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tv   Administration Officials Testify on Efforts to Regulate Fentanyl- Related...  CSPAN  January 3, 2022 5:14am-6:02am EST

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a hearing with medical professionals on fentanyl over
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doses and reducing the deaths in the u.s. members took a vote earlier. live coverage on c-span3. >> to learn how fentanyl was impacting utah directly. won't surprise you that i was shocked over the facts on fentanyl, and the personal story on utah. according to the patrol in utah, there has been 90% increase in fentanyl seizures in the first three months of this year compared to entire last year. 90% more in three months to entire last year. total deaths related to fentanyl doubles from 2019 to 2020 and largest age in fentanyl deaths, 18 to 24, followed by 24 to 35-year-olds. obviously, this is increasing risk to our communities that needs local government, state
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government, and federal government all hands on deck, everybody working together. i spent time with the coalitions fighting addiction including utah general's office over dose district response team, dea. bureau drug recognition experts. additionally, i put out word to my district that i'd like to hear their stories, and within 24 hours, i was delivered 250 personal stories of the way these families have been impacted. every one of these stories will break your heart. every one of these stories represents not just an individual but family and their network and i think it's been said earlier today that it would be hard to find anyone of us that hasn't been impacted by this. if you'll indulge me, i'd like to read a couple parts of two of these stories. when my brother adam was young, he was involved in an accident saw him severely burned, hospital prescribed him what
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turned out to be highly addictive opioid and years afterwards struggled with addiction, alcohol, marijuana and eventually heroin, fall of 2013, enrolled in university with plans for a degree in construction management, i remember the night of the december 21st and what happened afterwards in a blur, getting a call from my mom that night, lowering my brother's coffin into the ground, feeling numb for months and most of all feeling ashamed of what my brother did. nothing could turn back what happened to my brother but i hope we can talk more openly about addiction, opioid use and flux of fentanyl into our country. addiction doesn't discriminate, first step is talking about it. next story. i'm a recovering herion addict where my addiction began with prescription opioids at age 13, i suffered dislocated knee and
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was prescribed percocet. by age 18, i was addicted to heroin, went through immense trauma, put my family through more turmoil than any family should endure. was sober since, but lost my brother to a heroin overdose and his story isn't just mine, it's all of ours. a society made us into a taboo when in reality, every family and community is affected by this. a societal norm no one talks about. i work as a review specialist for residential and outpatient substance abuse in utah county where i can work on the stigma against this and recovering addicts. a couple questions.
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deputy administrator, i learned fentanyl can be prescribed but most of the fentanyl in utah is illegally produced, i was told as much as 90% of it, related to substances or analogues distributed through channels. the average is 40 grams but one gram of illicit fentanyl can contain 500 lethal doses, 500 dead people. the department of justice from prior administration testified before the senate judiciary committee that the current thresholds necessary for mandatory minimum penalties for fentanyl and fentanyl analogues are extremely out of date. given what we know about the tremendous potency and harm associated with these substances, do you agree? >> congressman, thank you for sharing those, members of the
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dea lost loved ones, myself included. it's a terrible thing and that's why we're focusing on those who are harmed by this. as far as mandatory minimums, we're a law enforcement agency, our mandate is to ghoe after those harming the community, we work with our partners and the judges with the construct provided them will dole out sentences. >> dr. i understand there is a proposal for dealing with fentanyl analogues but when dealing with the dangerous nature of these substances, why not go through with due diligence, why are we rushing it? >> it's a good question, i don't think we're rushing. i don't think the proposal does this. i think the proposal goes over,
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thoroughly, the pharmacology. >> is there a precedence for this? >> there is a precedence for the control -- >> or skipping the analysis and just using one factor -- >> i'm not familiar with the precedent that would be exactly the same as what's under this proposal. normally we go -- >> i apologize, unfortunately, out of time. i yield my time. >> happy to help. >> the chair now recognizes the gentlewoman from delaware, mrs. rochester. >> thank you, and thank you to our witnesses for being here today to discuss the biden's interagency proposal for
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illicit fentanyl. i understand the impact it has had on delaware communities, over 80% of the drug overdose deaths involved fentanyl, and data suggests we may be on track for another record-breaking year. it's so important we get the policies right and last time the acting direct of office of national drug control policy before this committee, i highlighted my concerns from previous approaches to drug control rooted in stigma and punishment and not public health, as a result, we introduces the stop fentanyl act, a comprehensive package of public health policies to address the proliferation of synthetic opioids, i want to thank those who provided feedback on our bill and continue to work together. in 2020, we tragically lost over 90,000 people to drug overdoses. based on the most updated data
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you have, can you tell us how many overdosed deaths were caused, not just present, but caused by fentanyl-related substances? >> can you use your microphone, please? >> i apologize. thank you for the question. i believe that the number is 70,000 of the 100,000 but i want to confirm with the colleagues on the panel, but it is a massive number, the vast majority are attributed to the fentanyl overdose deaths. >> and does the dea have surveillance systems in place to understand how many of those deaths are attributed to fentanyl and illicitly manufactures fentanyl including fentanyl analogues and related substances? >> we do work with interagency partners. there's always more to do with those partnerships across the science community, so we're moving in that direction with our current administrator, and very focused on those heat maps
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and how to better understand where the threats are. >> great, thank you, and dr. throckenbergen has the united states addressed a case based on the nature of the substance. >> the best example would be the endrogenic steroids based on a class-based on structure. >> is it possible to tell whether a substance would lead to opioid-related harms just looking at the structure? >> thank you, no, it is absolutely not possible to do that yet. structure gives us one piece and it is an important piece. we think it's sufficient to identify compounds at high risk of being dangerous substances in the frs class, but that's why we're recommending the potential for using other testing, the pharmocologic testing in the
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biden administration proposal, because we believe those kinds of data are necessary to understand whether a product is going to be dangerous or whether in fact, it is not less dangerous, or not dangerous at all and should be eligible for research more easily. thanks. >> and a structural definition of fentanyl-related substances could potentially classify thousands of substances as schedule 1 drugs under the controlled substance act without knowing whether they are addictive or have potential medical use. what would be the consequences of that? >> well, i think -- i share your concern, but i think the proposal as it's laid out addresses that in the right balance. it recognizes the emergency we face with this class of dangerous compounds. uses a structured base mechanism to place them under control, so the dea can make sure they're not available. but it also puts in place a mechanism to remove them quickly
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from that scheduling if the data shows that they are not dangerous. i think that balance really is the right approach to take here. it affords the greatest public health protection while still protecting the need to be able to support the research of compounds that are not, that are not like oxycodone, not like fentanyl, that have less danger. >> right, and could potentially, maybe there's some kind of cure or thing we could use like maloxone or other things. representatives from the criminal justice and civil rights communities believe a class-wide scheduling would remove the prosecution burden to prove there are the psychoactive effects of fentanyl. for follow-up, if we could comment on that concern. i think we have votes, so i'll ask if you could submit that in writing to us and say thank you so much for your answers and i
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yield back my time. >> gentlewoman yields back and make sure you submit the last question in writing, so that it's actually seen, and thank you. don't rely on me to repeat it. >> we want everyone's questions answered. the chair is very pleased to recognize, last but not least, the gentlewoman from minnesota, ms. craig for her five minutes of questions. great to see you. >> thank you so much, madam chair, and in particular, for calling this really important hearing. clearly, the fentanyl and opioid crisis remains one of the glaring public health challenges of our time. i want to focus on the administration's proposal of fentanyl-related substances and
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clarify how they're distinct from other controlled substances. the opioid epidemic has been described in really three waves, when it began, overdosed deaths mostly due to prescription opioid pills, then heroin-related overdose started rising, now fentanyl opioid deaths causing more deaths than ever. in september, the dea issues a safety alert on the amount of fentanyl-laced counterfeit pills in circulation. by mid year, department of public safety already seized 23,000 pills, a dramatic increase over the previous year. these fake pills are often sold through social media platforms to people who think they are purchasing painkillers, that's what happened to a young man from my district, devin, who died from accidental overdose last year after buying a pill he bought on snapchat.
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devin's birth is september 19th. this year he would have turned 21 years old. like too many others, devin should still be with you should. i look forward to working with my colleagues and crafting the strategy to deal with the scourge of fentanyl and fentanyl-related substances. as we confront the challenges synthetic opioids pose, it is important we consider the challenges of how to regulate them most effectively. in mr. chester's testimony, he noted based on substances seized by cbp, forensic partner laboratories, it may be possible to synthesize as many as 48,000 fentanyl analogues with rather simple ramifications. can you explain in layman's terms why it is relatively simple to produce these
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fentanyl-related substances. >> yes, congresswoman, thank you and i may have misspoke, that is 4800 substances, and i am not a chemist so i have chemists who explain this to me. you're talking about a base molecule with four distinct rings on it and other molecules attached to it so you can make in addition to that skeleton or substitute one chemical for another. that causes an alteration in the chemical itself that turns it into a fentanyl analogue or, ultimately, a fentanyl-related substance. that's the basic chemistry of those these things are altered, although i could turn it over to dr. valcov or this. rockmorton for a bit more sophisticated examination.
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>> dr. valcov any answers on that? >> well basically to identify the advances we have done in chemistry, now we can modify molecules that were unprecedented and use it for good or nefarious purposes as is the case for the drug dealers. unfortunately, technology is not just in the hands of those that want to do healthcare intervention, so there's an enormous amount of innovation in the chemistry side and that's why i said before, these synthetic drugs are here to stay, with very toxic and addictive compounds, and very profitable. >> thank you so much. it allows for sentences that are critical to a schedule one or two substance to be treated as if it were listed in schedule one. someone suggested we should utilize the authorities under the federal analog act to control fentanyl-related
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substances. why does the administration not take that approach? >> with the massive amount of fentanyl coming in, we need a reactive response and most certain way to do that is to keep everything scheduled to seize it before it comes in and deal with it when we encounter it in our communities. the analog act has some parts that are very reactive and very cumbersome and it doesn't meet the current threat, sophisticated drug traffickers and the threat the substances pose. >> thank you for that answer. looks like i'm out of time. thank you for testifying today. i yield back. >> the gentlewoman yields back.
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mr. mckinley has joined us but i'm told because you are waiting on, i need to take the democrats first. we recognize you for your five minutes of questions. are you with us? >> thank you. thank you to our witnesses today. this is such an important issue. i'm listening to my colleagues and it affects the community. i think about the people lost just in the last year from opioid over doses. mostly from fentanyl. i'm so glad to see the biden administration working across all of these agencies the find solutions, curb demand, crack down on traffickers and save lives. in my home state of washington, like every other state, fentanyl has had a profound and devastating impact. in 2020, there were 672 deaths
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involving synthetic opioids. it's double the number we saw the year before. 672 compared with 3700 people died from covid in washington state. there's been a massive effort to manage the pandemic. this hit way too close to home in 2019 when three high school students ingested fentanyl laced candy and had no idea what it was. they died. two of those were in my communities. this is very personal just like it is for so many of you. we need to ensure that less of this is not accessible.
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can you explain how the penalties differ from those corresponding from the importation or export of fentanyl? >> thank you very much for the question. the first thing is and i think one of the most elegant things about this solution is there would be no difference between fentanyl-related substances and fentanyl itself because they would both be ked one drugs. talking about illicit fentanyl. there's no difference. when you talk about the international side, i'm dplad you asked that question because -- >> yes. >> thank you for clarifying that. can you tell me how this might impact international affairs with china and other countries?
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>> excellent question. it's not a u.s. only problem. it's a global problem. we understand the opioid crisis and all of the things that we been through as nation over the last decade or so and other counties look to us for our leadership. we went to the chinese government in 2018 and asked them if they would schedule fentanyl as a class because they were the source of these substances coming into the united states and we wanted their help and they did that. 24 allows us to do two things number one, meet the chinese requirement that we asked them to do in order to do this. number two, show other countries around the world that the united states understands how difficult this is, can come up with
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comprehensive common sense solutions even if our complicated government in order to be able to get a handle on this particular problem. i think it's enormously helpful for our legitimacy around the world in dealing with this problem? >> i agree. we lead and others follow in respect. i have a couple of quick questions and i'm going to turn to doctor. i was wondering if you can clarify, can morphine, some other substance substitute for opioid in hospital, medical uses. is there anything fentanyl can do that those can't?
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>> fentanyl is very helpful agent. it's used in anesthesia departments all around the united states. it gives you the ability to bring them rapidly. there's many advantages when used properly and provide other conditions. the problems become substance and mideast of is misuse and leading to the over dose. it's manufactured fentanyl. i think that understanding that it has potential for negative actions with misuse, we cannot jeopardize all of the potential valuable things that fentanyl offers as an agent. >> thank you. i appreciate that. i yield back. i'm out of time.
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>> the gentlewoman yields back. >> i really appreciate the urgency to properly address the opioid and over dose crisis especially the covid pandemic.
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in addition to the proposals who address fentanyl-related substances, the biden administration released an over dose prevention strategy that prioritizing primary presengs and highlights the fda consideration of mandatory or prescribed education. buyers complete a one time, eight hour training on identifying patients with a substance abuse bis order. the requirement is a minimal for practicing physicians in most states. many include training
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requirements and main management. it will result in addiction training being more widely incorporated in programming for physicians. mr. chester, could you provide an update on how they work medical schools to ensure adoption of a curriculum that includes preventing addiction as well as patients with a substance abuse disorder. >> yes. i'd be glad to. one of the major points of emphasis and one of the things that dr. gupta emphasized is building the addiction work force. there's an understanding the addiction treatment work force that we have is being overwhelmed by the subject we're talking about today which is this dynamic nature of synthetic opioid and the need for treatment, the need for quality treatment is so large that we need the leverage more resources
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in order to be able to provide that. the second thing is that a addiction treatment work force that is not as large as it should be is a barrier in and of itself like all of the other barriers we have discussed. reduces barriers to treatment, providing evidence based quality treatment and building the addiction treatment work force through areas of big emphasize that dr. gupta has since he's shown up as the director. >> we authorize the practictioner education grant program established which expands the integration into standard curriculum of lelt care education programs. just last month i had the opportunity to visit umass medical school substance abuse and mental health services administration program and they are already aligning with the provisions in the act. just critical for medical schools across the country to build up the comprehensive
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curriculum. could you comment on the value of grant program and mainstreaming education and expanding the number of practictioners that can provide this high quality of treatment. >> thank you for that question. as we just discussed, the ability for an individual who clearly has will just call it an opioid use disorder. who clearly has an opioid use disorder and needs to get access to treatment. the gap between their ability to identify for themselves they they need it and be able to get it is absolutely critical. into that gap one or two things can happen. either the treatment can be provided by the map streaming as to what you talk about or as we talk about earlier the mobile vans for treatment. it's a whole series of things you can do in order to close that gap which most important is we assure the actors that we
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talked about all day today who have these substances available are not the ones that fill that gap and serve as a barrier to keep the person from getting the treatment that they need. that's why this particular provoe sal is important to forestall the production in the movement of these substances. however, part of a more come prehencive approach that we need to do for long term recovery for americans who need it desperately. >> thank you for that. i'm out of time. i yield back. >> thank you. i thank you so much for allowing me to wave on. i have a question for mr.
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chester. they seem to agree that scheduling will lead to misclassification as schedule one. how are you addressing the concerns to ensure that we are not contributing to the mass incarceration crisis?
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>> we do know there is some possibility that could be the case. these are dangerous substances. the question is what do we do about that. what we have done is two things. the first thing is to allow the colleagues at the table with me here today to have an unprecedented level of access to these substances even though they are in schedule one and have a streamline process so they can do the testing on them and they can determine where they fall within the scheduling regime and if they are harmful or not. in the case that something is scooped up and an individual is convicted of that and it's determined that the substance should be moved either
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unscheduled or schedule down, then there are provisions in this to ensure that individuals are not unduly harmed by that from a criminal justice perspective. when we talk about this being a comprehensive approach, those are the elements we use in order to make sure we don't do undue harm in our desire to protect the american people. >> are you saying the provisions are locked in there? >> yes, absolutely. >> thank you for the question. we believe the administration's proposal will allow us to protect the public and keep them safe from these deadly drugs.
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there's proposals that will streamline access to work. we're committed to working with them to streamline where we can squint with the csa. we have to balance that against these deadly substances that are killing so many every day in our communities. >> thank you. we have livered through this war on drugs. we don't want to set up a process that's going to end up with incarcerating people who really shouldn't be. i hope this process of drugs that are classified or misclassified don't end up incarcerating people that shouldn't be there.
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we want to make sure there's over sight an investigation. we don't have to go unlock of people that have been misclassified. thank you very much for your testimony an answers. >> the gentlewoman leads back. the chairperson is pleased to recognize the gentleman mr. mckinley for your five mips of questions. >> thank you for the patience of your panel that's been going on for hours here today.
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we're the epicenter of that. we looked at no other industrialized nation have a crisis like we have in america. our over doses are 50 times higher than japan. 33 times higher than europe and five times higher than uk. 100,000 people lost their lives last year. husbands have lost their wives. wives have lost their husbands. parents have lost their children. we could go on and on with this. i want to make sure i understand this. let me get this straight. the biden administration's policy to combat there over dose epidemic is to shorten sentences
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for fentanyl traffickers. seriously. this is your answer. come on, man. we can do better than this. our communities and states like west virginia, new hampshire and delaware expecting something far better than that kind of response. i've heard from other doctors, i'm an engineer. >> clinics are clearly part of
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the solution. >> i want to build off of that is -- west virginia has the highest death rate in the nation, unfortunately. we only have our ratio is about one methadone clinic per 200,000 people. new hampshire used to be number two in the nation in over dose deaths but they concentrated on methadone clinics and increased their ratio to one per 100,000. twice the situation we have in west virginia. they lowered their numbers.
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delaware is now number two. they have three times the number of methadone clinics. >> there's multiple factors driving it higher in one state versus the other. they credit that they had 1 and 20,000. they have increased number of clinics and seen the number
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drop. >> the clinics will help. we massively expand. think about new hampshire. >> what would be the best thing state like ours could do? >> expand all types of treatment. expand or try types of treatment. >> thank you very much. i yield back.
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>> chairing the committee and time our members speak in the case and i would like my colleagues to weigh with me into the record. >> thank you -- are you yielding? i couldn't quite follow because you broke up here. >> yes. >> i would like to enter a video of parents telling their story for the record. it can be found at
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stopthevoid.org. i'd like to introduce that into the record. >> without objection. can you hear me? >> i can hear you now. you're breaking up a bit but we can hear you. sgla i have do objections. >> the record will reflect the documents that have been entered into the record. thank you very much for your cooperation.
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this committee is now adjourned.
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