COMBATING THE OPIOID CRISIS HEARING BEFORE THE COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM HOUSE OF REPRESENTATIVES ONE HUNDRED FIFTEENTH CONGRESS FIRST SESSION NOVEMBER 28, 2017 Serial No. 115–101 Printed for the use of the Committee on Oversight and Government Reform ( Available via the World Wide Web: http://www.govinfo.gov http://oversight.house.gov U.S. GOVERNMENT PUBLISHING OFFICE 31–521 PDF WASHINGTON : 2018 VerDate Nov 24 2008 15:52 Nov 02, 2018 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 H:\31521.TXT APRIL KING-6430 with DISTILLER COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM Trey Gowdy, South Carolina, Chairman John J. Duncan, Jr., Tennessee Elijah E. Cummings, Maryland, Ranking Darrell E. Issa, California Minority Member Jim Jordan, Ohio Carolyn B. Maloney, New York Mark Sanford, South Carolina Eleanor Holmes Norton, District of Columbia Justin Amash, Michigan Wm. Lacy Clay, Missouri Paul A. Gosar, Arizona Stephen F. Lynch, Massachusetts Scott DesJarlais, Tennessee Jim Cooper, Tennessee Virginia Foxx, North Carolina Gerald E. Connolly, Virginia Thomas Massie, Kentucky Robin L. Kelly, Illinois Mark Meadows, North Carolina Brenda L. Lawrence, Michigan Ron DeSantis, Florida Bonnie Watson Coleman, New Jersey Dennis A. Ross, Florida Stacey E. Plaskett, Virgin Islands Mark Walker, North Carolina Val Butler Demings, Florida Rod Blum, Iowa Raja Krishnamoorthi, Illinois Jody B. Hice, Georgia Jamie Raskin, Maryland Steve Russell, Oklahoma Peter Welch, Vermont Glenn Grothman, Wisconsin Matt Cartwright, Pennsylvania Will Hurd, Texas Mark DeSaulnier, California Gary J. Palmer, Alabama Jimmy Gomez, Maryland James Comer, Kentucky Paul Mitchell, Michigan Greg Gianforte, Montana SHERIA CLARKE, Staff Director WILLIAM MCKENNA, General Counsel SARAH VANCE, Healthcare, Benefits, and Administrative Rules Subcommittee Staff Director MICHAEL KOREN, Professional Staff Member SHARON CASEY, Deputy Chief Clerk DAVID RAPALLO, Minority Staff Director (II) VerDate Nov 24 2008 15:52 Nov 02, 2018 Jkt 000000 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 H:\31521.TXT APRIL KING-6430 with DISTILLER C O N T E N T S Page Hearing held on November 28, 2017 ...................................................................... 1 WITNESSES PANEL I The Honorable Chris Christie, Governor of New Jersey Oral Statement ................................................................................................. 5 Written Statement ............................................................................................ 10 PANEL II Mr. Richard Baum, Acting Director, Office of National Drug Control Policy Oral Statement ................................................................................................. 43 Written Statement ............................................................................................ 46 Dr. Leana Wen, Health Commissioner, Baltimore City Health Department Oral Statement ................................................................................................. 57 Written Statement ............................................................................................ 59 Dr. Caleb Alexander, Co-Director, Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health Oral Statement ................................................................................................. 83 Written Statement ............................................................................................ 85 APPENDIX ‘‘The Opioid Epidemic From Evidence to Impact’’ October 2017 submitted by Dr. Alexander can be accessed here: https://www.jhsph.edu/events/ 2017/americas-opioid-epidemic/report/2017-JohnsHopkins-Opioid-dig- ital.pdf ................................................................................................................... 104 Representative Gerald E. Connolly Statement for the Record ............................ 105 Letter of November 21, 2017, from Association for Behavioral Health and Wellness submitted by Mr. Cummings .............................................................. 107 National Healthcare for the Homeless Council Statement for the Record sub- mitted by Mr. Cummings .................................................................................... 110 Response from Mr. Baum, Office of National Drug Control Policy, to Ques- tions for the Record .............................................................................................. 114 Response from Dr. Wen, Baltimore City Health Department, to Questions for the Record ....................................................................................................... 115 Response from Dr. Alexander, Johns Hopkins Bloomberg School of Public Health, to Questions for the Record ................................................................... 117 (III) VerDate Nov 24 2008 15:52 Nov 02, 2018 Jkt 000000 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 H:\31521.TXT APRIL KING-6430 with DISTILLER VerDate Nov 24 2008 15:52 Nov 02, 2018 Jkt 000000 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 H:\31521.TXT APRIL KING-6430 with DISTILLER COMBATING THE OPIOID CRISIS Tuesday, November 28, 2017 HOUSE OF REPRESENTATIVES, COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM Washington, D.C. The Committee met, pursuant to call, at 12:42 p.m., in the Chevy Chase Auditorium, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, Hon. Trey Gowdy [Chairman of the Com- mittee] presiding. Members present: Representatives Gowdy, Grothman, Palmer, Comer, Cummings, Norton, Clay, Lawrence, Raskin, and Welch. Also present: Representatives Sarbanes and Ruppersberger. Chairman GOWDY. Thank you, Governor, thank you, Mayor Pew, thank you, Johns Hopkins for pardoning the inconvenience of hav- ing a Committee of Congress come, and appreciating the serious- ness of the issue that brings us here. The Committee will come to order. Without objection, the Chair is authorized to declare recesses at any time. I am going to break from protocol a little bit because we are in Mr. Cummings’s hometown, and because he cares so pas- sionately about this issue, we are going to recognize you first for your opening statement. Mr. CUMMINGS. Thank you very much, Mr. Chairman, and I want to first of all, take a—just to mention one thing that is so im- portant to me, Mr. Chairman, and to the members of this panel. I cannot come into this hospital without saying thank you to Hopkins for saving my life, and spent 60 days here this summer, a lot of it in this building. And so I want to thank—I see a lot of white coats out there and others, but pass the word. I thank you for what you have done for me and my family. I want to begin by thanking Chairman Gowdy for calling today’s very important hearing, and for bringing the Oversight Committee to Baltimore. I also thank my colleagues for coming to Baltimore, and certainly my colleagues who represent Baltimore along with me as Dutch Ruppersberger and John Sarbanes. I thank you for being here. I have been in Congress now for 20 years and I have been through and seen a lot of field hearings. I have never seen as many members attend any field hearing since I have been in Congress. I believe today’s remarkable turnout reflects the fact that the opioid crisis is truly a national emergency that does not discrimi- nate based on politics. It affects the red states and blue states, and every state in between. So I am extremely grateful that the Chair- man agreed to my request to bring the Committee to—on the road to investigate the devastating effects of this very difficult problem. (1) VerDate Nov 24 2008 15:52 Nov 02, 2018 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 H:\31521.TXT APRIL KING-6430 with DISTILLER 2 I also want to thank Dr. Miller and Johns Hopkins for your warm welcome and your hospitality. The work that you do makes a huge difference in our community and around the globe. I also thank our esteemed guests, Governor Hogan and Mayor Pew, for joining us. We are honored to have you in our presence. And of course, I thank our witnesses, Governor Chris Christie, Commis- sioner Wen, Dr. Alexander, and Mr. Baum. Thank you for testi- fying and for all that you are doing to help us combat opioids and save lives. A year and a half ago at our Committee’s first hearing on this issue, I warned that so many people were dying in communities across America and that we could no longer ignore this emergency. Today, the Centers for Disease Control and Prevention estimates that more than 64,000 Americans died from drug overdoses in 2016, an increase of more than 20 percent over the year before. To put this in perspective, the death toll from drug overdoses last year alone was higher than all U.S. military casualties in Vietnam and Iraq wars combined. Every 20 minutes someone does from an opioid overdose. If today’s hearing lasts for two hours, half a dozen families will have lost a parent, a sibling, or a child to opioids. We have the reports. We have had years of talk. Now it is time for ac- tion. The American people are looking for us to take action. They are looking to the President and the Congress, and they are asking what are you going to do? Governor Christie and the other members of the President’s Commission on Drug Addiction have given us an excellent blue- print for action with dozens of recommendations. Now it is up to us, Republicans and Democrats, Federal, State, and local officials, researchers, policymakers, doctors, drug companies, health pro- viders on the ground, and families of the faith communities. We