[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
THE OPIOID EPIDEMIC IN APPALACHIA: ADDRESSING HURDLES TO ECONOMIC
DEVELOPMENT IN THE REGION
=======================================================================
(115-31)
HEARING
BEFORE THE
SUBCOMMITTEE ON
ECONOMIC DEVELOPMENT, PUBLIC BUILDINGS, AND EMERGENCY MANAGEMENT
OF THE
COMMITTEE ON TRANSPORTATION AND INFRASTRUCTURE
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
DECEMBER 12, 2017
__________
Printed for the use of the
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transportation
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COMMITTEE ON TRANSPORTATION AND INFRASTRUCTURE
BILL SHUSTER, Pennsylvania, Chairman
DON YOUNG, Alaska PETER A. DeFAZIO, Oregon
JOHN J. DUNCAN, Jr., Tennessee, ELEANOR HOLMES NORTON, District of
Vice Chair Columbia
FRANK A. LoBIONDO, New Jersey JERROLD NADLER, New York
SAM GRAVES, Missouri EDDIE BERNICE JOHNSON, Texas
DUNCAN HUNTER, California ELIJAH E. CUMMINGS, Maryland
ERIC A. ``RICK'' CRAWFORD, Arkansas RICK LARSEN, Washington
LOU BARLETTA, Pennsylvania MICHAEL E. CAPUANO, Massachusetts
BLAKE FARENTHOLD, Texas GRACE F. NAPOLITANO, California
BOB GIBBS, Ohio DANIEL LIPINSKI, Illinois
DANIEL WEBSTER, Florida STEVE COHEN, Tennessee
JEFF DENHAM, California ALBIO SIRES, New Jersey
THOMAS MASSIE, Kentucky JOHN GARAMENDI, California
MARK MEADOWS, North Carolina HENRY C. ``HANK'' JOHNSON, Jr.,
SCOTT PERRY, Pennsylvania Georgia
RODNEY DAVIS, Illinois ANDRE CARSON, Indiana
MARK SANFORD, South Carolina RICHARD M. NOLAN, Minnesota
ROB WOODALL, Georgia DINA TITUS, Nevada
TODD ROKITA, Indiana SEAN PATRICK MALONEY, New York
JOHN KATKO, New York ELIZABETH H. ESTY, Connecticut,
BRIAN BABIN, Texas Vice Ranking Member
GARRET GRAVES, Louisiana LOIS FRANKEL, Florida
BARBARA COMSTOCK, Virginia CHERI BUSTOS, Illinois
DAVID ROUZER, North Carolina JARED HUFFMAN, California
MIKE BOST, Illinois JULIA BROWNLEY, California
RANDY K. WEBER, Sr., Texas FREDERICA S. WILSON, Florida
DOUG LaMALFA, California DONALD M. PAYNE, Jr., New Jersey
BRUCE WESTERMAN, Arkansas ALAN S. LOWENTHAL, California
LLOYD SMUCKER, Pennsylvania BRENDA L. LAWRENCE, Michigan
PAUL MITCHELL, Michigan MARK DeSAULNIER, California
JOHN J. FASO, New York
A. DREW FERGUSON IV, Georgia
BRIAN J. MAST, Florida
JASON LEWIS, Minnesota
------
Subcommittee on Economic Development, Public Buildings, and Emergency
Management
LOU BARLETTA, Pennsylvania, Chairman
ERIC A. ``RICK'' CRAWFORD, Arkansas HENRY C. ``HANK'' JOHNSON, Jr.,
BARBARA COMSTOCK, Virginia Georgia
MIKE BOST, Illinois ELEANOR HOLMES NORTON, District of
LLOYD SMUCKER, Pennsylvania Columbia
JOHN J. FASO, New York ALBIO SIRES, New Jersey
A. DREW FERGUSON IV, Georgia, GRACE F. NAPOLITANO, California
Vice Chair MICHAEL E. CAPUANO, Massachusetts
BRIAN J. MAST, Florida PETER A. DeFAZIO, Oregon (Ex
BILL SHUSTER, Pennsylvania (Ex Officio)
Officio)
CONTENTS
Page
Summary of Subject Matter........................................ iv
TESTIMONY
Panel 1
Hon. Harold Rogers, a Representative in Congress from the State
of Kentucky.................................................... 3
Panel 2
Hon. Earl Gohl, Federal Cochair, Appalachian Regional Commission. 6
Barry L. Denk, Director, The Center for Rural Pennsylvania....... 6
Nancy Hale, President and Chief Executive Officer, Operation
UNITE.......................................................... 6
Jonathan P. Novak, Esq., Former Attorney for the Drug Enforcement
Administration................................................. 6
PREPARED STATEMENTS SUBMITTED BY MEMBERS OF CONGRESS
Hon. Tom Marino of Pennsylvania.................................. 28
PREPARED STATEMENTS SUBMITTED BY WITNESSES
Hon. Harold Rogers............................................... 31
Hon. Earl Gohl................................................... 35
Barry L. Denk.................................................... 42
Nancy Hale....................................................... 48
Jonathan P. Novak, Esq........................................... 54
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
THE OPIOID EPIDEMIC IN APPALACHIA: ADDRESSING HURDLES TO ECONOMIC
DEVELOPMENT IN THE REGION
----------
TUESDAY, TUESDAY, DECEMBER 12, 2017
House of Representatives,
Subcommittee on Economic Development, Public
Buildings, and Emergency Management,
Committee on Transportation and Infrastructure,
Washington, DC.
The subcommittee met, pursuant to call, at 10:01 a.m., in
room 2167, Rayburn House Office Building, Hon. Lou Barletta
(Chairman of the subcommittee) presiding.
Mr. Barletta. The subcommittee will come to order.
The purpose of today's hearing is to examine the impact of
the opioid crisis on economic development in Appalachia. The
opioid crisis has touched the lives of countless Americans.
This public health emergency has taken the lives of far too
many of our Nation's citizens, and has had significant adverse
effects on our economy and labor force participation. As a
subcommittee with jurisdiction over a number of economic
development agencies, including the Appalachian Regional
Commission, we are specifically focusing today on the ways the
opioid crisis has affected the Appalachian workforce, and
efforts to promote economic development in the region.
The opioid epidemic has profoundly affected all of our
districts and uprooted the lives of so many of our
constituents. Ninety-one Americans die every single day of an
opioid overdose. In my home State of Pennsylvania, 4,642 drug-
related overdose deaths were reported in 2016. In 2015, there
were 5,594 overdose deaths in Appalachia--a drug-related death
rate 65 percent higher than the rest of the Nation. Sixty-nine
percent of those deaths were caused by opioids. An overwhelming
majority of these deaths throughout Appalachia were individuals
between the ages of 25 and 44, people who were in their prime
working years. These troubling statistics makes it clear that
the opioid crisis is not only destroying lives, it has created
a significant challenge to workforce expansion and economic
development throughout Appalachia.
This crisis is economically disastrous for our Nation. This
past month, the White House office of economic advisers
released a report that estimated the opioid epidemic cost our
Nation $504 billion in 2015. That is an important number to
remember as we begin today's hearing, because it points to the
lost potential for economic activity and productivity in
communities battling opioid addiction. That is our focus here
today.
To that end, I remind our witnesses and my fellow Members
that this subcommittee's jurisdiction is economic development
programs in the Appalachian Regional Commission. We have no
oversight of the Department of Justice or the DEA. Our goal is
to have a hearing that this subcommittee can use to inform our
committee's decisions regarding agencies within our
jurisdiction. Therefore, I would ask that all testimony and
questions be confined to the issues within our jurisdiction.
Further, I would like to reiterate that today's hearing is
meant to be bipartisan. The opioid crisis does not recognize
political parties. I think that we can all agree, Republicans
and Democrats alike, that the priority here is to finding
solutions for the communities and the families who are being
devastated by this epidemic, not playing politics with people's
lives.
Just a few days ago, the Transportation and Infrastructure
Committee showed what it can accomplish when we work in a
bipartisan fashion. We unanimously approved the Disaster
Recovery Reform Act because of the good work that was started
here in this subcommittee. Let's continue to work in that same
fashion here today to look for solutions within the programs
and agencies under our jurisdiction.
It is my hope that today we can come together to examine
the impact of opioids in Appalachia and the ways in which
existing Federal economic development programs can help States
and communities address and combat this growing epidemic. I am
sure our witnesses today will help us answer those questions. I
thank you for being here.
I now recognize the ranking member of this subcommittee,
Mr. Johnson, for a brief opening statement.
Mr. Johnson. Thank you, Mr. Chairman. Good morning, and I
would like to thank Chairman Barletta for holding this very
important hearing on the opioid epidemic in Appalachia and how
it is impacting adversely and severely the lives of our
brothers and sisters in Appalachia.
Since the formation of the Appalachian Regional Commission
in 1965, Appalachia has made significant progress in executing
its mission of addressing persistent poverty and economic
despair. However, the progress made in attracting industry to
Appalachia and reducing poverty has been threatened by the
current opioid epidemic sweeping the Nation.
According to the Centers for Disease Control and
Prevention, the CDC, drug overdoses are now a leading cause of
death in the United States resulting in approximately 52,000
deaths in 2015. Fifty-two thousand deaths in 2015, or 142
deaths every day. In Appalachia, the problem is even worse. In
2009, the mortality rate in the Appalachian region was 24
percent higher than the non-Appalachian United States. By 2016,
the mortality rate was 37 percent higher than the rest of the
Nation.
The opioid epidemic also happens to strike in the most
devastating way men and women between the prime working ages of
25 and 44. Although the mortality rate is lower in the Georgia
counties in my congressional district covered by the ARC, I
think there can be important lessons learned for the Southeast
Crescent Regional Commission, another economic development
commission that I introduced legislation reauthorizing earlier
this year.
This is a full-blown crisis that demands the attention of
Congress. The high rates of substance abuse and mortality in
Appalachia compared to the rest of the United States is a
serious impediment to sustained economic growth. Employers are
seeking a healthy workforce when making decisions about where
they will locate their businesses. High rates of substance
abuse and mortality make it difficult for employers to find and
hire qualified candidates. The ARC in its mission to promote
economic development in the region has understood the great
threat of opioid addiction to the economic viability of the
region.
In 2017, the ARC commissioned two reports that clearly
outlined that men and women of prime working ages are beset
with high rates of substance abuse and mortality. I support
ARC's conclusion that increased access to treatment services,
prevention, and overdose medications to address the opioid
epidemic are necessary. I am pleased that the approach to the
opioid epidemic in all of ARC's commissioned reports discuss
this problem in the context of it being a public health issue
as much as it is a law enforcement issue. We must not repeat
the mistakes of the past where drug abuse was overcriminalized
as it was during the crack cocaine epidemic of the 1980s. The
Government's response to drugs in the 1980s did not have the
effect of easing the problem, but instead, only intensified the
severity of the problem.
Hopefully, we have learned some things from our past.
Today, the comprehensive reports and testimony before this
committee make clear that the genesis and driving force for
this epidemic starts with the proliferation of prescription
drugs. I am glad that we will have a former DEA official talk
about how changes in the law and policy at DEA contributed to
the explosion in prescription pills in Appalachia. There is no
silver bullet to solve the opioid epidemic, but I look forward
to hearing from today's witnesses on how a comprehensive
multifaceted approach can address this crisis.
And with that, I yield back.
Mr. Barletta. Thank you. The Chair now recognizes the
ranking member of the full committee, Mr. DeFazio.
Mr. DeFazio. Thanks, Mr. Chairman. I won't delay things
here. I am here in the hope of hearing from the witnesses
before I have to leave.
Thank you.
Mr. Barletta. OK. I am pleased to welcome on our first
panel, our colleague, Representative Harold Rogers of Kentucky.
I ask unanimous consent that our witness' full statement be
included in the record. Without objection, so ordered.
For our witness, since your written testimony has been made
a part of the record, the subcommittee would request that you
limit your oral testimony to 5 minutes.
Representative Rogers, you may proceed.
TESTIMONY OF HON. HAROLD ROGERS, A REPRESENTATIVE IN CONGRESS
FROM THE STATE OF KENTUCKY
Mr. Rogers. Thank you, Mr. Chairman. And thank you, members
of the committee, for holding this hearing and for allowing me
to be here to introduce a constituent who will be testifying
immediately after me.
It is a pleasure to introduce Nancy Hale. She is the
president and CEO of a group called Operation UNITE. My area
was impacted most severely at the very outset. It is where this
epidemic began.
Mr. Barletta. Excuse me. Can you pull that microphone a
little bit closer to you?
Mr. Rogers. Is that OK?
Mr. Barletta. Yep.
Mr. Rogers. Unbeknownst to anyone, I am talking 2002 or so,
the State newspaper had this banner headline saying that
eastern Kentucky is the painkiller capital of the world. It is
where OxyContin got its start, in the coalmine fields of east
Kentucky. I didn't know what to do. This is completely out of
the blue. No one knew or suspected that this was going on. So I
called together, over several weekends, people from all walks
of life, from all professions: preachers, doctors, orators,
judges, social workers, you name it. And we barnstormed, what
in the dickens can we do to stem the tide? Kids were dying in
the hospitals every night.
And out of that came this organization called UNITE.
Unlawful Narcotics Investigations, Treatment and Education.
Holistic three-pronged attack. You can't arrest your way out of
the problem. You can't treat your way out of the problem alone.
And you can't educate your way out of it. You got to do all of
them at the same time, across the board, in every community,
with everyone involved. And you got to involve the public. So
the public pressure comes to bear on judges, prosecutors, the
law enforcement community, the medical community, the education
system and the like. And so, there are 32 counties in Operation
UNITE. We had 35 undercover agents that could work in those 32
counties. So far, they have arrested and convicted some 4,300-
and-so pushers.
But now with this Operation UNITE program, we have got
treatment centers. We have got counselors in schools. We have
got drug courts in every county, every community. And we have
got law enforcement that is now pushing and pushing and
pushing.
So the operation is a success. Is it solving the problem?
No. We are still going up in drug use. It has shifted a lot
from prescription pills to heroin laced with fentanyl, meth,
and other substances. I am sure all of you have the same
problem in your own districts back home. All of us in Congress
have been touched, in some way, by opioid abuse. As the flames
of addiction have fanned across communities small and large, my
area spanning Kentucky's Appalachian region, the very heart of
Appalachia, has been acutely impacted.
While I was first initially skeptical of that newspaper
story about the widespread abuse of OxyContin, it didn't take
me long to find out it was true. The overprescription diversion
of painkillers was wreaking havoc on our small towns. Addiction
was pervasive and deadly, with overdoses tragically far too
common. Something had to be done.
But addressing this issue, the misuse of illegal drugs, was
far from black and white. And that is how we came by the
Operation UNITE organization.
I don't want to steal Nancy's thunder when she testifies in
a few minutes, but I want to emphasize that this organization
is the national leader now in combating opioid addiction at the
regional level. UNITE has taken this holistic model to the
national stage by hosting and putting on the National
Prescription Drug Abuse and Heroin Summit, now in its seventh
year. We will meet again in April in Atlanta. We will have all
of the agencies there: The DEA, the FBI, Department of Justice.
Last year, we had the President come. We will have the head of
the CDC, NIH, DEA, the drug czar, you name it. And I hope a
number of Members of Congress. The chairman graced us with his
presence a couple of years ago. And, Mr. Chairman, we want all
of you back again next April.
I know today, given the jurisdiction of your subcommittee
over the Appalachian Regional Commission, you are focused on
finding solutions in this geographical area which has been a
bellwether for national trends in the opioid's space.
Let me state that ARC has been a valued partner. And Mr.
Gohl answered the call when UNITE asked for support for this
summit 8 years ago. And, Mr. Gohl, we are grateful for your
support for the ARC summit, and we would not be where we are
today without you.
But I also believe that the opioid epidemic is indelibly
tied to the future economic development of Appalachia, and that
ARC could be doing more to help organizations like UNITE tackle
the challenges associated with substance abuse. UNITE has found
creative ways to do more with less as funding has become more
difficult to come by. But I believe, Mr. Chairman, a vision
without funding is a hallucination. Without additional Federal
support, UNITE simply cannot maintain the level of service that
will be necessary to save lives in our region and in
communities around the country.
As a long-time appropriator, I understand better than most
that ARC has a broad mission and limited resources. However,
one thing is painfully clear. The continuation of our addiction
crisis and a vibrant Appalachian economy cannot coexist. The
need for more targeted action is urgent as innocent children
are left behind in the wake of deadly overdoses, and as more
employers search for a drug-free workplace, both in Appalachia
and across the country.
I think today's hearing, Mr. Chairman, is an important
first step, and I am grateful that you have made it a priority.
I stand ready to assist the members of your subcommittee and
you in any way as we work together to find solutions to this
crisis.
So thank you, Mr. Chairman, for allowing me these minutes
and for your hospitality towards Nancy Hale, who is on the next
panel.
Thank you, and I yield back.
Mr. Barletta. Thank you. Thank you for your testimony. Your
comments have been very helpful to today's discussion.
We will now move to our second panel.
Mr. Barletta. On our second panel, we have the Honorable
Earl Gohl, Federal Cochair of the Appalachian Regional
Commission; Mr. Barry L. Denk, director, The Center for Rural
Pennsylvania; Ms. Nancy Hale, president and chief executive
officer, Operation UNITE; and Mr. Jonathan P. Novak, former
attorney for the Drug Enforcement Administration.
I ask unanimous consent that our witnesses' full statements
be included in the record. Without objection, so ordered.
For our witnesses, since your written testimony has been
made a part of the record, the subcommittee would request that
you limit your oral testimony to 5 minutes.
Chairman Gohl, you may proceed.
TESTIMONY OF HON. EARL GOHL, FEDERAL COCHAIR, APPALACHIAN
REGIONAL COMMISSION; BARRY L. DENK, DIRECTOR, THE CENTER FOR
RURAL PENNSYLVANIA; NANCY HALE, PRESIDENT AND CHIEF EXECUTIVE
OFFICER, OPERATION UNITE; AND JONATHAN P. NOVAK, ESQ., FORMER
ATTORNEY FOR THE DRUG ENFORCEMENT ADMINISTRATION
Mr. Gohl. Thank you, Mr. Chairman, and members of the
subcommittee for holding this hearing examining the impact of
opioids in Appalachia. I also want to acknowledge Congressman
Rogers whose leadership has challenged us all to look at how
opioids are holding Appalachia's economy back.
My name is Earl Gohl. I serve as the Federal Cochair of the
Appalachian Regional Commission. ARC is a partnership between
the Governors of the 13 Appalachian States and the Federal
Government. The Commission was created by Congress to help
Appalachia achieve socioeconomic parity with the rest of the
Nation. ARC has a broad mandate to foster and support economic
growth across the region's 420 counties.
Mr. Chairman, opioid abuse poses a major threat to the
economic prosperity of Appalachia. It is not just a public
health and public safety issue. It is an economic issue. It
drains the region's resources, both human and financial. It
shatters Appalachia's families and communities. It would be
understandable if this scenario led to a narrative of defeat.
But my narrative, based on 8 years of intensive engagement,
working with communities, partnering with a variety of groups
and interests and making hundreds of friendships is not a tale
of woe. It is, rather, a narrative of proud Americans who are
resilient, determined, and full of grit. There is an army of
Appalachians with ambition and hopes who get up every day and
work incredibly hard to make their communities better places
for their kids and their grandkids.
Today, these folks bring energy and innovation and
determination to many communities. They are focused on the
challenge of a stronger, new, and diverse local economy. It is
a story of groups like SOAR in eastern Kentucky, Coalfield
Development Corporation in West Virginia, the Foundation for
Appalachian Kentucky, the Pennsylvania Wilds, and the West
Virginia Hub, the list goes on, who are incredibly focused on
writing the narrative of Appalachia's future.
But we also know the studies, the data, the roundtables,
the focus groups, the discussions, the casual conversations
with friends and partners make it clear. Opioid addiction is a
significant barrier preventing Appalachian communities from
reaching their economic potential. Mayors tell me that
prospective employers ask about the state of opioid addiction
in their communities. Law enforcement understands they are
confronting a disease. Friends and partners, employers will
pull you aside and say, this is touching every family, with the
emphasis being on ``every.''
In 2008, ARC published a research report by the Walsh
Center for Rural Health Analysis that showed Appalachian
hospital admission rates for abuse of prescription painkillers
were more than twice those in the rest of the United States. It
showed the rate rising, both nationally and regionally, but it
was rising faster in Appalachia. The ARC study was the first to
document that Appalachia was being disproportionately harmed by
the growth of prescription drug abuse.
This fall, the President released the opioid commission
report that outlined the challenges of opioid abuse nationwide.
ARC recently published another study from the Walsh Center that
described the extent of the opioid challenge in our region. It
put opioid-related drug abuse in context with two other
diseases of despair, suicide and alcoholic liver disease, and
showed that the region's mortality rate for all three combined
is 37 percent higher than the rest of the Nation. The same
study also illustrates that the gaps between Appalachian and
non-Appalachian mortality rates are highest among people in
their prime working years.
In 2015, overdose-related mortality rates for Appalachia's
25-to-44-year-old age group were more than 70 percent higher
than the same age group in the country's non-Appalachian areas.
Seventy percent of all the data points. This is the one that
all of us need to focus on. It is the one that will have the
greatest impact on the economic growth--economic opportunities
of the Appalachian region.
You probably already know that Appalachians are not folks
who are going to stand by and wait for someone to tell them
what to do when there is a problem that impacts their families
and their community. Appalachians recognize that the opioid
challenge requires everyone's engagement and commitment. They
understand that ARC can partner with them and--to help them
take on the region's toughest challenges.
You will hear from Nancy Hale. The story of UNITE is an
example of what Appalachian communities can accomplish. ARC is
very proud to call ourselves a partner of Operation UNITE. We
have all heard about the heroics of the Huntington, West
Virginia, city emergency responders who have been on the front
line of this opioid crisis. ARC is currently supporting the
work of the Cabell-Huntington Health Department to expand its
opioid harm reduction services from one site to six, making the
program available countywide.
Organizations like FAHE [Federation of Appalachian Housing
Enterprises] in Kentucky recognize that they can contribute to
this effort by partnering with service providers to develop
recovery housing and employment support for individuals. ARC
has invested $1 million in our POWER [Partnerships for
Opportunity and Workforce and Economic Revitalization]
Initiative that targets coal-impacted communities to help FAHE
establish three treatment and recovery facilities in Kentucky.
Using the ARC funds, the Center for Rural Health
Development in Hurricane, West Virginia, is strengthening the
healthcare industry in a 15-county region by providing business
development systems to care providers.
At its core, each one of these examples is about creating
job opportunities in Appalachia, which is what ARC's core
mission is.
ARC believes that supporting the workforce and creating new
jobs and businesses are strategically important in solving the
region's opioid crisis. Over the past 5 years, ARC's
investments have helped create and retain over 100,000 jobs.
Each of these jobs gives someone hope, a reason to get up every
day, and make the region a better place for their kids, their
grandkids, and themselves.
Mr. Chairman, thanks so much for this opportunity.
Mr. Barletta. Thank you for your testimony, Chairman Gohl.
Mr. Denk, you may proceed.
Mr. Denk. Thank you.
Good morning, Chairman Barletta, Ranking Member Johnson,
and members of the House Subcommittee on Economic Development,
Public Buildings, and Emergency Management. I appreciate the
opportunity to be with you today. I am Barry Denk, the director
of The Center for Rural Pennsylvania. The center is a
bipartisan, bicameral legislative research agency serving the
Pennsylvania General Assembly. For those who may not know,
Pennsylvania has the third largest rural population in the
Nation with 3.5 million rural residents. Rural Pennsylvania
compromises 75 percent of our Commonwealth's land area.
The center began sponsoring a series of public hearings in
July 2014, on the issue of what we now know is the public
health epidemic of substance use disorder due to heroin and
opioid addiction. We conducted our 13th hearing just this past
October of 2017. The Center for Rural Pennsylvania received
testimony from over 150 professionals totaling over 35 hours,
all viewable on my chairman's website as well as their written
testimony. We heard firsthand from the attorney general, from
police officers, district attorneys, judges, EMS professionals,
coroners, doctors, superintendents, business leaders, treatment
providers, Federal and State government officials, and we heard
from families who have lost loved ones to addiction, and we
heard from persons in recovery.
One of the individuals who testified at two of our
hearings, the most recent being in October of 2017, is the
president and CEO of the Pennsylvania Chamber of Business and
Industry. He noted a Princeton economist, Alan Krueger, who
released a report in September 2017 that analyzed how the
opioid crisis has contributed to workforce challenges. By
comparing county level data for opioid prescription rates, and
labor force data for the periods of 1999 to 2001, and from 2014
to 2016, Dr. Krueger concluded that opioid prescriptions
accounted for a 20-percent decline in the workforce
participation among men, and a 25-percent decline among women.
The Pennsylvania Chamber of Commerce also commissioned a
survey of its members in 2016 about their experiences and
expectations concerning the workforce. Over 400 of the members
responded to the survey, and they painted a daunting picture. A
combined 52 percent said it is very, or extremely difficult to
recruit qualified candidates to fill the workforce needs for
their companies. Over 61 percent said finding qualified
applicants has become much more difficult within the past 5
years, and over 57 percent expect that same situation to play
out over the next 5 years.
Over 20 percent of the respondents said the job applicants
or potential new hirees very often, or somewhat often, failed
to pass a drug test. He also stated that it is becoming
increasingly evident that addressing the prescription drug and
opioid epidemic must be an integral component of any workforce
development strategy.
We are also aware of a study that was completed in two
Appalachian counties in Pennsylvania, namely Allegheny, where
Pittsburgh is located, and Westmoreland County. The Allegheny
Institute for Public Policy released its report in May 2017,
stating that their estimate is that there are 16,000 opioid
medicine abusers in Allegheny County, and over 5,000 heroin
abusers/users in Allegheny County coming at a cost for
healthcare, crime, and lost wages and benefits estimated at
$472 million for those opioid medicine users and over $350
million for heroin users.
For Westmoreland County, the costs were placed at $102
million for opioids, and $108 million for heroin. We are also
aware of a study by the National Bureau of Economic Research
that surveyed 35 Appalachia counties known for a high
propensity for heroin use. It found that, as unemployment
increases by 1 percent, there is a 3.6-percent increase in
opioid-related deaths, and an over 7-percent increase in
emergency room visits for opioid-related health crises.
These are just a few examples, given the time today, to
help document the impact that the heroin and opioid epidemic is
having on our workforce and our economy in Appalachia, and,
specifically, in rural Pennsylvania.
A few closing comments. Specifically, I will provide a
quote from my chairman, Senator Gene Yaw, who testified before
the Pennsylvania Senate Health and Human Services Committee in
May of 2017. And his quote is this: ``Today, 13 Pennsylvanians
will lose their lives to a drug overdose. This week, over 1,000
people will die of an overdose in the United States. By
comparison, the Vietnam War, a period that spanned 10 to 12
years, claimed more than 56,000 American lives. We are now
approaching that level of lives lost every year due to drug
abuse and misuse, and estimates are that these numbers will
continue to surge.''
The Center for Rural Pennsylvania since 2014 has been
investigating this issue. But our work addressing rural
Pennsylvania and the challenges and opportunities that face
those residents in those communities dates back to 1987.
I will leave this final comment with you: While the heroin
and opioid crisis is an unbelievable impact for our communities
and our citizens, it is also important to put it in the context
of much broader challenges that are ongoing and systemic in
rural Pennsylvania, and, I would offer, in rural Appalachia.
Two things are constant, regardless of what we are talking
about: geographic isolation, and lack of density population.
And that makes it extremely challenging to aggregate, to get
return on investment, and to provide goods and services that
can move the economies for rural Pennsylvania.
One of the maps that I provided for you in my written
testimony shows the per capita income gap between urban and
rural Pennsylvania. That gap in 1970 was just under $5,500.
That income gap, adjusted for inflation in 2015, increased to
over $12,000, a per capita income gap. That means an awful lot
of things for how rural Pennsylvania can do a lot of things,
invest in a lot of programs, whether it is drug treatment or
whether it is economic development programs. Those are
constants that remain in rural Pennsylvania and speak to the
broader picture of some of the challenges, but also, some of
the opportunities that can turn things around for our
Commonwealth.
Chairman, thank you so much for the privilege to be here.
Mr. Barletta. Thank you for your testimony, Mr. Denk.
Ms. Hale, you may proceed.
Ms. Hale. Good morning, Chairman Barletta, Ranking Member
Johnson, and members of the subcommittee. Thank you for giving
me the opportunity to speak with you. I am Nancy Hale,
president and CEO of Operation UNITE.
UNITE stands for Unlawful Narcotics Investigations,
Treatment and Education. Operation UNITE was launched in 2003
by Congressman Hal Rogers, after the Lexington Herald-Leader
published a report on addiction and corruption. Per capita, we
were the top painkiller users in the entire world. UNITE
pioneered a holistic approach that has become a model for other
States and the Nation. Eastern Kentucky's economy has been hard
hit by the rising rate of substance abuse among its residents.
Local employers are losing skilled workers to substance use and
are unable to find qualified employees who can pass a drug
test.
So how is UNITE addressing the problem? UNITE's enforcement
effort has resulted in the removal of more than $12.3 million
worth of drugs from the street, 4,400 arrests with a conviction
rate of more than 97 percent, and nearly 22,000 calls to our
tip line. But we realize that we cannot arrest our way out of
this epidemic.
We staff a statewide treatment line to connect people to
resources, and have supplied vouchers to help more than 4,000
people enter long-term rehabilitation. In addition, the number
of drug court programs has increased from 5 to serving all 32
counties in our region. But prevention is paramount. UNITE has
reached more than 100,000 students through our drug education
programs.
A National Center for Injury Prevention and Control study
estimated that prescription opioid abuse cost the economy $78.5
billion in 2013. That did not include factors like lost
productivity. We have provided State-certified, drug-free
workplace training to more than two dozen companies which
benefit from reduced workers' compensation insurance premiums,
safer workplaces, increased productivity, and reduced
absenteeism. UNITE focuses on addiction, the signs of drug use,
the effects in the workplace, and how to find support services.
We also help with employee assistance programs. We have
implemented many evidence-based solutions. The good news is
that these programs can be replicated. The bad news is they
require funding.
You have already heard Congressman Rogers say a vision
without funding is a hallucination. Operation UNITE received
Federal appropriations in the early 2000s for enforcement
efforts. SAMHSA helped provide treatment vouchers. Through our
AmeriCorps program, students show a more than 50-percent growth
in math knowledge and drug education knowledge. Our
achievements would not have been possible without these
appropriations, many of which are no longer available. We seek
private and State investments, and continue to explore
opportunities through the competitive grant process. Our unique
regional holistic structure does not fit many funding models.
The Appalachian Regional Commission has been invaluable.
Please refer to my written testimony for those details. I would
like to focus today, though, on the National Prescription Drug
Abuse and Heroin Summit. Congressman Rogers asked UNITE to
create a summit where stakeholders could collaborate,
cooperate, and discover data-driven solutions to the epidemic.
The ARC agreed to serve as educational partner for the first
summit in 2012. Its investment of $50,000 paid for travel
expenses for more than 200 leading experts and the ability to
offer continuing education credits.
Since inception, attendance has more than tripled,
attracting nearly 2,400 people in 2017. The Institute for the
Advancement of Behavioral Healthcare now promotes and stages
the summit. UNITE remains active as the educational adviser. In
2016, UNITE received ARC funding for effective sustainable
social media strategies. UNITE implemented a campaign to raise
awareness of the summit, and received training from Oak Ridge
Associated Universities, enabling us to build a strong regional
presence and increase Facebook followers by 24 percent.
In 2017, ARC provided funding to share social media best
practices at the summit; to expand our media presence in the
Appalachia region; to assist with the CDC's campaign to prevent
prescription opioid abuse; and, create a strategic plan, a
sustainability roadmap.
Unfortunately, many people are unaware of how to replicate
our initiatives, and UNITE has endured drastic funding cuts.
UNITE and organizations utilizing our model are desperate for
Federal support to keep the doors open. We hope we can maintain
and expand upon our partnership with ARC and other Federal
agencies. UNITE helps ARC fulfill its mission. And ARC support
has enabled UNITE to create hope and change the culture, not
only in southeastern Kentucky or Appalachia, but on a national
stage. By supporting a national dialogue through the Rx summit,
ARC is creating positive changes well beyond its service area.
But we need the ARC to do more. Funding and expansion of our
drug-free workplace training would help economic development in
Appalachia. In addition, we need funding to support medical
symposiums on prescribing addiction, alternative treatments,
and recovery.
UNITE looks forward to working with other communities
across the Nation to address our Nation's opioid epidemic. And
thank you for giving me the opportunity to share today.
Mr. Barletta. Thank you for your testimony, Ms. Hale.
Mr. Novak, you may proceed.
Mr. Novak. Good morning, and thank you for the honor of
speaking here today.
From 2010 through 2015, I had the great honor to serve as
an attorney for the Drug Enforcement Administration. My work
was focused almost entirely on enforcement actions against
doctors, pharmacies, distributors, and manufacturers of opioid
controlled substances, all registrants under the Controlled
Substances Act.
For several years, with an eye on protecting the public
health and safety, DEA shut down pill mills and practices run
by greedy, immoral drug dealers in lab coats, all betraying not
only their duties under the CSA, but their ethical obligations
to their fellow human beings. I watched as DEA fought hard
against the rising tide and struggled not to drown as the
opioid epidemic swelled around us.
The opioid epidemic was a slow burn fire. Traditionally,
many opioids used to treat pain included acetaminophen, a drug
which, if taken long term, caused severe liver damage. So in
the 1990s, a pharmaceutical company decided to remove the
acetaminophen and start promoting the use of opioids for long-
term pain management. Their proposal was backed by claims that
opioid medicines are rarely addictive. Too late. We now know
that this is not true.
As these drugs were marketed, the very people selling the
pills went about changing hearts and minds about the dangers of
opioids. Soon, opioid phobia was replaced with frowny-faced
pain measurement and a general misunderstanding by many
physicians of what exactly they were prescribing. Over the
course of time, opioid usage was normalized in America and
heralded as a wonder drug. Opioids were digging in everywhere
across the country, especially in blue collar and poorer areas,
where those seeking a prescription felt validated by the fact
that their drugs came from a doctor and where those seeking a
buck found incredible profits in sharing their stash.
Unemployment and disability numbers rose, and the number of
employable members of the workforce diminished.
As DEA endeavored to help the people of this country, we
began broadening our investigations and enforcement actions to
look at the role of distributors and manufacturers in this
threat of opioid addiction. Then, for no readily apparent
reason, DEA began to slow down, not ramp up, its enforcement.
And DEA became afraid to use its strongest enforcement tool:
the immediate suspension order.
The ISO was a tool for immediately halting the shipments of
opioid controlled substances sent by a distributor to a
pharmacy. During my time at DEA, it seemed to me that these
larger pharmaceutical corporations and industries were not
interested in doing the right thing, at least until their
profits were hurt and their names were being tied to the opioid
epidemic in the headlines.
Soon after, DEA began losing more and more attorneys
recruited over to represent the industry. When these attorneys
left for the industry, they brought with them an intense and
brilliant understanding of DEA regulations and case law. I
believe this brilliance and understanding, now representing
some of the largest DEA registrants in the country, was what
DEA began to fear. This was, to my understanding, what caused
much of the slowdown in DEA enforcement.
It was, to my knowledge, a former DEA attorney who drafted
the Ensuring Patient Access and Effective Drug Enforcement Act
which stripped DEA of the ISO. While DEA attorneys feared that
a bad decision in Federal court might strip DEA of the ISO,
Congress effectively legislated the ISO away, ostensibly in the
name of ensuring patient access to opioid controlled
substances. Without the ISO in its tool belt, DEA will likely
have little effect enforcing regulations against manufacturers,
distributors, and large pharmacy chains who, in my experience,
only ever seem to listen when it hurt their bottom line.
Ensuring patient access is a misleading description painting
the picture of an altruistic industry only concerned with
saving lives and easing pain.
While we may not consider corporations to be people, there
is simply no such thing as an altruistic corporation. And by
limiting DEA's ability to enforce its regulation and the CSA
against these pharmaceutical corporations, we have effectively
condoned the poisoning of our populous, and ushered in the loss
of an entire generation to highly addictive and deadly drugs.
According to the CDC, 80 percent of heroin users in America
today got their start on opioid painkillers. Overdose deaths in
America are at an all-time high, making the heroin epidemic of
the 1970s and the cocaine epidemic of the 1980s look tiny in
comparison. We are killing our own people, and DEA is falling
down on the job. This is an epidemic that focuses on no race,
no gender, no socioeconomic classification, because it affects
them all.
Everyone has a story of a loved one injured on the job now
living a life of addiction, pain management, and unemployment,
because their doctor kept increasing their prescribed dosage,
or of a student injured in a high school football game
prescribed opioids by a well-intentioned physician, and now in
jail for possession of heroin or dead of an accidental
overdose.
Significant damage has been done not only to those who now
are addicts, but to our communities, our workforces, and our
economies. Old methods of treatment are failing in the face of
this long-term physical and biological addiction. And yet,
these pills seem easier and easier to find and harder and
harder to avoid. We need to focus on changing the laws,
restoring DEA's ability to enforce, and looking at funding to
educate our population, and to help those already addicted to
fully recover and become productive members of our society
again. We need to focus on local law enforcement and legal
actions by States and counties. All of this starts with
effective enforcement to shut off the overflow of opioids into
our communities.
And thank you very much for this opportunity today.
Mr. Barletta. Thank you for your testimony, Mr. Novak.
I will now begin the first round of questions limited to 5
minutes for each Member. If there are additional questions
following the first round, we will have additional rounds of
questions as needed.
Mr. Denk, The Center for Rural Pennsylvania has done a lot
of work for the Pennsylvania General Assembly. It seems the
impact of the opioid crisis on the workforce is significant.
From the information the center has gathered, can you
highlight how opioid abuse has created barriers for attracting
jobs? And how will the general assembly use the information you
have collected to address this issue?
Mr. Denk. We have heard from a number of testifiers,
particularly those in recovery, where prior felony convictions
still linger for them, not just in employment opportunities,
but with regard to housing itself. And so I know my boss,
Senator Gene Yaw, is looking at that issue.
There is concern that those felonies, while committed
because somebody was addicted to a substance, need to be looked
at. And at some point in time, maybe that can be removed from
their record.
We heard from one young individual in Greensburg,
Pennsylvania. Started the path into drugs at age 13 because of
her home environment. And she eventually went to heroin. She
committed two felonies by the age of 20. That woman turned her
life around completely. She now has a master's degree, and she
now works for the Allegheny Health Network as an addictions
counselor, helping individuals. Those two felony convictions
still linger on her record. And she has been turned down for
housing because she reports, yes, I have been convicted of two
felonies.
So we have heard that. We have heard from employers,
particularly in the gas industry, which is important to
Pennsylvania's economy with the drilling, of individuals who
fail to pass some drug tests. We heard at one of our hearings
in Williamsport where the local single county authority, the
agency that provides treatment services, they are meeting with
employers and developing a list of employers who are willing to
give a second chance to an individual who may have had a
substance use disorder, may have had some kind of criminal
activity as a result of that.
We also heard from a number of judges about the effects of
drug courts and how helpful they are, and somebody who has
committed a crime but needs to turn their life around. And so
we are looking to expand drug courts across the Commonwealth.
Currently, out of 67 counties, only 38 drug courts exist in
those counties. There are a number of things that are being
looked at to further document the question that you raise and
take a look at from a legislative standpoint as to what might
be done.
Mr. Barletta. Thank you.
Ms. Hale, Operation UNITE has done a lot in eastern
Kentucky and has become a resource for other communities.
What types of programs have you found to be the most
impactful in addressing the opioid crisis? And are there models
that other States like Pennsylvania can use?
Ms. Hale. I think our education prevention programs have
had the greatest impact. We have seen and heard anecdotal
evidence from some of our summer interns who were students in
college share that, on their college campus in attending frat
parties and sorority parties, where there, unfortunately, is a
great deal of alcohol and drugs being used at the parties, the
students have noted that there are a number of students who do
not engage in those activities, and then they begin noting that
those students were from eastern Kentucky, and have grown up
for the last 10 to 12 years hearing about substance abuse,
being trained in making healthy choices and things such as
that. We are seeing an impact on that generation.
Also, we are seeing an impact in our program in working
with the administrative office of the courts through our drug
court programs. We are learning that drug courts do work. There
are many people who are in recovery who make excellent
employees because of what they have endured, what they now
understand, the structure that has been brought into their
lives through the drug court programmings.
Education and prevention. We have a mobile prevention unit
that we target 7th and 10th graders. That has had a huge
impact. The University of Kentucky compiles the data from the
pre- and post-surveys with that program. We also have programs
that we are taking into the elementary schools where we are
introducing young people at an early age to the dangers, the
harms, preparing them with knowledge, helping them make healthy
decisions, even as early as third grade.
And then, of course, our AmeriCorps program. We have 54
AmeriCorps members serving in 13 counties in our district. And
those AmeriCorps members work primarily on math tutoring. But
they also are introducing a Too Good for Drugs curriculum that
impacts the parents, the staff, and the community in prevention
initiatives.
Mr. Barletta. Thank you.
The Chair now recognizes Mr. Johnson for 5 minutes.
Mr. Johnson. Thank you, Mr. Chairman.
Mr. Denk, you have testified that alcohol and drug
treatment funding has been cut by 25 percent, while requests
for service have quadrupled since 2014.
Mr. Denk. Yes, sir.
Mr. Johnson. Have you identified either Federal or State
funds that could reverse those cuts in future fiscal years?
Mr. Denk. That testimony came from one of the single county
authority directors, who specifically gave those statistics.
There is hope that at the Federal level, there might be some
funds that would be earmarked, additional funds that would be
made available. The CURE's [Commonwealth Universal Research
Enhancement program] grant. Pennsylvania received about $26.5
million under the CURE's grant from the Federal Government to
deal with drug addiction and treatment services. Also, the
Pennsylvania General Assembly, our budgets are extremely
strapped, but I know there is interest in looking at expanding
treatment options. There was over $30 million provided in the
State budget to set up what we are calling Centers of
Excellence around the Commonwealth. So there has been new money
provided at the Federal and State levels to support treatment
programs.
Mr. Johnson. Well, are you fearful that the passage of the
tax cut bill that is pending before Congress now will have an
adverse impact on the ability of the Federal Government to fund
these grants that have been insufficient in the past?
Mr. Denk. I really can't speak to that, sir, quite
honestly, in terms of not knowing all the details of the tax
cut bill. I think, you know, priorities need to be made in
terms of what works best for the Nation as a whole. But, quite
honestly, I have not looked at the specifics of the tax cut
bill.
Mr. Johnson. Well, let me ask you this question.
Mr. Denk. Sure.
Mr. Johnson. Do you anticipate that future healthcare cuts
based on changes in Federal healthcare laws and regulations,
such as the repeal of the Affordable Care Act, also known as
Obamacare, do you think that that could have an impact on the
ability of those seeking treatment to get drug treatment?
Mr. Denk. If funds are cut serving Medicaid-eligible
individuals who are in need of drug treatment, then there will
be challenges that present themselves for those individuals. We
have found community foundations and others stepping up to the
plate and helping out in terms of providing services for
indigent individuals. Time will see as to what impacts at the
Federal level that filter down to the State play out for those
audiences, sir.
Mr. Johnson. Well, thank you.
Ms. Hale, in your testimony, you state that the second
pillar of addressing the opioid epidemic is treatment.
Has the Affordable Care Act, also known as Obamacare,
affected the ability of residents of Kentucky to get treatment
for drug addiction?
Ms. Hale. Has it affected the ability? I probably can't
address that properly.
Mr. Johnson. Let me ask it this way then: Have there been
opportunities for people to get treatment in Kentucky for drug
abuse and drug addiction, because they had access to the
healthcare system through the Affordable Care Act, and the
State's expansion of Medicaid under the Affordable Care Act?
Ms. Hale. There have been opportunities, I am sure, that
that has resulted. One of the things that UNITE did before is,
in providing the vouchers for people who did not qualify, did
not have private insurance or Medicaid, to enter long-term
rehabilitation.
Mr. Johnson. Well, do you worry that a withdrawal of
Federal resources from social services can adversely impact the
ability of people to get treatment for drug abuse in Kentucky?
Ms. Hale. I think our communities are rallying, our State
is rallying around to fit those needs. What I would be
concerned about is if the system could handle all of that.
Mr. Johnson. I know it is a political football, but we got
to get away from politics and start looking at how we help
people, and whether or not Federal policies are helping.
Now, Mr. Novak, what is the historic role of the DEA in
stopping the flow of suspicious drug shipments in Appalachia?
Mr. Novak. Historically, that was exactly the purview of
what DEA was doing nationwide. Appalachia was especially hard
hit. And, you know, the problem is the suspicious orders are to
be monitored and reported by registrants. DEA has historically
been, you know, reactive, not proactive, because there are
suspicious orders going into West Virginia, in a town of 925
people, that is getting 9 million oxycodone pills, and that is
not reported to DEA. DEA then finds out about things like that,
and can go in and try to shut them down.
But, you know, that is exactly what DEA relies on in
putting together its cases and trying to have a registrant,
like a distributor or a manufacturer, monitor what is going
out. Unfortunately, historically, we found that they weren't
and they were just pushing orders of that size into regions
with no concern whether or not that order was suspicious.
Mr. Johnson. Thank you. My time has expired.
Mr. Barletta. Again, just a reminder that our committee's
jurisdiction is not a healthcare policy or DEA enforcement. We
want to find solutions that we can act on as this committee.
The Chair now recognizes Mr. Mast for 5 minutes.
Mr. Mast. I want to thank you for the time, Mr. Chairman.
This epidemic is something that greatly affects my region
in Florida, as well as it does many other areas of the country.
I have three beautiful children. I literally couldn't imagine
this being something that affects my family. I have a very good
old military friend of mine I speak to reasonably often, and he
lost his son. So it is something that touches close to home for
me.
I just want to ask a couple of questions quickly, just a
little bit of fact-based questions here. What are the quantity
of opioids that are obtained legally versus those that are
obtained illegally that are relating to whether an overdose or
an overdose resulting in death? What are the statistics that we
are looking at comparatively, whoever can answer that?
Mr. Novak. I can at least start with that. The problem that
we are seeing in this epidemic is that you can't get the pills,
for the most part--every pill that is getting out on the street
was prescribed by a doctor, filled by a pharmacy.
The problem is the people who are overdosing aren't just
people abusing. The directions for taking your oxycodone, it is
not a one-size-fits-all. Addiction can be caused as quickly as
after a 10-day program of opioids. There is a 20-percent chance
you are addicted a year later.
The overdoses are happening, not just from abuse, but from
standard use, because I don't believe that our medical
community is nearly as informed about the dangers of these or
the potential for overdoses as they need to be.
Mr. Mast. Certainly. But do you have a number saying this
is how many opioid deaths or overdoses that were treated that
are as a result of somebody that filled the prescription that
was assigned to them, or somebody that purchased it secondhand
from somebody else? That is what I am asking.
Mr. Denk. Sir, I am not aware that that information is
available in Pennsylvania.
One of the challenges would be is, who collects that data.
If it is stolen medication or taken out of a house, whether law
enforcement gathers that information, the county coroner upon
autopsy or a hospital, there could be a number of organizations
involved in dealing with that death from an overdose. And, so,
the data analytics on that is challenging to get.
I have one statistic for you, but it doesn't distinguish
your specific question. This is from the U.S. Drug Enforcement
Administration in a report in July of 2017 for Pennsylvania.
``In 2016, the presence of an opioid, either illicit or
prescribed by a doctor, was identified in 85 percent of drug-
related overdose deaths.'' So whether it is illicit or actually
prescribed, opioids are still a major, major player, obviously,
in overdose deaths in Pennsylvania.
Mr. Mast. Very good. Thank you for your response.
What is the most commonly used opioid for overdose? Is it
methadone? Oxycodone? Hydrocodone? Fentanyl? What ranks as the
number one drug within this epidemic, or number two. You can
give me a couple.
Mr. Denk. In Pennsylvania, it is a mix. Oxycodone. But we
are seeing because of Pennsylvania now has in force for a
couple years, our prescription drug monitoring program, which
is cutting back dramatically on opioid prescriptions out on the
streets, illicit or otherwise. The presence of fentanyl,
increasing deaths in Pennsylvania due to fentanyl.
Mr. Mast. So are you saying that filled the gap that was
created by enforcement elsewhere?
Mr. Denk. I am not sure that it filled the gap. I think
those that are in the drug-dealing business can make more money
by mixing fentanyl into their heroin. The person who uses it
has no idea of the purity of that heroin. And that, because of
the PDMP [Prescription Drug Monitoring Program] being in place
and controlling opioids, it was predicted that we would see a
rise in heroin use and overdose deaths. But now with the influx
of fentanyl, what we are seeing is a major cause of overdose
deaths now in certain counties.
Mr. Mast. Thank you for your responses. This is undoubtedly
something that we all need to find the absolute best way to
work together on this across the States, across the Federal
Government, across every locality to combat this.
I thank you for your responses, and I yield back, Mr.
Chairman.
Mr. Barletta. Thank you. I ask unanimous consent that
members not on the subcommittee be permitted to sit with the
subcommittee at today's hearing and ask questions.
The Chair now recognizes Ms. Norton for 5 minutes.
Ms. Norton. Thank you very much, Mr. Chairman.
I thank you for calling this hearing. Of course, it focuses
on Appalachia. We know that opioids are a problem throughout
the United States. It is interesting how drugs tend to find
their favorite places, and the link between opioids and heroin
and how that is playing out. But this is particularly
bothersome, because we find opioids here in Appalachia where
there is, to begin with, poor education, low income, often
rural areas, the last place that needs this kind of epidemic.
It is really heartbreaking. Opioids, of course, the difference
between opioids and heroin is that ain't nobody prescribes
heroin. Initially, opioids are prescribed and then they become
a kind of rogue drug.
What interested me was to note that the Chamber of Commerce
in Pennsylvania has seen a link between employability and the
skills gap and this opioid crisis. And I am wondering, in light
of a survey that has been cited to us, for example, that
businesses find that over 20 percent of applicants, or their
potential new hires, often fail a drug test.
So I am interested, Mr. Denk, in what your legislature is
doing, given what appears to be an effect on the economy itself
and on getting people who might otherwise be employed a job.
Mr. Denk. There has been no legislation with regard to the
issue of the business and industry with employers in terms of
their right to issue, you know, drug tests on individuals.
That----
Ms. Norton. I understand their right, but they are having
to do it because they suspect so many of those who are applying
for jobs have been caught up in this crisis. And I wonder if
the legislature has found any way to address this problem of
employability with an ultimate effect on your economy----
Mr. Denk. Sure.
Ms. Norton [continuing]. In Pennsylvania.
Mr. Denk. Ma'am, no short-term answers. No quick fixes. I
think it has been recognized, certainly from the public
hearings that we have held across the Commonwealth, education
on prevention, and education starting at the lowest levels. And
we heard this from the UNITE program. That has been seen as the
long-term fix in this long-term crisis.
Ms. Norton. So if people are better educated, or they are
not caught up in this opioid crisis, and they can pass the drug
test, and it is basically poor people that are involved. If it
is a question of education, is the link between education and
employability such that you can get a hold of these people once
you try to get them off of the drug and deal with the education
problem at the same time?
Mr. Denk. Yes, ma'am. Pennsylvania implements what is
called a PAYS study. Pennsylvania Youth Survey. It is done
every year. And that measures attitudes, behaviors, influences
of youth in 6th and 10th and 12th grades.
We are seeing individuals coming from family members where
parents are approving marijuana use. They would rather them do
that, or they would rather them drink in the home as opposed to
going outside. So with this whole education, it is getting in
early and changing attitudes and behaviors and mindsets. It is
going to be a long-term solution.
Ms. Norton. I want to ask this before my time runs out.
Mr. Denk. I am sorry.
Ms. Norton. I appreciate that answer. I want to ask Mr.
Novak a question. Because I am wondering, why this problem has
grounded itself in areas like Appalachia, whether or not the
DEA had a role in stopping this kind of entrenchment at any
time, and when did it become so entrenched, and why did it
become so entrenched in an area like this?
Mr. Novak. First of all----
Ms. Norton. I want to know all I can to keep it from
becoming entrenched in the big cities.
Mr. Novak. And, you know, what we are seeing now is it is
becoming entrenched everywhere, or rather, it has become
entrenched everywhere. It is a problem that we didn't recognize
until it was far too late. Poor areas or isolated areas, they
found a market for these kinds of drugs, because they seem to
be valid because a doctor is prescribing you. And if a doctor
is prescribing it, it must be good for you. But it is also, you
know, that almost gave people a pass. ``Well, I am not abusing,
I am just using what my doctor prescribed to me for my pain
management.''
DEA, again, you need to look at the fact that there are
divisions around the country and the larger an area and the
bigger the population and the more funding that that division
has, you know, the more proactive they could be. And
unfortunately, some of the worst problems I saw at DEA were
cases coming out of areas that nobody cared about until it was
too late.
I know Florida, for instance, got hit devastatingly with
all of this, but it was always in the smaller towns, a little
farther away. You know, it wasn't Miami, it was Oviedo. And
that is where this all took route. It took route with the
populous that, you know, could get these drugs for much cheaper
at the time, and then felt validated in using them. Again, it
is staggering how addictive these things are, and 2 months of
being on an opioid, suddenly you are addicted. And it just
escalates and escalates.
Ms. Norton. Thank you, Mr. Chairman.
Mr. Barletta. Thank you. The chairman now recognizes Mr.
Faso for 5 minutes.
Mr. Faso. Thank you, Mr. Chairman. I appreciate the
witnesses being here today on this topic.
I am wondering, Ms. Hale, if you could tell us what you
think it would take to replicate the type of program that you
are operating in Kentucky around the country, and what kind of
funding streams have you been able to--you or others--been able
to postulate? Maybe even Mr. Denk may have some ideas in that
regard as well.
Ms. Hale. To replicate the holistic approach that Operation
UNITE, when we first began, when Congressman Rogers launched
the program, we had Federal grants from the Department of
Justice working, starting out with about $12 million and in
receiving other grants, you know, like our AmeriCorps grant,
funding from ARC, that sort of thing.
Mr. Faso. So, in other words, you would cobble together,
whether they were specific appropriations that Mr. Rogers was
able to secure, or specific funding streams from other
agencies, cobble that together to run your program?
Ms. Hale. Correct. The State support that we receive now
allows us to keep our doors open somewhat. One of the things
that we have done is developed community coalitions within
every one of our 32 counties. These are people in that county
who are volunteers who serve. They have their own nonprofit
status, and they are working to secure grants and funding. We
have several drug-free community grants in our area that we are
working with those areas as well.
Mr. Faso. So I guess our task is to find out how we can
maybe combine some existing Federal funding streams together
with perhaps some new efforts in order to attempt to replicate
these efforts around the country.
You had mentioned that you had also been able to fund
vouchers, you said, I think, 4,000 vouchers, for people to get
substance abuse treatment. I guess that would be short- and/or
long-term.
Ms. Hale. No, sir, we only fund long-term treatment.
Mr. Faso. Long-term. And so where did you get the money for
that?
Ms. Hale. Starting out, that money came from SAMHSA. The
Commonwealth of Kentucky supports that. We use the proceeds
from the National Prescription Drug Summit. We also had a lot
of buy-in from businesses and organizations, such as Kentucky
River Properties gave us $500,000, because they understood the
need for helping their employees who were suffering from
substance abuse, get into long-term treatment.
Mr. Faso. Yeah, I would think, in line with what you just
said, that it would be important for us to try to not just
simply let people think that there is one source of funding for
this from Washington, but combining sources from States,
localities, but also the private sector. Because I think that
if everyone has some skin in the game--Mr. Denk, did you have
something to add in that regard?
Mr. Denk. Not on the scale of Operation UNITE, but there is
an entity in Williamsport, Pennsylvania, called Project Bald
Eagle. Similar concepts, doing a lot in the area of prevention
and education, nothing in the area of treatment.
Their core funding came from higher education, the
healthcare system and the Chamber of Commerce. They all kicked
in $25,000 apiece to jump start what's called Project Bald
Eagle. So I think there is local money to be had. There is
community foundation funding. I think as long as there is a
solid game plan, local investment can occur, and certainly, if
that can be piggybacked and parlayed with other moneys,
Federal, State, I think you get a greater return on investment.
The investment, as has been demonstrated, must be owned at
the local level.
Mr. Faso. Yes. And I think that is a very important point
that you just made.
Now back to you, Ms. Hale. Again, you mentioned that you
conduct drug-free workplace training that is a State-certified
training, I think you said. How prevalent is that among the
States? Do all 50 States have such programs or is this unique
to your area?
Ms. Hale. I don't know if all the other States have that
program. It has been unique to our area in Appalachia, simply
because before UNITE, we weren't aware of any drug-free
workplace training that was taking place.
Mr. Faso. Thank you. I think, Mr. Chairman, the fact is
that we are seeing, right now, among the lowest workforce
participation rates of able-bodied people between 18 and 65.
And this, in line with what the Pennsylvania study suggested,
is really a prevalent problem that exists all across the
country.
In my district, I have counties that have under 60 percent
workforce participation rates of people between 18 and 65, and
I think opioid and drug abuse is a major part of that. And I
appreciate your convening this hearing, and I appreciate the
witnesses being here today on this topic. And I yield back.
Mr. Barletta. The Chair recognizes Mr. Smucker for 5
minutes.
Mr. Smucker. Thank you, Mr. Chairman, for the time. I
appreciate it.
Mr. Denk, thank you for your testimony. Welcome to
Washington, DC.
Mr. Denk. Thank you. My pleasure.
Mr. Smucker. It is great to see you.
Mr. Denk. Thank you.
Mr. Smucker. As you know, I am also from Pennsylvania,
served in the legislature and State senate for 8 years, and so
I am familiar with the work of your organization. You have been
a tremendous resource to the legislature in Pennsylvania. And,
Senator Yaw, the chairman, is a good friend. In fact, I sat
next to him in our caucus for much of the time that I spent
there, so really great to hear from you.
Mr. Denk. Thank you.
Mr. Smucker. Senator Yaw, I know, and your organization did
a lot of work, hearings all across the State, really bringing
an awareness to this issue a number of years ago when you
started the work that was so valuable to all of us. And we have
had a lot of conversations in caucus in the State senate in
regards to how we can respond. And, you know, just the
magnitude of this is hard to imagine at times. And just
repeating what you said in your testimony, 4,642 Pennsylvanians
died in 2016 as a result of a drug overdose with thousands more
affected by addiction, either personally or through family,
friends, coworkers, employees or neighbors. That was an
increase of 37 percent from 2015 when, as you mentioned, 13
people died each day of a drug-related overdose.
Just specifically, my area in 2016, my district includes
portions of three counties, Lancaster averaged 22.3 deaths per
100,000 people; Chester County averaged 19.4; and Bucks County,
28.4 overdose deaths per 100,000 people. It is just absolutely
devastating to our communities.
One of the takeaways that I always heard from Senator Yaw,
and you mentioned here this morning, is there are no simple
short-term solutions. In fact, there is no silver bullet here
to solve this. And, you know, we think it can be solved but it
will take a number of solutions, a broad range of solutions,
from enforcement to treatment to--you mentioned drug courts,
which have been particularly effective in my area.
We did a number of pieces of legislation at the State level
as a result of the hearings that you have done. One of those
you mentioned was a prescription drug monitoring program. And
as with any new program there was pushback. It, of course, was
additional work for every party, you know, including medical
doctors, pharmacies and all. But I am curious, how well do you
think it is working, and are there ways that we should improve
a program of that type?
Mr. Denk. Thank you. The office of the PDMP is right next
door to my office, so I do meet with them on a regular basis.
It is working in Pennsylvania. I don't have the figure in front
of me, but I know that the director has talked on numerous
occasions about the thousands of pounds of opioids that have
been stopped because of the PDMP and the doc shopping that was
occurring. And so that has been critical.
There is interest in revisiting the prescription drug
monitoring program to tighten it up a little bit. We had one
doctor who oversees a residency program, and he would like
language that allows someone to query the querier, kind of a
checks and balance as to who is checking into the system and
using it, that type of thing. Some comments that we have heard
that dentists should be required to subscribe to that. Dentists
prescribe opioids. And from a medical standpoint, often opioids
are not what is needed to deal with pain from a dental
procedure.
So there is interest in reopening it. As you know so well,
you open any piece of legislation, and it is ripe for a lot of
other things to be taken a look at.
Mr. Smucker. And sorry to cut you off, but I am running
close to the end of my time.
I am curious, from your perspective, what is it that we
could do at the Federal level to help? What would be your
number 1, number 2 things that we should be--specific actions
that we can do to help communities combat this?
Mr. Denk. The public face of this epidemic, I think the
Federal Government can play an even greater role in recognizing
that it is an epidemic affecting all segments of our society,
and has direct impact on the economy, on infrastructure, you
name it.
I think a much stronger face and getting Federal agencies,
and I see this in Pennsylvania, and State agencies, to really
work together. Unfortunately there is still too much siloing in
our work to address this epidemic.
Mr. Smucker. Thank you. Mr. Chairman, I have additional
questions. Do you want me to wait for the second round?
Mr. Barletta. Yeah, sure.
Mr. Smucker. Thank you.
Mr. Barletta. I will now recognize each Member for an
additional 5 minutes of questions.
Mr. Gohl, the ARC is a Federal economic development agency.
How did the problem of opioids get on your radar, and do you
think ARC's programs are good templates for other Federal
economic development agencies, such as the EDA, and if so, how?
Mr. Gohl. Thank you, Mr. Chairman. I think that, a couple
things. In our work within the region, this clearly became an
issue within several communities.
And you know, part of the work of Operation UNITE has a
little bit of magic about it, because it is not just the money,
but it is the leadership, and the long-term leadership. And the
effort and the work that Congressman Rogers has put into
growing Operation UNITE is a lot of the reason for its success
and its recognition.
And not every community has a Harold Rogers to be there all
the time pushing, pushing, pushing, challenging people like me.
And that is an important part of it. So, you know, giving money
to folks is one thing, but having leadership pays huge
dividends.
In terms of our experience, in one of the research projects
that we did back in 2008, the data showed that Appalachia was
leading the Nation in the hospitalization as a result of
prescription drugs. And that really was a surprise to us. That
really got our attention. In working and talking with
Congressman Rogers and his staff around an agenda, we got to a
point of developing and working with Operation UNITE to do a
national prescription drug abuse summit and to take a role in
terms of education--the extended education--as our contribution
to the summit.
And I think that really, for us, put us in a position where
we weren't just supporting a conference, but we were supporting
education and the development and strengthening of the
workforce. That is where we felt pretty comfortable. And
clearly, as you look at our plans and look at our strategies,
developing and strengthening the workforce is a critical area
of our work.
The other thing I would say is that we currently have a
partnership with NIDA, the National Institute on Drug Abuse,
where we, with CDC and a couple agencies--but NIDA is really
the lead--are working in five different communities, or five
different initiatives around the region to focus on community-
based solutions to treatment and prevention of substance abuse.
And we are very hopeful that that evidence-based work would
really provide some direction and some really strong guidance
for going forward.
Mr. Barletta. And what would help ARC's work on opioids be
more effective?
Mr. Gohl. You know, I would say that a seat at the table is
probably the most effective thing that works in this town, that
when ARC is part of the discussion, or ARC is part of the
development and ARC is part of hearings like this, it makes
sure that the rural voice is heard. And oftentimes, I think you
just heard one of the witnesses talk about that nobody really
knew. Well, it is collecting data and making sure that the
rural communities are part of the discussion is often the
biggest part of the challenge. And so, it is hearings like
this; it is being a part of initiatives and work, not only in
the Appalachian region, but to partner with other folks who are
doing work outside the region is very helpful. I think that our
partnerships with CDC, and NIDA in particular, over the last
few years, has given us, not only resources, but it has also
given us a place and a voice to raise the issues of Appalachia
and the challenges that we have.
Mr. Barletta. And what is the role of ARC in helping to
address the opioid problem?
Mr. Gohl. I think we have several roles. I think that it is
important for us to work with our State partners who really are
the agenda setters for the Commission in terms of investment of
dollars, to work with them and make sure that the issue of
opioids in the workforce and how it affects communities is a
challenge that they focus on and that they use the resources to
invest in.
I think that we need to continue to work around community
organizations and being able to empower them and give them the
tools. I think it is important for us to invest in initiatives
like NIDA as a way of really getting to strategies that work.
There is no reason to invest in strategies that don't work.
I think part of the ongoing effort right now is around
social media, and how do you use social media as part of this?
Social media just consumes us all, and it is a way of
communicating. It is a way to share challenges and issues. And
I think as you go forward, we are going to learn more about
effective strategies for how do we communicate. Groups like
Operation UNITE can engage their communities. It is not just a
matter of ``just say no.'' It is really a matter of these are
the reasons, these are the challenges we face, and to be able
to drill down and get people to understand the challenges and
the dangers that they are facing.
And I think one of the other issues that we really need to
focus on is making sure that people understand that this is a
disease and that we need to treat it like a disease. And, you
know, this country has faced a lot of diseases over the years
with polio, or small pox, or the flu, or HIV/AIDS, and we
defeated each one of those. And the challenge is to look at the
history and look at what has worked in the past and how do we
move forward to make sure that we defeat this disease as well.
Mr. Barletta. Thank you. The Chair now recognizes Mr.
Johnson for 5 minutes.
Mr. Johnson. Thank you. Mr. Gohl, given the Appalachian
Regional Commission's efforts to address the opioid epidemic in
Appalachia, if the President's fiscal year 2018 budget
recommendation to eliminate the ARC were affirmed by Congress,
what other Federal agency would be able to meet the needs of
Appalachia?
So in other words, if the Appalachian Regional Commission
ceases to exist, as is called for under President Trump's 2018
budget, what would be the effect on Appalachia, and on the drug
epidemic that ravages America and Appalachia?
Mr. Gohl. You know, ARC over the last number of years has
been very focused on creating opportunities, changing the level
of education, working, you know, very deliberately for the
region to be on parity with the rest of the Nation in terms of
socioeconomic----
Mr. Johnson. Well, let me ask you the question this way. I
really want to get a yes or no, a quick answer.
Will the defunding and the removal of the Appalachian
Regional Commission from the Federal budget, that would hurt
Appalachia, wouldn't it? Yes or no?
Mr. Gohl. Mr. Johnson, I have a great deal of respect for
you, and I appreciate your work----
Mr. Johnson. And I really just want to get--I am not trying
to be political. I am just making a point. I think it is a fair
point. Because what we do up here, the Federal policies that we
enact up here have an impact back at home, back on the streets.
People pay taxes, people deserve a fair deal. When they pay in,
they should get a return on it.
So when we start talking about giving tax cuts to wealthy
individuals, multinational corporations and the like, it has an
impact on people on the street who are paying taxes. And when
we have a proposal to eliminate the Appalachian Regional
Commission because we are spending too much money and the
Federal Government has to cut its deficit and debt, so we
sacrifice the Appalachian Regional Commission because we want
to give tax cuts to the wealthy. I mean, that is a fair point,
I think, for me to make and for me to ask you. And I am just
asking you what the impact of that policy would be on the
Appalachian region? And this is what I was talking about in
terms of us being honest and not playing politics, and let us
really look at the impact of our policies on how it affects
people in Appalachia. That is the only thing I am trying to do.
And I know that you don't want to answer the question. It
is hard to--the truth hurts. And that is the bottom line.
Mr. Gohl. Sir, I would say this: Every year we release a
document that talks about what we did. And the document talks
about the number of folks we educate, the number of jobs we
help folks create, and if ARC isn't here, we are not going to
issue that report any longer.
But in all fairness, Mr. Johnson, the support that was
vocalized in March of this year by a bipartisan group of
Members about ARC, which was really very impressive, and what
we did was we got to work on doing our jobs, of taking the
funds that the Congress provided us, and worked diligently
every day to focus in on our work and what Congress told us to
do.
Mr. Johnson. Well, if those funds went away, it would hurt
the people of Appalachia, who I really feel for, suffering and
pain and no hope about the future. And I believe that there is
something that the Federal Government can do, should do, and
must do in order to help the people of Appalachia and the
people throughout this country who are suffering and looking
for a better deal from their Government. And with that, I will
yield back.
Mr. Barletta. The Chair recognizes Mr. Smucker for 5
minutes.
Mr. Smucker. Thank you, Mr. Chair.
Ms. Hale, impressive program, it sounds like, in your
community. For the benefit of our communities who are
interested in similar initiatives, how important were the
coalitions that you built within the community, and who should
be at the table for that?
Ms. Hale. The coalitions are really the foundation of
Operation UNITE. Those people within those communities from all
sectors, whether it is education, law enforcement, treatment,
faith-based. Every one of them lives in those communities, they
understand the problems and they are looking for the solutions
themselves. They are the ones who are motivated to work within
their communities. They are the ones who are motivated to look
for sources of funding and not depend totally on the Federal
Government. However, the Federal Government has done things,
just like CARA has brought a renewed sense of hope into our
Commonwealth. We are looking at programs that will allow us to
be more proactive rather than, as Mr. Novak said, you know, we
have had to react for so long.
And so those coalitions are the grassroots of what we are
doing in Operation UNITE, and throughout the Commonwealth.
Mr. Smucker. How do you measure success? And maybe talk a
little bit about how success for your program has been. What
are some of your key performance indicators, if you will?
Ms. Hale. Well, one of the ways that we measure success is
taking, for example, the vouchers that we have provided to over
4,000 residents, and looking at the followup, coming back, you
know, when they are coming out of long-term recovery, moving
back into their communities. UNITE follows that with looking at
how we can support them, how can we work with our
administrative office and the courts to help them find jobs, to
build the economy.
The University of Kentucky is helping us collect data on
each one of our programs to show the success. Some of our
success has been anecdotal, but then, we are looking at
developing those programs, our educational programs that we can
use, evidence-based, we are using evidence-based programs to
find those solutions.
Mr. Smucker. I will ask the same question I asked Mr. Denk.
What is it that we could be doing at the Federal level to
better help? I know funding is one. Is there anything else?
Ms. Hale. I think looking at programs that will be
proactive. One of those that Kentucky is looking at this year
with our legislators is developing an essential skills bill. We
are working with the Kentucky Chamber of Commerce, our business
and industry, and our education system to develop K through 12,
helping young people develop those skills that they are going
to need for them to be effective members of the workforce. And
included in that essential skills bill is going to be a huge
prevention component in educating them on how to be drug free.
Mr. Smucker. Thank you. It sounds like you are doing great
work. I really appreciate all of you taking the time to share
with us the good things that are happening in your communities.
Mr. Barletta. Thank you. I ask unanimous consent to enter
into the record a statement of Congressman Tom Marino. Without
objection, so ordered.
[The statement of Congressman Tom Marino is on pages 28-30.]
Mr. Barletta. Thank you all for your testimony. If there
are no further questions, I would ask unanimous consent that
the record of today's hearing remain open until such time as
our witnesses have provided answers to any questions that may
be submitted to them in writing, and unanimous consent that the
record remain open for 15 days for any additional comments and
information submitted by Members or witnesses to be included in
the record of today's hearing.
Without objection, so ordered.
I would like to thank our witnesses again for their
testimony today. If no other Members have anything to add, the
subcommittee stands adjourned.
[Whereupon, at 11:36 a.m., the subcommittee was adjourned.]
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