[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]
PRESCRIPTION DRUG ABUSE EPIDEMIC
IN AMERICA
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON CRIME, TERRORISM,
AND HOMELAND SECURITY
OF THE
COMMITTEE ON THE JUDICIARY
HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
MARCH 7, 2012
__________
Serial No. 112-95
__________
Printed for the use of the Committee on the Judiciary
Available via the World Wide Web: http://judiciary.house.gov
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COMMITTEE ON THE JUDICIARY
LAMAR SMITH, Texas, Chairman
F. JAMES SENSENBRENNER, Jr., JOHN CONYERS, Jr., Michigan
Wisconsin HOWARD L. BERMAN, California
HOWARD COBLE, North Carolina JERROLD NADLER, New York
ELTON GALLEGLY, California ROBERT C. ``BOBBY'' SCOTT,
BOB GOODLATTE, Virginia Virginia
DANIEL E. LUNGREN, California MELVIN L. WATT, North Carolina
STEVE CHABOT, Ohio ZOE LOFGREN, California
DARRELL E. ISSA, California SHEILA JACKSON LEE, Texas
MIKE PENCE, Indiana MAXINE WATERS, California
J. RANDY FORBES, Virginia STEVE COHEN, Tennessee
STEVE KING, Iowa HENRY C. ``HANK'' JOHNSON, Jr.,
TRENT FRANKS, Arizona Georgia
LOUIE GOHMERT, Texas PEDRO R. PIERLUISI, Puerto Rico
JIM JORDAN, Ohio MIKE QUIGLEY, Illinois
TED POE, Texas JUDY CHU, California
JASON CHAFFETZ, Utah TED DEUTCH, Florida
TIM GRIFFIN, Arkansas LINDA T. SANCHEZ, California
TOM MARINO, Pennsylvania JARED POLIS, Colorado
TREY GOWDY, South Carolina
DENNIS ROSS, Florida
SANDY ADAMS, Florida
BEN QUAYLE, Arizona
MARK AMODEI, Nevada
Richard Hertling, Staff Director and Chief Counsel
Perry Apelbaum, Minority Staff Director and Chief Counsel
------
Subcommittee on Crime, Terrorism, and Homeland Security
F. JAMES SENSENBRENNER, Jr., Wisconsin, Chairman
LOUIE GOHMERT, Texas, Vice-Chairman
BOB GOODLATTE, Virginia ROBERT C. ``BOBBY'' SCOTT,
DANIEL E. LUNGREN, California Virginia
J. RANDY FORBES, Virginia STEVE COHEN, Tennessee
TED POE, Texas HENRY C. ``HANK'' JOHNSON, Jr.,
JASON CHAFFETZ, Utah Georgia
TIM GRIFFIN, Arkansas PEDRO R. PIERLUISI, Puerto Rico
TOM MARINO, Pennsylvania JUDY CHU, California
TREY GOWDY, South Carolina TED DEUTCH, Florida
SANDY ADAMS, Florida SHEILA JACKSON LEE, Texas
MARK AMODEI, Nevada MIKE QUIGLEY, Illinois
JARED POLIS, Colorado
Caroline Lynch, Chief Counsel
Bobby Vassar, Minority Counsel
C O N T E N T S
----------
MARCH 7, 2012
Page
OPENING STATEMENTS
The Honorable F. James Sensenbrenner, Jr., a Representative in
Congress from the State of Wisconsin, and Chairman,
Subcommittee on Crime, Terrorism, and Homeland Security........ 1
The Honorable Robert C. ``Bobby'' Scott, a Representative in
Congress from the State of Virginia, and Ranking Member,
Subcommittee on Crime, Terrorism, and Homeland Security........ 2
WITNESSES
The Honorable Harold Rogers, a Representative in Congress from
the State of Kentucky
Oral Testimony................................................. 11
Prepared Statement............................................. 13
The Honorable Nick J. Rahall, II, a Representative in Congress
from the State of West Virginia
Oral Testimony................................................. 18
Prepared Statement............................................. 20
The Honorable Mary Bono Mack, a Representative in Congress from
the State of California
Oral Testimony................................................. 22
Prepared Statement............................................. 24
The Honorable Stephen F. Lynch, a Representative in Congress from
the State of Massachusetts
Oral Testimony................................................. 27
Prepared Statement............................................. 29
APPENDIX
Material Submitted for the Hearing Record
NIH Public Access Study on Opiod Deaths in Rual Virginia......... 45
Prepared Statement of Ameritox, Inc.............................. 65
Prepared Statement of Anne McGee, Director, Cabell County
Substance Abuse Prevention Partnership......................... 68
Prepared Statement of Greg Puckett, Executive Director, Community
Connections, Inc............................................... 70
Prepared Statement of Timothy Bradley, Captain, West Virginia
State Police................................................... 85
Prepared Statement of Kimberly Becher, MD; and Kane Maiers, MD,
Paul Ambrose Health Policy Fellows, Marshall University
Department of Family and Community Health...................... 88
PRESCRIPTION DRUG ABUSE EPIDEMIC
IN AMERICA
----------
WEDNESDAY, MARCH 7, 2012
House of Representatives,
Subcommittee on Crime, Terrorism,
and Homeland Security,
Committee on the Judiciary,
Washington, DC.
The Subcommittee met, pursuant to call, at 10:02 a.m., in
room 2141, Rayburn Office Building, the Honorable F. James
Sensenbrenner, Jr., (Chairman of the Subcommittee) presiding.
Present: Representatives Sensenbrenner, Goodlatte, Marino,
Gowdy, Adams, Conyers, Scott, and Jackson Lee.
Staff present: Caroline Lynch, Majority Chief Counsel;
Arthur Radford Baker and Tony Angeli, Majority Counsel; Ron
LeGrand and Ashley McDonald, Minority Counsel; Lindsay
Hamilton, Clerk; and Veronica Eligan.
Mr. Sensenbrenner. The Subcommittee on Crime will come to
order. Without objection, the Chair will be authorized to
declare recesses during votes in the House.
The Chair yields himself 5 minutes, in order to make an
opening statement.
Today's hearing examines the subject of prescription drug
abuse in America. According to the most recent data from the
U.S. Centers for Disease Control and Prevention, legal and
illicit drugs killed almost 40,000 people nationwide in 2009.
Over 100 people die from drug overdoses in the United States
every day.
Nearly 3 out of 4 prescription drug overdoses are caused by
prescription painkillers, also called opioid pain relievers.
Common examples of these painkillers are Vicodin, Percocet,
OxyContin, and Demerol.
In 2008, there were nearly 15,000 deaths from prescription
painkiller overdoses. For every one of these deaths, there are
10 admissions for drug abuse treatment, and 32 emergency room
visits for misuse or abuse of prescription drugs. That amounts
to over 475,000 emergency room visits per year, a number which
has doubled in just the last 5 years.
Prescription painkillers work by decreasing the perception
of pain. These powerful drugs can create feelings of euphoria,
cause physical dependence, and frequently lead to addiction.
Prescription painkillers also slow down a person's breathing. A
person abusing prescription painkillers might take increasingly
larger doses to achieve a euphoric effect. These larger doses
can cause breathing to slow down so much that breathing stops,
resulting in a fatal overdose.
Very few prescription drugs involved in overdoses come from
pharmacy theft. The vast majority come from physicians'
prescriptions obtained by one person and sold or given to
another. More than 3 out of 4 people who misuse prescription
painkillers get their drugs from someone else. For the past few
years, individuals who doctor shop, or seek care from multiple
physicians, but fraudulently pretend to be in pain, have been a
primary source of diverted prescription drugs.
The law enforcement officials in Florida, once the
epicenter of prescription drug diversion, have left other
States to initiate expensive enforcement programs, as the so-
called pill mills migrate across the country.
Prescription drug abuse has been an epidemic for much too
long. Some of the more notable people who have died from
prescription drugs include Marilyn Monroe, Bruce Lee, and Elvis
Presley. Even former Indiana Senator Edward A. Hannegan
overdosed on morphine in 1859. In December of 2010, a 13-year-
old Utah boy died after stealing a bottle of OxyContin from a
kitchen counter of a friend's house. He took all the pills in
the bottle, except one, and died in his sleep. Famous or not,
no one is immune from the grip of prescription drug overdose.
This hearing will explore the growing issue of prescription
drug abuse in our Nation. We have here today four distinguished
Members of Congress, who have dedicated their efforts to stop
prescription abuse in America. I look forward to hearing about
their legislative proposals and other efforts to address a
serious national challenge. And I would like to thank our
witnesses for participating in today's hearing.
It is now my pleasure to recognize for his opening
statement, the Ranking Member of the Subcommittee, the
gentleman from Virginia, Mr. Scott.
Mr. Scott. Thank you, Mr. Chairman. Mr. Chairman,
prescription drug abuse is a serious problem. The number of
overdose fatalities has increased dramatically over the recent
years. I must admit, though, Mr. Chairman, I am puzzled as to
the purpose and usefulness of today's hearing. I am used to
hearings being an opportunity for witnesses to put forth
varying views regarding an issue or issues before us, with the
opportunity to question such witnesses to gain a keener insight
and understanding of the issues.
We would then have a legislative hearing for further input
and analysis, including legal analysis, and ensuring that we
have constitutional and effective legislation. While I have no
doubt that our colleagues who are witnesses today will provide
helpful information, I anticipate that they will discuss the
bills that they have sponsored or cosponsored, which makes them
advocates for the bills, and limits us to one side of the
debate on the issues raised by those bills.
Therefore, I trust and also ask that this hearing not serve
as the only basis for any Judiciary Committee or other
consideration of legislation that we will hear about, but
merely serve as a traditional opportunity we give Members, on
occasion, to appear before us to present their legislation.
The bills I anticipate my colleagues will discuss as
witnesses include H.R. 1316, 1065, 1925, and 2119. To the
extent that they provide additional education, training, and
research on safer administration and use of prescription drugs,
I am inclined to believe that they may contribute to
effectively addressing the problem. However, to the extent that
they impose congressionally mandated restrictions on access to
legitimate medications and business-as-usual draconian
increases in Federal penalties, I am inclined to believe that
they will be counterproductive.
Such approach is not likely to be successful, as our
efforts to effectively address elicit drugs. They will lead to
over criminalization, over federalization, and cause many
people the laws purport to protect to end up with unjust and
inflexible prison terms, such as the mandatory minimums, which
one of the bills calls for.
Mandatory minimums have been proven to be a waste of the
taxpayers' money, and violate common sense, when compared to
traditional sentencing. And I would ask unanimous consent, Mr.
Chairman, to introduce the Rand study that points this out.
Mr. Sensenbrenner. Without objection.
[The information referred to follows:]
__________
Mr. Scott. When we think of a pill mill operator dispensing
death and destruction on a mass scale, we may conclude that no
punishment is too great, but without definition of what limits
the application of such person to such circumstances, the,
quote, Pill mill operator may be a college student in a dorm
room, with a bunch of pills given to his dorm mates.
What has proven to work best to address drug abuse, in
general, including prescription drug abuse are evidence-based
solutions aimed at preventing drug abuse addiction, injury, and
death, rather than inflexibly rushing to increased penalties,
and restrict legitimate excess to prescriptive drugs.
We should not continue to take the same approaches, hoping
for different results. I am not saying that we should not
punish lawmakers, but we are already using the criminal justice
system as much as reductively can be used. We now need to focus
on prevention and early intervention.
There are innovative evidence-based approaches that are not
likely to be discussed today. One is the use of Naloxone. That
is a lifesaving medicine used to reverse opiate-based drug
overdoses. It has been FDA approved since 1971, and is the
first line of treatment for paramedics and emergency room
physicians who encounter an opiate overdose victim.
It presents no potential for abuse, because it has no
pharmacological effect. It has no effect if it is taken by a
person who does not have opiates in their system. It takes as
little as 2 minutes to start working, and provides a 30- to 90-
minute window to call for medical assistance during a drug
overdose.
Drugs that can be reversed are heroin, OxyContin,
methadone, Vicontin, and several other drugs. If we are
concerned about drug overdose deaths, we should be considering
this as one of the suggestions.
The second thing we need to consider, Mr. Chairman, are a
911 Good Samaritan law. The chance of surviving an overdose
like that, of surviving a heart attack, depends greatly on how
fast one receives medical treatment. Witnesses to heart attacks
rarely think twice about calling 911, but witnesses to an
overdose often hesitate to call, or simply don't make a call,
because they fear police involvement.
People using illegal drugs often fear arrest, even in cases
where they need professional and medical advice, or assistance
for a friend or family member. The best way to encourage
overdose witnesses to speak up and call 911 is to provide some
kind of immunity to those that make such calls.
Mr. Chairman, such legislation does not protect people from
arrest for other offenses, such as outstanding warrants or
other crimes, but this policy protects only the caller and the
overdose victim from arrest and prosecution, simply for calling
911. Several State legislatures, including New York, New
Mexico, Washington, Illinois, and Connecticut have passed 911
Good Samaritan laws, and Congress should consider doing the
same.
For the reasons stated above, Mr. Chairman, I agree with my
colleagues that prescription drug abuse is an issue about which
we should be concerned. Anyone who has a friend that is a
physician or a dentist will recite patients that present with
symptoms that call for these drugs, and they go doctor to
doctor, shopping, and we need to do something about those who
will actually prescribe to those patients. But we should not
rush to enact such legislation without thorough assessment of
the effective options we have before us, and I certainly do not
agree that imposing more severe mandatory minimums on
physicians and pharmacists, who provide legitimate medications,
would be a good use of our time or efforts.
Mr. Chairman, I would ask, also, unanimous consent to enter
into the record a letter to us from the Drug Policy Alliance.
Mr. Sensenbrenner. Without objection.
[The information referred to follows:]
__________
Mr. Sensenbrenner. It is now my pleasure to introduce
today's witnesses.
Hal Rogers has represented the Fifth District of Kentucky
since 1981. He currently serves as Chairman of the House
Appropriations Committee, of which he has been a Member for 29
years. He received both his bachelor of arts and LLB from the
University of Kentucky.
Congressman Nick Rahall has represented the Third District
of West Virginia since 1976. He currently serves as the Ranking
Member of the House Transportation and Infrastructure
Committee, and received his bachelor of arts from Duke
University in 1971.
Mary Bono Mack has represented the 45th District of
California since 1998. Ms. Bono Mack sits on the House Energy
and Commerce Committee, and serves as Chairwoman of the
Subcommittee on Commerce, Manufacturing, and Trade. She
received her BFA from the University of Southern California in
1984.
Congressman Stephen Lynch has represented the Ninth
District of Massachusetts since 2001. He currently sits on the
Financial Services Committee, and the Committee on Oversight
and Government Reform, where he serves as Ranking Member of the
Subcommittee on Federal Workforce, U.S. Postal Service, and
Labor Policy. He received his bachelor of arts degree from
Wentworth Institute of Technology and his master in public
administration in 1998, from Harvard.
Without objection, all of the witnesses' written statements
will be entered into the record in their entirety. And I ask
that you please summarize your testimony in 5 minutes or less.
And we will start out with Congressman Rogers, since I kind of
respect seniority.
TESTIMONY OF THE HONORABLE HAROLD ROGERS, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF KENTUCKY
Mr. Rogers. I thank you, Mr. Chairman. Chairman
Sensenbrenner, Ranking Member Scott, Mr. Gowdy, and other
Members of this great Committee, thank you for granting me a
few minutes to speak on an epidemic that quietly began in rural
parts of Kentucky, West Virginia, and Virginia, one doctor at a
time, and now grips every corner of our great Nation in
prolific fashion. As you will no doubt hear from the panelists
and fellow Members of the Congressional Caucus on Prescription
Drug Abuse, the statistics about this problem speak volumes.
In 2010, Mr. Chairman, 254 million prescriptions for
opioids were filled in the U.S. That is enough painkillers to
medicate every single American adult around the clock for a
month. ONDCP has identified prescription drugs as the fastest
growing drug problem, easily eclipsing cocaine and heroin
abuse.
Our military soldiers are coming back from war hooked on
these pain pills. In the last 2 years, over 150 soldiers have
died from overdoses. In my home state, we are losing about 82
people a month to prescription drug abuse. More than car
crashes. Our medicine cabinets are more dangerous than our
cars.
But statistics are just numbers. The four of us on this
panel each have been touched in a personal way by this tragedy.
In some counties in my district, Mr. Chairman, 50 percent of
all children are living in a home without their parents, over
half, in large part, because of prescription drug abuse.
I have met with single moms struggling to get through drug
court, kids living with foster parents, unsure of where their
real parents are. We have lost mothers, grandfathers, police
officers to this scourge. My home county sheriff, Sam Catron,
community leader, personal friend, dedicated public servant,
was assassinated, because of his pursuit of prescription drug
traffickers. A tragic loss. My field representative's nephew, a
physician in my district, was shot down, senselessly, by a
disgruntled drug abuser unable to get his fix.
The most dangerous job in my district? The driver of a
delivery truck, UPS, FedEx, carrying drugs by mail. I suspect
my colleagues have similar stories that they would share. This
epidemic touches big city movie stars and rugged mountain men,
and it has to stop.
We all recognize that this problem will require a
coordinated multi-pronged approach that incorporates law
enforcement, treatment, education, and research. I have worked
closely with Congressman Frank Wolf, to stand up a leading
grant program in the Department of Justice, which supports
State-run prescription drug monitoring programs. PDMPs monitor
the sale and purchases of controlled substances, bridging the
gap between legitimate medical need and potential misuse.
Since 2002, we have seen the number of States with
authorized PDMPs triple from 15 to 48. That is a huge
accomplishment, but our work is nowhere near done. The next
challenge will be facilitating the secure interstate exchange
of data among these PDMPs, so we can eliminate once and for all
the doctor shopping which has fueled the pill pipeline around
our country.
In the next few weeks, I plan to introduce legislation to
support the DOJ in opening up lines of communications between
States. At the appropriate time, I would request that you give
this bill, Mr. Chairman, your immediate consideration.
I also helped to establish an organization in my
congressional district called Operation UNITE, standing for
Unlawful Narcotics, Investigations, Treatment, Education. It is
a bright star in our charge to empower our youth and create an
anti-drug culture, and knock out abuse for good. So far, on the
law enforcement side of that organization, it covers some 42
counties. Those undercover agents, some 30 of them, have sent
to the prison around 4,000 pushers, in just my district.
UNITE, with its focus on investigations, treatment, and
education, is a fantastic model, ripe for replication around
the country. Operation UNITE is the lead sponsor for the
national RX drug summit later this spring in Florida.
Collectively, Ms. Bono Mack, Mr. Rahall, Mr. Lynch, and
others have introduced a number of bills focused on law
enforcement, prescriber education, and research that would help
to curb the rising tide of abuse. Many of them have been
referred to this Subcommittee.
While I appreciate the opportunity to elevate this issue,
which continues to plague my people and communities around the
country, I would much rather see your Subcommittee mark up
these bills, move the ball forward, and take decisive action to
end this debilitating drug problem. And I stand ready, Mr.
Chairman, Members of the Committee, willing and able to assist
you in any way that you might request.
[The prepared statement of Mr. Rogers follows:]
__________
Mr. Sensenbrenner. Thank you very much, Mr. Rogers. And I
understand that you have an appropriations meeting to go to.
So, I think it is best we excuse you. But don't forget the
appropriation for our Subcommittee for our Subcommittee,
please. [Laughter.]
Mr. Rogers. Rest assured, Mr. Chairman.
TESTIMONY OF THE HONORABLE NICK J. RAHALL, II, A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF WEST VIRGINIA
Mr. Rahall. Thank you, Mr. Chairman. I appreciate the
opportunity to be before your distinguished Committee today.
And while I do outrank Mr. Rogers in seniority, I certainly
agree with you yielding to him first, as the Chairman of the
Appropriations Committee, and my dear friend and neighbor from
across the river, in my district.
Mr. Sensenbrenner. Praise will get you a long way, my
friend.
Mr. Rahall. I appreciate that, Mr. Chairman. And I
certainly associate myself with his testimony, and commend him
for his efforts in organizing UNITE, to which he referred in
his testimony. I appreciate the efforts of my colleague from
California, Ms. Bono Mack, and from Massachusetts, Mr. Lynch.
This is an issue that crosses all partisan lines,
philosophical lines, class lines, every line in our society.
This issue crosses and affects all of us.
I will be presenting testimony to the Subcommittee on
behalf of law enforcement officials from my district,
healthcare professionals, and community leaders. And I am sure
this Subcommittee will make this testimony public in our
continued efforts to educate the public and the American people
as to this tremendous epidemic that faces all of us.
It was once described as America's silent epidemic, but it
can now be openly witnessed any hour, any day, or any night on
countless street corners across the country. It is the
crippling epidemic of prescription drug abuse that we are
facing. And every day we face new stories and reports of
overdoses, deaths, accidents, families torn apart by the
vicious cycle of prescription drug abuse.
Headlines such as this, dealing with addiction in McDonough
County, in my district. These appear every day in every
newspaper. And believe you, me, they are touching stories about
how these communities are trying to deal with this vicious
cycle.
Unlike cocaine or heroin, as Mr. Rogers has said,
prescription drugs are legal, frequently prescribed by caring
physicians, lead by the principle oath of ``First, do no
harm.'' Yet, alarming statistics show that children and adults
are blind to the harmful consequences of these drugs. Even as
they become addicted, paying upwards of $150 per pill to buy
them on the black market.
Distressingly, my home State of West Virginia has our
Nation's highest rate of drug-related deaths. In fact, between
2001 and 2008, more than 9 out of 10 of those deaths involved
prescription drugs. And incredibly, as Mr. Rogers has, again,
pointed out, drug overdoses now kill more West Virginians than
car accidents.
But the alarming use and deaths by prescription drugs is
not just in West Virginia. As our other distinguished Members
will testify, it is across this country. And I could go into
the figures, Mr. Chairman, but you have those figures as well,
about what drug overdose death rates are in this great country,
how they have tripled since 1990, and have never been higher in
our Nation's history.
I have met numerous times with law enforcement, community
organizations, educators, physicians, and many more of my
constituents. We have had drug summits, and we will continue to
have networking processes in which we try to involve all
aspects of our community, and to involve those that are
personally affected, to get them to get to communicate. If they
don't want to openly, at least at these networking seminars,
with those law enforcement officials with whom, perhaps, they
have been afraid to have contact in the past, but now find a
forum, and find other people in like circumstances as them, and
which their fear is no longer preventing them from coming
forward and telling what is happening on the streets, and how
they feel the problem can be addressed.
So, these networks are important. This hearing is vitally
important. We must strengthen drug diversion, educate our
children and adults on prevention, work with the medical
community on addiction and pain treatment, and treat and
rehabilitate those that are affected by this vicious addiction
before they succumb to the death spiral.
There are a number of pieces of legislation I and my
colleagues have joined in cosponsoring. This Subcommittee is
certainly aware of those. And I leave it in your wisdom to join
these bills, perhaps, or to pick, as you see as most
appropriate, which bills should make it to the floor of the
House of Representatives. But many bills will establish
mandatory physician and consumer education, as well as
authorizing Federal funding to help States create and maintain
prescription drug monitoring programs that all States can
access.
This is one of the bills that I have introduced. It would
set up a uniform system for tracking painkiller-related deaths,
helping States and law enforcement personnel to be able to
manage and report data. The West Virginia State Police, our
attorneys general, and even physicians all consistently stress
the need to access a prescription drug monitoring system that
is shared between State lines and updated in real time.
So, Mr. Chairman, I urge you and this Subcommittee to
consider and move forward on legislation that encompasses the
provisions I have mentioned, and many others. Let us act with
dispatch and compassion, with an acute understanding of the
enormity of the challenge before us.
I conclude by thanking you once again for conducting this
hearing, and allowing me and my colleagues to be with you.
[The prepared statement of Mr. Rahall follows:]
__________
Mr. Sensenbrenner. Thank you very much, Mr. Rahall.
Ms. Bono Mack.
TESTIMONY OF THE HONORABLE MARY BONO MACK, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Ms. Bono Mack. Thank you, Mr. Chairman. I am honored to be
here with my colleagues, as you hold this critically important
hearing on the growing and deadly dangers prescription drug
abuse poses to our Nation.
One incident last year, in particular, graphically captures
the seriousness of this issue. On June 19th, in Medford, New
York, a man walked into a pharmacy and murdered four people for
11,000 tablets of Hydrocodone. One of those gunned down was a
33-year-old customer, who was just engaged to be married.
Instead, she was buried in her wedding dress. A 17-year-old
pharmacy employee was also killed, and later buried in her prom
dress, along with her high school diploma.
This senseless tragedy is just one example of a growing
wave of drugstore robberies by prescription drug addicts. But
it is also part of a larger rapidly escalating struggle
nationwide against prescription drug abuse and addiction, which
is expected to claim the lives of nearly 30,000 Americans this
year. Just last weekend, I met in California with dozens of
parents who have lost children to this horrible epidemic.
Two classes of medicines, painkillers, and insomnia and
anxiety drugs, are responsible for about 70 deaths and nearly
3,000 emergency room visits every day. That is right, a day.
And these are truly stunning numbers.
But what is very insidious is the way these powerfully
addictive narcotic prescription drugs quickly turn people,
without any real emotional or physical problems into desperate
people suddenly facing life-or-death struggles. Few things are
more destructive.
According to the CDC, drug overdose is now the leading
cause of injury death in the United States, not just in West
Virginia, but in the United States, in large part due to
prescription drug abuse. It is not hard to understand why.
Today, some 12.5 million Americans regularly abuse prescription
drugs, and the problem, as I have said, is growing rapidly.
There are approximately 7,000 new abusers every day, many of
them teenagers and young adults.
This alarming trend, now a health epidemic, according to
CDC, is taking a huge toll on society. Today, the abuse of
prescription drugs, especially painkillers, stimulants, and
depressants, is the fastest growing drug problem in America.
As Chairman of the House Subcommittee on Commerce,
Manufacturing, and Trade, which has jurisdiction over consumer
protection, I have made combating prescription drug abuse a top
priority. I believe there needs to be a national awakening
about the threat this alarming epidemic poses to our families
and to our communities. Simply put, we are in the midst of an
American tragedy.
What can we do? For starters, we must do a better job of
monitoring and limiting access to prescription drugs containing
controlled-release oxycodone hydrochloride, including the
popular painkiller and killer, OxyContin.
Originally, OxyContin was intended to be prescribed only
for severe pain, as a way to help patients dealing with last-
stage cancer and other severe illnesses. Today, however, more
and more people across America are prescribed OxyContin, as
well as other generic oxycodone drugs for less severe reasons,
clinically known as moderate pain, greatly expanding the
availability and potential for abuse of these powerful
addictive narcotics. Someone with a toothache or a sore knee
should not be prescribed a potentially addictive painkiller.
Clearly, expanded public education plays a role in
addressing the problem, but we are not going to make any real
progress until we limit access to these powerful narcotic
drugs, and ensure that only patients in severe pain can obtain
them.
We must also improve prescriber education by getting
doctors, dentists, nurse practitioners, and other prescribers
up to speed on the dangers of addiction. Today, I have
legislation pending in Congress, the Ryan Creedon Act, H.R.
2119, to accomplish this goal.
The pervasiveness of prescription drug abuse made national
headlines when Federal, State, and local law enforcement
agencies, led by the DEA, cracked down on so-called pill mills
in Florida, where painkillers were routinely dispensed just
like M&Ms from a gumball machine.
Congress needs to make it much more difficult for these
rogue pain clinics to operate, and we should treat offenders
like any other street drug dealer. By better coordinating the
efforts of local, State, and national agencies, and by reducing
the supply of highly addictive opioid painkillers, I am
convinced that we can eventually save thousands of lives, and
spare millions of American families from the heartache of
addiction. Mr. Chairman, no child should ever be buried in a
prom dress again, because we ignored this problem.
And I just want to say, in closing, that this past weekend,
when I met with these parents, a number of them spoke about a
Dr. Lisa Tseng, in Rowland Heights, California, who is being
charged for three counts of murder for supplying prescription
drugs to young men, who all overdosed. These parents went and
confronted the doctor, and she showed absolutely no remorse,
whatsoever. And I think we should do all we can to ensure she
is put away for a very, very long time, if she is found guilty.
So, thank you very much for allowing me to testify today.
[The prepared statement of Ms. Bono Mack follows:]
__________
Mr. Sensenbrenner. Thank you very much.
Mr. Lynch.
TESTIMONY OF THE HONORABLE STEPHEN F. LYNCH, A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF MASSACHUSETTS
Mr. Lynch. Thank you, Mr. Chairman, and Ranking Member
Scott, for your kindness in allowing us to testify on this
important issue.
My colleagues have told the story of drug abuse in America
today, but I do want to amplify the issue that Ms. Bono was
speaking about, and that is OxyContin. I will associate myself
with the remarks of the 3 previous speakers, and rather than
take my whole 5 minutes, I just want to offer a couple
thoughts.
Number one, this OxyContin is so powerful, it is so
powerful that in a very limited period of time a person who is
prescribed this becomes addicted. And we have seen stats now
that 99 percent of addicts who are involved with heroin, that
are in facilities today in the United States, started on
OxyContin. And the pattern is that they stay on OxyContin until
they are financially unable to do so, and then they switch over
to heroin, which is much, much cheaper.
But when you allow a company to create a product that is so
powerfully addictive that in a very short time they create
customers for life, that is a very troubling situation. It got
so bad in my district that I had to create, well, a residential
rehab facility, first, for boys, and then later for girls,
because these kids are getting addicted so young, there is
nowhere else to send them. We didn't have any adolescent rehab
facilities in my State. So, we had to create two.
We have a situation now where Perdue Pharma lost their
exclusivity, and now OxyContin is going to go generic. This is
tremendously powerful. And think about this, the profits here
are enormous. We are creating a national healthcare system that
will allow all of these people to continue to financially get
the support from these pill mills, the drug from these pill
mills, having the American taxpayer contribute to that. So,
this is a very, very dangerous situation.
And I noticed that on March 1, OxyContin was actually
pulled from the shelves in Canada. That is according to the
Toronto Star and the CBC news. I sponsored legislation here in
Congress several years ago to remove OxyContin from the market.
But, let's face it, there are so many drug company lobbyists up
here that that bill didn't have a prayer, because the
pharmaceutical company lobbyists outnumber Members of Congress
probably 7 to 1.
We have a serious problem here. And I commend you for
giving us the time here to try to address it. And I commend my
colleagues for the fights that they are making in their own
districts, and now, hopefully, we will be able to collectively
use our experience to push this issue nationally.
So, I thank you for your time. I appreciate it. And I yield
back the balance of my time.
[The prepared statement of Mr. Lynch follows:]
__________
Mr. Sensenbrenner. Thank you, Mr. Lynch.
I would like to thank all of the Members of Congress who
took time out of their schedules to come and testify here, as
well as the Members on the Subcommittee who have come and
listened to all of these graphic stories. And I am sure that
this is just the tip of the iceberg. This is a very serious
issue. It is one that needs to be addressed, and it needs to be
addressed in the proper manner.
Does the gentleman from Virginia have anything else he
wants to say or to insert into the record?
Mr. Scott. Yes, Mr. Chairman. Another Rand study showing
that demand investments work better than supply control.
Mr. Sensenbrenner. Without objection, the material is
inserted.
[The information referred to follows:]
__________
Mr. Conyers. Mr. Chairman, can I congratulate you on
starting our inquiry in this matter with Members of Congress
who have some great and different experiences about this
problem? And I thank you for starting it.
Mr. Sensenbrenner. Well, I thank the Chairman emeritus. I
am always happy to accept congratulations. They mean more from
that side of the aisle than my own. [Laughter.]
So, again, thank you very much. And without objection, the
Committee stands adjourned.
[Whereupon, at 10:36 a.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Material Submitted for the Hearing Record
Prepared Statement of Anne McGee, Director,
Cabell County Substance Abuse Prevention Partnership
My name is Anne McGee and I have been the director of the
Cabell County Substance Abuse Prevention Partnership, a
coalition of concerned individuals, agencies and organizations
for the past six years. We are located in my hometown of
Huntington, WV which is located on the Ohio River and borders
Kentucky and Ohio. The single biggest change in my hometown, in
my lifetime, has been the devastation wrought by the ``drug
problem.'' When the Cabell County Substance Abuse Prevention
Partnership was founded in 2006, we thought that crack cocaine
being brought in from Detroit was the main problem. As we
gathered data and studied the problem, we learned that crack
may be the drug that garnered the headlines and the attention
of law enforcement, but far more disturbing and pervasive was
the non-medical use of prescription drugs. Our teenagers were
reporting increasing use of prescription drugs; the lines at
the for profit methadone clinic every morning were out the
door; drug overdose fatalities were reaching record highs;
obstetricians were reporting more addicted patients; and
reports of drug seekers in the emergency rooms were a daily
occurrence.
In 2007, we held a roundtable discussion for healthcare
providers to discuss the data we had gathered regarding
prescription drug abuse. The consensus from those in that
earliest discussion was that the overprescribing of
prescription pain relievers and benzodiazepines by the local
medical community was a major part of the problem. We followed
up with a community wide drug summit where we included all
sectors of the community. We learned that not only was
overprescribing a problem, but it was far more complicated:
prescription drugs and the selling of those drugs by the
patient on the black-market was supplementing the incomes of
many living on fixed incomes; that patients have unrealistic
pain expectations and demand and expect pain free recuperation
from injury or surgery; that the Appalachian culture promotes
and supports the sharing of prescription drugs among friends
and family. And that our children were diverting medications
prescribed to the adults in their lives for both medical and
non-medical purposes. Our schools reported that many of the
expulsion hearings were for students caught bringing
prescription drugs to school. Local property crime rates were
increasing throughout the county and copper and other metal
thefts were rampant. Then the Journal of American Medical
Association published the findings of a CDC study showing WV
had the highest death rates in the nation for prescription drug
overdose. Fatality rates began to skyrocket across the nation
with WV leading the charge with greatest number of fatalities
and Cabell County having some of the highest mortality rates in
the state.
As we focused on our youth, we realized there were no
evidenced based strategies or programs that focused on
preventing prescription drug abuse, we also knew from community
readiness assessments that the community as a whole had little
or no awareness of the growing prescription drug abuse problem,
unless and until it struck too close to home. We took the
lessons learned in preventing youth use of other legal drugs
like alcohol and tobacco and we started with general awareness
strategies combined with attempts to limit youth access to
prescription drugs.
We recruited a few physicians to our cause and they drafted
a letter on the coalition's behalf to every healthcare provider
with prescribing privileges in Cabell County, sharing our data
and urging and encouraging the use of the WV Board of Pharmacy
Controlled Substances Monitoring Database. We conducted
awareness presentations throughout the community. We offered
trainings to nurses, teachers, coaches, parents and
grandparents. We conducted social marketing campaigns and held
dozens of public forums and summits; and we recruited
volunteers and coalition members along the way. We have
involved the media in every one of our efforts and we have seen
community readiness increase and a slight decrease in the
percentage of students reporting the non-medical use of
prescription drugs.
Knowing that limiting access is a key strategy in reducing
youth substance use, we have sponsored and promoted
prescription take back events collecting over 500 pounds of
unwanted medications in the past year. We have partnered with
the local hospital to provide information to local senior
citizens regarding medication safeguarding and disposal. We
have sponsored programs for the local medical society and we
have talked to every elected official who will listen.
Prescription drug abuse is destroying southern West
Virginia. The statistics and data support the severity of the
problem. Unlike illegal drugs, prescription drugs are subject
to regulation and control. Community efforts like the Cabell
County Substance Abuse Prevention Partnership can only do so
much in reducing the abuse and misuse of these substances. We
need stronger and better controls over controlled substances.
We are losing our children, our work force, and our quality of
life to an epidemic that is 100% preventable.
Prepared Statement of Kimberly Becher, MD; and Kane Maiers, MD, Paul
Ambrose Health Policy Fellows, Marshall University Department of Family
and Community Health
Drug abuse in Southern West Virginia has an effect on our
daily practice of medicine. As family medicine residents we are
not only exposed to drug-seeking behavior, but see the long
term effects of drug abuse in our patient population. Because
we are new providers in the community, our continuity clinics
are targeted by patients requesting controlled substances for
recreational use. These visits not only take away slots in
which we could be treating legitimate medical problems, they
frustrate us as providers. We chose to be family physicians
because we have a genuine desire to improve the health outcomes
of our communities and we sincerely value the physician-patient
relationship. We work hard to develop rapport and do not like
to disappoint our patients. Despite the level of compassion and
professionalism displayed as we deny unreasonable requests for
pain medication, many visits with drug-seeking patients end
with aggression, anger, and occasional threats of violence
toward the provider. On more than one occasion a patient has
revealed a weapon in our office.
Unfortunately, the most difficult of cases involve patients
with progressive chronic disease that is unable to be properly
addressed due to the patient's fixation on obtaining opiates or
benzodiazepines. These patients emotionally drain us as
providers. We spend the most time on these visits and make the
least progress in decreasing the patient's morbidity and
mortality despite our attempts at intervention. This patient
population contributes a disproportionate amount to the cost of
health care in West Virginia. This is not only limited to
emergency room visits but also to the complications of
untreated comorbid conditions that require hospitalization for
a population that is largely uninsured or receiving Medicaid.
The addiction circle is not limited to the patients we see in
the office. To the unemployed, obtaining a thirty-day
prescription for oxycodone will more than adequately pay their
bills. One resident reports admitting at least one patient to
the ICU per night who overdosed on prescription drugs they were
not prescribed.
We need help combating this epidemic in Southern West
Virginia. We need a national controlled substance monitoring
program that is real time. Patients routinely fill
prescriptions in Kentucky and Ohio, but we have also had
trouble with more organized patients travelling to pharmacies
in Florida. We need educational opportunities that prepare us
to properly address prescription drug-seeking behaviors from
the first day of practice. There is no grace period here. For
many of us, our first patient encounter was a test of our
ability to deny an unwarranted prescription.
Thank you for championing the development of legislation to
curb prescription drug abuse.