WASHINGTON—U.S. Senator Chris Murphy (D-Conn.) spoke on Tuesday at a U.S. Senate Health, Education, Labor, and Pensions Committee Hearing on the federal response to the fentanyl crisis with Miriam E. Delphin-Rittmon, Ph.D, Assistant Secretary for Mental Health and Substance Use, and Kemp Chester, Senior Policy Advisor for Supply Reduction and International Relations in the Office of National Drug Control Policy.

Murphy highlighted that despite progress made, the United States still leads the world in overprescribing opioids that put people on the pathway to fentanyl: “We've made a lot of progress when it comes to the overall number of opioids that are prescribed in this country. And there is a direct line between individuals who become addicted to these pain medications and then those that end up seeking illicit drugs, in black markets, that often end up having fentanyl attached to them. So, we've seen this drop in the number of opioids that have been prescribed, and we sort of pat ourselves on the back. And yet, when you look at our numbers, even with this drop — compared to the rest of the world — we are still a crazy outlier, right? We are still five percent of the world's population and somewhere between 70 and 80 percent of the world's opioid prescriptions, even with a 40-percent drop in the overall number of prescriptions that are being made. So, just talk for a second about — as we're talking about the Fentanyl crisis here — the work that we still have to do to alter prescribing patterns as a means to stop people from getting on this pathway to fentanyl."

On the trafficking of drugs like fentanyl, Murphy said: “[W]e have made through the Appropriations Committee — I chair the subcommittee that writes the budget for DHS —some significant investments in technology at those ports of entry. But there's sometimes an impression here that a lot of this product is being moved across in the dead of the night through the desert. But the reality is: We still don't catch as much as we should that is walking straight through public ports of entry. And there's additional investments that we can make to try to catch more of it and ultimately deter more of that activity.”

You can read Murphy’s full exchange with Delphin-Rittmon and Chester:

MURPHY: "Thank you very much, Madam Chair. Thanks for this hearing. You're all doing super important work. We appreciate the testimony.”

"Dr. Delphin-Rittmon, I wanted to talk to you about the genesis of the opioid crisis, which, of course, at first is rooted in America's penchant to prescribe opioids and addictive pain medication at a rate that is unparalleled in the rest of the world. We've made a lot of progress when it comes to the overall number of opioids that are prescribed in this country. And there is a direct line between individuals who become addicted to these pain medications and then those that end up seeking illicit drugs, in black markets, that often end up having fentanyl attached to them. So, we've seen this drop in the number of opioids that have been prescribed, and we sort of pat ourselves on the back. And yet, when you look at our numbers, even with this drop — compared to the rest of the world — we are still a crazy outlier, right? We are still 5 percent of the world's population and somewhere between 70 and 80 percent of the world's opioid prescriptions, even with a 40-percent drop in the overall number of prescriptions that are being made. So, just talk for a second about — as we're talking about the Fentanyl crisis here — the work that we still have to do to alter prescribing patterns as a means to stop people from getting on this pathway to fentanyl."

DELPHIN-RITTMON: “Yeah, you know, thank you for that question, Senator.

“You know, the prescribing patterns and, you know, ultimately ensuring that people have access to evidence-based services and supports is so critical. We've seen that over time, and we know that the evidence-based practices and treatments — such as medication assisted treatment, whether it be buprenorphine or methadone — can help people who are struggling with opioid related substance challenges. In terms of prescribing patterns, I mean, one thing that we're working on is to increase that access for individuals that may be struggling is to allow individuals prescribers — that is, prescribers — to treat up to 30 individuals with buprenorphine. And so we've revised the buprenorphine practice guidelines, such that those individuals can treat individuals struggling with opioid addiction with buprenorphine.”

MURPHY: “But I guess what I'm talking about, right, is pain management. I'm talking about the fact that we still are prescribing far more pain medication — addictive pain medication — than the rest of the world, and that we've got to, from your perspective, you've got to focus on trying to find alternative ways to manage pain, so that people never get in the position of being addicted to pain medication that then becomes an addiction to heroin, fentanyl, etc.”

DELPHIN-RITTMON: “Yes, and we do have grants, actually, that do that type of training. So for example, our state opioid response grant does train providers on alternatives to pain management such that, you know, prescription medications aren't the first course and so other strategies to manage pain, and that can help to alter and change some of the prescribing practices that we are seeing.”

MURPHY: “Mr. Chester, I want to talk to you a little bit about how fentanyl and other illicit substances come into the United States through the southern border. It is still true, correct, that the lion's share the vast majority — not all, but almost all — of the product coming into the United States comes through our ports of entry?

“And we have made through the Appropriations Committee — I chair the subcommittee that writes the budget for DHS —some significant investments in technology at those ports of entry. But there's sometimes an impression here that a lot of this product is being moved across in the dead of the night through the desert. But the reality is: We still don't catch as much as we should that is walking straight through public ports of entry. And there's additional investments that we can make to try to catch more of it and ultimately deter more of that activity.”

CHESTER: “Yes, Senator, you're correct. So the preponderance of the drugs do come through the existing ports of entry. The technology that they have available is very impressive, and the men and women of Customs and Border Protection—those are our most experienced folks on the ground. It is the most efficient way to be able to move them across and then have access on the other side to an available network to get them quickly across the country. So, they do come through most of the ports of entry, but there is obviously more that we can do. And so, you know, the President's budget asked for $300 million in enhancements for Customs and Border Protection, for that very reason that this is an evolving threat. But there are other places obviously — through the mail system through maritime conveniences — that these drugs get into the country as well.”

MURPHY: “I just make that point, Madame Chair, because a lot of our colleagues think that, by putting up this wall on the border, you're going to stop fentanyl from coming into the country. The reality is fentanyl is coming in through the ports, and so we can make investments. But the idea that it's the unwalled portions of the border where the fentanyl is pouring in is just not what the facts bear out.

“Thank you, Madam Chair.”

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