Examining the 2022 National Drug Control Strategy and the Federal Response to the Overdose Crisis
Summary
Printed record of a June 27, 2022 hearing of the Committee on Oversight and Reform, House of Representatives, on the 2022 National Drug Control Strategy and the federal response to the overdose crisis, Serial No. 117-90. Hon. Carolyn Maloney, chairwoman of the committee, presided. The sole listed witness is Dr. Rahul Gupta, Director, Office of National Drug Control Policy, Executive Office of the President. The index of documents lists letters from police and sheriff officials submitted by Rep. Comer and a Customs Border Protection report submitted by Chairwoman Maloney. A closing statement calls for passing the CARE Act to expand access to treatment, overdose reversal medications and fentanyl test strips; the committee adjourned at 3:37 p.m.
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“Examining the 2022 National Drug Control Strategy and the Federal Response to the Overdose Crisis.”
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[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
EXAMINING THE 2022 NATIONAL
DRUG CONTROL STRATEGY AND THE
FEDERAL RESPONSE TO THE
OVERDOSE CRISIS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON
OVERSIGHT AND REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
SECOND SESSION
__________
JUNE 27, 2022
__________
Serial No. 117-90
__________
Printed for the use of the Committee on Oversight and Reform
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available on: govinfo.gov,
oversight.house.gov or
docs.house.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
47-929PDF WASHINGTON : 2022
COMMITTEE ON OVERSIGHT AND REFORM
CAROLYN B. MALONEY, New York, Chairwoman
Eleanor Holmes Norton, District of James Comer, Kentucky, Ranking
Columbia Minority Member
Stephen F. Lynch, Massachusetts Jim Jordan, Ohio
Jim Cooper, Tennessee Virginia Foxx, North Carolina
Gerald E. Connolly, Virginia Jody B. Hice, Georgia
Raja Krishnamoorthi, Illinois Glenn Grothman, Wisconsin
Jamie Raskin, Maryland Michael Cloud, Texas
Ro Khanna, California Bob Gibbs, Ohio
Kweisi Mfume, Maryland Clay Higgins, Louisiana
Alexandria Ocasio-Cortez, New York Ralph Norman, South Carolina
Rashida Tlaib, Michigan Pete Sessions, Texas
Katie Porter, California Fred Keller, Pennsylvania
Cori Bush, Missouri Andy Biggs, Arizona
Shontel M. Brown, Ohio Andrew Clyde, Georgia
Danny K. Davis, Illinois Nancy Mace, South Carolina
Debbie Wasserman Schultz, Florida Scott Franklin, Florida
Peter Welch, Vermont Jake LaTurner, Kansas
Henry C. ``Hank'' Johnson, Jr., Pat Fallon, Texas
Georgia Yvette Herrell, New Mexico
John P. Sarbanes, Maryland Byron Donalds, Florida
Jackie Speier, California Vacancy
Robin L. Kelly, Illinois
Brenda L. Lawrence, Michigan
Mark DeSaulnier, California
Jimmy Gomez, California
Ayanna Pressley, Massachusetts
Russ Anello, Staff Director
Miles Lichtman, Deputy for Health Oversight and Policy
Elisa LaNier, Chief Clerk
Contact Number: 202-225-5051
Mark Marin, Minority Staff Director
------
C O N T E N T S
----------
Page
Hearing held on June 27, 2022.................................... 1
Witnesses
Dr. Rahul Gupta, Director, Office of National Drug Control
Policy, Executive Office of the President
Oral Statement............................................... 4
Opening statements of the Members, and the prepared statement
for the witness are available in the U.S. House of
Representatives Repository at: docs.house.gov.
INDEX OF DOCUMENTS
----------
The documents listed below are available at: docs.house.gov.
* Letter from Rob Boothe, Lieutenant, Spokane Police
Department; submitted by Rep. Comer.
* Letter from Brent White, Sheriff, Lyon County Sheriff's
Office; submitted by Rep. Comer.
* Letter from Matthew Thomas, Chief Deputy, Pinal County
Sheriff's Office; Rep. Comer.
* Letter from Philip Welch, Chief of Police, Coon Valley Police
Department; submitted by Rep. Comer.
* Letter from Brendan F. Kelly, Director, Illinois State Police
re Opioids; submitted by Rep. Comer.
* Letter from Don Barnes, Sheriff-Coroner, Orange County
Sheriff Department, re: Impacts of Fentanyl on Local
Communities; submitted by Rep. Comer.
* Arizona News-U.S. News, article, ``Cops: 500,000 Fentanyl
Pills Found in Arizona Traffic Stop''; submitted by Rep. Biggs.
* List of 117th Congress Hearings Held with Biden
Administration Officials; submitted by Chairwoman Maloney.
* Study of the Impacts of Massachusetts Narcan Distribution
Program; submitted by Rep. Tlaib.
* U.S. Customs Border Protection Report; submitted by
Chairwoman Maloney.
* President Biden 2021 Executive Order, re: Transnational
Cartels and Drug Traffickers Sanctions; submitted by Chairwoman
Maloney.
* Questions for the Record: to Dr. Rahul Gupta; submitted by
Rep. Holmes Norton.
EXAMINING THE 2022 NATIONAL
DRUG CONTROL STRATEGY AND THE
FEDERAL RESPONSE TO THE
OVERDOSE CRISIS
----------
Monday, June 27, 2022
House of Representatives,
Committee on Oversight and Reform,
Washington, D.C.
The committee met, pursuant to notice, at 1:40 p.m., in
room 2154, Rayburn House Office Building, and via Zoom; Hon.
Carolyn Maloney [chairwoman of the committee] presiding.
Present: Representatives Maloney, Norton, Lynch,
Krishnamoorthi, Raskin, Khanna, Mfume, Tlaib, Wasserman
Schultz, Welch, Johnson, Kelly, DeSaulnier, Comer, Foxx,
Grothman, Cloud, Norman, Biggs, Fallon, and Donalds.
Chairwoman Maloney. The committee will come to order.
Without objection, the chair is authorized to declare
recess of the committee at any time.
I now recognize myself for an opening statement.
Today's hearing focuses on an issue of urgent importance to
Congress, to families across the country, and to me personally:
overcoming the addiction and overdose crisis that continues to
ravage communities in every part of the United States. As chair
of this committee, I have worked to ensure that every person
dealing with addiction can access comprehensive treatment and
care. And when it comes to the bad actors that fuel this
crisis, like the Sackler family, the Purdue Pharma, and
McKinsey, I have used this gavel to hold them accountable for
their actions.
This hearing comes at a very difficult moment for our
Nation. Overdose deaths in America have been rising for more
than two decades, and during the coronavirus pandemic, fatal
overdoses skyrocketed to historic levels. Tragically, overdose
deaths increased by more than 30 percent in 2020, and by
another 15 percent in 2021 when more than 100,000 lives were
lost. The Biden-Harris Administration and Democrats in Congress
have taken aggressive action to address both the supply and
demand factors contributing to this crisis. Since President
Biden took office, we are stopping more fentanyl at the border
than ever before. This administration has increased drug
interceptions, seizing roughly 800 pounds of fentanyl each
month. This represents a fourfold increase in fentanyl
interdiction over the previous administration's efforts in
2019. To build on this progress, President Biden's 2023 budget
calls for more than 10 percent in additional funding for
interdiction efforts, a request I hope all my colleagues will
support.
At the same time, the Biden-Harris Administration and
Congress have made significant progress in treating addiction
as the disease that it is by expanding access to treatment and
wraparound services. The American Rescue Plan allocated nearly
$4 billion to services for mental health and substance use
disorder. That law also created the first Federal fund for harm
reduction services. Additionally, the administration's Overdose
Prevention Strategy has invested tens of millions of dollars in
initiatives to reach underserved communities, combat stigma,
and expand access to lifesaving treatment. These programs save
lives, and I am grateful that this administration has
prioritized them.
Today, we will hear from Dr. Rahul Gupta, the director of
the White House Office of National Drug Control Policy, who
will testify about the Biden administration's 2022 Drug Control
Strategy. This National Strategy focuses on what works. It uses
evidence-based strategies to build on the progress already made
by the Biden administration, and it outlines a plan to invest
in communities, prevent substance misuse, and increase access
to treatment and recovery services. The National Strategy takes
bold steps to ensure that medication to reverse overdoses is
available to anyone in a moment of crisis, a strong bipartisan
priority that will save lives. The Strategy promotes access to
fentanyl test strips which are a vital tool for overdose
prevention, especially among young adults. The National
Strategy also builds on the administration's progress to
disrupt the supply of dangerous substances into the U.S. by
targeting transnational criminal organizations that are
manufacturing and trafficking fentanyl.
This year's National Strategy also goes further than any
prior drug control Strategy to address structural inequities
that lead people in some communities with insufficient access
to healthcare and makes them more likely to be pulled into the
criminal justice system as a result of drug misuse.
The overdose crisis affects every community, represented by
our committee members here today, both Democrats and
Republicans. We owe it to our constituents to do everything we
can to build on the administration's progress and work together
to advance solutions to this public health crisis. That
includes sending to the President's desk the strong bipartisan
mental health and substance use disorder package that the House
approved last week. It also means passing H.R. 6311, the CARE
Act, a bill I authored and introduced with Senator Elizabeth
Warren and others, that advances the objectives of the National
Drug Control Strategy by providing crucial resources to the
local communities on the frontlines of this public health
crisis.
I thank Director Gupta for appearing before the committee
today and for the Biden-Harris administration's continued
commitment to ending our Nation's overdose crisis.
I now yield to my good friend, Ranking Member Comer, for
his opening statement.
Mr. Comer. Thank you, Chairwoman Maloney, for calling this
hearing today. Our committee's mission is government efficiency
and effectiveness. Our committee's mission is to protect
taxpayer dollars from government fraud, waste, and abuse. Our
committee's mission is to hold government officials
accountable. Republicans on this committee have been pushing
for months to hold hearings on the many pressing crises caused
by the Biden administration. While I am pleased we finally have
a top-level Biden official testifying today, I must say this is
long past due. I urge the chairwoman to hold more hearings like
this one where we can examine the many crises impacting America
today. Thank you, Dr. Gupta, for testifying today.
In January, Republicans on the Oversight and Energy and
Commerce Committees launched an investigation into America's
fentanyl crisis. We sent letters to the Office of Drug Control
Policy, Customs and Border Protection, and the DEA seeking
information about the Biden administration's plan to address
the crisis at the Southern border and overdose epidemic. We
appreciated the response from your Agency, Dr. Gupta, but many
important questions remain unanswered. One of these outstanding
questions is how President Biden's border crisis and this
administration's open-border policies have aided and abetted
trafficking of illicit drugs, such as fentanyl, into our
country. Fentanyl is being smuggled across the southwest border
at unprecedented rates. U.S. Customs and Border Protection
seized over 11,000 pounds of fentanyl in Fiscal Year 2021. That
is more fentanyl seized in one Fiscal Year than fiscal years
2020 and 2019 combined.
The standard fatal overdose of fentanyl is 2 milligrams.
Eleven thousand pounds of fentanyl is more than 5 billion
milligrams. That means we seized about 2.5 billion lethal doses
of fentanyl in one fiscal year. That does not include all the
fentanyl that we know has been smuggled across our borders
undetected. Cartels are overwhelming Border Patrol Agents and
providing a steady supply for dealers and users alike. So, a
primary question is, what is President Biden going to do to
secure the border and cutoff the free flow of illicit drugs
into our country. We also wrote an open letter to law
enforcement seeking information about how the fentanyl crisis
is impacting local communities. We received distressing
responses from communities across the country. They tell us of
the devastating effects fentanyl has had, of young lives lost,
and families destroyed.
Madam Chairwoman, I ask unanimous consent to submit these
response letters into the record.
Chairwoman Maloney. Without objection.
Mr. Comer. Thank you. On top of the crises at the Southern
border, Democrat lockdowns and school closures caused increased
stress and mental health complications for teens and adults
alike, leading to historic overdose rates. According to
preliminary data from the CDC, more than 107,000 people died
from a drug overdose in the U.S. in 2021. That is a nearly 15-
percent increase over 2020 which is already a 31-percent
increase over 2019.
Our Nation's mental health crisis continues to worsen due
to the economic hardship and supply chain crises caused by
President Biden's disastrous policies. Studies have shown that
stress over money can make people up to 20 times more likely to
attempt suicide. Inflation remains at a 40-year high, gas
prices are the highest in American history, and many families
are stressed, wondering how they are going to make ends meet.
Tragically, fentanyl overdoses are becoming the leading
cause of death for Americans aged 18 to 45, more than COVID,
car accidents, gun violence, breast cancer, or suicide.
Teenagers and young adults are turning to Snapchat, TikTok, and
other social media apps to find Xanax and other pills, many of
which are counterfeit and laced with fentanyl. Fentanyl has
also been found in counterfeit vape pens and marijuana. We must
act now to secure our Southern border to stem the flow of
illicit fentanyl. It is heartbreaking to see how desperately
people are trying to escape the impacts of President Biden's
policies. His administration has flooded the market with
illicit drugs, so they can do just that.
Thank you, Madam Chair. And I yield back.
Chairwoman Maloney. The gentleman yields back. Thank you
very much. And I would note in response to your statement that
we have already held more than 25 hearings this Congress with
Biden administration officials and other government witness.
Today is the 26th. I have a list of these hearings.
Without objection, I will enter it into the record.
Chairwoman Maloney. And now I will introduce our witness.
We will hear from Dr. Rahul Gupta, the director of National
Drug Control Strategy.
The witness will be unmuted so we can swear him in. Please
raise your right hand.
Dr. Gupta? I don't see him up there. Is he on? Is he with
us?
Voice. He is just not speaking----
Dr. Gupta. Madam Chair, I am on.
Chairwoman Maloney. I see you now. Please raise your right
hand.
Do you swear or affirm that the testimony you are about to
give is the truth, the whole truth, and nothing but the truth,
so help you God?
Dr. Gupta. I do.
Chairwoman Maloney. Let the record show that the witness
answered in the affirmative. Thank you.
Without objection, your written statement will be made part
of the record.
With that Dr. Gupta, you are now recognized for your
testimony.
STATEMENT OF RAHUL GUPTA, DIRECTOR, OFFICE OF NATIONAL DRUG
CONTROL POLICY, EXECUTIVE OFFICE OF THE PRESIDENT
Dr. Gupta. Chairwoman Maloney, Ranking Member Comer, and
members of the committee, thank you for inviting me to testify
about President Biden's inaugural National Drug Control
Strategy.
This Strategy was released in a time of unprecedented
challenges. For far too many years the overdose crisis has been
unraveling the very social fabric of our Nation and destroying
American lives and livelihoods. The Centers for Disease Control
and Prevention estimates that overdoses have claimed more than
1 million lives over the past two decades. In 2021 alone, we
lost more than 107,000 Americans. That is one life lost every
five minutes. These are our friends, family members, co-
workers, and neighbors. Since 2015, overdose deaths in America
have more than doubled, and the COVID-19 pandemic has amplified
the existing difficulties in accessing treatment for substance
use disorder.
As a practicing physician for the last 25 years, I have
treated many patients with addiction who have gone on to lead
successful lives in recovery, but I have also seen too many
patients succumb to their disease, and I have attended far too
many funerals. Working in the emergency room, I have
experienced weeks and months where I was reversing overdose
every shift. Now, behind these overdoses, fatal overdoses,
there are millions of individuals experiencing non-fatal
overdoses that are overwhelming our first responders and the
healthcare system. Underneath these overdoses are tens of
millions of Americans suffering from substance use disorder.
There are other effects as well. Research estimates that the
economic cost of the epidemic to be a staggering $1 trillion a
year, and up to 26 percent of the loss in U.S. labor force
participation can be attributed to the disease of addiction.
Now, addiction and the overdose epidemic is a nonpartisan
issue, which is evidenced by the fact that it touches everyone,
regardless of where you live or how you vote, and this is why
ending the opioid epidemic is part of President Biden's unity
agenda, and why it has strong support across the country and
across political parties for finding comprehensive and
meaningful solutions.
As the Office of National Drug Control Policy developed
this Strategy, we focused on the fact that this epidemic is
being driven largely by untreated addiction and drug
trafficking profits. This Strategy's seven goals focus on
reducing substance use, overdose deaths, and the supply of
illicit substances, and increasing prevention, harm reduction,
treatment, and recovery efforts, and finally, improving the way
the criminal justice system addresses substance use disorder so
that people can get the help they need before it is too late.
There are also four key priorities that cut across the
Strategy. At a time when 3 out of 4 overdose deaths involve
opioids, it is critical that we are making sure everyone can
access naloxone. We are also working to ensure that everyone
can get the treatment. We are disrupting drug trafficking
operations. The United States has the fundamental
responsibility to protect its borders, and this is precisely
what the Biden administration is doing. And we are improving
data collection, particularly for non-fatal overdoses, as they
are a good indicator that someone will experience a future
fatal overdose. Now, taken together, these goals and priorities
usher in a new era of drug policy that is comprehensive,
holistic, and targeted at saving lives first.
At this moment in history, our Nation is at an inflection
point. Our actions must rise to the occasion by being bold and
innovative, but also compassionate and consequential. The
Biden-Harris Administration's inaugural National Drug Control
Strategy is an unprecedented evidence-based blueprint designed
to save lives immediately, build the infrastructure for
treating addiction our Nation so desperately needs, and
disrupting drug trafficking and the profits that fuel it, all
the while ensuring that the Federal Government is accountable
and serves as a good steward of taxpayer dollars.
Saving lives is our North Star because I believe that every
life is precious and worth saving. If this Strategy is
implemented as intended, we could be saving 164,000 lives over
the next three years and help tens of millions of people get
into treatment on the path to recovery. The President and I are
committed to seeing this through because American lives depend
on it.
Thank you for your continued efforts to make our country
safer, and as President Biden said, let us come together to
beat this. I look forward to your questions.
Chairwoman Maloney. The gentleman yields back.
I now recognize myself for five minutes for questions.
Thank you very much, Director Gupta, for coming before the
committee today and for your leadership, and thank you for your
tireless commitment to ending the overdose crisis which has
devastated so many families in our country. I know that this
has been a top priority of the Biden-Harris Administration
since day one.
Director Gupta, in addition to issuing this year's National
Drug Control Strategy, what progress has the administration
made so far in expanding access to services and care to prevent
overdoses and treat addiction?
Dr. Gupta. Thank you, Madam Chairwoman. We have had
significant progress made. In fact, now there are telehealth
provisions that allow providers to treat addiction across the
country, especially in rural areas, underserved communities,
and behind the walls. Telehealth, including phone consultation,
is a crucial aspect of expanding treatment. We know that less
than 1 out of 10 people today are getting the treatment that
they need. DEA has mobile vans for methadone as well as take-
home methadone. These aspects are helping us improve and expand
treatment at a time when oftentimes people are dying without
treatment. We are also making efforts to make sure that
everyone can get naloxone, which is the antidote for opioid
overdose reversal, which 3 out of 4, almost 80,000 people are
dying because of the lack of naloxone. At the same time, we are
allowing more and more physicians, and providers, others to be
able to write prescriptions through practice guideline changes
so that they will have, able to get more treatment across.
For our goal of treating untreated addiction, creating the
infrastructure, the American Rescue Plan has invested $4
billion, unprecedented amounts, and the President has now
called for an increase in $3.2 billion. Seventy-five cents on
the dollar of that increase of the $42 billion drug control
budget goes toward making sure we are expanding treatment, we
are expanding prevention, we are expanding recovery services.
Chairwoman Maloney. The coronavirus pandemic strained every
aspect of the American healthcare system with a
disproportionate burden falling on people with addiction and
the providers who treat them. One way the Federal governmment
responded to this crisis was by promoting the use of telehealth
to increase American access to addiction treatment. Dr. Gupta,
does the administration support the continued use of telehealth
flexibilities for addiction treatment beyond the coronavirus
pandemic? Can you expand on how it is made available to people?
How are they made aware that they can have this type of
treatment?
Dr. Gupta. Thank you, Chairwoman. It is extremely important
for President Biden, for this administration to ensure that
telehealth services are available and are made available beyond
the public health emergency. My reason for that is that,
especially people in rural areas, like my home state of West
Virginia, who are often not able to drive, not able to take the
effort to get where it needed because of the rurality, these
telehealth services allow much more efforts to be provided to
people. It is a time where we need to meet people where they
are, and telehealth, including phone consultation, allows us to
do just that. And same goes for people, especially in
communities of color, who already have a difficult time and a
delayed time accessing services. This is another service that
will help us expand treatment.
Chairwoman Maloney. OK. Last December I led nearly a
hundred of my colleagues on the Democratic side in
reintroducing the CARE Act, landmark legislation that would
provide $125 billion in new Federal funding directly to
communities and care providers, over 10 years to overcome the
overdose crisis. Director Gupta, do you agree that we need to
provide sustained comprehensive investments in treatment and
care to communities at the frontlines of this crisis as our
CARE Act would do? Why or why not?
Dr. Gupta. Thank you, Chairwoman. It is one of the critical
aspects of this particular crisis that we provide these types
of services to folks, not just for treatment, but beyond
treatment, to provide that support, a comprehensive support.
So, it is important that we think about the ability to get
people to help when they need it, where they need it, and
efforts like this help us get there quicker and ultimately save
lives.
Chairwoman Maloney. Thank you. I commend the administration
for its tireless work to overcome this crisis and reduce the
harm it inflicts on our society, and I am a proud partner with
you in this work, and you bring invaluable experience to the
country from your work in West Virginia.
I now call on Representative Norman.
Mr. Norman. Thank you, Chairwoman Maloney, Doctor, and
thank you for taking the time to come. Now, I was listening to
your opening words. You said this, that the Biden
administration had a top priority for protecting Americans,
protecting the border. Did you say that? I mean, am I right, he
is doing a great job of protecting the border?
Dr. Gupta. Thank you, Congressman, for that question. We
believe strongly that it is an important part of every Nation
to be able to secure and protect its border. There are a number
of things that are going on in this area of counternarcotics
that I think is important to note. As I visit, I speak to the
women and men on the border----
Mr. Norman. No, no. Look, Doctor, I don't mean to
interrupt. I got a limited amount of time. Is he taking the
steps to close the border? Is that what I understand you to
mean?
Ms. Gupta. Congressman, thank you again. The President is
certainly taking steps to make sure that our border remains
secured, part of which is----
Mr. Norman. Oh, my Lord. OK. Doctor, OK. This is two
different universes. I assume you agree with the numbers of
illegals coming across. We are going to average 585,000 a
month. We are up to--what is this--1.6 apprehensions. Donald
Trump with the wall had this solved. We have 50 during the
three prior years. Those on the terror watch list were
basically zilch. This past year is 50 on the terror watch list.
How can you sit there and say that this administration has a
goal of protecting Americans?
I am in the construction business. We had a leak on one of
our projects. You stop the leak in the pipe. We had a dam that
had a leak in the dam for the water. You stop the leak. I mean,
really, this is a mischaracterization at best. Either the
numbers are completely false. We are getting a unprecedented
number of people coming across. We already got 3 to 5 million
illegals in this country, so I guess we don't want words, and
we don't want hearings. We want action. All he has to do is
build a wall and have a designated point of entry.
How many times has the Vice President been to the border
that you know of? She was supposed to be the big czar heading
this up. How many times has she actually been to the border to
see what is going on?
Dr. Gupta. Congressman, I will leave that to the Vice
President to answer. What I can tell you is I have been----
Mr. Norman. Zero. Zero. She is giggling. She is laughing
about it. How many times have you and your staff been to the
border?
Dr. Gupta. Yes, Congressman. Thank you for that question
again. I, on my first week in office, I actually went to our
Southwest border and I went to Mexico. Recently, last month, I
went to the San Ysidro border in San Diego. The first one is El
Paso. I was able to spend a considerable amount of time. And I
will say that, as the ranking member mentioned, since last
year, beginning, we have apprehended 600,000 pounds of illicit
drugs, including 11,000 pounds of fentanyl. And I will tell you
why that is important.
Mr. Norman. No, that is because it is coming across
unfettered, Doctor. I mean, they are unfettered. I mean, they
are coming across. That is why the cartels are winning. They
are making a billion dollars a month, and they are unfettered
coming into this country. I am tired. The blood is on the hands
of this administration for what he is doing. Our police
officers are sick and tired of the danger they face on the
streets today in South Carolina because of his inaction.
And now, I tell you, this is one of the tragedies that is
going to be hard to walk back. This administration will not
take ownership, and to start touting things he has done, he has
opened up this country, our sovereignty is at stake, and we are
losing it. I know you are part of the administration, but it
astounds me you are making these statements because it is just
not true with the open borders that he is allowing to happen
and endanger everybody in America.
Dr. Gupta. Congressman, if I can complete my response. What
I was saying is that that amount of drugs is not in our
communities killing Americans right now. The proceeds, up to
$16 billion, and we are denying those to the transnational
criminal organizations that are often used for crime for
corruption and other events in the host countries that often
destabilize fragile democracy and become the cause of migration
in the first place. So, I am proud of the work that our men and
women are doing at the border, but I also want to mention this
problem doesn't start or end at the border. It starts with
precursor shipments in China and ends up as overdose and fatal
overdoses in our communities. We have----
Mr. Norman. Doctor, how many countries are we----
Chairwoman Maloney. The gentleman's time has expired. We
could have a second round, but we have to keep moving.
Congresswoman Norton, you are now recognized.
Ms. Norton. Thank you very much, Chair Maloney. Dr. Gupta,
let me preface my questions by noting that I am extremely
disappointed that the Biden administration's two budgets have
proposed maintaining the right that prohibits the District of
Columbia from spending its local funds on commercializing
recreational marijuana. I will be submitting a question for the
record on this matter.
Ms. Norton. With that said, since assuming office, the
Biden administration has shown a robust commitment to advancing
equity and centering recovery over punishment in our Federal
response to the overdose crisis. In 2022, the National Drug
Control Strategy clarified further this crucial commitment. Dr.
Gupta, could you explain the racial disparities that currently
exist in incarceration and arrests for drug-related offenses?
And how have these incarceration disparities perpetuated
inequities in the ways communities experience the drug overdose
crisis?
Dr. Gupta. Thank you, Congresswoman. It is no doubt that
the disparities in incarceration that exists and continue to
exist have perpetuated a lot of challenges. I would say the
question in the matter of D.C. rider, I understand it is with
Congress, and I will leave it at that. And having said that,
the President has been very clear that he supports decisions
regarding legalization of marijuana up to individual states,
but at the Federal level, he has supported decriminalization of
marijuana use and automatically expungement of records. And
part of the reason is because of the disparities in
incarceration.
Now, one of the things we are doing through the Strategy is
looking at all of the metrics that are available to us and
where the data makes sense, for example, pre-arrest diversions.
We were able to put forward a state model on deflection.
Deflection is the idea that for nonviolent crimes, if someone
has a mental health disorder or addiction, let's get the person
the help. Let's get them the treatment. Let's get them figured
out housing. Let's get them other things instead of
incarcerating them. It is not only a good thing to do, prevents
recidivism, but it is also cost-effective for the communities.
It is these type of things that the Strategy looks at. It is
figuring out how to solve problems at a community level and
making sure that we are doing that with equity with the lens of
equity at it.
Ms. Norton. Thank you. To address the inequities in our
criminal justice system, the Strategy urges the Department of
Justice to identify opportunities to amend Federal statutes
requiring mandatory minimums for drug-related offenses, and it
calls for greater intergovernmental collaboration to address
the root causes. How will these steps advance racial equity in
our Federal response to the overdose crisis?
Dr. Gupta. Thank you, Congresswoman. You know, as a
physician who practiced for 25 years, I have seen the effect
not just for individuals but also the family, the
neighborhoods, the community. So, it is important for the
administration to make sure that we are looking at every option
and every possible way to have both judicial independence, and,
at the same time, figure out what is the best way forward in
ensuring that we are addressing equity at the same time we are
addressing the drug crisis that is happening.
So, it is important for us, as I mentioned, to look at the
alternatives. That includes drug courts. That includes making
sure that people have this help while incarcerated. We know
that 2 out of 3 people behind the walls have a substance use
disorder or addiction. It is important for us to make sure that
people are getting the treatment, both behind the walls but
also upon reentry. And the reason for that is that is a
commonsense smart way to not only save lives, but also save
money and have more productive communities. As I mentioned, up
to 25 percent, 26 percent of the labor force participation loss
has been because of addiction, and we need to change that. And
looking at it through the lens of equity is an important piece
of doing that.
Ms. Norton. The 2022 National Drug Control Strategy
proposes steps for the Federal Government to better understand
these racial inequities across our criminal justice system. It
calls for universal substance use disorder screening for people
who are arrested. How will these steps help to ensure that
people in incarcerated settings have access they need to treat
addiction? And why is this such an important component of the
fight against addiction----
Chairwoman Maloney. The gentlelady's time has expired. The
gentleman may answer her question.
Dr. Gupta. Thank you. This allows us to provide access to
treatment behind the walls. The Federal Government is already
working on that for Federal prisons because we want to walk the
talk, we want to make sure that we are leading. So, we are
currently working with Bureau of Prisons, Department of
Justice, DEA, and HHS to make sure that we could provide
treatment behind the walls so we can have productive
communities at reentry.
Chairwoman Maloney. Representative Cloud, you are now
recognized.
Ms. Foxx. Madam Chair, this is Virginia Foxx. I think I am
on next.
Chairwoman Maloney. Oh, we would----
Mr. Cloud. That is fine with me. She can go first.
Ms. Foxx. Thank you, Michael. Thank you, Madam Chair. Dr.
Gupta, it is interesting to me you say, ``behind the walls.''
It is impossible for you to say, ``people in prison,'' I guess.
Dr. Gupta, what percentage of drugs coming across the Southern
border are fentanyl or laced with fentanyl?
Dr. Gupta. I can speak about the seizures. I do not have
direct data on the amount or percentage of the seizures.
Ms. Foxx. OK. Well, of the seizures.
Dr. Gupta. Of the seizures, the volume of it, because most
of those seizures----
Ms. Foxx. No, just what percentage are fentanyl or laced
with fentanyl?
Dr. Gupta. I can get you that data, Congresswoman.
Ms. Foxx. OK. I think it is most of them. Since fentanyl is
one of the most deadliest drugs that is coming across the
Southern border, what policies has this administration
implemented to stop it, and I would just like you to say one,
two, three, four, policies. Don't go into extraneous
information, please.
Dr. Gupta. Yes, Congresswoman. So, first of all, there is a
United States-Mexico Bicentennial Framework that is looking at
particular policies that fuel the trafficking, that fuel the
transfer across the border, and work with Mexico as a partner
to make sure that, we are working on that. The second,
President signed an executive order that expands the
prosecution and placing of sanctions to not just individual
traffickers, but also the enablers, their financiers, and I can
provide details later on to you for that.
Ms. Foxx. OK. And the first thing you gave nothing. There
is nothing in what you said. It is a working on an agreement,
so nothing there. You are saying just one thing, and I will
look for the details. So, during the Trump administration, we
saw the first annual decrease in overdose deaths in 30 years,
with the Trump DHS setting an all-time high for the amount of
drugs seized at the border, and the Trump administration
awarded a record amount of Federal grants in support of drug
interdiction and public health programs. What can we do to
replicate this kind of success moving forward, and why hasn't
the Biden administration already kept those programs in place?
Dr. Gupta. Thank you, Congresswoman. I was Virginia health
commissioner at the time, and I can tell you that during 2018,
the deaths from fentanyl actually went up by 10 percent, so the
decrease was not, unfortunately, in fentanyl during that time.
What we have seen now, two weeks ago, CDC provided its first
12-month numbers, that have shown a few hundred decline in the
deaths for a 12-month period from month to month. We are now--
--
Mr. Foxx. OK. Well, let us have that information. We would
like to be able to compare what happened during the Trump
administration with what is happening because that is not what
we understand. The Trump administration's stance on securing
the Southern border helped make America safer, stopped the flow
of opioids into the Nation, and reduced overdose deaths, but
the Biden administration's stance on the border is making us
less safe and allowing opioid overdose deaths to continue
increasing, despite what you are saying. So, without addressing
our Southern border security, we simply cannot stop the flow of
fentanyl into the country.
According to the CDC, in 2021, more than 107,000 people
died from drug overdose, up from 91,799 in 2020. Why has the
Biden administration failed to bring down drug overdose deaths?
Dr. Gupta. Thank you, Congresswoman. I believe we are
seeing now a blunting of the curve of overdose death. We know
there are multiple factors. We also know that it is very
important to secure our border and continue to secure our
border. That is exactly why President Biden has proposed a
budget of increase of $300 million for Customs and Border
Protection, for the drug budget. It is really important that we
provide the men and women on the border in uniform the
resources, the technology, as well as the infrastructure that
they need to do the job that they are supposed to do.
Mr. Foxx. Oh, come on Mr. Gupta. You can't believe that.
Let me ask you one more question. As a physician who served in
rural communities, like many throughout my district, can you
describe what should be done to protect rural communities from
fentanyl and other dangerous opioids?
Dr. Gupta. Thank you, Congresswoman. I think, first of all,
we got to get naloxone out there. We can prevent about 80,000
deaths, a majority, if we can get naloxone out there, then
connect people to treatment. We also need to have robust law
enforcement drug trafficking efforts to make sure that we are
cutting into the profits. That is where the High Intensity Drug
Trafficking Area, or HIDTA, programs are important because they
bring in local state and Federal partners to work collectively,
and they are doing a great job of interdicting that supply
right now. It is a combination of both, public health and
public safety, especially in rural communities.
Ms. Foxx. You seem to know what to do, but you are not
doing it. Thank you, Madam Chair. I yield, expired.
Chairwoman Maloney. The time has expired. Representative
Lynch, you are now recognized. Representative Lynch.
Mr. Lynch. Thank you, Madam Chair, and, Dr. Gupta, thank
you for joining us, and thank you for all your good work.
You know, I have been at this a while, and we have had a
difficult time in addressing the drug problem in this country.
We seem to have gone from a policy where we tried to get people
clean and sober to a policy where we now try to get them off
one drug and put them on another drug. And I am speaking
specifically about suboxone and how we have taken the lid off,
and allowed doctors to have hundreds of patients and just give
them suboxone and not really deliver any behavioral health
services that would get at the underlying addictive activity.
And I am seeing it in my district where we have got a couple of
clinics that hand out suboxone. The patients go out the door,
and then they either trade that or they buy fentanyl or
methamphetamines, which is even a worse problem. They can't get
high with the suboxone, so they are going to harder drugs, and
we are actually seeing much more violent activity because an
individual on methamphetamines might be up for days, and we are
seeing a lot of stabbings, a lot of violence.
And I am just questioning the whole policy here where we
seem to be moving away from, you know, getting people straight,
getting them clean, getting them sober, getting them back into
their lives, and instead we are getting them on different
drugs, and I just don't see a good result as a result of that
policy. You got any thoughts on that?
Dr. Gupta. Thank you, Congressman. You know, one of the
things we have realized in the last few decades is this is a
brain disease. It is just like a lot of other diseases. It is a
brain disease, and the way we need to treat that is as a
disease of the brain. That includes making sure that we
understand the disease better, we provide the FDA-approved
medications to help the person. And people may have different
ways of getting at the treatment, Congressman. Some people may
actually do OK, cold turkey. Others may actually need the
medication for varying amounts of time.
But one thing that I have in my 25 years learned is we got
to figure out how to get the help to people when they need it
and where they need it because they may not be coming back. The
next time they come back would be as a fatal overdose in my
emergency room, and that is why we have taken effects and
actions here to save lives first. And part of that means to get
people the help they need, figure out what works for them while
not giving up on our research agenda, making sure that we are
looking----
Mr. Lynch. I appreciate that, Doctor, I really do, but I am
just telling you. I am trying to give you a little feedback. It
is not working where I am. It is not working in the 8th
congressional District of Massachusetts. I got 10 cities. I got
hundreds and hundreds and hundreds of people all together right
next to the suboxone clinic, right next to the methadone clinic
that are shooting up. And, you know, they are shooting up 5 or
6 times a day and, you know, it is just a very bad situation. I
have had to go down there and look for young people who have
left their families and are now totally off the grid and
addicted, you know, to fentanyl and methamphetamines, and it is
a sad, sad state.
You know, The Journal of Medicine just came out with an
article last week, two weeks ago, that in one year, between
2019 to 2020, the adolescent death rate has gone up 100
percent, double in one year. And, you know, I just think that
we are pushing more of this stuff out. It is not helping, so I
think we have got to reassess.
One last question. You know, I am also on the
Transportation Committee, and I had an unclassified briefing
with the Department of Homeland Security and FAA, and this was
on Judicial Watch as well. We had 9,000 unauthorized drone
incursions over the Southwest border last year--9,000. And I am
just wondering, you know, these drones have a payload of
anywhere from 3, to 5, to 8 pounds, and I am sure a lot of
fentanyl is coming in over the border by drone. Not by
individuals, but by drones. They are shipping it in. And I am
just wondering, I know the number of interdictions has
increased, but I am just worried about volume. Is that because
there is more volume coming over? Do you have any thoughts on
that?
Dr. Gupta. Thank you, Congressman.
Chairwoman Maloney.--expired, but the doctor may answer
your question.
Dr. Gupta. Thank you. On the first part, I would say it is
tragic, Congressman, and we are willing to work with you and
Congress in any way possible we can help Americans, too many
dying, unacceptable. On the second part, that is exactly the
challenge today. The 21st century tools and technology that we
need to be a deterrent to these air drone, marine drones,
subterranean tunnel, some of which I have been inside of, we
are going to need to work collectively to have deterrence
technologies of the future because our adversaries are not
waiting on us to develop them to fight this. And so I would
look forward to working with Congress on some of those aspects
which the bad guys figure out one way or the other to bring
drugs in----
Mr. Lynch. I look forward to working with you as well.
Thank you, Madam Chair. I yield back.
Chairwoman Maloney. The gentleman yields back.
Representative Cloud, you are now recognized.
Mr. Cloud. Thank you, Madam Chair, and thank you for being
here, Dr. Gupta. I have a few very quick questions for you.
That should be pretty easy. How many fentanyl deaths have there
been in the last year?
Dr. Gupta. About 80,000. That is----
Mr. Cloud. About 80,000, and we know the majority----
Dr. Gupta. That is opioids, including fentanyl, sir.
Mr. Cloud. Yes, we know the majority of that is coming over
the Southern border. You already touched on a little bit, but
where is most of the fentanyl coming from? Where are the
cartels sourcing it from, either the fentanyl or components to
make it?
Dr. Gupta. Predominantly China, some amount----
Mr. Cloud. Predominantly China, yes. And if China were to
send over some sort of bomb, chemical warfare that killed
70,000, 80,000, to 100,000 people in our country, do you think
that would be considered an act of war?
Dr. Gupta. Congressman, I think we are already trying to
make sure that China understands the importance and
significance of cooperation in this area, but certain----
Mr. Cloud. If they had sent that many people over with guns
that killed 70,000, 80,000 people, do you think that would be
considered an invasion?
Dr. Gupta. Congressman, clearly people are dying already
from fentanyl, of course.
Mr. Cloud. Yes. In the few years that I have been in
office, we have gone from the coyotes on the Southern side of
the border who kind of duck and hide until our armed border
patrol would move their posts, and then they would try to sneak
people and drugs across, to now the coyotes are armed sometimes
better than our Border Patrol agents, and our Border Patrol
agents have been told to stand down. And so now the cartels,
armed, bring their loads to our cartel members and tell them to
get them to the station for processing. This is a completely
backward approach to border security.
And the chair at the beginning of this hearing tried to
make some benefit and make it sound good that we are catching
more fentanyl at the border. That is a ridiculous notion and a
spin on some really, really bad news. We are catching more
because there is more coming across, not because we are
catching more of a percentage of what is coming across. There
is almost a half million got-aways coming across our border
that are suspected undetected got-aways, not to mention the
people who we know that we are not catching that are coming
across, and the cartels are wreaking havoc on our Nation while
this Nation stands down.
Now you are wanting more money from us to fix this issue,
but my question for you is we have already sent you money to
secure the border, the Biden administration. How do we know
that if we send you money for anything, you are going to use it
for what you are legally obligated to use it for?
Dr. Gupta. Thank you, Congressman.
Mr. Cloud. Why should we as Congress trust the Biden
administration at this point?
Dr. Gupta. Thank you, Congressman. I think when I go down
and I talk to individual agents as well as leaders of the
Customs and Border Protection, as well as the other Federal
agencies, look at the technology that is there that can be
enhanced, I look at the infrastructure, the people, the
resources that could be enhanced, all of our deterrent and
detection technologies that can be enhanced, I think that is
the rationale to making sure. I can tell you that----
Mr. Cloud. We have already paid in Congress. We have
already authorized and paid for much more border infrastructure
and technology to be put in place. And the Biden administration
continues to pay more than what it costs to put the wall up
than to keep it down, and manned, and guarded, and rusting away
in a stockpile. So, we could be doing a lot more to stop the
cartel activity coming across the border. We are turning Mexico
into a narco-state because of our inaction on the border, and
they are beginning to have even footholds and even take over
communities in the United States of America. I don't understand
how the Biden administration makes any sort of positive news
out of this.
Dr. Gupta. Congressman, I went to the wall in San Ysidro,
and then I walked 10 meters back to United States. And I went
down several feet into a tunnel, a drug smuggling tunnel that
was coming from across the border. There are hundreds of those.
Women and men of the Border Patrol and Customs and Border
Protection are working to seize and provide mitigation to those
tunnels. We need cooperation from the Mexicans to do that on
their end, but the fact is that it is----
Mr. Cloud. Well, tunnels is one aspect, but they are coming
in drones, but the wall that we have already paid, that the
administration is breaking the wall and not to build, we have
already paid for it. We have given the direction to do it.
Their job is to execute the laws of the land, and they are not
executing, so there is no way around that. They need to execute
the laws of the land as sworn to do, as you had sworn to do, as
Biden is sworn to do, as Kamala Harris is sworn to do.
So, I am going to move on to Big Tech for a little while. I
am curious to know what you have done. A lot of this is being
bought by young people over TikTok. Cartels are even recruiting
over TikTok to make transports and those sorts of things in
social media as well. The Big Tech and social media company has
been pretty effective at clamping down on ideologies that they
don't like to be particularly conservative ideologies. What
kind of communication have you had with Big Tech when it comes
to getting them to just allow cartel activity on their
platforms?
Dr. Gupta. Thank you, Congressman. We have had several
conversations with Big Tech companies. We are working here at
the office, particularly with one large one, where also CDC is
working to make sure that there are PSAs, that Big Tech is
taking its own accountability in place. DEA is, as well,
providing the One Pill Can Kill Campaign through a variety of
mechanisms, including social media, and clearly there is more
that we need to do. Why? Because we still have kids oftentimes,
but others as well, who do not often understand the importance
of counterfeit pills these days, but the conversation and the
work is ongoing. I have been personally engaged and involved in
some of those conversations and actions.
Mr. Cloud. Thank you, Chair. My time is up. I yield back.
Chairwoman Maloney.--time has expired.
Representative Raskin, you are now recognized.
Mr. Raskin. Thank you, Madam Chair. Dr. Gupta, addiction is
a terrible brain disease as you have described it, and I
believe the administration has adopted an approach called harm
reduction of trying to help people recover from addiction and
trying to reduce the other lethal harms of the terrible traffic
in addictive drugs. Can you explain what is the overall theory
behind harm reduction, and what are the components of it, and
how well is it working now?
Dr. Gupta. Thank you, Congressman. Over my 25 years, what I
have seen oftentimes is, or the only time I will see somebody
is when they are dead in my emergency room. I will often see
them auto reversing and they go away. The fact is that where
people are utilizing drugs, where they are using, we are not
there. And where we are, four walls of the doctor's office,
hospital, they are not there because there is a lack of trust.
There is a lack of understanding, and the idea behind harm
reduction is to meet people where they are, engage them, and
build trust. And ultimately, what studies have shown is these
types of strategies allows more people to enter into treatment,
it allows more people to be saved, meaning in terms of saving
the life, and it is cost effective.
The administration is embracing proven strategies like
naloxone, the antidote, making sure people get them antidote
for opioid overdose. Because we talk about counterfeit drugs
that are out there in the community now, we are looking at how
do we get people to help be able to check their own drugs to
make sure that they are not playing Russian roulette each time
they are using those drugs. And last, the Syringe Service
Program that help us prevent the spread of dangerous, fatal,
and very expensive, lifelong diseases like HIV and hepatitis.
We have gone through a pandemic. We know what an epidemic or
outbreak of HIV and hepatitis looks like, and it is a proven
strategy to prevent that from happening. Those are the three
aspects that were in the Strategy mentioned with the goal of
making sure we are saving lives, first and foremost, and then
obviously engaging individuals.
Mr. Raskin. OK. And is that a policy that most of the
states and local governments are participating in along with
the Federal Government?
Dr. Gupta. Yes, Congressman, it has bipartisan support, and
it is one that has been adopted by many state and local
governments and have, as a result, saved lives.
Mr. Raskin. Well, how do you envision the role of the
national government going forward in expanding access to harm
reduction services? Obviously, we are in the thick of this
terrible crisis, and our people are suffering, and more and
more people are getting addicted. So, how can the Federal
Government become an instrument of actually getting assistance
to our people who need it?
Dr. Gupta. Thank you, Congressman. Harm reduction policies,
as me, as a provider and a local health physician, I can tell
you is all about building community trust, bringing all
partners together, including law enforcement, to build that
trust. The Federal Government can certainly, and Congress can,
of course, provide the resources that are needed for
communities to be able to, on a voluntary basis, if they want
to, pursue these, but also the ability to heal the community
through building trust, through connecting people back with
treatment and the offering resources that they need to move
forward. We have too many broken communities across the Nation
because of this crisis, and this is another opportunity to do
that, just that, with the resources, of course from Congress.
Mr. Raskin. OK. Thank you. I will yield back to you, Madam
Chair.
Chairwoman Maloney. The gentleman yields back.
Mr. Grothman, you are now recognized.
Mr. Grothman. Thank you. Can you hear me? Mr. Gupta, the
statistics I am looking at show that two Aprils ago, April
2020, 6,000 people crossed the border and were let in the
country. Most recent April, we are at 183,000. So far, from
6,000 in April to 183,000. Do you feel that that is a complete
and total embarrassment? How would you describe that
performance as far as its effect on what we are discussing
today, 6,000 to 183,000.
Dr. Gupta. Thank you, Congressman. I am having a little bit
difficulty hearing you. I believe you were comparing numbers.
Mr. Grothman. OK. We will say 6,000 people crossed the
border and were let in the United States in April 2020. The
most recent April number was 183,000, so we have gone from
6,000 to 183,000. Do you consider that a complete
embarrassment? And do you think we have to do something to get
back the policy that went up to 6,000 if we are going to reduce
the amount of illegal drugs flowing into this country?
Dr. Gupta. Thank you, Congressman. I believe, obviously, at
ONDCP we are concerned about the amount of obviously fentanyl
and other drugs that are trafficked across the Nation, but
globally. And one of the things that I think is really
important for us and for us to not lose sight of is where are
these drugs coming from, how are they being manufactured, and
obviously what is happening to the American people falling
victim to these poisonous----
Mr. Grothman. Do you care at all? Six thousand to 183,000,
does that bother you?
Dr. Gupta. Congressman, clearly it is important that we
have a robust border. And I do believe that, to the extent our
men and women are doing their job, they are doing their job,
and we need to provide them the resources that they need.
Mr. Grothman. Would you prefer to go back to the system or
the rules under which they operated two years ago when they had
6,000 people crossing instead of 183,000?
Dr. Gupta. Frankly, Congressman, I would prefer to go back
to a place where we didn't have literally any overdose deaths,
and the fact is that we have too many overdose deaths. Over a
million Americans have died, and we have got----
Mr. Grothman. OK. I will give you another question if you
don't want to answer that one. Given the huge number of deaths,
the 110,000 from illegal drugs, 12-month period, do you feel
more people than now should be put in prison for selling or
trafficking these drugs in general and fentanyl in particular?
Dr. Gupta. Congressman, I believe that people who are
trafficking, manufacturing, and routing these drugs for the
sole purpose of profits need to be held accountable, and they
are our rule of law. No doubt about that.
Mr. Grothman. Right now, you were hearing 10,000. Do you
feel more people should be going to prison for trafficking or
selling fentanyl and all?
Dr. Gupta. I feel that people should be accountable for
their actions. Of course we have the most lethal drug supply we
have ever had in this Nation's history.
Mr. Grothman. Right. If we had to do last year over, do you
feel more people should be going to prison than now for the
10,000 deaths?
Dr. Gupta. Congressman, I think the responsible people
should be----
Mr. Grothman. OK, you don't want to answer the question.
Next question. Do you know what the total number of
professionals dealing with addiction and that sort of thing has
been, say, this year compared to 10 years ago when the problem
was not as bad? Could you give an estimate of the number of
people making their living as addiction professionals?
Dr. Gupta. Congressman, I can tell you we have significant
shortage of professionals for addiction medicine that----
Mr. Grothman. That wasn't the question. Can you just do me
a favor and answer one of my questions? Do you know the total
number of people working in this field today compared to, say,
10 years ago?
Dr. Gupta. I can get the figures for you, Congressman. I do
know we have significant shortages, but I can get you exact
numbers.
Mr. Grothman. OK.
Dr. Gupta. We have had significant turnover during the
pandemic as well, so that would be----
Mr. Grothman. OK. Now, the next question. I know people who
have been stuck in this addiction from all sorts of family
background. Nevertheless, I feel there are all sorts of
problems in our country that correspond to the decrease in
family backup. Do you have a statistics on either people who
die or people who are convicted for selling these drugs as to
their family background, or does anybody have those statistics?
Dr. Gupta. Of family background, Congressman?
Mr. Grothman. Correct. You know, what type of family
structure, family structure? You know, they have no father at
home, or they have mom and dad at home, they have no parents at
home. Does anybody collect those statistics?
Chairwoman Maloney. The gentleman's time has expired. The
gentleman's time has expired.
Representative Kelly, you are now recognized.
Ms. Kelly. Thank you, Madam Chair. The Biden administration
is committed to a health equity approach to addressing
substance use disorders and recognizes that, for far too long,
people have been unable to obtain treatment simply because they
experience low income or because they live in a community
lacking adequate recovery resources. President Biden's National
Drug Control Strategy aims to address the systemic health
disparities that previous administrations have frankly ignored.
Director Gupta, I understand that there is a link between
unemployment or experiencing low income and substance use
disorders. How has the administration been addressing this and
other root causes?
Dr. Gupta. Thank you, Congresswoman. I think one of the
aspects that this strategy looks at is the underlying factors,
and it is important for us to understand the childhood
experiences matter. We call them adverse childhood event, and
experiences, and ACEs. It is important that we know from this
data that somebody who has these types of events, five or more,
has almost tenfold increased risk of using illicit drugs, also,
overall, lack of education, less likely to have or hold a job.
So, these things are all connected. But when we look at the
underlying factors, we look at things like housing, things like
job, economic security, food security, all of those aspects are
important to a person's not just survival, but also thriving.
So, it is important for us as we work with other agencies, like
HUD, or Transportation, or others, to make sure that we are
looking at the entirety of the picture of communities and
addressing it from that perspective as well.
Ms. Kelly. Yes. I was going to ask, how does the
administration plan to utilize prevention methods to
specifically address the social determinants of health?
Dr. Gupta. Thank you, Congresswoman. One of the things that
we want to be able to do, as the President's HUD announcement
and President has taken a leadership on this, which is to make
sure that people have the housing needs that they need.
Especially in the area of substance use disorders, it is
critical, and that same thing goes for food security. It goes
for economics. It also goes, as I mentioned, for deflection, to
get people to help instead of incarcerating them. Those aspects
that are part of the Strategy allow us to build a more
resilient population, and actually, while making sure we are
focusing on primary prevention for school-aged children as well
so we can have a more robust future America which is really
important part of this Strategy.
Ms. Kelly. I know you have only been around not even quite
two years, but any improvements or any consequences of your
work already in ensuring equity when addressing treatment for
opioid use disorder? Have you seen any pattern changes by using
your strategies?
Dr. Gupta. As I mentioned, two weeks ago, CDC for the first
time demonstrated a 12-month pattern with fewer deaths than the
past, report a month ago. This is a very small amount of
change. We are hoping and expecting that as we continue this
effort, it will have more. We are also making sure we are
working with Department of Education to have information
disseminated to school districts around prevention messages as
well.
The President is committed to ensuring that equity is
something that we are looking at carefully, because we are
seeing for the first time some of the highest rises in overdose
deaths in African American population, especially black males.
The worst problem is that we also know some populations have
the most difficulty entering treatment. So, we are trying to
narrow those two gaps to make sure that we are, at the end of
the day, saving lives.
Ms. Kelly. Thank you. And is further research and
methodologies surrounding the social determinants of health and
substance use something the administration is prioritizing?
Dr. Gupta. Yes, Congresswoman, it is something that we are
making sure that we are looking into the research, not just to
what is, but what are those differences, how can we make it
better, how can we also look at treatments and prevention
aspects that could help us get to a place where fewer Americans
are using drugs, but fewer Americans are ultimately dying.
Ms. Kelly. Thank you so much. I just want to say we cannot
fully address substance use disorder without first addressing
its root causes and ensuring that marginalized communities
receive the support they need. And with that, thank you, and I
yield back.
Chairwoman Maloney. The gentlelady yields back.
Representative Biggs, you are now recognized.
Mr. Biggs. Thank you, Madam Chair. Dr. Gupta, thanks for
being here. Last month during a traffic stop, police in Pinal
County, which is not a border county, but it is in my state,
stopped two women for speeding. They found 500,000 fentanyl
pills. Last month, 500,000. Synthetic opioid deaths, including
fentanyl, up 23 percent from last year. Cocaine deaths, up 23
percent from last year. Meth and other stimulants, up 34
percent from last year. In Arizona, in a two-month period, the
end of last year, seized more than 3 million fentanyl pills.
And, Madam Chair, I ask that this article be put into the
record.
Chairwoman Maloney. Without objection.
Mr. Biggs. Thank you. Thank you so much. And also, Dr.
Gupta, just two weeks ago at Calexico, at the POA there, they
found 55 pounds of fentanyl stuffed into a gas tank coming
across the border, so, hallelujah, they are stopping some. Here
is the score: 2018, Pinal County zero fentanyl pills; 2019, 700
fentanyl pills, 2018-2019; 2020, 200,000-plus fentanyl pills;
and then in 2021, more than 1.1 million fentanyl pills in that
county alone. Dr. Gupta, in your written testimony you state
the United States has a fundamental responsibility to protect
its borders and this is precisely what the Biden administration
has been doing. Just two months ago on the Judiciary Committee,
Secretary Mayorkas testified that the Biden administration had
operational control over the border.
Dr. Gupta, are you familiar with the Secure Fence Act of
2006?
Dr. Gupta. I am aware of it.
Mr. Biggs. So, here is how they define operational control:
``the prevention of all unlawful U.S. entries, including
entries by terrorists other unlawful aliens and instruments of
terrorism, narcotics, and other contraband.'' You wouldn't say
that our border is operationally secure knowing the amount of
narcotics that are coming across, would you?
Dr. Gupta. Well, Congressman, what I would say that our
border is secure, but there is a lot more we can do.
Mr. Biggs. You are saying the border is secure. OK. Well,
see, that kind of undermines the credibility, so let me let me
go through this. You say approximately 92 percent of the heroin
seized and tested in the U.S. is from Mexico. Ninety-two
percent of the drug that is killing Americans is smuggled over
our Southern border. That is not operational control. So, let
us go through just a little bit more. According to the DEA, 42
percent of pills tested for fentanyl contained at least 2
milligrams of fentanyl, which is considered a lethal dose. In
the eight Texas ports of entry, they saw over a 1,000-percent
increase in seized fentanyl.
But here is the deal. You said that that is a great sign,
and it is good, we are stopping some of it. But Brandon Judd,
who is the president of National Border Patrol Council,
testified under oath this year that CBP is lucky if they seize
even five percent of what is coming over the border. You
understand what I am saying, right? The ratio indicates that we
are failing in interdicting drugs, and yet you are telling us
that the border is secure.
And you said that you have visited the border in two places
San Ysidro and El Paso. I would love for you to come with me.
Just you and me, incognito. We don't tell them I am a
Congressman. We don't tell them that you are the director of
the National Drug Control Policy. We won't tell them that. Just
you and me, come on down. We will go to the border. I will take
you to places where you can watch what is happening. You can
watch our men and women of CBP overrun. So, there are literally
hundreds of miles unprotected, which is where drugs are coming
in. We will find a place. We will watch people come across in
camo, carpet shoes, backpacks on, carrying drugs. I am happy to
do that with you.
And when you say we want to do $300 million to get
interdiction materials, and you want to make sure you have high
tech and you want to have all of that, fantastic, but you know
what? When you talk to Border Patrol agents, and if you come
with me, we will talk to real Border Patrol agents and even
managers who will tell you, if they don't know who you are, and
they know they can trust you, they will tell you what is going
on. And they will say, look, we may need more resources, but
you know what we really need? We need the policy so we can
enforce the law to secure our border.
And as long as we fail to do it, then we will continue this
rather inhumane approach to the borders where you have drug
trafficking, you have human smuggling, you have human
trafficking coming across. You have people like the lady who
was wandering around in the desert, found by some sheriffs'
deputies just about a month, actually about two months ago now.
Why are you carrying those pills? What are those pills? They
are morning-after pills because I knew I would be raped
repeatedly coming across.
Dr. Gupta, it is incumbent upon you before you can solve
the problem that you are trying to solve, and I appreciate you
are trying to take a full-on multifaceted approach. It is a
huge task. I don't envy you the task. But as long as you are in
denial on what is happening on the border, you are not going to
solve the biggest part of this, and that is the smuggling that
is coming across. So Dr. Gupta, I do extend to you an
invitation to come with me down to the border. I go often. I go
to a lot of places, and I would love to have you there with me.
And with that I yield back. Thank you, Madam Chair.
Chairwoman Maloney. Representative Wasserman Schultz, you
are now recognized.
Ms. Wasserman Schultz. Thank you, Madam Chair, and thank
you, Director, for your testimony and to the work of your
office, as well as the Biden-Harris Administration's effort to
combat this crisis. And let me just state to the record that
your efforts are the furthest thing from not understanding what
the crisis is. And in my experience with you and the
conversations I have had with you, it is very clear to me that
you understand the depth of the crisis, and also clear to me
that immigration policy and border policy is not in your job
description.
So, our colleagues on the other side of the aisle in this
committee talk a lot, a good game about focusing on what we are
actually responsible for. That policy is not what we are
responsible for in the Oversight Committee. But I do want to
talk about an issue that directly affects my home state of
Florida, and any of the deadly dozen states that haven't
expanded Medicaid, how inadequate health insurance coverage
contributes to our Nation's addiction and overdose crisis.
Research shows that overdose rates are lower in states that
expanded Medicaid coverage under the Affordable Care Act. In
fact, states that expanded Medicaid coverage experienced at
least 10-percent fewer overdoses involving synthetic opioids
like fentanyl, and 11 percent fewer overdoses involving heroin
when compared against states that haven't expanded Medicaid.
So Director Gupta, how would further Medicaid expansion
combat the opioid epidemic and improve access to treatment and
recovery for individuals experiencing substance use disorder?
Dr. Gupta. Thank you, Congresswoman, and I really
appreciate the efforts and the fact that we were able to see
some offloads. Once again, the interdiction aspect is so
important.
Ms. Ms. Wasserman Schultz. Yes. Yes.
Dr. Gupta. The treatment part is so critical because as we
try to get people the help, one of the reasons people do not
get the help is because they don't have the coverage, and the
very people that we are trying to help often cannot afford to
see a physician or a provider, and that is tragic, and that is
unfortunate. So, we know that there is a direct link between
increasing access to care and getting actually the care, and it
is critical. That is probably one of the most important pieces
of the backbone that we are going to need to solve this crisis
and save the 107,000 lives or perhaps increasing number in the
future. So, access to care is a critical component, and
obviously, people who get it are able to then have at least one
more issue that they don't have to worry about while seeking
care.
Ms. Wasserman Schultz. Absolutely, thank you. And I mean,
we are all painfully aware of how the addiction and overdose
crisis has impacted our Nation's young people. In fact, the
final two years of the Trump administration, the overdose
mortality rate among U.S. adolescents went up 94 percent, and
this crisis also affects young adults, especially those who may
struggle to find adequate health insurance. And let me tell
you, you and I together saw firsthand the efforts that are
being made with an entire depth full of interdicted drugs in
South Florida that were brought in, among the largest
interdictions of drugs in our history that the Coast Guard was
able to recover, and you and I were there to witness it. So,
any suggestion that there isn't every effort being made to
interdict the smuggling of illicit drugs is erroneous.
So, I want to also just focus on Medicaid expansion and how
it would help young adults acquire health insurance. How would
increased access to health insurance lead to access to
effective treatment and recovery and, thus, improved outcomes
for young adults and for society generally? I mean, again, we
have 12 states in the country, mine included, that have not
expanded Medicaid, and as a result, the rate of drug overdose
is higher in those states than it is in those states that have
expanded Medicaid.
Dr. Gupta. Thank you, Congresswoman. First of all, it is
important to note that about half of the people with substance
use disorder have mental health and vice versa. So, this
overlap in mental health, that also is part of the importance
of access to care. It is true and tragic that young people are
perishing at higher rates than ever before, because of the
overlap of the two. It is also true that majority of people
that have the 107,000 deaths that happen are between 25 and 54
years of age. That means that is our working-age population
across this country, that we are losing 100,000 people at a
time, every year. So, if you think about it from economics, if
you think about it common sense, if you think about it from the
ability to get people, the ability to feel that they get help
and overlap is critical.
Ms. Wasserman Schultz. It is basic math. Really, what it
boils down to is. If you have health insurance, if you can
afford to pay for your healthcare, you are much more likely to
be able to get access to that care and prevent either ever
being addicted to drugs in the first place and be able to
overcome substance use disorder in the second place. So, I
appreciate your explanation of how expanding Medicaid is
absolutely vital in our fight against this terrible crisis.
The Affordable Care Act provides a powerful tool to fight
addiction and overdoses, yet Republicans, like Florida Governor
Ron DeSantis, refused to expand Medicaid to reduce the misery
and death that this disease brings on. Sadly, because Governor
DeSantis is immune to facts, science, and even the shame of
adding to the overwhelming grief that families must endure,
because of his callous inaction, he is not likely to be moved
to act. But that doesn't mean we stop calling out his and other
Republican Governors' cruel indifference and how it compounds
this crisis and adds to the pain that millions of American
families will suffer.
Thank you, Madam Chair. I yield back the balance of my
time, and, Dr. Gupta, thank you so much for your service.
Chairwoman Maloney. Thank you. Wasserman yields back.
Representative Fallon, you are now recognized.
Mr. Fallon. Thank you, Madam Chair. Dr. Gupta according to
the DEA, the illegal smuggling of narcotics in our country has
increased dramatically over the last two years. Do you agree
with the DEA's assessment that smuggling of cocaine and
methamphetamine and fentanyl is on the rise?
Dr. Gupta. Congressman, we are seeing an unprecedented drug
supply environment that this country has never seen before.
Mr. Fallon. OK. And I thought it was interesting too,
Doctor, that the DEA said the only major drug that is actually
on the decline as far as vis-a-vis illegal smuggling is heroin,
but it is only because fentanyl has replaced it because it is
cheaper, it is easier to smuggle, and there is greater profits,
and it is a lot deadlier. And, Doctor, is it accurate to say
that fentanyl is, I think it is 50 times more powerful than
heroin and 100 times more powerful than morphine. Is that
accurate?
Dr. Gupta. Congressman, that would be accurate. I just
wanted to mention one thing----
Mr. Fallon. Sure.
Dr. Gupta [continuing]. that we are seeing a transition
from plant-based organic compound, like heroin, to synthetics,
and a Pandora's box has been opened with the lab production of
synthetics like fentanyl.
Mr. Fallon. OK. And then I think this is important from
your testimony, one of my colleagues, but the country that the
lion's share of these drugs are being smuggled from and into
our country is which country again?
Dr. Gupta. Obviously where they are being produced is
Mexico, but obviously it is other nations like China from which
the resources are coming from.
Mr. Fallon. Right. So, is it fair to say most of the
methamphetamine that is smuggled in to the country is produced
in Mexico, and most of the fentanyl is produced in China. But I
also heard from some of our DEA agents that fentanyl production
in Mexico is also on the rise. Is that accurate?
Dr. Gupta. Congressman, as of today, for North America or
for United States actually, the precursors are shipped for both
of these predominantly from China, production for fentanyl and
meth happens in Mexico, and obviously Americans bear the
burden.
Mr. Fallon. Sure, because, you know, you can understand my
concern. I mean, when you have 107,000 deaths, American deaths
due to drug overdoses, mostly opioids, and I think you just
said 80,000 to fentanyl alone. My home state has a 1,254-mile
border with Mexico, which has been proven time and again to be
a de facto narco-state. And here we have the worst on record
for illegal encounters was April with 234,000, but then that
record was broken in May with a nearly 240,000 illegal border
crossers. And during the Biden administration, 2.9 million
illegal border encounters and 700,000 known got-aways, so that
is at least 3.6 million. And if only one percent of those folks
that are crossing the border are smuggling narcotics, even
small amounts, that is 36,000 times. That is remarkable.
So, here are some stats. The Customs and Border Patrol
estimate that during the Biden administration, over a million
pounds of illegal narcotics have been seized along the border,
and 7,000 pounds of fentanyl, which is enough to kill every
American multiple times over. So, Secretary Mayorkas last year
testified in front of the House committee that the border was
secure, and he then reasonably said there was operational
control, and I was a little surprised. I think my colleague,
Representative Biggs, did an outstanding job in his
questioning. I just want to hear this again. Your testimony is
as that Director of the National Drug Control Policy for the
Biden administration, that our border is secure. Is that
correct, because that is what you said to him.
Dr. Gupta. Thank you, Congressman. We believe certainly
that the border is secure with respect to making sure that we
are seizing both the drugs but also the counternarcotics
aspect. We are partnering closely with Mexico to ensure that,
because the problems do not begin or end at the border when
they are concerned with narcotics and other illegal drugs, we
want to make sure we are addressing the causes of production,
the causes of transportation, the routes, as well as shipment
from China----
Mr. Fallon. And, Doctor, I apologize. I have to reclaim my
time only because I have five minutes, but I am just shocked. I
think that is shockingly inaccurate, and it is just shows just
gross negligence. I mean, a porous border is a dangerous
border, and it is an immoral border. And the Mexican drug
cartels, the fact of the matter is, are controlling our
Southern border, not our Federal Government. And that is a
gross dereliction of duty from this administration that is
putting Americans at risk. And we see that in Texas with the
political shift. Folks are leaving in droves the Democratic
Party and coming to the Republican Party because they are sick
of the chaos, the corruption, the cartels, and the crime.
Madam Chair, thanks very much. I yield back.
Chairwoman Maloney. The time has expired. And to followup
on the discussion we just had, I would like unanimous consent
to enter into the record President Biden's 2021 Executive Order
imposing sanctions on transnational cartels and drug
traffickers. Just this year the administration has extradited
10 transnational criminals from Mexico to the U.S., including
several top cartel operatives. The administration has also
sanctioned another 26 operatives and 10 trafficking
organizations. So, the truth is the Biden administration has
been aggressively going after the cartels.
Now I would like rec to place it in the record.
Voice. Without objection.
Chairwoman Maloney. Without objection.
Chairwoman Maloney. Now, Congressman Ro Khanna, you are now
recognized.
Mr. Khanna. Thank you, Madam Chair, and thank you for your
leadership. It is clear that the Sackler family and Purdue
Pharma, alongside with other major pharma companies, are
responsible for massive crimes on the American public and the
harm that they have caused with the opioid epidemic. We should
read Beth Macy's work on this. They need to be held
accountable. They shouldn't be able to hide behind bankruptcy
court or shield their assets for the crimes they have committed
on the American public.
My questioning wants to focus on the current research that
shows that cannabis can be a key alternative to opioids when it
comes to relieving pain. Access to cannabis is associated with
the reduced rates of opioid use and abuse, reduced rates of
opioid-related hospitalizations, reduced rates of opioid-
related traffic facilities, reduced rates of opioid-related
drug treatment admissions. One study showed a 64-percent
reduction in opioid use amongst chronic pain patients who use
medical marijuana.
Dr. Gupta, I appreciate your leadership. I imagine you and
the administration are aware of these studies. Is that true?
Dr. Gupta. Thank you, Congressman. We are closely
monitoring these. As someone who has implemented a medical
cannabis program in the state of West Virginia, I understand
this work, and we are monitoring those studies as well.
Mr. Khanna. Thank you, Dr. Gupta. Would you say, based on
your experience, that it is true that cannabis use is an
effective alternative for chronic pain patients?
Dr. Gupta. There is evidence to suggest that in cases of
certain chronic pain, cannabis can be efficacious.
Mr. Khanna. Dr. Gupta, when it comes to acute pain, what
category do opioid prescriptions fall under? Do you know, or I
can let you know if you don't.
Dr. Gupta. Most of the opioid prescriptions are Class 2.
Mr. Khanna. Exactly. Exactly, Schedule II. And yet,
cannabis is still categorized as Schedule I, as a Schedule I
drug, which is the most heavily restricted category and which
prohibits scientists and researchers from conducting rigorous
large scale-studies on cannabis. Just to be clear, this means
that cannabis has more restrictive policies then currently
opioids have, even though opioids have killed tens of thousands
of Americans. Do you see this, Dr. Gupta, as a contradiction
that needs to be resolved?
Dr. Gupta. Thank you, Congressman. Clearly the President
has been clear about this in regards to the decriminalization,
but also it is important for us to continue to look at this
from a research perspective, from a medical use perspective,
but it is clear the policies that we have had in this country
with regards to marijuana have not worked, and the President
has said so.
Mr. Khanna. I appreciate that, Dr. Gupta, and I admire your
public service. I know you have to be careful not to get ahead
of the President, and you are being appropriately diplomatic in
your responses. But the President has the executive authority
to direct DEA, HHS, and FDA to consider administratively
rescheduling marijuana, which would facilitate research, which
would facilitate patient access. I am for legalizing, at the
very least decriminalizing, but the President could at least
make sure that it is rescheduled so it is not more restrictive
than opioids themselves. Dr. Gupta, you don't have to make
public comments, but can you assure the committee today that
privately, at the very least, you will urge the President and
the administration to follow the best judgment of science here
and medical research, because that can really help in solving
this problem.
Dr. Gupta. Thank you, Congressman. I think it is the
foundation for so many ways to proceed forward, including our
current Strategy, is to follow science, follow data, and I can
commit to you that we are going to continue to do that.
Mr. Khanna. Thank you, Dr. Gupta. I just would hope you and
the administration really will consider the rescheduling, and
to look at what can make a difference in patients' lives, and
resolve this discrepancy where currently cannabis, which is
actually more effective and isn't killing thousands of people,
is more restrictive than the opioids that have done so much
harm in American life. And I appreciate your public service, I
appreciate your work, and thank you for appearing before this
committee.
Dr. Gupta. Thank you.
Chairwoman Maloney. Thank you. The gentleman yields back.
Representative Donalds, you are now called upon.
Representative Donalds?
Mr. Donalds. Thank you, Madam Chair. Dr. Gupta, thanks for
joining us. Quick question, Doctor. You were talking about
transportation of fentanyl and other opioids, routes,
manufacturing. You mentioned that there is precursor that comes
from China. Wouldn't you say that most of the actual pills that
are pressed with fentanyl are actually manufactured in Mexico?
Dr. Gupta. Congressman, yes. They are manufactured in
Mexico after production.
Mr. Donalds. OK. So, they are manufactured in Mexico, and
then where do they go from there?
Dr. Gupta. Congressman, they are often trafficked. We know
that they end up in the hands of unsuspecting Americans
oftentimes----
Mr. Donalds. So, how are they are trafficked into the
United States, Dr. Gupta?
Dr. Gupta. Well, we understand that they are trafficked
across all routes, from land borders, sea border, ports of
entry, air, as we have been discussing. So, there is all----
Mr. Donalds. Dr. Gupta, I have a question, side question,
but it is on the point of trafficking itself. Wouldn't you say
it would be better for Border Patrol agents to be fully focused
on the trafficking of narcotics as opposed to processing people
coming across the border at an illegal point of entry?
Dr. Gupta. Congressman, I think you are trying to get to
the point of resources, I guess, and the fact of the matter is
that we have to be able to do both. But when it comes to
counternarcotics----
Mr. Donalds. Dr. Gupta, to your point about resources,
resources are finite. There are only about so many resources
you actually have at your disposal. We know that there are only
about so many men and women of Border Patrol at the disposal of
the United States. So, would you say it will be more effective
drug policy to have Border Patrol agents actually monitoring
drug trafficking than processing people with asylum
applications who are coming to an illegal point of entry?
Dr. Gupta. Congressman, what I would say to you is, it is a
distribution of resources. The President has asked for budget
to match that, but we must also look at the profits that are
driving the transnational criminal organization. I say this
because it is not only drugs. These are poly crime
organizations that are involved in smuggling people, they are
smuggling guns, they are smuggling cash.
Mr. Donalds. Dr. Gupta, I actually completely agree with
what you just said. They are smuggling people, drugs, cash, and
weapons. So, if we know these things, as you just alluded,
isn't it the best policy from the White House, and then
definitely with respect to your purview in the administration,
so make sure that border agents are focused on trafficking of
all of these things as opposed to just processing people just
on the border, because let me add this point to my question.
Fine point.
I have been there four times. I know the President has not
been, but I have been there four times. When a border agent is
at the Southern border and a group of people come out of the
brush crossing our border illegally, the border agent, as
usually just him by himself or herself, has to stop actually
patrolling the section they are responsible for, and they have
to go through the process of doing intake of everybody that
approached them. I was at a border stop where people came
across illegally about a week ago in McAllen, Texas. I
witnessed this firsthand, and that agent is now distracted.
Now, at that time, when that agent had to deal with people
coming across the border illegally, on the radio, there were
runners coming through the McAllen section who did not want to
give themselves up. And I would assume they were running with
narcotics, namely fentanyl.
So, I am going to go back to the original point of
questioning here. Isn't it better policy in the United States
for border agents to be focused on trafficking from the drug
cartels and multinational criminal organizations, as opposed to
actually going through the process of processing people coming
into our country at an illegal point of entry?
Dr. Gupta. Congressman, I hope we can do both, and I hope
we can do both because what drives----
Mr. Donalds. Well, hope is not the strategy, Dr. Gupta.
Hope is not a strategy. Hope is wishful thinking. The reality
is, as you already dictated, there are finite resources. It is
only about so many border agents. So, if you have to choose,
which one do you choose, Dr. Gupta?
Dr. Gupta. Congressman, if we follow the strategy that is
laid out, the President's strategy, Drug Control Strategy, I
think you will find a number of technological aspects for both
detection and deterrence that allow us to actually save money
by using technology for that, but we must go after the profits
of these transnational criminal organizations. They are not----
Mr. Donalds. I completely agree with you, Dr. Gupta. I am
going to reclaim my time. We go after their profits. The No. 1
thing we do is we actually stop processing people at an illegal
point of entry because then they won't pay the drug cartels.
Those are profits to traffic them into the United States. The
drug cartels are using human trafficking into our country as a
way to actually increase drug trafficking into our country,
which is a direct thing that goes with the amount of fentanyl
deaths in the United States.
Thank you, Madam Chair, for the indulgence. I yield back
the rest of my time.
Chairwoman Maloney. The gentleman's time has expired. OK.
Representative DeSaulnier, you are now recognized.
Mr. DeSaulnier. Thank you, Madam Chair. Thank you, Doctor,
for being here. Thank you for your lifetime work in this field.
I want to talk to you a little bit about and very much
appreciate the evidence-based approach. We have had success in
a bipartisan way on criminal justice reform. We have had people
like the Heritage folks agree that evidence-based research
policies can work and they are effective, and they clearly work
when it comes to substance abuse. Only 30 million Americans,
who have substance abuse problems, almost 70 percent of them
say they are either in recovery or have recovered. For those of
us who are familiar with recovery, there is certainly an
argument to be made you are always in recovery once you have
become addicted.
One of my frustrations, Doctor, is, and I am sure it is
yours as well, the scale of this country, your institution. I
was at an event this Sunday for a sober living nonprofit that I
have been involved with since I was in local government 30
years, myself and the presiding judge of our drug court, who is
a Republican nominee. And we were talking about, ironically,
the last comments about hope and the hope of having programs
like that at a community level where users and families, users
of services, addicted people, can see them work because of the
evidence-based research.
So, the frustration is getting the Federal Government to be
in the role of, from my perspective, identifying those programs
that work and then incentivizing investments in that programs,
in those programs at a community level. Could you speak to
that, both your frustrations and the successes? I look at
places like Johns Hopkins and UCSF here where I live, where the
exponential research and understanding of addiction and
neuroscience is so wonderful, but then deploying that to the
communities that need it are so frustrating.
Dr. Gupta. Thank you, Congressman. I think it is an
important piece to understand at least two-thirds of people
that are incarcerated have a diagnosis of substance use
disorder or addiction. Therefore, it is important, first of
all, to think about all the programs that could do a pre-arrest
diversion, like deflection programs. We have just put out a
state model law that put public safety and public health
communities to work together, to get people the help they need
in lieu of arrest and incarceration. It says money is common
sense. Second, drug courts. I want to make sure that before
either pre-trial diversion, drug courts, and other aspects like
that, we have robust training. The Strategy calls for ensuring
that people have the opportunity for non-violent crimes to
have, to move on, to make sure that happens.
Treatment for people incarcerated is critical, and we are
doing that because people become more productive. The death
rates declined significantly at the scene in states like Rhode
Island when we can treat people, and recidivism in all quarters
costs go down as well. And then, reentry. It is important to
make sure that when people are ready to reenter society, we get
them the tools that need to be successful, and that is where
treatment continuing and community connection become important.
And then recovery support services. Understanding the recovery
is not about a treatment only, but it is about all the support
that individual needs with their health, with their home, with
their community, and with their purpose in life to make sure
that they have all of those surrounding services and supports
to make them successful across the lifetime.
Mr. DeSaulnier. A followup on that. Having had multiple
discussions with Secretary Walsh, and a member of the Education
and Labor Committee, and chair of that committee's Health,
Employment, Labor, and Pension Subcommittee, and with Xavier
Becerra, a good friend, how do we coordinate those services? So
again, at the community level, years ago I had a conversation
when I was in the legislature, and we were dealing with both
criminal justice reform that has been successful here in
California and the ACA. I had the warden of San Quentin tell
me, why are you surprised that we release people from here back
into your district in Richmond, California or Oakland, and they
are back here within a month when we only give them $200 and
say ``good luck.'' So, how are we coordinating those services
at the Federal level and at the state level?
Dr. Gupta. At a Federal level, Congressman, it is important
for us to be working together. That is where ONDC comes in with
the Strategy because it allows us to work with Health and Human
Services, with Labor, with HRSA, with making sure that we have
both recovery-ready work force as well, but also recovery-ready
employers and employment places that allow that to happen. So,
it is a matter of coordination, and that is exactly what we are
doing by bringing all the 18 drugs controlled by the Agency
together and work on it collectively.
The state level, I am proud when I talk to leaders, like
Governor Sununu in New Hampshire, who is actually leading
recovery-ready work force, recovery-ready workplaces. I visited
him, and I was happy to see how far we are moving when we
decided that this is the right thing to do because it makes
sense. And there are Governors across the country that are
actually moving to understand it is effective. There are 23
million Americans that the President called out in the State of
Union speech that are on path to recovery. We need to support
them and do everything we can to provide them the resources.
Mr. DeSaulnier. Thank you, Doctor. Public health is public
safety, right? I yield back.
Dr. Gupta. Yes, sir. Thank you.
Chairwoman Maloney. Representative Comer, you are now
recognized.
Mr. Comer. Thank you, Madam Chair. Dr. Gupta, is fentanyl
the deadliest drug currently coming across the border?
Dr. Gupta. Congressman, there are some others, but
predominantly it is.
Mr. Comer. And is fentanyl being manufactured in
clandestine labs on the Mexican side of the border?
Dr. Gupta. Yes, Congressman.
Mr. Comer. And when they are manufacturing these synthetic
opioids, where are they obtaining the precursor chemicals from?
Dr. Gupta. Mostly from China, Congressman.
Mr. Comer. What is this administration doing to hold China
accountable for helping the cartels create and distribute
fentanyl?
Dr. Gupta. Congressman, I agree with the words of Secretary
Blinken, who spoke recently about China policy, which is that
we have to work with the PRC to make sure that the criminal
elements within the PRC are held to account. And if China is to
be the global leader and demonstrate the leadership, that it
must actually be held accountable.
So, one of the things we are doing is I am working very
closely with our Ambassador, Nick Burns, in Beijing to see how
we work together. We have very specific asks of the People's
Republic of China, and we have provided them the asks, both in
meetings as well as in writing. Those asks are that we want you
to make sure that there is labeling and you are following the
uniform international shipping standards. We want you to make
sure your companies know the customer, KYC, Know Your Customer
protocols all the way to the end user, and making sure that
some of these dual-use chemicals, we are keeping a track and
working mutually to do that. Now that spoken----
Mr. Comer. Let me reclaim my time there. You know, we
obviously don't feel that that is a firm stance with China. We
all know from history, China is not the most truthful country
we deal with. They steal our patent. They steal our
intellectual property. They are contributing to the fentanyl
crisis we have here in America. Now back to the Mexican drug
cartels, they smuggle both people and drugs in their
operations, correct?
Dr. Gupta. Correct.
Mr. Comer. Are the cartels using their human smuggling
operations to facilitate their drug smuggling operations?
Dr. Gupta. Congressman, we believe sometimes they are and
sometimes they are not, so it depends. There are reasons for
both.
Mr. Comer. Well, I can tell you, and the reason you have
had so many questions is the Republicans on the Oversight
Committee, we have been to the border numerous times, and the
drug cartel tell us that, in fact, that drug cartels use human
smugglers to get their fentanyl across the border. So my
question, sir, is why was the Southern border only mentioned
twice in the National Drug Control Strategy for 2022?
Dr. Gupta. Congressman, I might point to you that part of
the responsibility ONDC is to provide border strategy. So,
there is an entire accompanying document that focuses just on
the border strategy: the Southwest border, the Caribbean
border, and the Northern border. So, there is an entire
complement that has the border strategies, the full written
complement.
Mr. Comer. Dr. Gupta, you know, you have been asked this
question by many Republicans on the committee, and I am going
to give you one last opportunity to answer the question since I
am the last question, and I want to remind you that you are
under oath. But do you believe the Biden administration is
doing everything it can to control the illicit flow of fentanyl
across the Southern border?
Dr. Gupta. Congressman, I believe we can do more, and I
think we need to do more. And I believe part of that requires
making sure that we are holding Mexico and Mexican Government
accountable with the same level of energy and enthusiasm that
we are working on South Dong, gun trafficking, as well as cash
trafficking. We want them to act accordingly and as robust as
we are because we put a lot of resources into Mexico. We could
do more in terms of President's budget and making sure it kind
of helps us with making sure that folks have the technology,
the resources, as well as infrastructure. We think we can do
more to stop the shipment of precursors from China and make
sure the next country in the line does not substitute for that.
Mr. Comer. And I will close with this. My time is about up.
You know, there aren't many areas right now, unfortunately,
where there is bipartisan agreement in Congress. There is one
agreement that the fentanyl is coming across the Southern
border, and this administration needs to do more. When you ask
for more funding and when we talk to the Border Patrol, they
say that this administration continues to do things to tie
their hands, like the recent announcement to suspend Title 42,
that is only making the illegal border crossings significantly
increase. When the border crossing increases, there is more
drugs at----
Chairwoman Maloney. The gentleman's time has expired.
Mr. Comer. Now this administration is going to have to get
serious. Madam Chair, I will wrap it up here. You can't have a
committee hearing on the National Drug Control Strategy and the
Federal response without addressing the crisis at the Southern
border, and that is what we have is a crisis. And this
administration's response is substandard and certainly making a
bad situation worse. I yield back.
Chairwoman Maloney. The gentleman yields back.
Representative Tlaib, you are now recognized.
Ms. Tlaib. Thank you so much, Chairwoman, and thank you Dr.
Gupta for being with us today. You know, I know addiction is a
critical issue. You know, even as my colleagues focus so much
on some of the border and immigration policies, I know within
our own country, we just have not done enough to push back in
understanding or push back on this rhetoric that we don't have
a substance abuse issue and problem in our country, especially
with even some, you know, legal pharmaceutical companies
pushing, you know, contributing to the opioid crisis right here
at home. And many of my colleagues continue to actually benefit
through political contributions from some of the same folks
that continue to push those drugs onto our families.
You know, one of the things I want to talk about is that,
you know, expanding access to an opioid overdose reversal
medication as you know, the current Narcan, would help achieve
so much in saving tens and thousands of lives, as you know,
Doctor. And we have seen in places like Massachusetts and
where, you know, Narcan distribution program reduce opioid
overdoses and deaths by an estimated 11 percent without
increasing opioid use.
And if I may, Chairwoman, I would like to submit for the
record a study to show some of the impact of that program, that
distribution program.
Chairwoman Maloney. Without objection.
Ms. Tlaib. Thank you. To maximize the lifesaving potential
of these treatments, it is imperative, as you know, Doctor,
that the overdose reversal medication are affordable and easily
accessible in every city and town across the United States.
Doctor, how does the current administration's National Drug
Control Strategy increase access to Narcan so it can be readily
available for people who need it the most, including those
historically neglected communities like mine? I mean, you
should know this, you know, seeing some of the information
coming out, I think, with the past decade, over 2,000 of my
fellow Detroiters lost their lives. Many corporate funding
pushed, you know, addiction on them. Of them, 364 overdose
deaths in 2019, 86 percent of those deaths were involved
opioid. And so what can you tell me that you all are doing to
increase the access?
Dr. Gupta. Thank you, Congresswoman. Naloxone or Narcan,
this is about making sure it is affordable and it is
accessible. And one of the things we are doing is making sure
that states have a set-aside amounts to be able to both acquire
as well as have a distribution plan to especially the most
vulnerable communities within the states to be able to
distribute. It does no good sitting on the shelf because it
expires. It is not saving lives. But we are very intentional
about making sure that we are removing the affordability aspect
of a naloxone and we are providing naloxone in the hands of
people who need it because we know that if we do not, we are on
track to have 163,000 deaths a year by 2025. But if we do what
the Strategy calls for, we can reduce that number literally by
half to 81,000.
And if you accumulate over the next three years, we are
talking about hundreds and thousands of American lives that can
be saved, and naloxone is lifesaving. For every dollar, there
is a $2,760 return investment. It is the biggest bang for the
buck in terms of saving lives, and it is a critical aspect of
the Strategy. So, we are moving forward to make sure that we
are working closely with HHS, with our other Federal agencies
and state partners, as well as local partners.
Ms. Tlaib. Well, thank you so much. One of the things as a
parent I want to talk about is, how do we have it accessible in
some of our high school and some universities and campuses,
because, you know, I have been hearing obviously an increase in
addiction played among our, you know, college age, I would say,
and youth. And so anything that we are doing in that regard?
Dr. Gupta. Thank you, Congresswoman. It breaks my heart
every time we see children especially die, unknowingly,
unsuspectingly, because of the abuse, a counterfeit pill. It is
important while we work on the supply side, we also make sure
that kids are aware. This is no different than learning CPR,
than having AED device in the wall. So, it is going to be very
important for us to make sure we are removing the stigma out of
this and getting people to understand this is about saving a
life, not making judgments, because we believe every life is
precious and it is worth saving.
Ms. Tlaib. Absolutely. And you know, again, as I look at
our country, if it is not this crisis of addiction, there are
others in the future, so we really have to try to work on this
holistically as well. So, thank you all so much, and I yield,
Madam Chair.
Chairwoman Maloney. Thank you. Before we close, I want to
offer the ranking member an opportunity to offer any closing
remarks he may have. Ranking Member Comer, you are now
recognized.
Mr. Comer. Thank you, Madam Chair, and, again, Dr. Gupta,
thank you so much for coming before this committee. We
appreciate your willingness to give us an update of what this
administration is focused on with respect to drug control. But
I think you heard loud and clear that Republicans are concerned
with the lack of border security along the Southern border, and
we get this from many conversations with Border Patrol and with
local law enforcement. Even in Kentucky, in rural Kentucky, my
drug task force agents tell me that all the fentanyl and all of
the crystal meth, which are the two main drugs of choice right
now on the street in rural Kentucky, in rural America, for that
matter, are coming across the Southern border.
So, I don't think it makes a lot of sense for this
administration to say they are focused on drug control when we
have a border that is wide open. And this administration
continues to do things to tie the hands of our border agents by
announcing that they are going to do things like suspend Title
42. We need to get serious about the border, and we need to
hold Mexico and China accountable for the drugs that they are
working together to manufacture in Mexico with inputs from
China that they are sending across the border. And I think that
we can do that, but this administration is going to have to
take this seriously and greatly reverse course with respect to
border security on the Southern border.
With that, Madam Chair, I yield back, and thank you again
for holding this hearing.
Chairwoman Maloney. Thank you for participating, and I
thank our panelists and all of my colleagues for participating.
And before I get to my closing statement, it is clear we need a
comprehensive approach to this crisis.
I would like to enter into the record a Customs and Border
Protection Study showing that as of 2019, 90 percent of heroin
and 80 percent of the fentanyl coming into the country, a lot
arrived at a legal border crossing point, and Trump's border
wall would not have stopped any of these opioids. And diverting
resources away from proven interdiction efforts to build a wall
would be poor use of taxpayers money.
So, I ask unanimous consent to put this U.S. Customs and
Border Protection Report into the record.
Without objection.
Chairwoman Maloney. The opioid epidemic has been ravaging
this country for years, and it has affected all of our
communities in red states and blue states. Often, it can feel
hopeless. But as we heard from Director Gupta, the Biden-Harris
Administration is committed to combating the opioid crisis that
has already made meaningful progress, and it has a clear
strategy to stop fentanyl from devastating our communities and
families. This clear plan is what gives me hope.
I am grateful because the administration has adopted a
public health and harm reduction approach that will help ensure
people with addiction receive lifesaving treatment regardless
of who they are and where they live. That includes the
director's announcement today that he supports extending the
use of telehealth services to provide medication for opioid use
disorder. The administration has also laid out a plan to build
on the success of seizing illicit drugs at our Southern border
by encouraging Federal, state, and local law enforcement
agencies to work together and by investing in the right
technology to keep our Southern borders secure.
Today's hearing makes clear that we cannot reduce the
prevalence of drugs in our communities through interdiction and
law enforcement alone, nor is it possible through public health
measures alone. Instead, we need to address both supply and
demand that requires a whole-of-government approach with public
health and law enforcement agencies working together to get the
job done. Every life lost to an overdose is a tragedy. The 2022
National Drug Control Strategy provides the roadmap to prevent
these tragedies and to finally address this crisis.
Now, Democrats and Republicans must work together through
legislation and appropriations to make this plan a reality. We
should start by passing my CARE Act, which would further expand
access to key resources like treatment, overdose reversal
medications, and fentanyl test strips by providing the
comprehensive sustained funding needed to finally overcome
overdose crisis.
So, with that, and in closing, I want to thank all of our
panelists for their remarks, and I want to commend my
colleagues for participating in this event.
With that without objection, all members have five
legislative days within which to submit extraneous materials
and to submit additional written questions for the witnesses to
the chair, which will be forwarded to the witnesses for a
response. I ask our witness to please respond as promptly as
you possibly can.
Chairwoman Maloney. And with that, this hearing is
adjourned.
[Whereupon, at 3:37 p.m., the committee was adjourned.]
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