: Thank you. It is the fourth most dental -- densely populated per square mile but we have a population of about 500,000 people and a little more than 300 square miles. Very affluent county, has the highest level of education per capita that is not host home to a nature university. And a great quality of life. One of the top school systems in the state.
▶ 1:50:33Sheriff Lemma: When we look at the significance of the reduction, we are proud about that. I talked about a 29% reduction in overdoses or poisonings andy 42% reduction in fatalities but when you look at the volume of numbers, the overdoses last year representing the 29% decrease is 427 and the fatalities are 66.
▶ 1:50:58Sheriff Lemma: If we had a community meeting just there in the county and laid 66 body bags and the tragic effects they have on the entire family, it would be devastating and it would be a topic of conversation that everybody would lean in and talk about tremendously. This is one of the most successful counties in the state of florida based on recent data. Palm beach county is another county that had a remarkable reduction, 40% or more, reduction in fatalities.
▶ 1:51:29Sheriff Lemma: I think this is a testament to the strategy that absolutely works, and in addition to that, in seminal county alone, we've charged 39 drug dealers with first-degree murder for dealing deadly doses of narcotics and at the same time, we worked with the photo legislator -- legislature to change the burden of proximate cause of death to substantial factor.
▶ 1:51:53Sheriff Lemma: Another key success point is in areas across the country, the most important thing is to protect and preserve human life, so greater access to opioid antagonists and reversing the effects of overdose or bringing people back to life with medicine on gun belts and in the back of patrol cars and private citizen pockets.
▶ 1:52:14Sheriff Lemma: We created a new law in the state of florida that allows us to charge every drug dealer with second-degree culpable negligence if we can prove that they dealt a deadly dose of drugs and we've revived them with the use of naloxone. This is creating momentum and is something people are talking about across the country and we would be happy to share it, and I think it really saves lives.
▶ 1:52:37Chair Scott: Ranking member gillibrand.
▶ 1:52:39Ranking Member Gillebrand: Thank you Mr. chairman. Thank you to each of you for your testimony. I was very moved by everyone's perspective and the work you are doing on the ground to save lives, and what has happened to your practice and what had happened to your community really does matter. Mrs. mateer, thank you so much for sharing your story about your grandson. He sounds like a wonderful boy. You gave some very persuasive recommendations at the end of your testimony.
▶ 1:53:09Ranking Member Gillebrand: I thought they were excellent. Can you give us a little more guidance on what types of services or supports would make a difference? I have a piece of legislation called supporting families through addiction act which would provide $2500 to community programs to provide families with the resources they need to support loved ones battling addiction. That grant money is pretty flexible but I would love to hear from you, at different stages in your life raising your grandson, what types of supports could have made a difference for you and your family?
▶ 1:53:41Mrs. Mateer: Thank you for the opportunity to speak and for your reinforcement. It means so much. I think from my standpoint, when I was first showing up at the pediatrician's office with an infant child, and I wasn't the parent, right then and there it would have been helpful for that community to provide me with at least some basic information.
▶ 1:54:09Mrs. Mateer: Where to go for things, what to do. A pamphlet on what type of crib to buy, car seat. A generation later, all of these things changed. How to feed a baby. Everything is different. Wherever we touch, it would be good to have some sort of supportive measure in place that would provide information. Maybe a list of where to go for resources.
▶ 1:54:37Mrs. Mateer: What community groups are there where you can go to get baby clothing or things like that. Services through pediatricians offices.
▶ 1:54:49Mrs. Mateer: It seems to me that they don't see the issue, they don't recognize it. I know there are so many of us out there but it's not above e radar. It is quiet.
▶ 1:55:00Ranking Member Gillebrand: Very helpful, thank you. Dr. burnett, thank you for testifying about what you are doing to help older adults access these critical addiction services in your community. In your testimony, you challenge -- you discuss the challenge of accessing evidence-based addiction treatments for those who need it and you discuss the impact on older adults who are struggling with their addiction.
▶ 1:55:29Ranking Member Gillebrand: Can you expand on some of the challenges that older adults face with regard opioid substance abuse disorder and are there policies or changes you would recommend to address some of those barriers?
▶ 1:55:40Dr. Burnett: Dr. stein also highlighted this very eloquently. Older adults have a multitude of chronic disease issues that you have to manage in addition to the substance use care.
▶ 1:55:57Dr. Burnett: Being able to connect your substance use disorder care to their general medical care in and of itself is a challenge, so it requires a team-based effort between the nurses on the team, the peers on the team and collaboration within other -- with other physicians who might be taking care of this patient population. There are lots of different strategies and policy solutions we could come up with.
▶ 1:56:24Dr. Burnett: Largely focusing on medicare, so we could certainly expand the health parity and addiction equity act so that reimbursement for these services could be paid at an equal rate within the medicare population because currently that is excluded. We could authorize medicare coverage of non-hospital-based residential treatment.
▶ 1:56:48Dr. Burnett: Currently, it is difficult for individuals to be able to participate in community-based iop and hhp programs because medicaid -- medicare does not cover that. The medicare sud bundled payments provision could be increased. There are lots of different ways that we can ensure that more providers are able to take medicare and take care of those patients with substance use disorder.
▶ 1:57:14Ranking Member Gillebrand: Thank you. Dr. stein, you also discussed some of the challenges with treating an older population with substance use disorder. You mentioned one of the challenges as being an acute shortage of the workforce and a lack of preparedness among the workforce to treat older adult with co-occurring substance use disorder and dementia. Could you elaborate on this issue and what we can do to help?
▶ 1:57:38Dr. Stein: Thank you for the question. It is a challenge, because as we've heard, many of the individuals providing treatment are the addiction specialists and they don't necessarily have this expertise. One solution that has come up as I have talked to colleagues is either to enhance training in geriatrics for those individuals or find ways to support those systems in bringing in physicians' assistants for
▶ 1:58:09Dr. Stein: People who have more basic training in caring for geriatrics to partner with the care system so they don't have to move back and forth. The other one we need to focus on his primary care, because that honestly is where the majority of the elderly are going to continue to get care and despite many of our efforts, any of them still don't provide medication treatment for opioid use disorder that we know to be effective.
▶ 1:58:35Dr. Stein: One of our recent studies showed that there are probably only about 1200 clinicians in the country that treat over a third of the older adults receiving morphine. It is highly concentrated. One of the things we need to think about is in that group of primary care clinicians, treating the elderly, so much of our focus has been trying to get a new clinician to prescribe -- but maybe we need to start focusing on the types of supports, whether it be
▶ 1:59:05Dr. Stein: Additional supports within the office, better connections with nonphysician substance abuse treatment services to omit those clinicians more likely to not prescribe -- but one elderly patient but more of those physicians in -- and physician assistants and nurse practitioners should treat more elderly with it. Let's try to build a greater workforce of somewhat higher volume prescribers for the elderly that can merge this expertise.
▶ 1:59:34Ranking Member Gillebrand: Thank you so much and thank you Mr. chairman.
▶ 1:59:37Chair Scott: Commissioner duckworth, what are some examples of success you think we ought to do at the federal level?
▶ 1:59:45Hon. Duckworth: Thank you very much for the question. Some of the issues in west virginia into the sheriff's point, his county of 500,000 would represent about one third of our home state. We are very rural, and very family oriented. Going back to the seniors, and what I came prepared with today, the grandparents raising their grandchildren, helping those folks and getting programs in place that helps the seniors.
▶ 2:00:17Hon. Duckworth: I think it is key. I think we are missing a whole generation of people, we are missing workforce. A whole generation of the family tree is missing. To the senator's point on non-opioid medications, like 50 in every 1000 of the babies born in west virginia are addicted to some oxen -- addicted to somoxyn .
▶ 2:00:47Hon. Duckworth: Getting to non-opioid treatments would be a huge success for what west virginia needs and where my space is.
▶ 2:00:52Chair Scott: I think we have over 50 million americans working age that don't have a job. That doesn't help. Dr. stein, we know that increased access to naloxone works.
▶ 2:01:17Chair Scott: What are some lessons from past mistakes that we should learn from when designing future policy?
▶ 2:01:23Dr. Stein: I think the awareness that there are sometimes unintended consequences for well-meaning policies is critically important. One area we have certainly seen this and learned about it goes back to 2010 and the reformulation of oxycontin which was approved by the fda and was well intended. Oxycontin at that point was subject to being abused and misused and they reform elite it to make it that much more difficult.
▶ 2:01:52Dr. Stein: About three years later, that old formulation was taken off. What we've learned there is subsequently, that reformulation led to higher rates of heroin use, higher rates of overdoses from opioids and the consequences still stay with us.
▶ 2:02:09Dr. Stein: The communities that were subject to the effects of that reformulation continue to have higher rates of fentanyl overdoses, cocaine problems and higher rates of child suicide. I think as we are putting in place these policies, one of the things that becomes critical is continuing to monitor and evaluate. It is not one and done. We can't do these things and turn away.
▶ 2:02:37Dr. Stein: We have to continue and learn because the crisis is going to continue to evolve and our ability to understand how to respond to the changing landscape requires us to continue to pay attention.
▶ 2:02:47Chair Scott: Sheriff, are there any different law enforcement issues dealing with seniors?
▶ 2:02:57Sheriff Lemma: I think when we look at the baby boomers, particularly -- they are named baby boomers for a reason and we saw a significant population growth in that time and we find many of that generation are evolving into some dependency and what the unintended consequences of covid was a senior population was thrusted into having a greater online presence that they weren't necessarily prepared for.
▶ 2:03:28Sheriff Lemma: A clue is if you are still paying $25 for an aol account, you are probably a prime target for some online scamming. We are seeing an increase in white-collar crimes and demise asian of seniors -- and victimization of seniors.
▶ 2:03:47Sheriff Lemma: We have always tried to balance the need for reliable services and opioids have its place in certain environments, and making sure the people who need the medicine are not not getting it, not living in pain as a result, and I think back when you were governor, we saw that occur in the state of florida with prescribing three days and seven days for acute pain, so prolonged issues whether it is cancer or other items, seniors
▶ 2:04:18Sheriff Lemma: Are able to get access to that. The greatest increase we are seeing is victimization because many of the population was thrusted into this online presence and because of that, they've become more vulnerable.
▶ 2:04:32Chair Scott: I want to thank each of you for being here. Thank you for caring so much about this issue. It has impacted -- I don't know of a family that hasn't been impacted either by alcohol abuse or drug abuse. I lost my brother last spring, and he started out using marijuana and eventually used all the drugs and it impacted his life. It doesn't just impact him, it impacts the whole family.
▶ 2:05:03Chair Scott: I feel sorry for everybody that goes through this. I thank each of you for being here and I want to thank the ranking member for her hard work. Thanks.