Policies to Protect Our Communities From Illicit Drug Threats

We are, we are just going to get through some openings, so the fact that all the witnesses aren't seated is fine at this moment. The subcommittee will come to order, and the chair recognizes himself for five minutes for an opening statement. In today's hearing, we will discuss 14 bills aimed at protecting Americans from illicit drug threats. Illicit drugs continue to pose a serious and evolving challenge to American safety and national security, fueling overdose deaths, increasing crime, and putting immense pressure on law enforcement and public health systems. So far this Congress, we have gotten strong policies across the finish line to crack down on the illicit drug crisis that we see across the country. However, there is still more to be done to protect our communities from these lethal substances. This is an issue that affects particularly Virginia and Appalachia, where we have unfortunately been impacted by the opioid epidemic. I hear countless stories across my district of individuals taking illicit drugs and mixing them with drugs we will be discussing today, like xylazine and fentanyl. Many of these illicit drugs are coming from illegal pill presses, often with ingredients coming from China. Our local law enforcement have been on the front lines battling this crisis, and this hearing will give us the opportunity to build on the work this subcommittee did in passing the HALT Fentanyl Act, led by myself and Mr. Latta, and Support for Patients and Communities Reauthorization Act, led by Chairman Guthrie. The President signed both of these pieces of legislation last year. We will examine H.R. 1266, Combating Illicit Xylazine Act, led by Representative Pfluger from Texas. This bill would classify xylazine as a Schedule III substance under the Controlled Substances Act, while also protecting its legitimate use in large animal veterinary medicine. This is extremely important for my district because, according to the National Cattlemen's Association, Virginia's 9th District is the largest cattle-producing congressional district east of the Mississippi. H.R. 5630, an important data collection issue that is championed by Representative Houchin from Indiana, would require enhanced data collection and reporting for opioid use disorder diversion data as part of the states' plan for their substance use prevention, treatment, and recovery services block grants. H.R. 2004, Tyler's Law, is led by Representative Latta from Ohio. The bill would require the Department of Health and Human Services to complete a study on how frequently hospitals test for fentanyl in patients experiencing an overdose and then use its results to issue guidance on implementing fentanyl testing in emergency rooms. Also introduced by Representative Latta is H.R. 7970, the Strengthening Tools to Outlaw Poisonous Stop Nitazenes Act, which would permanently schedule nitazenes as a Schedule I controlled substance. H.R. 8000, the End Needless Distribution of 7-OH Act, led by Representative Bilirakis from Florida, would regulate synthetic versions of 7-OH as a Schedule I controlled substance. The Preventing Rogue and Equipment for Synthetic Substances Press Act, H.R. 7184, introduced by Representative McDow from North Carolina, would criminalize the intentional importation of unlisted precursor chemicals and related equipment used to manufacture controlled substances. H.R. 8005, the Stop Pills That Kill Act, introduced by Representative Evans from Colorado, would implement new penalties and close a sentencing loophole for counterfeit pill production. Representative Hageman from Wyoming champions H.R. 5880, the Fight Illicit Pill Presses Act, which would add a serialization requirement for pill presses and punches. H.R. 1227, the Alternatives to Prevent Addiction in the Nation, or PAIN Act, led by Representative Miller-Meeks from Iowa and Representative Barragán from California, which I am also a cosponsor of, would expand access for seniors to non-opioid pain management options in Medicare Part D. H.R. 2715, the Destruction of Hazardous Imports Act, introduced by Representatives Higgins and Carter from Louisiana, would grant the FDA authority to destroy any FDA-regulated products that pose a significant risk to U.S. public health found at our ports. We will also be discussing other bills that deal with addressing this illicit drug issue, and while some of these bills may need further work, it is critical that we continue to look for ways to restrict access to lethal and dangerous substances in order to protect American lives, strengthen public safety, and prevent further harm to families and communities nationwide. I look forward to hearing from our witnesses and to the discussion. I now recognize the ranking member of the subcommittee, Ms. DeGette, for her five-minute opening statement.

Thank you so much, Mr. Chairman. Today we're considering 14 bills related to illicit drugs and the crisis in substance use disorder in our country. Thanks to investments made by Congress and the Biden administration, drug overdoses are amazingly going down. In 2023, after climbing since the beginning of the COVID pandemic, overdose deaths started falling nationwide, but of course, any death is too many deaths. The reason though that they're falling is a strategy that puts public health first. Meet people where they are, provide support, get them to beat addiction. We can't forget the context in which all of this is hearing. A year of chaos at the public health agencies, during which billions of dollars of grants to fight substance use disorder have been slashed, hundreds of dedicated public servants have been fired, and a community of advocates whose only goal is recovery faces existential questions about the support of their government. I hear about this from people in Denver all the time. Earlier this year, President Trump issued an executive order on addiction. It says, quote, "The framework for addiction treatment should parallel that of other chronic diseases, utilizing evidence-based care, scientific advancement, continuous support, and community connection." I agree with that. I don't think anybody would disagree with that. But actions speak louder than words, and the actions we see from the administration and from the majority on this committee show they are just determined to go in the opposite direction, opposite of even what President Trump said will work. In a press release following the executive order, it bashed Biden administration policies like getting support out to people struggling with addiction and reducing harm, which are the very policies that helped to reduce overdose deaths. Last year, driven by the disastrous DOGE, this administration cut $1.7 billion in block grants administered by SAMHSA that supported exactly the tools described in the administration's plan. Blue states, including my state of Colorado, sued and they got their funding reinstated. But red states, which as the chairman said, have a huge opioid crisis, did not sue and they still don't have the funding, leaving their citizens, ironically really, leaving their citizens worse off and with fewer resources to address addiction. And today, many of the bills we're considering simply focus on criminalizing substances, not helping the people affected by the synthetic opioid scourge. We simply can't schedule, prosecute, and punish our way out of this. We've seen this over the years. We know time and time again we learn, and researchers confirm, that just upping a mandatory minimum fails at its stated goal of deterrence and certainly doesn't help anyone, especially when you're talking about addiction. We need to make sure that communities across the United States have the tools they need to educate, prevent, and treat. Addiction is a disease. We don't send people to jail for getting diabetes or cancer. We help them. We provide them with what they need to live a healthy life. For addiction, that might look like medication-assisted treatment, therapy, housing, and social supports and other supports to get life back on track. One bill we're considering today, H.R. 5629, goes the opposite direction. It rolls back groundbreaking policies to make medication-assisted treatment more available and help people build and live stable lives while getting treatment. One of our witnesses today, Dr. Olsen, was instrumental in developing these important policies, and I expect that today's hearing will reveal just how counterproductive this bill really is. Now, I'm glad that at least some of the bills we're considering today are positive. Tyler's Law will give hospitals guidance on testing for fentanyl poisoning, making sure that clinicians have the information they need to effectively treat overdoses. Tyler's mom, Julie, is here today, and I want to thank Julie for her tireless work to get this policy where it is. To build on this and to have a more productive hearing, we would consider legislation to reverse the chaotic cuts to government agencies whose job it is to tackle the overdose crisis and to empower communities to take care of the people who need it the most. I look forward to this discussion. I look forward to moving forward, and I yield back.

Gentlelady yields back, and now recognize the chairman of the full committee, Mr. Guthrie from Kentucky, for his five-minute opening statement.

Thank you, Chairman Griffith. Thank you for having us here today, and thank you for bringing all of our witnesses before us today. We appreciate that, and we're going to hear from a diverse panel about existing and emerging threats and discuss policies designed to help keep our communities safe. And it is not just the one with substance use disorder that we focused on in this committee, that said that they do need assistance, not just in the penal system or the judicial system. And I want to point out that the President actually signed into law the Support Act, focused on that. But the people that are purveying these need to be, need to be held accountable. And so we are focused on scheduling so the people that are selling these to the people and moving these to the people that are suffering from substance use disorder are able to, we're able to address them. These threats continue to evolve from opioids like oxycodone to heroin to illicit fentanyl, and now we have prevalence of xylazine, nitazenes, as well as synthetic 7-OH, known as gas station heroin. Bad actors are using illicit pill presses and fentanyl to make pills, including punches and dies and printing logos on those pills, making them look like legitimate prescription medicine. Doing that, somebody thinks they're actually taking a legitimate prescription medicine and they could be laced with one of these other drugs. That's why a lot of people are, we're having the deaths from people who are thinking they're taking something that's legitimate and it's not. And just last week, DEA announced a significant seizure in my home, the Commonwealth of Kentucky, from this past January. The DEA seized approximately 17 kilograms of fentanyl, two industrial-grade pill presses, and two kilobrick presses. According to DEA, this seizure prevented almost nine million potentially lethal doses of fentanyl from reaching our communities. I'm proud of the work we've done in this committee to crack down on the influx of illicit drugs and to uplift individuals and families struggling with substance use disorder. As I said, the President signed in the HALT Fentanyl Act, which did look at it from the judicial side and scheduling, but also the Support Act, as I said, to make sure that people have the support they need. And so I'm thankful for my colleagues who have worked on these bills. We have the bills before us, Combating Illicit Xylazine Act, to permanently place xylazine into Schedule III of the Controlled Substances Act, while ensuring veterinarians and farmers and ranchers can continue to administer the sedative to animals. And Stop the Nitazenes Act to permanently place the drug class of nitazenes into a Schedule I of Controlled Substances Act. And further the End 7-OH Act and place synthetic 7-OH into Schedule I of the Controlled Substances Act. And we'll consider a range of bills aimed at cracking down on the illicit distribution of pill presses. My understanding also is that some of the Narcan and the countermeasures that work for fentanyl do not work for these, and so we've seen an uptick in deaths after we've had a decrease in deaths. So I think we all need to work on these together. I think they all work together, but we must work to advance policy that ensures those who make, import, and distribute these poisons in our communities are brought to justice on behalf of families who have experienced such pain already. So I hope we can work together. I thank the witnesses for their participation, and I yield back.

Gentleman yields back. Now recognize the ranking member of the full committee, Mr. Pallone of New Jersey, for his five-minute opening statement.

Thank you, Chairman. After more than two decades of an overdose crisis that have devastated families and communities throughout the nation, we've finally seen signs of progress over the last several years. Overdose deaths declined by nearly 28 percent from 2023 to 2024. This was driven in large part by public health measures from the Biden administration, like expanding access to naloxone and medications for addiction treatment like methadone and bup. The Biden administration also increased availability of fentanyl test strips, which can detect the presence of fentanyl in drugs. And this progress is now in jeopardy as federal funding for addiction treatment and overdose prevention is gutted. While focusing on illicit drugs in our communities, we can't ignore the chaos that the Trump administration has brought to the Substance Abuse and Mental Health Services Administration, or SAMHSA, the agency responsible for addressing the opioid crisis. The Trump administration proposed eliminating the agency altogether, but in the meantime, it has slashed substance use and recovery funding and reduced staff at the agency by more than half. Just this January, the agency abruptly cancelled over $2 billion in grant funding for mental health and substance use treatment, saying that the programs don't, quote, "align" with the Trump administration's priorities. The decision was reversed less than 24 hours later, but no explanation was given as to why they were cancelled in the first place. Now, congressional Republicans have done no oversight of the dismantling of SAMHSA and are putting forward two bills that would make it even harder for people struggling with opioid use disorder to access treatment. We need a robust SAMHSA, stable funding, and an administration that prioritizes substance use prevention, treatment, and recovery instead of undermining the progress that we've made. We also cannot ignore the devastating impact the Republicans' Big Ugly Bill is going to have on people who desperately need substance use disorder treatment. The Republicans' bill cuts healthcare by a trillion dollars over the next 10 years, the largest healthcare cut in our nation's history. But thanks to the Affordable Care Act's Medicaid expansion, millions more people have access to substance use disorder treatment. This expansion has saved lives. In fact, Medicaid is the largest source of health insurance coverage for substance use disorder treatment services, and Medicaid expansion is the way most people with substance use disorder are able to get this critical coverage. Yet Republicans' Big Ugly Bill directly attacks them, vilifying people who are eligible for Medicaid thanks to the ACA Medicaid expansion as people who are not deserving and subjecting them to barrier after barrier just to get and keep their healthcare. And if that's not devastating enough, in recent months, the Trump administration and committee Republicans have been on a state-by-state crusade to scrutinize and cut Medicaid funding for life-saving substance use disorder treatment services. Among the services being cut are peer recovery services, which evidence shows increases treatment engagement, reduces hospitalization, and improves recovery outcomes. For example, when the Centers for Medicare and Medicaid Services acted to withhold about 20 percent of all of Minnesota's federal Medicaid funding in January, a truly unthinkable and reckless action in my opinion, on its hit list was peer recovery services. Hiding behind stories of bad actors, the Trump administration didn't act to recover funding for legitimate investigated instances of fraud. No, it acted to withhold all of the federal Medicaid funding the state receives for peer recovery and 13 other services that help people live healthy and productive lives in their communities. And these Republican actions have real-life consequences. Without continued sustained support for people with substance use disorders, the result is devastating but not complicated: people can't get the care they need, and in the worst cases, they will die because of it. And these are the problems that I think that we have to be mindful of here when we have this hearing. So with that, Mr. Chairman, I yield back the balance of my time.

All right, the chairman yields back, we now conclude with member opening statements. The chair would like to remind members that pursuant to committee rules all members opening statements will be made a part of the record. All right, the chairman yields back. We now conclude with member opening statements. The chair would like to remind members that pursuant to committee rules, all members' opening statements will be made a part of the record. Now just so everybody knows where we're going, it appears that the debate is continuing and they have not yet called votes. We had anticipated that votes would have been called by now. We will start, I'll start going through the process and we will get as far as we can before votes are called and probably a little bit further, but we'll do the best we can, so bear with us. We want to thank our witnesses for taking their time to testify before the subcommittee. Although it is not the practice of this subcommittee to swear in witnesses, I would remind our witnesses that knowingly and willfully making material false statements to the legislative branch is against the law under Title 18, Section 1001 of the United States Code. You will have an opportunity to give an opening statement followed by questions from members. Our witnesses today are Scott Oulton, President, INTR3PID Solutions LLC; K. Fred Gingrich II, DVM, Executive Director, American Association of Bovine Practitioners, that'd be cows for all y'all back home; Dennis Lemma, Sheriff, Seminole County, Florida, and former President of the Major County Sheriffs of America; Nabarun Dasgupta, PhD, MPH, Senior Scientist and Gillings Innovation Fellow, University of North Carolina Chapel Hill; and Yngvild Olsen, MD, MPH, former Director of the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, and National Advisor, Manatt Health. Per committee custom, each witness will have the opportunity for a five-minute opening statement followed by a round of questions from members. The light on the timer in front of you will turn from green to yellow when you have one minute left. I now recognize Mr. Oulton for his five-minute opening statement.

Thank you. Chairman and ranking members and distinguished members of the committee, thank you for the opportunity to testify on the critical and rapidly evolving threat posed by emerging drugs in the United States. My name is Scott Oulton. I am recently retired as DEA's Chief of Forensics. For nearly 36 years, I've worked with DEA in various positions and oversaw DEA's forensics program and personally witnessed the most dangerous drug threats this country has ever faced. I am here today because I have seen firsthand what happens when we do not invest in the tools, technology, and the coordination necessary to confront modern synthetic drug trafficking. Today's drug landscape has fundamentally changed. We are no longer dealing with static drug markets. Instead, we are confronting a dynamic, adaptive, and increasingly synthetic threat environment that is outpacing traditional detection and response systems. The most urgent threat today is counterfeit prescription pills, especially the fake Oxy, Adderall, and Xanax. These pills are illegal, unregulated products that are mass-produced by transnational criminal organizations, often in pill presses capable of producing tens of thousands of pills per hour. The danger is simple but brutal: there is no quality control or consistency. Two pills that look identical, same color, same stamp, same size, can contain wildly different amounts of deadly drugs such as fentanyl, nitazenes, xylazine, etcetera. Oftentimes, the suppliers themselves do not know what are contained within these deadly pills. The cartels continue to adapt by exploring and introducing other synthetic opioids, including highly potent nitazenes and orphines, which can be even stronger than fentanyl and pose serious new risks. Cartels continue to innovate in response to enforcement, regulation, and demand. We will continue to see an opioid crisis in the U.S., and I fully expect that the cartels will continue exploring new dangerous drugs that will continue to threaten the lives of American citizens. One of the core challenges we face is that our current laboratory reporting systems do not always capture the full picture. Many state and local laboratories are appropriately focused on identifying the controlled substances. However, this often means that non-controlled yet highly dangerous compounds such as xylazine are not consistently identified or reported. First, we have to collect the dots in order to connect the dots. This is where the importance of DEA's GUARD method becomes clear. DEA's GUARD method provides identification and reporting of additional substances present in a sample, not just the primary controlled drug. When incentivized and implemented broadly, GUARD significantly improves the depth and quality of data submitted to the National Forensic Laboratory Information System. By expanding what laboratories report, GUARD allows NFLIS to evolve into a more actionable data platform. Speed matters. With this kind of insight is critical for both law enforcement and public health officials who must make real-time decisions to protect communities. However, even with improved laboratory reporting, we must acknowledge a fundamental limitation: drug data is inherently reactive. It tells us what has already been seized, not necessarily what is being consumed at scale. This is why wastewater testing is becoming an indispensable tool in this fight. Wastewater testing provides near real-time drug monitoring and can identify spikes in fentanyl analogs and the emergence of new synthetic compounds or shifts in stimulant use patterns. More importantly, it provides actionable early warning, allowing public health officials, law enforcement, and community leaders to respond proactively rather than reactively. We save lives moving upstream of the crisis. The drug threat we face today does not fit neatly into one domain. It requires a coordinated, data-driven response that leverages all available tools and expertise. Working together with a shared purpose of saving lives is bipartisan, and I think it's something we can all agree on. We need to support the forensic, coroner, toxicology, and public health workforce. Identifying novel substances requires advanced instrumentation, specialized training, and a sustained investment. We must remain agile, not only by working together but also legislatively to be able to move at the same pace and speed as these cartels. We need to move at speed that saves lives, not the speed of bureaucracy. The cartels producing these substances are constantly adapting, changing chemical structures, exploiting legal gaps, and leveraging global supply chains. Our response must be equally adaptive, grounded in science, and supported by timely, high-quality data. In closing, emerging drug threats are not just a law enforcement issue or a public health issue; they are a national security issue that is affecting all American lives. But with the regard to the right tools, the right data, and the right partnerships, we can get ahead of this crisis. Thank you for your time and your commitment to addressing this critical issue. I look forward to your questions.

Thank you very much. Now recognize Dr. Gingrich for his five-minute opening statement.

Thank you and good afternoon, Chairman Griffith, Ranking Member DeGette, and members of the subcommittee. I am Dr. Fred Gingrich, Executive Director of the American Association of Bovine Practitioners, and I appreciate the opportunity to provide testimony on behalf of the American Veterinary Medical Association's more than 111,000 veterinarian members across the United States. I've been in clinical veterinary practice for more than 30 years, focusing on cattle health, welfare, and productivity in both California and Ohio. In 2017, I also became the executive director of AABP, the largest cattle veterinary association in the United States, representing over 4,000 members. The AVMA strongly supports the swift passage of the bipartisan, bicameral Combating Illicit Xylazine Act. We believe this legislation represents a thoughtful, balanced, and urgently needed solution that both addresses the serious human health threat posed by illicit xylazine and preserves access to this essential drug for legitimate veterinary use as a controlled substance. The veterinary community is deeply concerned about the public health crisis caused by the rapid proliferation of illicit xylazine being found in combination with illicit fentanyl and other opioids. At the same time, it is critical to recognize that xylazine is an indispensable tool in veterinary medicine. As a non-narcotic, FDA-approved veterinary sedative, xylazine has been used for over 50 years to facilitate the safe handling, restraint, and treatment of a broad range of animal species. It is particularly important for use in livestock, zoo, and wildlife species, as well as in research settings. In cattle, there is no safe, practical alternative for sedation. Without xylazine, veterinarians and producers face significantly increased risks of injury, and animals may be subjected to unnecessary stress or harm during medical procedures. The Combating Illicit Xylazine Act is a balanced legislative solution. This bill is the result of over three years of productive conversations between congressional offices and committees, stakeholder groups, and federal agencies. The consensus language schedules xylazine under the Controlled Substances Act and contains several statutory changes designed to preserve the critical legitimate veterinary uses of the drug and keep it viable as a drug in the U.S. market. Absent congressional action, our understanding is that the DEA will administratively schedule xylazine. Administrative scheduling would unintentionally restrict how veterinarians use the drug and create burdensome regulatory barriers and jeopardize the continued availability of the drug in the legitimate marketplace. A disruption in the availability of xylazine would have profound consequences. Veterinarians could lose access to this critical medication with no viable substitute, increasing risk to practitioners, animal handlers, and the public. Animal welfare would be compromised, and the ability to provide timely and humane care would be diminished. Additionally, in the absence of a federal framework, states have begun to adopt their own restrictions on xylazine, resulting in a patchwork of inconsistent policies across the country. This fragmented approach creates confusion, complicates compliance, and further threatens the stability of the veterinary supply chain. In summary, legislative action on xylazine is not only preferable, but it is essential. The previous administration and the current administration support this policy approach, and the legislation has been endorsed by all 50 state veterinary medical associations and numerous national stakeholder groups. The AVMA commends the subcommittee for its attention to this critical issue. We also appreciate the committee's prior work advancing xylazine-related legislation with strong bipartisan support. We respectfully urge Congress to act swiftly to pass the Combating Illicit Xylazine Act and look forward to continuing to work with you. I am happy to answer any questions. Thank you.

Thank you. And now recognize Mr. Lemma for his five-minute opening statement.

Chairman Griffith, Ranking Member DeGette, and members of the subcommittee, thank you so much for the opportunity to be here with you today. I am Dennis Lemma, the sheriff of Seminole County, Florida, the current president of the Florida Sheriffs Association, and a former president of the Major County Sheriffs of America, the organization that I represent here this afternoon. Our members serve more than one-third of the United States population, and I can tell you without reservation that the drug landscape we are seeing today is more dangerous, complex, and lethal than anything that we've ever faced before. Today's drugs are more potent, unpredictable, and deceptive. People, many of them young people, believe that they are taking a legitimate prescription pill when, in all reality, they are ingesting something made in a clandestine lab laced with fentanyl or other synthetic substances. Often times, a single dose is fatal. We're also seeing increasing occurrences of substances like xylazine in our drug supply. There is a whole host of concerns about the human use of xylazine, but among them, since it's not an opioid, naloxone does not reverse its effects. That complicates overdose response and increases the likelihood of death. We're also seeing substances like 7-hydroxymitragynine, commonly referred to as 7-OH, gaining popularity in the illicit drug market. It is a highly potent compound that acts on opioid receptors and carries a significant risk of addiction, withdrawal, and even overdose. It is often marketed as a natural product, which creates a dangerous perception of safety. And at the same time, individuals we are encountering are not just dealing with one issue. We consistently see the intersection of substance use, mental health challenges, and a lack of stable support systems. That combination creates vulnerability, and today's drug dealers exploit it. This is why our response must be balanced and urgent, an approach that we know absolutely works. Florida's opioid overdose crisis forced us to act across systems, bringing together law enforcement, healthcare, treatment providers, and policymakers to identify what works and then replicate it. We expanded treatment, including medicines for opioid use disorder, increased access to naloxone, strengthened prescription monitoring, and perhaps most significantly, we held traffickers accountable. When we address both supply and demand simultaneously, we save lives. But the threat continues to evolve. In 2025 alone, the DEA seized enough fentanyl to potentially kill hundreds of millions of Americans. We are seeing more combinations of substances in far greater variance in potency. We're now encountering drugs like nitazenes. These synthetic opioids can rival or exceed the potency of fentanyl and are often engineered to evade detection and our current drug laws. Simply stated, the market's evolving faster than policy, and we must take appropriate steps to curb these emerging drugs. That includes congressional support. First, we must close scheduling gaps. Legislation like the Combating the Illicit Xylazine Act and the Nitazene Control Act would give law enforcement the tools we need to keep pace with emerging substances while preserving legitimate uses. Second, we must address illicit pill production. The Fight Illicit Pills Act would help us track and regulate the equipment used to manufacture counterfeit pills that are nearly indistinguishable from legitimate medication. Third, we must strengthen coordination. Continued funding and support for HIDTA is essential. They bring together federal, state, and local partners to share intelligence and disrupt trafficking networks. Fourth, we must invest in treatment and reentry. Local correctional facilities have become default providers for care for many individuals in crisis. Legislation like the Due Process Continuity of Care Act, the Reentry Act, RSAT Reauthorization, and the Second Chance Act will help ensure individuals leave custody with a real path forward and not a revolving door. Finally, we must ensure policing professionals have access to modern investigative tools and retain critical resources, such as asset forfeiture, that allow us to disrupt criminal networks. This is a complex crisis, which will ultimately require us to adapt quicker than this threat is evolving. We must hold and remain focused on saving lives while holding accountable those who exploit this crisis. Sheriffs' deputies and officers across this country stand ready to work with Congress to strengthen this response and deliver real results for our communities. Thank you for your leadership, and I welcome questions. ready to work with Congress to strengthen this response and deliver real results for our communities. Thank you for your leadership and I welcome questions.

Thank you very much. Now recognize Dr. Dasgupta for his five-minute opening statement.

Honorable members of the Health Subcommittee, thank you for the opportunity to speak. I have

Thank you very much. Now recognize Dr. Dasgupta for his five-minute opening statement.

Honorable members of the Health Subcommittee, thank you for the opportunity to speak. I had the honor of serving the WHO committee that decides international drug scheduling, so I know what it feels like to decide which schedule to put things in. What I learned was that the wrong schedule can make a bad situation worse. We balance medical use with drug problems, but we spend most effort avoiding predictable, unintended consequences. At UNC, we operate a mail-in street drug checking service. We receive samples from public health programs, health departments, hospitals, and paramedics in 40 states. Out of 20,000 samples, we've analyzed over 3,000 with xylazine. Nationwide, xylazine peaked in late 2024 and declined steeply all through 2025. Xylazine is rapidly being replaced with its fraternal twin medetomidine, just a few atoms different. Last month was the first we saw more medetomidine than xylazine in lab. So we can't talk about xylazine without talking about medetomidine. Good news, medetomidine doesn't cause horrific skin wounds. Bad news, quitting cold turkey can give you a heart attack and land you in intensive care. In Pittsburgh, hospitals are filling up, not with overdoses, but with people who tried to stop using what they thought was fentanyl but had medetomidine. This unintended consequence can be traced directly back to the moment when Pennsylvania permanently put xylazine in schedule III. Within two weeks, medetomidine started displacing xylazine in Pittsburgh. It's a complicated dance of 14 medications to treat these drug-induced heart attacks. Methadone is often the first step in the hospital and the last step with take-home doses. The natural thought might be to schedule both xylazine and medetomidine, but neither of these medicines really belongs in schedule III scientifically. Here's the second unintended consequence. Medetomidine is a really important medication in hospitals to sedate babies on respirators. And when kids get agitated from being hooked up to all those machines and tubes after surgery, it provides instant relief. Instead of immediately helping these very sick kids, schedule III would mean having to fetch it from locked cabinets, accounting for every drop, filing police reports, and having witnesses watch you dispose of leftovers. Hospital medetomidine isn't what's in the street supply, but that's where scheduling would be a disaster for medicine. If you schedule xylazine and medetomidine, there will be predictable consequences. Research is quicker with unscheduled drugs. Our partner lab at UNC has definitively proven that naloxone does act on xylazine directly and on xylazine combos. It takes a couple of hours for the sedation to wear off, but they are breathing. Xylazine also has positive unintended consequences. Hospital data show overdoses with fentanyl and xylazine together are less severe than fentanyl alone. Many medical examiners refuse to list xylazine as primary cause on a death certificate because a scientific causal link isn't proven. In our FDA-funded field study, we found that xylazine reduced fentanyl use, both how much and how often, initiating periods of abstinence and treatment and away from injection. The first takeaway then is that scheduling requires nuance with unintended but predictable consequences. The other takeaway is that each wave of new drugs destabilizes health systems. Again we have to pivot, and each pivot costs lives. Age can guide next steps. 70 percent of overdose deaths are among millennials and Gen X. Make it easy to get effective treatment. Between taking care of kids and parents and careers, being knocked out all day is not what they got into fentanyl for. There is huge dissatisfaction with the synthetic soup that is the American drug supply. In this dissatisfaction, we have a once-in-four-generation opportunity. This here, now, is not business as usual. Nationally, there have been 28 consecutive months of overdose decline. In the state of Maine, it has been 11 months since anyone under age 25 died of an unintentional overdose. Zero. This is real, tangible change. Gen Z is doing better than their parents and their grandparents. They don't initiate opioid use the same, they face less stigma, they get effective treatment. Across America, I see neighbors motivated by faith to render care. People meeting a moral obligation to prevent overdose. These vital programs blend opioid settlement with federal dollars, adapting science-based solutions to local circumstance. Their strength is their persistence. This is America at its best, and what we're doing is working. We're down 40 percent from peak fentanyl overdose in the United States. But we need to make sure nobody gets left behind, because we are still losing too many people we love. Unintended consequences aren't unintended if they are predictable and you do it anyways. I exhort you to see with fresh eyes. Don't lose momentum. After 40 years, this is the break we've been waiting for. Respectfully submitted.

Gentleman yields back. Now recognize Dr. Olsen for her five-minute opening statement.

Great. Good afternoon, Chairman Guthrie and Griffith, Ranking Members Pallone and DeGette, and members of the Energy and Commerce Subcommittee on Health. My name is Dr. Yngvild Olsen, and I trained as an internist and work as a board-certified addiction medicine physician. I have treated patients with substance use disorder for 25 years, have served on the board of the American Society of Addiction Medicine, and worked at the local, state, and federal levels under both Democratic and Republican administrations. From September 2021 to July 2024, I served as the director for the Center for Substance Abuse Treatment at SAMHSA, and I now work as a national advisor for Manatt. Thank you for the opportunity to testify in my personal capacity today. Our nation has lost over a million people to overdose in the last two decades. Our families and communities have experienced wave after wave of devastation from prescription opioids to heroin to fentanyl and other substances. Finally, finally, overdoses are falling. Overdose mortality has declined nationally by 25 percent per year in the last two years, and in some communities, it's closer to 40 percent. We are making progress. My primary message today is this: Congress must work to sustain this momentum and not move backwards. I have three specific points today. First, sustaining momentum means helping more people with addiction access effective treatment. Recently, a patient of mine celebrated two years of sustained recovery. I first met him when he was homeless and unemployed and at extremely high risk for overdose. It has taken time, but he has transformed, with promotion at work and looking forward to a future with his wife and children, all while taking methadone. In my line of work, stories like this are not rare. Studies show that treating opioid use disorder with methadone or buprenorphine reduces the risk of fatal overdose by over 50 percent. It reduces crime and increases employment. Expanding access to these medications has long been a bipartisan priority. Unfortunately, only about one in four people who can benefit from treatment with medications are able to access it. And that's why Congress, by a large bipartisan majority, removed the need for a special DEA registration to prescribe buprenorphine. That's also why, in 2024, SAMHSA updated regulations to improve access to care in opioid treatment programs. And that brings me to my second point. Sustaining momentum means keeping these much-needed modernized regulations in place. Before I left SAMHSA, I traveled across the country listening as people told me what this meant to them. One young man said that the new policies allowed him to keep his job and be treated for his opioid use disorder. Just imagine having to choose between life-saving treatment and your source of income. But that's how it was for decades for far too many people. We don't have to guess whether the new regulations will work. Evidence accumulated during the pandemic supports both the safety and effectiveness of the changes we made. That's why they have the support of state officials from across the country, hundreds of treatment providers, and the addiction medicine community. My third and final point is this. The major cuts coming to Medicaid are on a collision course with the goal of addressing addiction and overdose deaths. Medicaid plays an essential role in helping people with substance use disorders access needed care and treatment. In fact, it is a cornerstone of the prevention, treatment, and recovery system in the U.S. And I am deeply concerned that the new law will lead to loss of coverage, which research indicates is associated with a greater risk of overdose. My written testimony includes details about the reasons for my concern. Suffice it to say now that many of my patients will not be able to stay enrolled when faced with having to prove they should be exempt from work requirements and renew their coverage twice a year. Many lack a consistent mailing address, phone, or access to a computer. Adults with substance use disorders not yet in the Medicaid system, but who have finally made the decision to access treatment, may not be able to do so for lack of coverage. They instead might have to wait for weeks for a grant slot, as used to happen when the SAMHSA block grant was the primary source of treatment. In my experience, we lost a lot of people that way. In addition, as most Medicaid programs nationally lose billions of dollars in funding, states may well be forced to save money by cutting services for people with substance use disorders. In Medicaid, many such services are treated as optional, which means that when states are facing fiscal pressure, it is one of the first places that they may look for cuts. These include residential treatment, peer support, case management, services that help my patients get and stay well. I urge Congress to work with states to prevent these problems before they happen. It means closing gaps in H.R. 1 and ensuring that CMS implements the bill thoughtfully. Please, I implore you, do not take the nation's recent success against overdose for granted. Please do not move backwards on policy. Passing legislation to help more people with addiction receive effective treatment will accelerate our momentum and save many lives. Thank you again for the opportunity to testify, and I'm looking forward to your questions.

Thank you very much. As you can hear, the bells are ringing, votes are going to be called. What we've agreed to do is that I will ask my questions and then Ranking Member DeGette will ask her questions, then we will break and come back as soon as we can after votes and start with Chairman Guthrie at that point. All right, that said, I'm going to submit written questions later to fill this out, but I'm very big on Dr. Dasgupta, I am very big on research. I also, if there is a valid medical reason, I want to see that that happens. So I'm going to ask you some written questions later because I've got other things I want to get to about do we need a new schedule level that creates some kind of a hybrid and any language that you might recommend to make the bills that you're concerned about allow us to use the relative medicines or drugs when we have a child that's had a lot of surgery and needs it. So we'll come, I'll come back to that later, we won't get into that today. I'm now going to switch to Dr. Gingrich. Dr. Gingrich, many people may not know this, I'm sure you do, but my district is the only congressional district in the United States with two veterinary schools. One located at Virginia Tech, it's the Virginia Tech-Maryland school in Blacksburg, School of Veterinary Medicine in Blacksburg, Virginia. And the other one, while licensed in Tennessee to the Lincoln Memorial University, is actually located in Lee County, just over the line in the 9th Congressional District. What would happen in the veterinary schools if the DEA administratively schedules xylazine?

Thank you for that question. It's probably not surprising that in veterinary schools, few of those students, less than 10 percent nationally, are from rural communities, probably never having touched a cow before in their life. And so certainly, if xylazine is scheduled without the statutory changes to the Controlled Substances Act that is in the Combating Illicit Xylazine Act, we run the very real risk of no longer having access to that medication, which would increase the risk to those students in veterinary schools being around cows that are nervous or scared, especially if they're not used to working with them.

And we have a shortage of large animal vets in the country anyway, and that would increase the shortage probably as well of large animal vets?

Well, certainly, if you're injured by a cow as a student, it probably does not make you want to go into cattle practice, yes.

Yeah. As I said, my district's also the largest cattle-producing congressional district east of the Mississippi. In your testimony, you mentioned that there is no safe or practical alternative to xylazine for sedation in cattle. Can you elaborate on how restricted access could impact cattle farmers?

Yeah, thank you. So certainly anything that impacts cattle veterinarians will definitely impact cattle farmers too. Many may not have adequate facilities. We especially see that on smaller operations such as is in the eastern part of the United States, such as your district. And certainly having a sedative available to appropriately restrain those animals when they need an examined or a medical or surgical procedure is very important.

I appreciate that. Mr. Oulton, I know I'm a little odd. I've toured landfills and sewage treatment plants and have been interested in how we can use that kind of infrastructure to better detect viruses, phages, and community diseases. This committee worked to get additional language in the SUPPORT Act that was signed into law to allow for more wastewater surveillance, and CDC is also looking into it. Can you talk more about why wastewater is so beneficial when it comes to detecting community drug use and what we can do with that data?

Thank you for your question. I'd start by saying that it provides a powerful early warning system. Just recently in the news, you see that there was a Missouri had been working with various high schools that were voluntary testing. And what they had found over about a month and a half ago, tremendous amount of nitazenes were being found in the wastewater stream. So when we met with the leaders of the community and the folks that were involved in that, one of the first questions, one of the first points they made is we're not seeing a problem here, we don't see nitazenes. But this really highlights some of the issues. Medical examiners, toxicology, laboratories do not necessarily test for it. They do targeted testing. So if they don't test for it, they're not going to see it. So that's a good example of how it provides like a very, very quick within hours to days response. Also communicable diseases, it's one sample that they need to test and they can do a full gamut of tests on that. I do think primarily we need sustained federal investment in this type of technology. It provides not only the near early warning, but it also provides a critical tool towards public health. Look what happened during the pandemic, that they were much further ahead than the hospitals were seeing.

My time is almost up. I will say that I've been advocating that we get all of our groups collecting wastewater, in particular to maybe get extra samples because if the CDC's collecting it for one thing, if we're looking at it, you know, from a disease standpoint, if we're looking at it from a drug standpoint, if we're looking for treatments with phages, we've got different people collecting water and it's coming, can't get to all the, all those groups can't get to all the wastewater treatment. So what we're trying to do is get them all to work together and get extra samples so everybody can share. That being said, I yield back and I now yield to Ms. DeGette her five minutes for her questioning.

Thank you so much, Mr. Chairman. As I said in my opening statement, we've really made remarkable progress in addressing the opioid crisis and bringing down overdose death rates, but the job isn't nearly done. Dr. Olsen, could you briefly describe for us what drove the rise in overdose deaths in the late 2010s and early 2020s?

Certainly. So during that time period that you're speaking about, that was really the rise of fentanyl, kind of after prescription opioids, heroin, and then fentanyl as that third wave.

And then after that, overdose deaths have been decreasing, thank heavens. So I want to ask you, Dr. Olsen, when you were at SAMHSA, you required states to submit plans to get overdose reversal drugs as many places as possible as a condition on the State Opioid Response or SOR grants, is that right?

That's correct.

But what's the result of those initiatives been?

Yeah, so a couple of things. First, we were able to really quadruple the amount of naloxone through those plans and by working with states. So we had several policy academies where we brought about 26 states, the District of Columbia, and Puerto Rico together to really focus in and target particularly high-risk populations and high-risk areas.

And did those initiatives contribute, do you think, to the decline in overdose deaths?

The decline, I, in my view, absolutely, that that was something that really was a big contributor. I know my colleague Dr. Dasgupta actually has been looking at this, and so...

I'm about to ask him, so good, good entry. Now, in January, SAMHSA under this administration canceled $2 billion in grants. The grants then were just reinstated the day after they were canceled following public outcry. And so, Dr. Dasgupta, I want to ask you, has this instability at SAMHSA impacted the people on the ground who are doing critical substance use disorder prevention and treatment?

Yes. Frontline providers do the patient work of caregiving that we in suits and heels and lab coats can't do. And they're effective because they're consistent. Funding that blinks in and out destroys their consistency and makes them less effective.

Do you have any specific examples of people being laid off as a result of the instability?

I've hours of examples, but...

We don't have hours, we have seconds.

Lubbock and Amarillo, Texas, organizations that were distributing free naloxone closed down. South Carolina Alcohol and Drug Abuse Council cut outpatient services for treatment and inpatient detox in an area with little alternative. New York City medical staff who take care of patients with opioid use disorder were fired and had to walk out of the building with no continuity of care for folks on the cusp of recovery. Many FQHCs have stopped syringe service programs. And locally here, syringe residue testing for emerging drug threats just got axed.

And so, as you alluded to with New York, when people get laid off, that means people don't have the outreach or care that they need, is that correct?

Sadly, yes.

Now, the administration also fired about half of SAMHSA's staff in its reductions in force, and one particularly impacted program was the National Survey on Drug Use and Health, or NSDUH. So I want to ask you, why does NSDUH data, has it been so historically trusted and valuable?

It is the only nationally representative data source on addiction in the country. And it's been around so long we can see generational trends that no other data source has.

And so have staff cuts at SAMHSA had an impact on NSDUH?

NSDUH is kind of like the space program. It's not just the mission, but all the scientific advances that come from the methods research. I can't get anyone on the phone anymore, and the data have disappeared or have been delayed.

Now, are you and your colleagues still relying on this data, or are you looking other places because of a lack of reliance?

Yeah, we can't rely on it anymore to be there, so we look at state dashboards, but it's just piecemeal.

It's not a consistent federal look, is that right?

That's right.

Yeah, well, so I've got to say, I feel like I've been in Congress now 15 terms and I feel like I've been saying this the whole time, is criminalization isn't going to solve the problem. You have to give people the care they need and get them to transition. And as we saw by the decrease in deaths and other metrics, the Biden administration's investments actually worked because they were treating addiction as a public health issue. And so I hope we can get back to that because we really can't throw progress away with that. I yield back.

Gentlelady yields back. The committee will now stand in recess until Ms. DeGette and I return and a couple others. But we'll try to get started as quickly as we can after votes. All right, the committee will come back to order. I now recognize the chairman of the full committee, the gentleman from Kentucky, Mr. Guthrie, for his five minutes of questioning.

Thank you, thank you, Mr. Chairman. And what we just talked about a minute ago with Dr. Dasgupta, I will look at the research you said was out there. And I do hear from people on the street, people who are performing these kind of things, that naloxone hasn't had the effect, but I heard your testimony and we'll talk and we'll certainly do our research on that. The other one is on the Medicaid portion, that we do exempt people that are in recovery and treatment. And I do understand they have to show they're in recovery and treatment, also they have to recertify, but we saw fraud and abuse even before what we've seen in Minneapolis and in other other areas, quite honestly, where we're going to exempt in. So we want people to have their coverage, we also want hardworking taxpayer dollars to go to the people that need it the most, and so and not to the to the fraud. So we are going to continue to focus on that. So Mr. Oulton, in your written testimony, you mentioned how non-controlled yet highly dangerous compounds like xylazine and nitazenes are not consistently identified and reported. We know that permanently scheduling substances with potential for abuse gives law enforcement the necessary tools to crack down on drug traffickers and removes the incentive for transnational criminal organizations to make these substances. Can you discuss how scheduling is critical not only for law enforcement, but for patients and the community as well?

Yes, thank you for your question. I I believe absolutely scheduling is necessary because if we don't schedule, we don't know what the problem is. Many state and local laboratories do not test for non-controlled substances or even new synthetic substances because they don't either have the ability, the reference materials, the technology, the methodology. I think it's incredibly important that we schedule to get these things off the street. You've heard the term whack-a-mole. This is going to be a continued whack-a-mole problem, but the only way to stay ahead of it is to learn from what what we see, and we don't know what we see unless we're testing for it. I think several things that are important are detection and reporting is probably the number one gap that we face. The doctors don't know what they're dealing with. A lot of times the laboratories, illicit drug laboratories, are far behind. They have big backlogs, so they haven't even tested it for six to nine months later. Wastewater testing is incredibly helpful because it can tell you what they're ingesting quickly within hours and days. I think accountability and deterrence, it's incredibly important to do that. If we don't schedule these substances, they will continue to to use them and exploit the different various laws and regulations, taking a fluorine, taking it from here to there. It's just an incredible whack-a-mole game.

Good, thank you. So Sheriff Lemma, the HALT Fentanyl Act and the SUPPORT Act, as I said in my opening statement, we we understand there's a justice, criminal justice element to this and the people who are poisoning our children and and adults, and then there's also support, the effort to to deal with people that have substance use disorder. And we understand it's a both, it's not one way, it's two way, and multiple way actually. But they were signed into law by President Trump and each take a significant step towards reducing the toll of illicit fentanyl and fentanyl-related substances in our communities. There's more work to be done. So Sheriff Lemma, you have been in law enforcement over 30 years. Can you speak to how the drug threat landscape has evolved throughout your years of service and what threats you believe we need to prepare for next?

Yeah, thank you for the question. I think the American population has always struggled with some dependency and addiction. In the early 70s, mid-70s, we talked about marijuana and and LSD and other hallucinogenic drugs and, you know, we saw it evolve into base cocaine where crack cocaine was a major problem. We saw cocaine cowboys and I think one of the greatest crisis brewed under our nose as we were watching the more traditional lines of drugs and illicit drugs out out on the street. When we saw designer drugs in the influx of of raves, this was, you know, flunitrazepam, Rohypnol and all of these roofies and and MDMA, methylenedioxymethamphetamine. When when the FDA approved OxyContin and legally prescribed it, it created unprecedented addiction. And I think that many of us believed across this country, especially people in addiction and criminal justice space, what Nancy Reagan told us, just say no. And just say no works incredibly well if you've never started, but if you've started, it takes a little bit more than just saying no. So we saw people turning to street-level heroin and then we saw the cartel shifting to fentanyl. Wonderful medicine and a horrible drug. 100 times more potent than morphine, 50 times more potent than heroin and a microgram in many cases was a lethal dose. And we saw this pushed in pill pressed in clandestine...

Let me just so I got about 30 seconds left. So people are saying that it's useless to really schedule these drugs because they just evolve and change. Do you think that they need to be scheduled?

I think they absolutely need to be because I think that they absolutely need to be scheduled and regulated. And I think that if we don't do that, drug dealers will be incentivized to move in that direction and and harm American people.

Also see Dr. Oulton's shaking your head. All right, my time is expired and I will yield back.

Gentleman yields back. Now recognize the ranking member of the full committee, the gentleman from New Jersey, Mr. Pallone.

Thank you, Chairman. I'm I'm very concerned with the $1 trillion in healthcare cuts Republicans have enacted in their big ugly bill and the impact those cuts will have on our continued efforts to address the opioid crisis. These cuts could be devastating for people with substance use disorder. The bill included two provisions that specifically attack the 20 million Americans who rely on Medicaid expansion, the coverage pathway that the majority of people with substance use disorder rely on to access Medicaid. But because of the Republicans' big ugly bill, they're going to have a jump, I mean people are going to have to jump through all kinds of hoops to get this coverage, like eligibility checks, red tape requirements, demonstrating that they're eligible for an exemption because of their substance use disorder. So let me start with Dr. Olsen as someone who treats patients battling addiction and has spent your career trying to improve access to care. Can you walk us through an example of what keeping Medicaid coverage might look like for a person with substance use disorder, even with the so-called exemptions in what I call the Republicans' big ugly bill, if you will?

Thank you for that question. And you know, this is really not theoretical for my patients. One of the pieces that they're going to have to go through, as you mentioned, is this process of really confirming and redetermining their eligibility every six months. Now, I have a lot of patients who they move. They either move recovery houses, they're homeless and moving shelters, or just moving their own homes. So they really don't have a stable place where they can receive the notices that their redetermination is actually coming up. So they may then miss the deadline that because there's a deadline and a short window, they may miss that deadline in order to be able to actually respond in a way even if they meet that exemption category. The other piece is that, you know, if they're they in order to kind of meet that exemption category, we have to kind of cross our fingers that there are claims or signs in the system that they have a substance use disorder and could be exempt. Because otherwise they're going to be subject to a work requirement. Now, I have a lot of patients who work, but they work odd jobs, very part-time jobs, and so they may not have the the necessary paperwork or be in the system that that states are going to use to then match with their Medicaid rolls to really be able to identify that the person is exempt or is meeting the work requirement.

Now you were talking, I believe, about people that are already on Medicaid, but what about and tell me if I'm wrong, but what about people that become eligible for the first time, but you know, they have to enroll, who are substance abuse? What happens to them? Is that different?

Yeah, so I was so I you're correct, I was speaking about somebody who was already enrolled in Medicaid and had to then redetermine it every six months. Even that exemption piece, because it's not clear, we are still awaiting CMS guidance to even understand how long that exemption might exist for. And so it might be every six months, it might be a year, we're not sure, and states are really having to try and figure out and build their systems based on kind of lack of guidance. You know, to to talk to speak to what you were saying about somebody who's not yet in Medicaid. So we really want to get people into treatment as quickly as possible because the that motivation that they might have to get treatment is very fleeting and can just disappear. So in my clinic, when we have patients come in, we start them on treatment as quickly as possible, even if they don't have Medicaid because we have some grant slots. But I'll tell you a story of one patient that I actually saw last week. He had moved from Virginia, he lost his ID, he lost his birth certificate in that move, he's homeless. He now had to go and and so he has no Medicaid in Maryland. He had to go figure out how to get his birth certificate, get his ID, multiple different places. And once he had did that, then he went to the Medicaid eligibility office. He then had to go to a different social service office to then also start to apply for disability, which is what he wanted to do. Because of the short timeframes and each of these offices are different, that he missed the deadline. And so he now has to start all over again. That is what it how it works now. If he then in six, you know, and he doesn't have Medicaid. So if he comes now to us and is trying to get insurance and Medicaid, that he there is no way that he's going to be able to meet that six-month redetermination requirement or the work requirement and prove that he is exempt.

All right, thank you. Thank you, Mr. Chairman.

Gentleman yields back. Now recognize the gentlelady from Tennessee, the vice chairman of the subcommittee, Ms. Harshbarger.

Thank you, Mr. Chairman. Appreciate that introduction. Thank you to the witnesses for being here today. You know, I've spent decades on the front lines as a pharmacist helping patients safely use medications. But what we're seeing today are not legitimate medicines. These ingredients are unpredictable, they're often deadly substances sold as legitimate prescriptions. And I'll start with you, Mr. Oulton. You've testified that when two pills look alike, they're identical, they can have completely different potentially lethal potencies. And you know, when we had FDA-approved drugs on the market and even if they even sound similar, somebody would have to change the name of the drug. That's just the way it was. And if they look similar, they'd have to change the notation on the tablet. So from my perspective, that completely breaks the concept of dose safety. So how widespread is that risk today?

We're seeing a tremendous widespread difference. While I was still at DEA, we were testing individual pills that were in a batch. And we'd find that one would have four milligrams of fentanyl, clearly probably a deadly dose. Another one might have a half a milligram. So you really don't know what you're getting. There's not a quality control process that exists like pharmaceutical companies have to make sure.

I'm sorry. I say of course not, they're illicit.

Yeah.

And you know, it's just it's unbelievable what they can do. If they really wanted to differentiate those drugs, it'd be a different color or they'd have a tablet dye that you could imprint some type of, you know, identification on, but they don't want you to trace that to them, I'm sure. So given that reality, do tools look like real-time data sharing and expanded forensic reporting like your guards method need to be paired with policies like the Fight Illicit Drug Presses Act to really stop it at its source?

I do believe that'll help because we're like I said earlier, we're not connecting the dots. Laboratories are not unilaterally identifying all the substances that are present. Xylazine's a good example. A lot of laboratories don't identify it, so we don't truly know how much is being seized in the illicit drug market.

Well, true. Dr. Gingrich, appreciate your testimony. I've done a lot of vet compounding in my life, but I appreciate it because I understand the importance of balancing balancing access with safety and on xylazine, we're considering the Combating Illicit Xylazine Act. Does this bill appropriately target illicit use while preserving legitimate veterinary access? Because we do not want to prohibit you from accessing that drug for large animals.

Yeah. So I would say that according to AVMA, there is not significant diversion from the veterinary-approved product. It's critical to us. It's the only sedative we have in cattle. And so I think that this statutory change achieves that balance.

What are real-world consequences, for example, for both animal welfare and human safety if we don't get that balance right?

Well, we use it in multiple species, but for cattle, it's the only tranquilizer we have. And so for those of you that have never done a C-section on a cow in a barn that's trying to hurt you, giving them a small dose of xylazine plants her feet on the ground and makes it safe for us to do those procedures.

Seen that many times. Well, dehorning or even in goats, I guess?

Yes. Ruminants, so cattle, goats, they're very sensitive to the product. For an adult cow, we would give her maybe 0.1 to 0.2 ccs. That's four drops would sedate a 1,500-pound cow.

Not very much, is it? Well, I've got a minute and 15 seconds left. Sheriff, you mentioned people often don't know what they're taking, especially counterfeit pills laced with fentanyl, nitazenes, or xylazine. And what you're seeing on the ground, how often does that lead to fatal overdoses from just a single exposure? Because we've had friends who lost their sons or daughters to that because of one pill.

I think the greatest campaign the DEA had is one pill can kill, and that's what we're seeing.

That's it. That's it. And people didn't know. I remember back in the '80s, they did not know how OxyContin, how lethal that was and how addictive it was. And they told us at these international conferences, go ahead, come out of the closet, prescribe that because it'll take care of your patients. They should have used it with a notation for hospice patients or chronically ill patients, but that's not what happened, is it? Thank you, sir. And I yield back.

Gentlelady yields back, but I'm going to take a point of personal privilege and ask her to briefly explain the time that she created or her pharmacy created a treatment for an elephant.

Did the chairman ask you to for me to say that?

No, I came up with that one on my own.

Well, I will tell you this. Honestly, my icebreaker in Congress is have you ever made a suppository for an elephant? And yes, we have. So there you go, sir.

Her claim, one of her many claims to fame.

Oh, I've got many more stories.

Now recognize Dr. Ruiz of California for his five minutes of question.

Thank you, Mr. Chairman. As an emergency physician, I've cared for many patients overdosing on opioids. Yeah, and it's not a laughing matter. I have also comforted family members of patients who were not able to receive life-saving Narcan in time. It's one of the most difficult things to do, especially when they're young. I remember patients sometimes being dropped off, literally dropped from the side of a van from other friends or people that they were with who are too afraid to be associated with it that may have benefited from an intervention at that time. But I think that this country focuses so much more on the criminal justice aspect of this public health disease than the actual capture and treat method of this disease. Teenagers come in blue, we call them code blues. Usually if they come in the field, the paramedics give us report that they've used one or two of Narcan with minimal response or some response, they're starting to wake up and so we kind of get a sense of where they're at. When I was training, we were concerned if you give Narcan too fast, they'll start vomiting and can lead to pneumonitis and respiratory problems. But now we're concerned because they're pumping Narcan in the field and for a lot of them, it's unresponsive or they get responsive and then later on they just, so you have to admit them and keep them a little longer to observe them so that we can make sure that they're getting enough. Every story that ends in an overdose is tragic, but it cuts that much deeper when it could have been prevented had life-saving Narcan been available and used quickly and rapidly. According to UCLA Health in 2022, 22 adolescents ages 14 to 18 died every week in the U.S. from drug overdose. Depending on which community you're in, that could be the size of a whole classroom. So this is a public health crisis and we need to take action. We need to take action now to prevent overdoses through training, education, awareness, and we need to ensure widespread access to overdose reversal, opioid overdose reversal medications like naloxone or Narcan. These medications exist, but they only work if they are available. Okay? And that is why I introduced the H.R. 7994, the Helping Educators Respond to Overdoses Act or the HERO Act, a bill that will save kids' lives. The HERO Act will establish a grant program for schools to purchase opioid overdose reversal drugs, making these life-saving medications accessible in schools in the case, God forbid, a student needs them. It also establishes grants to provide critical training for staff and implement educational resources for students and communities to help combat the opioid epidemic. Prevention. Help us prevent them from getting sick. Naloxone is an intervention during a crisis. We need to end the crisis by preventing them. Dr. Olsen, during your tenure as Substance Abuse and Mental Health Services, what trends did you see regarding overdoses in youth?

Yeah, so I completely agree with you that this has been a public health crisis. And in fact, in kind of the the youth adolescent space, we saw overdoses and overdose death doubled between 2019 and 2020. It has come down a little bit since then given all the other reductions, but it still is much higher than it was pre-pandemic.

Dr. Dasgupta, what do you think about empowering schools to have more Narcan or opioid reversal drugs more readily available for students?

We do it in Wake County where I live in Raleigh. All the schools already have it. I think it destigmatizes it and more people know it and know where to get it. I think having...

So do you think educating the grant programs to educate the teachers and the students and possibly even their parents, that would make an additional impact in your schools?

It would. It would. I think if you look at the utilization data, naloxone only works if it's in nearby, if it's in someone's body when they're overdosing. It's more likely to be used if it's delivered to within networks of people who use drugs. So I'm an advocate for having it in schools, but it's about seven times more likely to be used within networks of people who use drugs. So that gives you an idea of the balance between school-based distribution and community-based distribution.

Absolutely. I think I think if they're readily available at the school, teachers and students can take them, then they take them into those networks.

You got it.

Thank you very much.

Thank you, Dr. Ruiz. Gentleman yields back. Now recognize Dr. Joyce of Pennsylvania for his five minutes of question.

Thank you, Mr. Chairman. Thank you, Chairman Griffith and Ranking Member DeGette for holding this important hearing. Illicit narcotics remain a scourge on our communities and an ever-evolving threat to public health and safety of our loved ones. This committee took an historic step to combating these threats last year with the passage of the HALT Fentanyl Act to permanently schedule deadly fentanyl analogs. Under the leadership of President Trump, we have finally closed our southern border and made all Americans safer by that action. However, we all recognize there is more work to be done. And I am pleased to see many pieces of legislation that are being considered today that will do exactly that. First, xylazine, referred to as tranq, is now reported to be the most commonly mixed, most commonly mixed alternate drug being stored and transferred and mixed and sold with heroin, with fentanyl, with cocaine. When I talk to the coroners at home and I ask them which drug is most commonly being used in South Central Pennsylvania, they say, I'll tell you what it's being mixed with. It's being mixed with tranq. And then it's a polymorphous mixture of drugs that come in with it. I'd like to really publicly express my strong support for H.R. 1266, the Combating Illicit Xylazine Act, led by Representatives Panetta and Pfluger, which would permanently schedule this substance while providing the necessary safe harbor for its continued legitimate veterinary use. Second, we are taking action on the N-70H Act from Representative Bilirakis to schedule synthetic 70H, sometimes referred to as, you've all said, gas station heroin, which is being maliciously marketed towards children and in some cases allowing unintentional overdoses, health emergencies, and even reported cases of death. Mr. Oulton, some say that class-wide bans are too broad as potentially thousands of compounds are defined by their chemical structures without regard for the pharmacologic activity. It's my understanding that the DEA intends to look at more than structural similarities when arriving at certain class-wide scheduling definitions. Can you explain why this distinction is so important?

DEA uses the SAR, structure activity and relationships. So they need to make sure that the structure is similar to another controlled substance. They need to make sure that it's active has an activity on the body, it it does affect one of the receptors. And then it in its relationships. So they do a a tremendous amount of scientific evaluation to be able to look at what are the trends? Are they seeing in toxicology reports? Are they seeing in illicit drugs? Is it causing poisonings or overdoses before they make any particular decision going forward as far as class. But for me personally, class action is the only way to address these these things because they can take a fluorine molecule and add it to a different part of the of the compound and turn it into a completely different drug. So the only way to combat it, to get ahead of it, is to absolutely support class-wide scheduling.

Thank you. We're also taking important steps under legislation like Tyler's Law to ensure fentanyl is being tested for routinely in emergency rooms during suspected overdoses and the Alternative to Pain Act to ensure non-opioid pain management drugs are available to our nation's seniors at the lowest possible cost. As we continue to see drug traffickers adapt to stepped-up enforcement efforts, the threat of illicit pill presses requires action. Nefarious actors are utilizing these devices to lace deadly substances into counterfeit medications that unfortunately often lead to overdose and many times death. There are a few bills related to cracking down on illicit pill press distribution that are under consideration today. Under U.S. law, the DEA must be notified on the import of any pill press that comes through foreign agents. And foreign pill press vendors often mislabel the equipment or send it disassembled to avoid law enforcement. Sheriff Lemma, can you elaborate on the threat that illicit pill presses pose to communities?

I think it's incredibly important to regulate and minimize the effects of illicit pill presses. This is how the drug cartels and and local people across the country are making in clandestine labs, processing this, and in many cases they don't know what they're doing. This is why that we see deadly doses. This is why we can see a a group of pills, maybe five or 10 pills that are maybe shared at a social event illegally, where one person can take a pill and absolutely die immediately and stop breathing and another person can have no effect. So putting a stop at the source is going to be incredibly important at protecting and preserving human life.

I think that's a great message, putting a stop at the source. Mr. Chairman, my time has expired, but with those words I yield back.

Gentleman yields back. Now recognize the gentlelady of Illinois, Ms. Kelly, for five minutes of questioning.

Thank you, Chair Griffith and Ranking Member DeGette for convening this hearing. It is striking a year later we are revisiting this urgent issue while the Trump administration has worsened conditions. I was deeply troubled when in February 2025, the administration halted over $15 billion in federal funding to address the opioid crisis, affecting programs on SAMHSA and NIH's drug abuse and addiction research. SAMHSA, as you know, oversees essential services including the 988 Suicide and Crisis Lifeline, state opioid response grants, and nationwide addiction treatment, housing support, and peer recovery programs. Yet these efforts have been undermined by widespread staffing cuts across mental health services, disease response, and disaster preparedness. Alarmingly, the SAMHSA website now lists no leadership for substance abuse treatment or prevention, no directors or division heads. This absence of guidance and investment comes at a time when strong federal leadership is more critical than ever to combat the ongoing opioid crisis. Dr. Olsen, you are the former director of the Center for Substance Abuse Treatment at SAMHSA. I want to thank you for your service first of all. SAMHSA has lost significant expertise due to staffing and funding cuts. What impact did these have on SAMHSA's programs and access to care?

Great. Well, thank you. You know, first I want to just say also that the people who are there still, the career servant public servants, are unbelievably dedicated to the work that they're doing. So I just wanted to say that. And I think it's been tough. You know, Dr. Dasgupta mentioned that people have been having a hard time getting through, getting their questions answered, getting some technical assistance around their grants. And secondly, there have been professional associations that have actually noticed the glaring gap in guidance, in advisories, in other educational materials that we, you know, even before going to SAMHSA, we relied on in the field to really be able to understand what was best practices, learning from some of the expertise that SAMHSA really has had.

Thank you. And let me go a little further on the staffing piece. H.R. 5630 would create more red tape by requiring states to provide additional state-level diversion data in order to receive grant funding under the Substance Use Prevention, Treatment, and Recovery Services block grants. How might this bill affect grant awardees and will the effects be exacerbated by the firings and staff shortages at SAMHSA?

Yeah, no, thank you for that question. You know, data is always important to have. I think one of the first steps though in understanding what data to collect is to understand and have a clear purpose of what that data is is being collected for and how it's going to be used and how the staff, particularly at SAMHSA, to be able to then interpret and analyze and put that that information back into some of the grant programs and other areas of work. I think one of the things that, you know, I am concerned about with that bill is that there is a piece of that that actually would require states to measure diversion of medications, misuse of medications. That really has not been part of SAMHSA's wheelhouse in terms of the data that they collect to monitor their programs as well as to understand what's happening on the ground in terms of treatment and treatment outcomes, recovery and prevention. It that usually is collected by law enforcement and so it would require a significant amount of investment at the state level as well as at SAMHSA to really understand and be able to gather that information. And then it would be unclear what to do what SAMHSA would do with that information, and again, not having necessarily the bandwidth to really analyze and interpret it. And I think again going back to, you know, what asking that question of what is the purpose, what are we trying to solve for is an incredibly important first step in that process of data collection. Asking that question of what is the purpose, what are we trying to solve for, is an incredibly important first step in that process of data collection.

Thank you so much. I would be remiss not to express my concerns about Medicaid cuts following H.R. 1 and the risk they pose to programs like the Maternal Opioid Misuse model, which addresses fragmented care for pregnant or postpartum Medicaid beneficiaries with opioid use disorder. In my district, I have seen the transformative impact of treating pregnant women and new mothers with dignity and compassion as they navigate substance use recovery. Institutions such as Haymarket Center and Federally Qualified Health Center look-alikes are leading this progress. Support for treatment and recovery is critical, especially for new mothers. Substance use disorder affects all populations: rural communities, women, communities of color, and those facing economic hardship. Mental health and substance use disorders are leading causes of maternal morbidity and mortality, yet they often go undiagnosed and untreated. This is a public health crisis and a matter of social justice. So I urge my colleagues to reconsider severe cuts and protect funding for essential recovery programs. I know I'm over. Thank you and I yield back.

Gentlelady yields back. Now recognize the gentleman of Ohio, Mr. Balderson, for his five minutes of questioning.

Thank you, Mr. Chairman, and thank you all for being here today. My first question's for the Sheriff. Sheriff, thank you for your service. I represent Ohio's 12th Congressional District. Has some of the highest rates of prescription opioids dispensed per capita in the state. For example, Perry County ranks second statewide at over 50 prescription opioid doses per capita. If Congress implemented policies to help ensure that patients in high prescribing areas have routine access to evidence-based non-opioid pain treatments, how would that impact the community from your perspective?

Thanks so much for the question and there in Ohio you're ground zero for the overprescribing and a lot of the problems that we faced across the country. I do think it's incredibly important for people have to have access to the gold standard of treatment, which is medical-based treatment therapy combined with cognitive behavioral therapy as well as opioid antagonists when appropriate. So having access to those resources are indeed incredibly important not only for the life-saving effort but for the criminal justice component as well.

Thank you. I'll follow up with you, Sheriff. As recently as 2021, 32 percent of the mental health and 43 percent of substance use treatment facilities still do not offer telehealth services. A 2024 study found that telehealth has declined and become more limited for mental health care services since the end of COVID-19 public health emergency. Given these trends and considering that rural communities may face barrier barriers such as transportation challenges, influx work hours, and limited paid time off, how would federal actions to improve remove obstacles to telehealth for substance use disorders treatment impact individuals suffering from addiction?

I do think access to any type of health is incredibly important, including telehealth. Ideally, I think that having the ability to see patients in a clinical environment is the most desirable, but if that is not an option in areas where where travel and other resources are limited, having access to telehealth is is at least a start and I think that's something that should be accessible in areas across the country.

Agreed. Thank you. My next question's for Mr. Oulton. Thank you, sir, for being here. Based on your experience leading DEA's forensic laboratory system, what gaps exist in our ability to detect new synthetic opioids early and what steps should Congress take to strengthen real-time data sharing between federal, state, and local partners so communities can respond faster?

Thank you for your question. I'd start by saying what I indicated earlier is that laboratories do not routinely and consistently identify substances and fully characterize them. There's a data lag between the time that it's identified and the time that it gets through. There's a lack of standardized methodology and and testing and reference materials. The laboratories need funding to to be able to build these things. Use of the GARDS method that I described earlier, getting information into NFLIS would be adding the dots so we can collect the dots. And then wastewater testing. So the three gaps that I would I'd isolate would be the speed at which information gets into this data system, the consistency in which it is added, and then the integration so we get everybody talking using all the tools in the toolbox to move forward so we can be predictive in and ahead of ahead of the problem.

Okay. Thank you very much. My next question is for Doctor, I'm going to stick with Doctor, I'm not going to try it, it might be not good situation. Kratom has been widely across rural Ohio despite the fact it has not undergone FDA approval clinical trials and lacks a robust evidence base for safety or effectiveness. Our governor in fact has just banned that within the recent month here. In communities like Ohio's 12th District, why Kratom is easier to access than evidence-based treatments for opioid use disorder? What gaps in regulatory and federal regulatory authority have allowed this?

So I think so Kratom has been a useful off-ramp for a lot of patients who got cut off of their opioid pain medications. And so it's unfortunate that it's an unregulated product. Any unregulated drug is not going to be safe at some level. So the lack of oversight of it by FDA I think is a serious problem and when we test Kratom samples in our lab, we find other things that are not Kratom in there sometimes too.

Okay. I'm short on time so I will not have a follow-up. So thank you all for being here. Mr. Chairman, I yield back.

Gentleman yields back and now recognize Dr. Schrier of Washington for her five minutes of questioning.

Thank you, Mr. Chairman, and thank you, Ranking Member DeGette, and thank you to the witnesses for your attention to this important issue and for being here today. In my state of Washington, like every other state that we've heard today, fentanyl and other illicit drugs have had profound and devastating impacts. And before I even start, I want to thank Tyler Shamis's mom, Julie, for being here today. Tyler passed away because routine hospital toxicology tests failed to detect fentanyl in his system, and I am a cosponsor of Tyler's Law, which would ensure that hospitals screen for fentanyl in routine toxicology tests. This is a serious issue, and I want to work with my colleagues to make sure that no parent ever has to lose their child or anybody else to illicit substances just because they failed to test for them. So, Julie, our condolences, and thank you for being here today to advocate. I also want to point out, because it's a bit of an elephant in the room, just the devastating impacts that Republican legislation will have on overdose deaths in this country. Republican Medicaid cuts will lead to millions of Americans, and already have, losing their insurance, and insurance covers substance use disorder treatment. This Republican administration is also determined to dismantle SAMHSA, the federal agency responsible for substance abuse prevention and treatment. And we can and should both stem the illegal flow of illicit substances into this country and also ensure that Americans have access to the treatment and the help that they need, and we've heard a lot today about medically assisted treatment. I'd like to turn my attention to xylazine. I'm encouraged that we're talking about this important issue of stopping the illicit use of xylazine, which has just been horrible. It's an important prescription sedative, though, in the veterinary world and is used in cattle and horses, and there really is no other substitute. Dr. Gingrich, how do veterinarians use xylazine, and what exemptions or exceptions should be put in place should Congress or the DEA move to schedule the drug as a controlled substance?

Thank you. So my patients are probably a little bit different than yours. They try to harm me sometimes, and so...

Mine too, and they also don't talk.

But so as it's the only sedative that we have available for cattle. It's safe, it's effective, and it's been used for 50 years. What those carve-outs would do will ease regulatory burdens on manufacturers. We only have two that are making the drug. It's low market, so any financial burden on them could, we could lose access. And then it also will allow us to prescribe and dispense it under certain circumstances in our normal course of practice with oversight.

Can you talk just for a moment, because it's a little bit of a foreign concept for a pediatrician, in the veterinary world, especially in rural America, in many ways the rancher is sort like an in-between veterinarian. They keep medicines on hand, that includes antibiotics, and my understanding is that sometimes that includes xylazine as well, and that is a very important tool to have if an animal is in distress. Would there be that carve-out as well?

Yes, the Controlled Substances Act is currently written with human prescribing in mind where the prescription would go to an owner or family member of the household. In cattle practice, we may be working with a large farm operation and the employees where it's not the owner that we're working with. So that carve-out is in the Combating Illicit Xylazine Act.

That makes sense because you're sort of the parent, or they are, sorry, sort of the parent. Okay, I'd like to now pivot to kids as a pediatrician and community resources. I'm really concerned about the increase in fentanyl poisoning of kids and teens. So much of it is accidental. Seattle Children's, really across the water from my district, has seen a dramatic increase of youth who have overdosed and need inpatient care. Sometimes this is accidental, sometimes it is an addiction that builds, and the crisis is straining emergency rooms and there aren't enough resources out there for the pediatric population. Can you, Dr. Olsen, tell us if there's any innovative models of care that we can use when it comes to pediatric addiction treatment and how can we meet kids and their families where they are at?

And thank you for that, and I know we're short of time, but just a note to say that medications for opioid use disorder, particularly buprenorphine, has really been underutilized in youth and adolescents who have an opioid use disorder. So I would definitely point to that and that the American Academy of Pediatrics actually has a position statement on that as well.

Thank you, and I yield back.

Gentlelady yields back. Now recognize the gentleman from Georgia, Mr. Carter, for his five minutes of questioning.

Well, thank all of you for being here today. Ladies and gentlemen, as a pharmacist by profession, I've seen firsthand how dangerous substances can be, whether they're legal or illegal, and I've experienced both of those and the impact that they can have on patients and families in our community. And it's encouraging to see that the overdose deaths are trending downward. I would submit to you there's a number of reasons for that, not the least of which is that we've secured our border and we don't have as many dangerous drugs coming across, and that's certainly important. But you know, Mr. Oulton, you mentioned something a minute ago that brought back a memory to me when I served 10 years in Georgia State Legislature and on our Dangerous Drugs Act, we were always identifying the drugs that we wanted to add to that, but they were from the previous year. And every time we'd identify them, it was like a cat chasing its tail. They'd just change one molecule or something and all of a sudden it was, we were behind. It's like the flu vaccine, you're always basing it on the year before and you know, you're just taking kind of a shot in the dark. So it's a good point, and I appreciate you making that. But one of the, obviously what we've been talking about is the xylazine and the veterinary tranquilizer. And I want to tell you that we all recognize that xylazine is not an opioid. But Dr. Gingrich, as you know, animal agriculture plays a vital role in the state of Georgia, and let me assure you that the Georgia Veterinary Association has done their job. They've been to my office, they have educated me and my staff about how important this is that we keep this available, and we understand that, and we certainly want to make sure that they have access to this necessary medication for legitimate veterinary use. And I understand how critical it is to have the right pharmaceuticals. We used to call it the seven rights of drug administration: the right drug at the right time by the right route to the right patient, blah, blah, blah. And that it is important. But I also, this bill that seems to strike a balance, and I hope it does, by amending the definition of ultimate user in the Controlled Substances Act to better reflect veterinary use of this drug. Let me ask you this: why is this change important? Why is it important that we define ultimate user?

Thank you. Well, if the DEA administratively schedules xylazine without congressional action that would statutorily change the Controlled Substances Act, we would be forced to follow what it currently says, which would not allow us to prescribe or dispense it under certain situations to individual farms. I think it's important to recognize we have 9.5 million dairy cows in this country, 110 million beef cows, and I mentioned in my comments there's 4,000 veterinarians in our membership. And so allowing and utilizing farm staff, owners, and caregivers on farm for handling injured animals or sedating animals when needed is very important.

Yeah, I would categorize this under the education component of this, and I think it is incredibly important. I know that many hospital groups and the Department of Veterans Affairs have already started doing that, many major companies and corporations have done that.

It is very important. It's a very dangerous drug, though, because it's not an opioid. You know, I keep naloxone in my backpack. I have it everywhere I go in case I need it, but it wouldn't help me in this situation, and that's very difficult. But anyway, I want to make sure that we keep this in focus on prevention, particularly by reducing our reliance on opioids in the first place. And Mr. Lemma, I want to ask you, I've got another bill that I'm supporting, the Alternatives to PAIN Act, which promotes access to non-opioid pain management options in Medicare. And I've seen the impact that opioids, I've practiced for 40 years, I started when I was 10, but anyway, I practiced for 40 years and I saw the impact that opioids can have. And they're great drugs when used properly, but they can be abused and they're just so dangerous. But from your perspective on the front lines, how important is it to expand access to effective non-opioid pain management options?

Yeah, I would categorize this under the education component of this and I think it is incredibly important. I know that many hospital groups and the Department of Veterans Affairs have already started doing that.

Thank you for mentioning that. The VA is horrible about this. They used to send out tons of opioids. So thank you for mentioning that. And it's so vitally important. I wish we had more options available for non-opioid pain management, but you know, it's just one of those things. More broadly, Mr. Lemma, based on what you've seen, would improving access to safer non-opioid alternatives help reduce substance misuse and strengthen public safety in your community?

I think it would be incredibly important. The best thing they can do is never start.

Absolutely. Couldn't agree with you more. And if we had more alternatives, and I'm always trying to encourage the pharmaceutical manufacturers, I know it's difficult because opioids work, they do what they're supposed to do, and when used properly, they're a great drug. But the misuse of them and prescription misuse and abuse is what causes so much of a problem. I want each of you to know how much we appreciate what you're doing. This is extremely important. From as a professional pharmacist, I appreciate your work. So thank you, Mr. Chairman, and I yield back.

Gentleman yields back. Now recognize the gentleman from Massachusetts, Mr. Auchincloss, for his five minutes of questioning.

I appreciate it. Learned a lot during this hearing. Not a lot of cows in Newton, Massachusetts, so I'm taking notes here. I want to talk about both the supply and demand side of this fight that we're in and that I think all of you have noted we are making progress on, and it's important to underscore that, that there has been notable progress even since I took office five years ago in this fight against opioid use and fentanyl. But we have to reinforce it, and it's not exogenous or magic, right? It takes public health work and public policy. First on the demand side, I know this has been raised already, but the Alternatives to PAIN Act, I'm also a sponsor of this bill that would, I think, meaningfully help deter and deflect not medically necessary prescriptions for opioids for acute pain. Dr. Dasgupta, your research shows that population-level opioid harm is closely linked to the volume and potency of opioid exposure. The 2025 American Medical Association report on substance use and treatment found that while opioid prescriptions have decreased by 52 percent since 2012, many patients still face barriers to non-opioid pain treatments, with insurance coverage often cited as the primary obstacle. In the report's recommendations, the AMA urges health insurers to increase access to non-opioid pain treatment options and it endorsed efforts to ensure that individuals managing pain can receive comprehensive multidisciplinary multimodal evidence-based treatment. And so the Alternatives to PAIN Act will, I think, meet the AMA's recommendation and I would by providing Medicare Part D beneficiaries access to non-opioid pain alternatives and ensuring coverage of these novel therapies that is not less restrictive than the coverage policies for opioids. Dr. Dasgupta, do you want to comment at all on whether and how you think this bill might drive people towards these non-opioid-based pain medications?

Yes. So we've published three studies on newly launched analgesics and what happens in actual practice. So there's a clear pattern. Early on, prescribing, so these are for, for early on, there's prescribing is super concentrated in a handful of zip codes. And then when we ask doctors why they're not prescribing newer hard-to-abuse analgesics, 69 percent say they prefer generics and older medicine and 64 percent cited insurance costs. The other barrier is from pharmacists, that stocking new products is a financially risky endeavor because they don't get dispensed before they expire. Right. So I think there's like the legislative change, but the practice and changing physician behavior doesn't come automatically.

Appreciate that. And Mr. Chairman, could I enter into the record the AMA report?

If we can take a quick look at it, I'm sure it'll be fine, but we like to review it.

That's fine. I want to talk on the now on the supply side. Actually, Dr. Dasgupta, I do want to give you a chance. You had mentioned something earlier that I hadn't heard before about the efficacy of naloxone to treat xylazine-induced overdoses. I just want to give you another maybe 15 seconds to just restate that.

Yes. So xylazine does act directly on, naloxone does act directly on xylazine. It doesn't wake people up and animate people. So what we say is carry naloxone, administer it, but count breaths, and you'll see that the breathing comes back, but they may not get up and moving for a couple hours. You want to stay with them so that they don't get raped or have their stuff stolen.

Okay. That's news, that's a, I think, an important public health announcement that we need to continue to disseminate, that that it works. On the supply side, I'll be brief here. Last Congress, I was the co-chair of the working group on fentanyl and we had a bipartisan bill, the CCP Fentanyl Sanctions Act, that targets what the select committee's bipartisan fentanyl report described as the Achilles' heel of fentanyl and related synthetic narcotic producers, which is their exposure to the U.S. banking system courtesy of their illicit activity, which is to say basically there's only about a couple dozen Chinese chemical manufacturers that are responsible for about 98 percent of exports of fentanyl APIs to the United States. And because they have so much illicit activity, they're quite exposed to the U.S. banking system and we recommended codifying and building upon Executive Order 14059, which would basically sanction these chemical manufacturers in China. Sheriff, I know you haven't seen that bill and so I don't expect an authoritative answer here, but is sanctioning Chinese chemical manufacturers who are exporting fentanyl to the United States something that you would imagine your association would support in theory?

Again, I haven't seen the bill, but it seems like it aligns directly with what our priorities are and some of the talking points about China's influence in the precursor chemicals and other connections that that may be associated with this. So I see something that would probably align with what our interests are.

I appreciate that. I think there's a public health, public safety alignment. This is a bipartisan bill. We had momentum last Congress and I'd like to see us get it across the finish line. I yield back.

Gentleman yields back. Now recognizes gentlelady from Iowa, Dr. Miller-Meeks, for her five minutes of questioning.

Thank you, Mr. Chairman, and thank, thank you to our witnesses for testifying before the subcommittee today. As a physician, I know all too well how an entire generation of healthcare providers were pushed into prescribing opioids as patient surveys and physician performance were determined by the level of pain and pain management, even include being pushed by JCAHO. We also know that all a heavy reliance on opioids can lead not only to addiction, but it also increases the healthcare cost and it may also have an adverse fallout by lack of access to opioids for those who need them or that's the only or best option. Just in my home state of Iowa, the total estimated societal cost of opioid use disorder was 23.5 billion in 2024 alone. Increasing access to opioid alternatives not only can reduce the cost of medical care, but can also improve patient outcomes. One of my constituents from Iowa City, John Greenwood's story exemplifies this strategy. John is the chief strategy officer of Goldfinch Health, an organization that launched the Billion Pill Pledge to help reduce the number of opioids left over after surgery by one billion. John trains healthcare professionals about optimal pain management, but this work is also personal to him because his son was born with a missing bone in his skull and has required 13 operations in five years. By utilizing only non-opioid therapeutics, his son was able to get through a seven-hour skull operation and recover with zero complaints about the pain while being treated at the University of Iowa Children's Hospital. Because of his son's recovery, which was smooth and comfortable, he was able to be discharged from the hospital four days early. This also saved the healthcare system and the family thousands of dollars in NICU cost alone. My bill, the Alternatives to Pain Act, is written to ensure more patients get this approach and reduce the risk of addiction from prescription opioids. Dr. Olsen, in that context, do you believe policy like Alternatives to Pain Act that make it easier for seniors to access non-opioid alternatives could represent a next logical step in exposure prevention by addressing the financial and utilization barriers that make opioids the default in pain management, particularly for Medicare beneficiaries?

Yes, no, I think the access to comprehensive pain management is absolutely critical. It was something that we did many, many, many years ago and then it kind of went away, got replaced by opioids and really the hope is that now that's going to be back.

Thank you. And you've cautioned against blunt prescribing limits that undermine clinical judgment, arguing instead for a system for system reforms that support safer decision making. Does the Alternatives to Pain Act address this concern by ensuring that non-opioid pain treatments are not just clinically recommended, but meaningfully accessible to seniors at the point of care?

Seniors really have seen some of the highest overdose rates in the last several years and so really being able to have access to comprehensive pain management specialists, interventions, etcetera, is really an important piece of the puzzle of really helping them deal not only with the pain, but also reduce the risk of addiction.

Thank you. Dr. Dasgupta, your research shows that population-level opioid harm closely tracks the volume and potency of opioid exposure, but you've also cautioned against simplistic cut prescribing approaches that can create new risk. From a Medicare policy perspective, how should Congress think about reducing unnecessary opioid exposure in a way that avoids rigid mandates and preserves appropriate pain care for seniors?

I think there's a lot of physician autonomy that needs to come into play. How you codify that into law is not my expertise, but I think that's really the core of it, returning the sanctity of the patient-prescriber relationship.

I couldn't agree more. You've also written that opioid exposure is often shaped by a health system design rather than individual patient behavior. In Medicare Part D today, low-cost generic opioids are often easier to access than FDA-approved non-opioid pain treatments. How do cost-sharing and utilization management policies influence exposure risk among seniors, especially opioid-naive patients?

So we did a study that was sponsored by FDA to look at this question of like what makes people prescribe certain types of opioids or analgesics in general. And the it's a really complex decision-making process where like there'll be some early prescribers who will always try new medications and then you'll get kind of a slower adoption and then some folks who are like only generic old stuff, right? And so I don't know how to fix that with with Medicare Part D alone, but if you get more opioid alternatives out there, then there will be this networking effect of people saying like okay, I can use this.

Well, thank you very much and before I yield back, I just have to say, Go Hawks! And Mr. Chairman, I yield back.

Gentlelady yields back. Now recognize the gentleman from Louisiana, Mr. Carter, for his five minutes of questioning.

Thank you, Mr. Chairman, and I thank this committee for reviewing my bipartisan bill with my Louisiana colleague Representative Clay Higgins, H.R. 2715, the Destruction of Hazardous Imports Act. This bill gives FDA the authority to require an importer to destroy an FDA-regulated product that was refused entry into the U.S. because it presents a significant public health concern. Additionally, this bill prohibits the unauthorized movement of an article designated for destruction by FDA. Under the current law, foreign exporters can ship contaminated or counterfeit products to the U.S., knowing they can withdraw the shipment if flagged by FDA and simply sell it somewhere else, often undercutting or providing items that are contaminated, especially imported foods, seafood, have been contaminated with carcinogenic drugs, pesticides, and pathogens like salmonella or listeria. This loophole puts American consumers at risk and undermines our food safety system. This is a real threat. Exporters, especially Chinese exporters, have been caught resubmitting rejected shipments into different ports. The problem extends beyond food. There has been a rise in dangerous vape devices, e-liquids containing banned substances, excessive nicotine, or harmful chemicals, products that are currently law does not allow the FDA to seize and destroy, leaving the critical gap between the consumer's protection. This bill will close that loophole, creating a real deterrent for exporters who currently face little consequences. They will have the opportunity to have these items destroyed and never put back into the marketplace. Providing this authority has been a bipartisan priority for both the Biden and Trump administrations. Last year, the Trump administration's FDA included this authority into its legislative priorities report. Mr. Chairman, I ask unanimous consent to enter into the FDA fiscal year 25 FDA legislative priorities report into the record along with letters from a broad group of industry organizations in support of this proposal, including the Southern Shrimp Alliance, Partnership for Safe Medicines, National Association of Controlled Substance Authorities, National Consumer League, among many others.

And we will take a quick look at that and then add it, we'll let you know if we don't add it to the list.

Very well. Thank you, sir. Dr. Dasgupta, in your experience working with the FDA, what are some examples you've seen where dangerous or impure products were imported even if they didn't pass the FDA's review at its initial port of entry?

So port shopping like you mentioned is a really common thing. So an example is we saw muffins that were sold at a major coffee chain in the United States that had plastic in it. And the those shipments were rejected and then showed up elsewhere and I saw those on the shelves at the store. Honey is another one. Like buy only local American honey because it's always just a lot of times when it's imported it's just just sugar water.

I've just got to admit a lot, it's a real issue. It's a real issue across the board, not just with foods but also with vapes and other harmful items that find them ways sometimes into shelves where kids can purchase them. Further, in my in the last minute that I have, I want to come back to you, Dasgupta, to ask about the negative impacts of criminalizing 7-OH through bills like H.R. 8000. The N7-OH Act could have on medical research and why scheduling the substance could cause more harm than help. Instead of letting fear drive our policymaking decisions, we need to take a step back and adopt policy health approaches by allowing the science and the facts. Can you share why preserving an option for medical research on this substance could be more important and how scheduling it could impede the actual work?

I'll start by saying I've lost one of my close friends has lost a son to 7-OH overdose. And what I've learned from from that and with my regulatory experience is that there are regulatory fixes that we can do now. So most of the 7-OH deaths are from the sublingual and dissolvable strips. Those need to probably go. But things like single unit packaging, blister packaging, clearer labeling, testing, there's a lot more that can be done on the regulatory side to get rid of some of the harms from 7-OH.

And we're not, to be clear, we're saying it's bad. There's just a better approach to deal with it. How could scheduling this substance endanger the lives of people who use 7-OH to manage their pain or currently trying to transition off altogether or may use it in ways to reduce their dependence on a more dangerous substance?

We don't want them to turn to street fentanyl. We don't want them to turn to the fake pills. They're more dangerous.

Real quickly and I don't have a second. Anybody else have a quick opine on that? If not, my time is up anyway. Thank you very much.

There will be lots of questions after the hearing that can be put into writing and we'll ask you to answer those. Now recognize the gentleman from Florida, Dr. Dunn, for his five minutes of questioning.

Thank you very much, Mr. Chairman. I want to start by recognizing how unfortunate that this is such an urgent meeting that we're having. You know, in 2025 CDC reported an estimated 72,000 deaths from overdose. You think about that for a minute, 72,000 people, souls lost. You know, it highlights the brokenness of our system. I think we can fix this. I think the bills before us today represent some real and concrete solutions to address a crisis that has claimed more American lives than any war in modern history. Fentanyl alone accounts for an estimated 45,000 deaths in 2025. And that threat is not static, it's evolving, it's changing as we've discussed today. It's almost faster than our regulatory framework can track. And I'm aware that there's many problems that cause this, but I want to focus on the sort of upstream sources right now. Now, and this is not just a domestic public health problem, this is a national security issue and it has a return address. The Chinese Communist Party has subsidized and incentivized the chemical companies in their country to export fentanyl and all these other related precursors to produce synthetic opioids and whatnot that are illicitly sold in the United States. And I don't think this is negligence, this is policy. When China banned fentanyl production in 2019, they pivoted to selling precursor chemicals that are needed to manufacture. And when we schedule those precursors, they shift again. This is an adversarial biotech competition and we're playing with a losing defense. I want to remind everybody we're supposed to renew the Pandemic and All-Hazards Preparedness Act this year. Obviously, fentanyl is not the whole story, nitazenes and whatnot are, we've detailed today, xylazine, my gosh, it's almost unthinkable all the new sources of problems. These novel substances are outpacing our scheduling process. And legislation before us today, scheduling emerging substances, restricting pill presses, which I'm very proud to cosponsor, are closing some of these loopholes. And I believe this is a layered response that this threat demands. Sheriff Lemma, counterfeit pill presses make counterfeit pills look like legitimate pharmaceuticals and they're a major cause for overdose deaths among young people especially. I'm a cosponsor of Addison McDowell's PRESS Act. From your perspective in law enforcement, does this bill close the right gap?

I think the bill does close the gap. If we look at the overprescribing of legitimate pills and the ability to buy online and have shipped to you a pill that looks exactly like the pill that was pharmaceutical grade has created deadly consequences for many people across this country. And I think that getting this passed would have a tremendous positive effect on this country.

Thank you very much for that. Mr. Oulton, Chinese Communist Party has repeatedly made scheduling concessions under diplomatic pressure, scheduling fentanyl in 2019 and nitazenes more recently, but each time the Chinese chemical companies pivot to unscheduled analogs or precursors. Is our scheduling-based regulatory model structurally capable of defeating this problem with chemical and pharmaceutical industry capacity or are we playing whack-a-mole?

Thank you for your question. I would start with an analogy. To me, it's like boxing. We're getting punched in the face five times and then we duck. That's what we're dealing with here. So I think speed absolutely matters. We are not legislating fast enough. We cannot keep up with it, so we need to throw every tool in our toolbox at it to be able to deal with this threat. They're an adversary that is incredibly hard to beat because they have the money, the funding, and they move faster than we do.

So if we can do this by class as opposed to by chemical compound, I think we're a lot better off. Sheriff Lemma, intelligence suggests that Chinese criminal networks are increasingly coordinating directly with Mexican cartels on precursor supply and finished product distribution. What does that convergence look like from a local law enforcement standpoint and what federal authorities and resources are urgently needed by you?

We have a great relationship with the DEA. Terry Cole has assembled many members of law enforcement and policing at a local level to come together and to collaborate. We know the precursor chemicals came from China and now Chinese chemists have taught the cartels, especially the two major cartels, the Jalisco New Generation and the Sinaloa Cartel, to train from their chemists there. So it's an incredible problem and the DEA and HIDTA and other organizations are working with local, state law enforcement to ensure that we can deconflict and protect American citizens.

Thank you very much for your work. Mr. Chairman, my time has expired, I yield back.

Gentleman yields back. Now recognize the gentlelady from New York, Ms. Ocasio-Cortez, for her five minutes of questioning.

Thank you, Mr. Chairman, and thank you to all of our witnesses who are here today. I want to take a step back today. We've been talking a lot about some of the emergent issues around xylazine and potential for regulation and scheduling. And I want to take a step back and have us really explore and examine the scheduling system in the United States as a whole and really how we think about this. Because we're often trying to slot in certain substances into our scheduling and to Dr. Dasgupta's point, we end up playing a lot of whack-a-mole in once you schedule one substance, people then start finding alternatives and before you know it, people are then starting to overdose on entirely new substances that we didn't even know existed a couple of years ago. And so I want to explore the efficacy and how we think about this scheduling system overall. And for people who are at home following along, our general drug scheduling system in the United States works on a sorting scale of one to five lists or schedules. And substances get sorted into a specific schedule based on their potential for medical use, abuse, and addiction. Dr. Dasgupta, as an expert in this field, would you say that's a fair summary of our current scheduling system?

Spot on.

And in theory, Schedule I drugs are supposed to have no potential for medical use and high risk for abuse and addiction, correct?

Yes.

So zero medical utility, high potential for addiction, that's what's supposed to get you on Schedule I. Drugs on Schedule V, the last in that list, on the other hand, have high potential for medical use and low potential for addiction, correct?

Yes.

And there are also specific penalties tied to each schedule. Once a drug gets scheduled, the penalties for possessing that drug can change overnight.

That's right.

And so when we look back at the point of scheduling, in about 1970 or so, right, Congress created this system to try to deter the use of dangerous drugs by applying criminal penalties to the possession of those drugs. And scheduling was also intended to ensure safety when these drugs are used in clinical or research settings. Now, since this system was established more than 50 years ago, we've seen how it's fallen short. We've endured the war on drugs and we've also had a lot of limitations in medical research. Dr. Dasgupta, what is, what are some examples of Schedule I drugs?

Cannabis, LSD, ecstasy.

And in your knowledge as an expert in this field, is the claim that there is absolutely zero evidence that cannabis, LSD, MDMA have zero potential medical application?

I think the medical literature is clear that they do have clinical benefits.

So right now our law says that these drugs have zero medical application, but the science says something else. Is that correct?

That's right.

And not only that, the wealth of medical research shows that these are potential treatments for treatment-resistant PTSD, traumatic brain injuries, but the schedule classification really prevents researchers from continuing to do work on this, correct?

Yep.

Can you share some other ways that scheduling is hindering research?

So there's, so like test strips, for example. So we've talked about nitazenes, right? And the nitazene ban that China had done in July of last year has shifted the nitazene supply in the United States. The current test strips for nitazenes in the U.S. can't even detect the new species of nitazene that's the most common. So to get those kinds of tools out quickly, we need to have things that are not scheduled so the research can move forward for safer tools.

And so some of the counters to that point would say, well, people are overdosing on some of these substances, so we still need to schedule them. But has adding criminal penalties successfully reduced overdose deaths?

I mean, I think Florida is an interesting example, right? They put xylazine in Schedule I and their overdose deaths in 2018, I think it was, and their overdose deaths went up from 3,700 a year to 6,400 a year. So it's not a panacea.

So no. So scheduling it, increasing the scheduling is becoming medically prohibitive for treatments, but then also adding the criminal penalties has not only not reduced overdose, but in the state of Florida it's doubled them. But I think we're all still here on the same purpose, right? We want to make sure that we're protecting people and doing what we can. Are there any methods that you've seen that can help us make progress on this?

I think scheduling does have an important role. I think there just needs to be a lot more flexibility to keep the science in line with the regulatory process. I think that's the bottom line.

Thank you. Thank you very much.

Gentlelady yields back. Now recognize the gentlelady from Indiana, Ms. Houchin, for her five minutes of questioning.

Thank you, Mr. Chairman, for the opportunity to examine this important issue. I also want to thank you for your assistance with the letter to the GAO on diversion. Today millions of Americans are suffering from substance use disorder. While we've seen encouraging progress in reducing overdose deaths, tens of thousands of lives are still lost annually. This reality underscores the responsibility that we have as policymakers to act, but also to ensure that our policies are effective, based on patient safety, and while minimizing collateral damage. Over the past several years, medication-assisted treatment has become a central component of how we respond to substance use disorder. However, not all treatment approaches are without consequence. The MAT itself can carry inherent patient safety concerns. Medications like methadone are effective for some, but are also associated with serious risks, including respiratory depression, cardiac complications, potential for misuse and diversion, and dangerous interactions with other substances, particularly in today's environment where illicit drugs are increasingly potent and unpredictable. Methadone overdose rates have increased sharply following the relaxation of restrictions to access these medications during the COVID-19 pandemic. And so I have a series of questions based on Dr. Olsen, your testimony, and I'm going to ask you a lot of questions if you can just keep your answers to yes or no, that would be appreciated. Is it your position that we need to keep or even expand COVID-era policies that loosened restrictions for methadone and buprenorphine?

Yes, and I would actually just say that I think the data that you quoted is not accurate.

I'm going to ask you some yes or no questions. Is it your testimony that increased access to methadone and buprenorphine reduced fatal overdoses by 50 percent?

Yes, and there's also...

And these drugs, in your words, they, in your words, you say they reduce crime, increase employment, and increase physical and mental health. That's your testimony. In your written testimony, you cite two studies to support your statements, the Larochelle study in footnote one and the Barrio study in footnote two. Is that correct?

There are a number of other studies that I can add.

And you've read those studies?

Yes.

Isn't it true that both of those studies were performed prior to the relaxed regulations for COVID?

Yes, and there are other studies that also have actually been done since COVID.

But you cited those in your testimony as backing up your statements. So those studies would have been under the pre-COVID rules, the ones that I'm trying to go back to, is that correct, the studies that I mentioned, Larochelle and Barrio?

So there are other studies that I also cite in there that are since COVID.

Okay. So to the extent that those studies that you cited in your own testimony, they support, if anything, rolling back the expanded regulations because they were prior to the relaxed regulations and you cited them in your study as evidence for it to continue.

I think I would actually probably interpret those studies differently than you.

You say that those studies support the proposition that methadone and buprenorphine reduce crime.

Mhm, there are studies in addition to the ones that I cited.

Those studies, though, you say those studies, those are the ones that you cited in a footnote.

Those are examples of studies.

Okay, you cited those in the footnote. I've read those studies and they don't say anything about crime reduction.

No, because those are studies, there are other studies that I did not cite.

Okay, but you cited those in your written testimony. Yes, those are the ones that you cited. Okay, I'm going to continue. You say those studies support the idea that medications increase, that these medications increase employment.

So there are additional studies that...

But the studies that you cited don't say that.

Because there are additional studies that I did not add.

So they don't speak to crime, they don't speak to employment, but what they do say is that those studies say that the overdose deaths slightly decreased for methadone and buprenorphine users under the stricter pre-COVID regulations. Isn't it, I mean, you don't believe this study, it's, I can cite it, Methadone-Involved Overdose Deaths in the United States Before and During the COVID-19 Pandemic by Kleinman and Sanchez from January 2023, Mr. Chairman, I'd like to submit that for the record.

We'll have to take a look at it, but we'll put it to the list if it works out fine.

This is newer than the studies and it does cite that you mentioned and it does cite that methadone increases 48.1 percent in 2020 compared to 2019 and in addition to that, there is a great risk when someone is taking methadone and they take other substances. In fact, it increases the risk of overdose when involving another drug, those overdoses were attributed 62 percent involving other drugs and 67 percent of cases from diverted medication. You mentioned that it would be important, or it wouldn't be important, you wouldn't know about diversion, wouldn't it be important for treatment purposes to know if people were diverting their methadone?

And we do actually find that out in my practice, I certainly find...

Okay, but you don't think that SAMHSA should have a responsibility for that.

So again, that is, has not been within SAMHSA's wheelhouse because we are about treatment, and I can't speak for SAMHSA anymore, I am no longer there. I get it. And I would also submit that I'm happy to share all the other data that actually supports all of what I said in my...

I would love to see the studies that do back up your testimony. One thing I'd like to say, Mr. Chairman, I know I'm short on time, but I am concerned about diversion and I'd like to...

The gentlelady's time is up, but we're happy to let you do questions for the record.

Thank you, I will submit those to the record. Thank you.

Thank you, appreciate it. Now recognize gentleman from Ohio, Mr. Rulli, for his five minutes of questioning.

I appreciate that, Chairman. This question goes out to Dr. Dasgupta. The opioid epidemic has devastated the state of Ohio. I believe in the right to research all potential therapies to help combat this. You authored a paper criticizing the FDA for not implementing appropriate post-market controls of psychoactives. You pointed out that certain psychoactives have the potential to treat substance and disorders, but current policy hinders that such research. So, Doctor, my question is, do you believe Congress should make it easier to study the effects of psychoactives on treating substance abuse?

Yes, I think it should be.

What barriers make it harder to study psychoactives in the United States?

Getting, having things that are scheduled is it very hard to get to do animal studies for. It's very hard to do patient studies for, so that's one part of it. The time lag between when grants are dispersed and written, like proposal and dispersal, the drug supply might have changed completely. I think that's a major problem in doing research in private industry as well as in academic setting.

I appreciate that. Ibogaine therapies have shown to stop opioid withdrawals within 48 hours as well as reduce long-term opioid cravings, but Ohio and Texas have both appropriated funds to support ibogaine research. Now me personally, I lost a cousin to opioid addiction and one of my best friends saved his daughter's life by ibogaine. So to me, the idea that this civilization isn't using ibogaine on a daily basis absolutely blows my mind. So my final question to you would be, what do you think of ibogaine research and its potential benefits for all the different subjects that we were talking about?

I tried to get funding to do ibogaine research myself. I think it's an incredibly powerful molecule. There, for clinically, one of the issues is that it causes some people hallucinations that we might not necessarily want to see in a general patient population. So there are small derivatives of the ibogaine parent molecule, like noribogaine and some of the other ones, that could be better clinical candidates that would get through FDA clearance. So I think a comprehensive ibogaine research study, clinical trial, that would look at the right metabolites, figure out the right balance would be great, but I think it's a really important critical molecule.

Is there a periodical that you would suggest to the general public that may be watching this hearing today to educate them that would be a good place for them to start? Because the idea that these drugs could save our kids from this horrific epidemic is I think incredible and I can't believe that Congress isn't moving quicker on this.

The Shaman's Drum is a periodical that I know has covered, done like entire issues on ibogaine going back to Gabon where it is a sacred ritual part of coming of age all the way through to the potential for treating addiction. So I think that's one of the periodicals, there's probably others you have in mind, but I just, I see a lot of stuff.

Open invitation to our office anytime you want to visit. I really appreciate your time. Thank you so much. And with that, Chair, I yield my time.

Gentleman yields back. I don't see any further witnesses. I ask unanimous consent to insert in the record the documents included on the staff hearing documents list and did that include the last bunch that we got as well, did you all have a chance to look at that? We're good? All right. I would like to thank all of our witnesses for being here. Members are going to have additional questions for you, I assure you. I remind members that they have 10 business days to submit questions for the record and I ask the witnesses to respond to the questions promptly. Members should submit their questions by the close of business on Thursday, April 9. We've had a lot of discussion here today and what this is why these hearings are great because there are a lot of bills that people are now talking about is there a way that we can refine those bills to make them better and that's what a hearing is all about. I appreciate you all's time. And without objection, subcommittee is adjourned.