Assembly Select Committee on Fentanyl, Opioid Addiction, and Overdose Prevention

There it is. All right. Good morning, colleagues. When they get here. And guests, welcome to the Select Committee on Fentanyl, Opioid Addiction and Overdose Prevention. My name is Matt Haney. I serve as chair of the Committee, and this is the third hearing we've had of this Select Committee.

The first hearing was an overview of the larger challenge that we face with opioid addiction and overdose. And we focused on prevention and education, treatment and enforcement. And then we had a hearing a couple months back that focus specifically on access to treatment, particularly medication assisted treatment.

In all of those hearings, we did have the opportunity to discuss the particular challenge that we face around opioid addiction and overdose among young people.

But one of the things that came up in all of those hearings was a real need to have a more focused conversation about this epidemic and how it is specifically impacting children, teens and adolescents, and what we can be doing here as the Legislature and as a state to confront this epidemic, to help to prevent addiction, prevent overdose, educate children, and make sure that we protect all of our youth.

The stark reality is that accidental fentanyl deaths increased by 1652% between 2016 and 2022. Over 11,000 deaths in California this past year were attributed to overdose, largely connected to opioids and fentanyl. That is an over doubling of the number of overdoses in just five years.

We also know that we've seen similar increases on both deaths and addiction among young people. According to data from the CDC, the equivalent of a high school classroom's worth of students, an average of 22 adolescents died of drug overdoses in the United States every week in 2022.

Of course, here in the Legislature, we are working to confront this epidemic. There have been bills that have passed that have focused on enforcement, increasing accountability, focusing on how we get these drugs off of the streets and holding people accountable who are selling them.

We've also focused on medication assisted treatment, including bills that will change how we provide access to buprenorphine, to methadone, and to other critical interventions. We've also focused on access to naloxone and making sure that naloxone is everywhere that it's needed, bringing it into schools, bringing it into other places where it can help to save lives.

But we need to focus specifically also on the ways in which we can prevent addiction and overdose among our children, the impact of social media, the lack of adequate education to youth about the dangers of opioids and the risks associated with any drug use when it comes to the possibility of poisoning, and the unique barriers that young people can face when receiving addiction treatment need much more robust and comprehensive action.

Our youth are particularly vulnerable to the influence ready accessibility and gamification purchasing drugs through social media. For example, Snapchat is one of the most readily used apps to get pills and other substances.

One study showed that by 203090% of the fentanyl overdose casualties in California are predicted to be directly linked to substances that were obtained on Snapchat. We also know that there are people who are preying on young people and targeting them, tricking them, deliberately, going after children in the most shameful, dangerous ways when it comes to drugs.

We have to educate our youth about the dangers of drugs and provide the information that they need in their family's need so that they can protect themselves. We have to create a culturally competent and interactive curriculum so that students can better retain, understand, and utilize the information we are providing them.

We have to make sure that the long bureaucratic barriers and stigma when it comes to youth enrolling in addiction treatment are addressed. The stigma alone can often prevent many parents and youth from seeking help when they need it. And we have to make sure that medications that can be used to treat addiction are available effectively to children.

And the people who are preying on children online in particular, are confronted, held accountable, and stopped from doing that. We have a crisis on our hands. It is a crisis that affects every single county and city in our state. It is not a political issue.

It is not one that affects only certain areas, not rural, not suburban, not urban. It's not a San Francisco problem. It is a problem that is affecting our entire state. And tragically and sadly, our children are being impacted as well, in some cases disproportionately.

We are going to explore all of these issues today, and we have a number of experts as well as individuals who have been directly impacted and have lost loved ones to this epidemic.

And we thank them for being here, and we thank everyone for their leadership and for having the courage to stand up and help us in this fight to save lives. A few housekeeping things. First, we'll have four panels today. Witnesses of each panel will come up together and provide their testimony. Our last panel will feature virtual testimony.

After each witness has testified, the Members of the Committee may ask that panel questions or take the opportunity to make any remarks. We are expecting five or so of our Committee Members here, and this is a bipartisan Committee. At the end of the hearing, there will be an opportunity for public comment for individuals in the hearing room.

A public comment will be limited to 30 seconds per person. We are not accepting public comment over the phone today, but you can submit written testimony to the Committee at assemblymember Dot haneysembly Dot ca.gov dot. This email is also on our website.

With that, I want to introduce the first panel which, because of his leadership and his role and his partnership in confronting this opioid crisis in California schools, we have California State Superintendent of Public Instruction Tony Thurman, who has a panel to himself to help to discuss with us what we are doing in our schools, which we know are such a critically important part of our response in prevention and education.

And we really thank you, Mister Superintendent, for your leadership, and we welcome you and you can begin when you like.

Good morning. Thank you, Mister chair, for your leadership of this important Committee, for that powerful opening statement that really, I believe, charts the course of what we need to do. Thank you to your staff for all the materials in preparation as you laid out in your opening statement.

We all have a responsibility to address these challenges, certainly from the educational perspective, to educate young people, for them to be safer and make good choices and prevention. This country has to have a serious conversation about substance abuse prevention for young people and adults without stigma and mental health.

And we continue our effort to recruit those who would be mental health Clinicians in our schools.

We offer a $20,000 scholarship for anyone who wants to make a two year commitment at least, and would say to those who follow the hearing today that they can receive that scholarship if they reach out to us at Teachinca.ca.gov. We use that for recruiting teachers and for mental health Clinicians.

And of course, law enforcement has a role about how these dangerous drugs enter our communities, enter our schools, and of course, the role of social media, as you have very clearly articulated.

As I start, I want to give appreciation to parents who've lost a loved one, who have, to all parents who've lost a loved one to the opioid crisis, and in particular to parents who have shared their story in a way to help others.

I know that Amy Neville from the Alexander Neville foundation is scheduled to provide remarks, and Laura Didier from song for Charlie, who worked with us on a number of ways to make sure schools get information and toolkits. I'm grateful. I'm grateful to parents and advocates and health policy professionals who are here today.

Our work to address the fentanyl crisis has been powered by the most impacted, especially those parents who have lost children.

I know that these stories are very painful to share, and I thank you for sharing them so that we can work towards real change it's our responsibility to hear you and to rise to the challenge of this moment so that we protect our young people.

The fentanyl and opioid epidemic should be top of mind for every parent, teacher, health educator and counselor right now. In 2012, California suffered 82 deaths attributed to fentanyl overdoses. In 2023, that number skyrocketed to more than 6000. Deaths from fentanyl accounted for more than 80% of all drug related deaths among California's youth in 2022.

In our schools, we can address this crisis and save our students lives by providing drug awareness education to our students and providing the life saving drug naloxone and training on its use for school staff.

I'm proud to have sponsored SB 10, the preventing and treating student opioid overdose, which expanded statewide prevention and education efforts in our schools to prevent fentanyl related overdoses among our youth.

Through this statewide effort, CDE has developed substantial online resources to assist California school district's county offices and charter schools as they design and implement local fentanyl education efforts to protect our youth.

I would note AB 889 codified fentanyl education in the California Education Code, mandating that all leas implement parent education about the danger of synthetic drugs such as fentanyl. This Bill was inspired by Laura and Charles Didier, who tragically lost their 17 year old son Zachary to a fentanyl overdose.

I want to share my heartfelt appreciation again to Zachary's mother, Laura, who's worked directly with our team at the Department of Education and Song for Charlie as we have developed webinars and other resources for the field at the California Department of Education, we have also worked with the California Department of Public Health to issue a standing order for naloxone in our schools so that school employees have access to this important life saving measure.

This crisis is the fastest growing cause of death for young people across the country. I'm sorry. Across California, we know that there are elements of this crisis that require us to ensure that both health education and life saving medication are part of the solution.

All too often, young people do not know that they are ingesting a pill that is made with fentanyl until it is too late. Drug awareness education for both our students and their families is critical in order to save our students lives. Health education is a powerful tool we can use to combat this crisis.

We have comprehensive, theory driven, evidence based research to educate, inform and empower our youth and families to make well informed decisions that lead to positive practices. SB 114, which just went into Ed code, solidifies schools access to naloxone.

The Bill requires county offices of education to stock at least two canisters of naloxone at every middle, high school, and continuation school.

SB 367 was passed to require all community colleges and CSU campus health centers to have approved opioid overdose reversal medication available, recognizing the significant need that exists on our college campuses, as state Superintendent, I command our school districts who have been adapting our statewide resources into toolkits, who have been taking part in the standing order of free naloxone for schools, and who have been training staff and educating parents in order to make sure that caring adults in our students lives are equipped with the knowledge and resources that they need to protect our kids.

I encourage all of our school districts to be proactive in utilizing health classes, using peer to peer counseling, and strengthening school based health centers to preventively address this issue. In closing, I want to thank you all for participating today. Your involvement, your valuable expertise, and your insights will help save lives and further drug awareness and prevention efforts.

Thank you for the opportunity for testimony, and I'm happy to answer any questions from the Committee.

Great. Thank you so much, Mister Superintendent. I'll kick it off, and maybe I want to welcome my colleagues as well for being here. So a few things about the education that's being provided. Is there a process by which data is being collected or surveys done to better understand what districts are doing in practice?

I know you all are providing significant resources that help districts, and now it's a requirement that they implemented at some level. Do we know that it's happening and what is it? Obviously it's coming back to you in their plans? And so how is that being collected and how are you using that data and then connected to that?

What's your sense of sort of when many districts, and is the curriculum that you have sort of geared towards a particular levels, or is it something that we're seeing happen or should happen at the elementary school level, at the middle school level, and at the high school level?

And sort of how are we looking at when this is happening and when the right time for or right times for this sort of education and prevention to be done, particularly in the classroom?

Thank you, Mister Chairman. As you note, the legislation that has been passed requires all school districts to put into their school safety plans, measures for addressing the opioid crisis and for training.

Staff and staff have to be trained on how to administer narcanous, and so the Department of Education is able to collect that data as each district does turn in a school safety plan and we can provide highlights at any time about any district that the Committee Members might be interested in.

In terms of the education, the emphasis does tend to be focused more in high school and middle school, but we have many districts that begin education about drug use. Early classes. In our elementary schools, people sometimes think, well, we don't need this in our school. I've heard people say, we don't need Narcan in our school.

And I tell them we have to have an honest conversation about drug use, that it's everywhere. It is not unique to any one zip code, any one group of people. And many times, even in more affluent communities, there's more money, there's more access to get access to drugs.

And so we advocate that school districts start education as early as possible. But there are certainly these components that are placing significant effort on how to help middle school and high school students navigate all that is coming at them.

Are there areas where you think we need greater focus or some gaps that existed? You know, you're now, you know. Thankfully, the state over the last few years has passed a number of laws that have really made prevention education around this epidemic much more central and comprehensive.

In terms of what you've seen so far and what you're hearing as you're traveling and talking to districts, either anecdotally or in some of the, the data and surveying and resources that you have, is there areas where you would say for the Legislature, we really need to have a continued focus, and there's still need.

Thank you for the question. I think you outlined the need to address the access that students get through social media, being targeted by social media. I think we always need more resources around substance abuse treatment and prevention.

We have to have honest conversations about young people and adults who use drugs to address what are really mental health issues. You know, anxiety, depression. And we know that anxiety and depression have grown dramatically since the pandemic.

Matter of fact, before the pandemic, research shows that we've had only a third of the mental health clinicians that we have needed to address anxiety and depression prior to the pandemic. And so we have to grow the workforce. We have to have peer educators.

We have to have those who have lived experience, who can work with young people and adults. We have to have honest conversations about why people use drugs and how we support them. And prevention. We can never do enough prevention, and I think we have to always double down our efforts around prevention.

Our schools have great programs that talk about prevention and education, but they often are struggling to Fund those programs and competing with other things, as they deal with declining enrollment, they're losing revenue and they're losing their ability to pay for these programs.

We have to have deeper partnerships with the healthcare community, with foundations and others who can help to make sure we have robust prevention programs. And we just have to have honest conversations with our kids. They have to know that even in social settings, someone might say, don't worry about it, or everybody's doing it.

We have to have honest conversations with them that every choice that they make could be a threat to their life and help them to be able to make good choices when they are oppressed in those situations.

Thank you. Thank you for that, colleagues. Yeah. Senator Waldron, thank you.

Thank you so much. It's good to see you. I apologize for coming in partway through your testimony.

It's good. I'll give you a note that you can take back to school.

Okay. Thank you. I did have kind of more a statement question thing back when I was on the City Council years ago as the opioid crisis. We started hearing about the opioid crisis coming from the East Coast, moving to the west.

And as you correctly said, a lot of times, a big part of the problems are in the more affluent communities. Back I remember in the early two thousands, we would look at the areas where people could buy an opioid pill for $50. And it started this crisis, and then folks moved to heroin.

And then there were a lot of issues behind the addiction. And I got involved in the San Diego County opioid task force at the time that they were starting. But what we learned is, and I was shocked as a parent, that I didn't know what was going on.

You know, that if you look for things in your child's room, like the foil that they were using to melt the safety release time release coating on the tablet, just inhale it. Things that parents didn't know if they would have known to prevent something like that. Now, with fentanyl, these pills can be laced.

They can be in there. They don't even know something. That, while it was devastating and debilitating, then, is even 10 times worse now. How do the schools get information out to the parents?

Because it started really, my interest in this whole area when I learned of some of these things that could be prevented if we only knew enough. And, you know, parents as part of that could be helpful. And I think the social media part that you're talking about could be helpful.

A few years ago, I ran the Hope act twice. The heroin and Opioid Public Education Act, which died in appropriations, unfortunately, both times, because it does cost money to put out information and education, trying to reach parents, trying to reach the General public, almost like they did with the milk cartons.

It was just, you know, in your face all the time. It's almost like we have to be to that aspect, and I didn't know how the schools are able to get information out to parents as well.

Thank you, Samuel Member, and thank you for all your work in the healthcare space and on these issues. As you know, communicating with families about school issues is hard enough as it is.

You know, in the old days, you could put a note in a backpack and, you know, reach, but sometimes the student never even took that note out of their backpack. You know, it is heartbreaking how many times I've heard a parent say, I just didn't know that my child was struggling.

I didn't know that my child was having a conversation with someone, either online or through another connection to get access to drugs. It is no fault of the families or parents, but there are so many.

The noise from all of the things reaching young people today is at a decibel level that is so much higher than anything that we've experienced, and we have to figure out ways to reach students and their families. I think that peer educators are very, very effective with young people, and we have to Hire A.

Our schools have to hire parent educators who know how to reach parents, who know how to organize programs where parents will find out about how to be safe with their children, and also about important resources that the school has access to. Our schools have $4 billion, thanks to the Legislature, for community schools resources.

And these are things that means that someone at the school can connect the family to any resource in the community that they need. But our families need to know that. They need to know that they can ask for that.

They need to know that the school is the hub for health and mental health and social services and other things that will ultimately help our students to have more academic success.

And so to your question, I just think peer education and parent education and those who know how to organize in the community to get the word out in different ways so that people know about the information is part of it. We do. We need good campaigns where kids get information from friends and from social media.

I always worry that when kids get information from friends, they only get part of the story. And, you know, that's why I worry about what kids see on social media, that that may not always be accurate.

And so we want to make sure that we find ways to get information to students and their families that they can count on, that they can trust, and that could save a life. Thank you.

I want to thank you again. I know you had a hard stop, and we want to respect your time, but we really appreciate you being here. We appreciate your leadership.

It really is great to hear a number of these laws that have passed that now you're tasked in part to implement and your attention to it, your focus on it, and your partnership is much appreciated.

We do know that if we're going to be successful in confronting this epidemic and save lives, that our schools are going to be at the forefront of that and education and prevention and safety and also, as you said, some of the root causes there related to mental health and physical health.

And so I want to thank you for your testimony today and for your contributions. And I don't know if there's anything you want to say in closing, but really just appreciate your continued partnership.

Just thanks. Thanks for your leadership and the Members of the Committee. You know, I would just note by the folks who are here, I know that this is a bipartisan issue. We all have something that we stand to win and gain by working together.

And I want to thank you all for what you're doing to protect children from these harms and support our families going forward. Thank you very much. Thank you. Thank you, Mister Superintendent.

I am now going to bring up our second panel, which is going to focus on early intervention, Low barrier access to treatment and community resources.

We are going to be focusing, as I said, on education, prevention, treatment, and of course, a part of that here is making sure that for young people who are experiencing addiction, that they have a place to go to get help, and that we address some of those barriers in order of testimony.

Today we have Theo Krizwicki, the CEO of Endoverdose, and Doctor Jamie Congdon, a pediatrician and addiction researcher at UCSF. And I want to invite them up to speak this morning.

Hello. My name is Theo Krzywicki. I'm CEO of a nonprofit called End Overdose.

If you could go to the next slide, I think I can see it over there, and the organization that I run, and part of the reason I hope to speak with you today is we're a nonprofit organization based in Los Angeles, California, that services the entire state as well as the nation.

And our organization is focused on a peer to peer led approach. What we do is we train young people to identify and respond to overdose and prevent overdose in their day to day lives. And if you could go to the next slide, we understand the gravity of the problem that we're faced with today.

We understand the severity of this problem. If you go onto the next slide as well. We understand that the overdose thefts nationally gone beyond 100,000. We also understand that drug use in age demographics, 18 to 25 and under 17 are some of the highest drug users in California. And this is information from the California almanac.

If we go to the next slide, that would be great. And our strategy is focused on peer to peer education, distribution, web based services, and making these services accessible to young people.

If we could go to the next slide, and what we've figured out, and at least what we found for ourselves, is that the ideal settings for these distributions are middle schools and high schools, college campuses, nightlife and music events, as well as online.

Right now, the society's really changed, and we have to be able to model our communication tools to the demographic that we're trying to reach, if we can go to the next slide. And for us, what's extremely important is, you know, making sure that we create agents of change in the demographic that we're trying to reach.

We have a chapter program that's led through college students. They've trained this year. They've already trained 14,000 students in California. And all these students were trained by a peer educator. If you could go to the next slide. We have 13 chapters in California and 50 nationwide.

And what they focus on is providing the resources that everyone, you know, has been so helpful in passing on to those schools and the students at those schools. If we could go to the next slide.

And part of this strategy is focusing on getting the information that we want them to receive in a way that they want to receive it. The information that we're trying to give them is only as good as if the person that is taking that information will hear it.

And we've had so many failed campaigns that have really gone nowhere. This is a much bigger uptake one of the settings that we do our distribution of this education, distribute naloxone. And this training is at nightlife events. We've been able to do nightlife events in California.

Training over 100,000 people with partnerships with the largest music companies in the Coachella Valley. Training hundreds of thousands of people. If you could go to the next slide.

And another piece of the thing that we focus on is taking a lot of the information that we receive in different types of toolkits and then repackaging in a way that people want to listen to. If we could go to the next slide. We use, obviously, social media to transmit a lot of those information.

I draw this conclusion just because our social media is relatively large and able to communicate a lot of these ideas. Next slide. And we provide an online digital training that allows for people to get these services. Next slide. We use influencers to really push this information.

This is really essential to gaining the trust of the community that we're trying to serve. Next slide. And one thing that I want to draw to is the work that we've done in middle school and high schools.

We actually started a study through the ORS and NACCHO, the National Association of County and Health Officials, to focus on whether or not this was done right after Melanie's laws was passed. If we could go to the next slide with partners of LA USDA, LA County Public Health and Santa Clara unified.

And what we really wanted to focus on is if the education that we're providing, the way that we're doing it, is increasing retention rates, which it did by 25%, if we can go to the next slide. In addition to this, this trained 6,000 students and we held different listening sessions.

We trained over 68 different high schools and middle schools. And this took effect right after Melanie's law was passed in October 10 of last year, up until this July, if you could go to the next slide.

And, you know, a lot of the things that we heard from the people that we were able to train was the perspective of the students and having them be part of the education that we're trying to have. Right. Creating different methods that will help them be educated and really engage their attention. Next slide.

And so just some key takeaways for us. Last year we trained over 216,000 people. 70% of those were in California. And these were all people that were led and taught by peers. This is a substantial thing that young people want. Next slide. And happy to answer any questions. Thank you guys for your time.

Next time we'll make sure I control. The PowerPoint so it was great.

Thank you so much for that presentation and for your leadership and your work. I'm gonna have Doctor Congdon go, and then we will have questions for both of you after that. Just gotta hit the mic.

Thank you for the opportunity to be here today. I appreciate all of your attention to this ongoing crisis and specifically for focusing on youth today. Just to level set where we are in terms of substance use and epidemiology in California, we are having some success. We're seeing declining rates of substance use in California.

So less kids are using opioids than in years past. However, we continue to see, despite less use, increasing rates of addiction or substance use disorders, and increasing rates of overdoses.

And the reason for that disconnect is that the opioids that kids are using today, and we're talking mainly about fentanyl, is much more addictive than opioids that were used in years past. So of the fewer people are using, but of the people who use, they are more likely to develop an addiction or a substance use disorder.

The other piece of that is seeing the increasing rates of overdose, and that is partly because of the fentanyl, but also because the contamination of our drug supply.

So we're seeing a lot more fentanyl in other substances, making them more addictive, and also making the kind of, when we see a combination of use, what we're seeing is we call polysubstance use, there's a much higher risk of overdose. So those things together are leading to that, even despite declining use, increasing rates of addiction and overdoses.

So I want to make sure, in addressing these, we're talking about both prevention and treatment today on the prevention side of things. I appreciate that Superintendent Thurmond was here, because when we're talking about adolescent health, we have to meet kids where they are. And I mean that both figuratively and literally.

And so the most reliable place you're going to find kids is in schools. And so that's such an important vehicle for delivering education and the resources, the tools to prevent overdose as well. So school based Clinicians and school based health centers are a really important part of the solution.

And Theo and others today, I think, are going to talk about some creative and innovative ways that they are addressing this. So I won't get into detail there, but I think that's really important. And I just, you know, there's been talk about narcan or naloxone today.

And I think it's great that the legislative efforts in the past year have made sure Narcan is available in public spaces. We're still seeing a lot of kids dying alone at home or with friends. And so also equipping kids with individual supply of naloxone or Narcan is really important, too.

So, moving over to the treatment side of things, the good news is that we have a safe and effective treatment for opioid addiction in young people.

We're mainly talking about buprenorphine, and I just want to stress, I know we talked about this in the last session, but effective or evidence based treatment for opioid addiction requires medication as part of it. Like therapy alone is, most of the time, not enough to treat a fentanyl addiction.

However, even though we have that safe and effective treatment available, we're still hearing from young people that it is easier to get fentanyl than it is to get treatment for fentanyl addiction.

And so just from my perspective as a pediatrician, the two, I would say, main buckets of barriers that I'm seeing fall into workforce issues and infrastructure issues. On the workforce side of things, I'll just talk briefly about what the landscape of treatment looks like.

There are a lot of possible provider types that could treat an opioid addiction in a young person. There's primary care providers, there are addiction medicine specialists, psychiatrists. However, if you kind of.

If you were to draw a Venn diagram of like, who are all of the providers who treat and have kind of the training and experience to treat pediatric patients or youth, and then in another circle, if you have all the providers who have the training experience to treat opioid addiction, there's almost no overlap.

And so while there's, you know, the fact that there are so many different types of providers and settings where you could treat opioid addiction, I think is an opportunity. And to be honest, I don't know what all the policy levers and possible solutions are to get at that.

But that is probably the biggest barrier that I see in access to treatment. And I should mention that, you know, the medicine is not so different in treating opioid addiction in a teenager versus an adult.

The biology is not so different, but it's kind of the, there's the comfort level aspect of it, and then there's all the developmental issues that surround it. There's issues related to involving caregivers and issues around confidentiality and consent. So there are some additional considerations in treating youth.

And then on the infrastructure side of things, I mostly wanted to just mention the severe shortage of residential treatment facilities. And that is the case across California in all age groups. But it is even more limited for minors. There was a study that was done in the last year that found, and I'll take a step back.

So, like residential treatment facilities, we have a limited number in the state, but if you then talk about needing access for someone who's on Medi Cal, that number becomes even smaller. If you're talking about, obviously minors, that number becomes even smaller.

If you're talking about someone who has another mental health problem, which is almost everyone like that number becomes even smaller. And there are some facilities that call themselves residential treatment facilities, but they don't offer medication.

So it really whittles down to almost no availability of residential treatment for minors who need that inpatient at least to start their treatment.

So I'll just sum up by saying we have continued to see rising rates of opioid addiction, rising rates of overdoses in youth, but we do have effective ways to prevent overdoses, and we have effective ways to treat opioid addiction. It's just a matter of getting the treatment and the resources to the people who need it.

Thank you again for your attention. Happy to take any questions.

Thank you. Thank you again for joining us and for your leadership and for helping us address some of these barriers. I know we've been able to work together on a few pieces of legislation that have tried to get at this, but we have a long way to go. Colleagues.

We can open it up for questions for either of our panelists, if you have any. Mister Kalra.

Thank you, Mister Chair. And thank you both for taking the time to be here on such an important issue. And both of you made reference to new ways communicating, social media being one of them.

And one thing, at least, certainly I've read some about, but I've noticed as well, just in terms of interaction, is that I think some things have never changed. Youth are typically not as responsive to formally packaged messaging. What have you, as opposed to, as mentioned, kind of the peer to peer, more organic type messaging and communication.

And so how, if and how is that being used in terms of communication on whether it's Instagram or TikTok or other forms of social media, where it's not kind of this really polished type of messaging, but rather one in which it's a more genuine, at least it gives that sense of a more genuine communication style, which, frankly, has really led to a lot of folks getting really popular on TikTok, is because they're not as packaged, as polished and as some of the companies or nonprofits that are trying to communicate in a more formal way.

So just, I don't know if that's something that you've noticed or tried to implement in an effective way or from a kind of medical standpoint in terms of how you reach youth, of why that seems to be more effective and how we can build upon that from a formal manner, build on informal communication.

It's part of a formal strategy.

Thank you, Santa Clara. So we've done some work over there, and we use social media very heavily. If you look at a lot of different campaigns that cities will sponsor and put on, they'll pay lots and lots of money. La County is putting on one that's about $4.6 million to reach people.

They hire an outside agency, they'll put in social media, aspect onto it, and then they'll pay for it with ads. Organically, you can reach the exact same level very intensely to these population centers.

But what's really, really important is the level of engagement, their attention, time on them, watching it and taking things that you would already be trying to communicate.

Public health pieces, for example, overdose prevention, where you get the resource, what is the thing accessible to you, and putting it in a language and a flow style with somebody that they are, are more interested in. Right. They're not interested in me. They don't want to listen to me talk about it.

They want to hear someone that's socially relevant to them. Right. They want to hear somebody. For example, we worked with a CEO of the largest electronic music company in the world, insomniac, and he made a post that reached 200,000 people. We didn't pay for that, and it created a social movement uptaken by young people.

So using these tools effectively and getting motivation behind the demographic that we're trying to reach is really how we're going to see a lot of change. So we use them constantly. They're very cost effective when done correctly, and they influence and change lives.

Thank you. I'll just build on that a little bit. I agree that listening to you, you mentioned genuine communication. I think that means something different to all of us in this room compared to, if you ask a 16 year old, what they see as, like, effective or genuine communication.

And so we really have to follow their lead in terms of how they think they will best hear messages and have them lead, that peer efforts are incredibly powerful. I think there isn't one right solution. Also, though, they do need to hear either from a pediatrician or teacher.

They need to know that there's a trusted adult who will not judge and who will connect them with resources if they need so I think that is an important piece still, but not the most important piece for delivering education and information.

Thank you, Miss Patterson.

Thank you, Mister Chair. I also want to let you know how much I appreciate what you do and how you do it. And I think the comprehensiveness, using disciplinary individuals and information and those kinds of things in idiomatic form that young people will understand and accept.

And Fresno county, over the years, has done what they have called a FORT team, the fentanyl overdose rescue team, and they have incorporated so many of the methodologies that you have outlined here. The schools are involved, the superintendents of public instruction in Fresno county, the media is involved.

In fact, ABC 30, which is probably the most watched news facility in Fresno county, produced an astounding and, frankly, award winning documentary called "One Pill Can Kill". And what Fresno county did was they created the kind of information, obviously, yes, up on social media, but it was on billboards as well.

But also it was in movie theaters, particularly where the movie was young people oriented, with great cooperation from the owners of the theater, the public health people, part of that team, they will have public health providers, when an overdose takes place, will go to the hospital, will help if that overdose was fatal, they begin to gather the information, and they begin to try to figure out where was that chain of command from the pill to the young person.

And that information then goes to our law enforcement partners, the Fresno County Sheriff's Department, the Fresno Police Department. We even had help from our California Highway Patrol and also the District Attorney's office, which, and our District Attorney was basically the one that put all that together.

And back in 2022, I authored a bill, and I appreciate every person up here voted in favor of it, which was taking that model and providing.

We asked originally for $3 million in state funding, and we stipulated that there were guidelines around this interdisciplinary, idiomatic health, the schools, media, multimedia, all of that, two in Northern California, two in Central California, and two in Southern California. And we had asked for $3 million.

Well, when the California Department of Health looked it over, and we actually passed it at the $3 million level, but when it got over to the governor's office, they bumped that up to $5 million. And so each of these replicas, if you will, of really quite a successful methodology that our educators really were very insistent.

We got to do this in language and visuals and messaging, in the idiomatic that kids understand, so that it is a familiar approach to them. And so we mirrored an awful lot of the things that really were. Obviously young people were catching on to and responding well to. And so those funds have been dispersed.

Fresno county was one of those that got part of that funding, which was important. Presto county had funded all of this on their own, and so they had several partners that were part of the pool that applied, and both in treatment and overdose and addiction counseling, things of that nature.

And so these projects up and down the state have a lot of pieces to it, like you have outlined here. And we're grateful for the Legislature and these Members, but I'm also grateful to the Administration, who saw this as so important and gave us more than we asked for, which was kind of nice in 2022.

We were having a little bit of budget issues back then as well, but I wanted the Members to know I appreciated their support for it.

Also the appreciation that the governor's office recognized it and bumped the funding up, and for the intensive and significantly effective way that the California Department of Health Services looked at the applications and chose those that best mirrored this multidisciplinary, idiomatic, focused, and also not just law enforcement, but treatment and interaction with, with parents.

And part of that coalition was a very successful opioid treatment nonprofit in Central California with pain. Pain. And so we're seeing some really good results. And it's gratifying for me to sit here and hear from your perspective and that we. I think we got it right in Fresno on our own, simply because it made so much sense.

And we had leadership from the District Attorney's office and from our school, our countywide school superintendents. And it just. I'm just grateful that we were able to do it.

And there are these similar programs now being stood up in Southern California, the two of them in Central California and two in Northern California, as a result of the legislation and the Administration seeing that it was important to do a little more than the 3 million. And that was a pleasant surprise, and I was grateful for it.

So thanks for what you do. But also it has been an encouragement that Fresno county and these other organizations are putting them together similar to what you have found to be so successful, particularly engaging with the young people on their own terms, in their own idioms, and in their own spaces of input and experience. So thank you.

And I'm grateful also for colleagues back in 2022, because this Committee was put together to listen, to learn and act.

And I think one of the things I'm grateful for is that I think this Committee helped significantly for the rest of the body, both in the Senate side and the Assembly side, to see that this was an effective way to act.

Based on the history that we had in Fresno county and the fact that it was comprehensive and a lot of team Members who were engaged in it. So thank you for what you do. And I also want to say thank you for what my colleagues did.

And I will just close with we need more action as a result of these hearings. We got some action on AB 2356. I'm grateful for that. But we can't stop there. And so I'm hoping that from this, in following sessions of the ledge, I'm going to, I'm termed out. So I'm at the end of this year.

So, you know, I probably watch from afar, but I just want to encourage us finding out about it, being informed about it, that's important, but it cannot stop there. There are creative ways to act legislatively that can fill some of these gaps. And I think our approach and the 5 million mirrors a lot of that.

And so I'm hoping that from hearings, you know, ideas are birthed that match up with the need, and you've explained some of that need. So I appreciate it. And thank you. And I appreciate the chair for inviting me to be on the Committee and grateful for being able to participate here. Thanks.

Thank you Mister Patterson, and thank you for those words and for your leadership. I know you've made a huge impact on this issue. And Fresno, as you've shared with me, is really leading in confronting this, particularly on the prevention and education front.

And I think there's a lot to learn from what is happening out there and to be extended throughout the state. I know Doctor Congdon has to leave very soon, but the other Mister Patterson had a question that he wanted to share, and then we can allow the Doctor to be able to make her next appointment.

Well, thank you. Thanks for letting me go after my slightly older brother over here, the one with hair. I have a question.

Last year there was legislation, SB 641, which I think we have two of the co authors up here, which was bipartisan, past Senate, 40 to nothing, and the Assembly 76 is zero, which would have given more flexibility to emergency officials to give naloxone in higher doses than four milligrams.

It could have done eight milligrams, it would have put it on the naloxone distribution program, and unfortunately the Governor vetoed it. But almost every police officer or first responder that I speak to, emergency rooms, people are using fentanyl, often by choice. The nasal spray, you may need multiple.

So I was just wondering, are we seeing higher doses of the. Do you have any opinions on whether you think emergency personnel having the eight milligrams available or higher doses available on hand would be helpful?

Not used to this. I was going to defer to you on that question. It's safe to give. But you're a first responder, am I correct?

I am. I am a first responder. So I forgot to mention that I've also been in EMS for 10 years. I was a paramedic in Riverside. I've been in LA City for many years. And from a professional responder side, the way that we approach these emergencies is very different. Right.

Like, from a paramedic side, our first line of defense isn't actually intranasal at all. It's really focused on intravascular. Right. This has really been made for the convenience, you know, of somebody that is more of a layman responder. And what we're seeing is we're seeing the opioid epidemic change, right? We're seeing stronger, stronger, stronger analogs of Fentanyl.

Stronger, like, nitazene coming into this space. And what I can tell you is not everybody has the ability to respond in the same way that I do. They don't have the ability to assess respirations and mechanical ventilation the same way that I do. And they're not as comfortable doing something called just titrating to respiratory effect.

We have. And as a paramedic, we have a wide array of different medications that we're able to select from. And with our growing concern with all these things happening, I believe that we should make every single FDA approved Naloxone available to the public so they have the option of what they want to use.

I would say that the one thing that is worrisome is if you don't have a lot of experience. When we do a lot of education, we do it at these, like, nightlife settings, different types of club drugs where people overdose, especially downtown Los Angeles, that's typically where you see different analogs being mixed in.

So from an emergency responder perspective, we're using intravascular Naloxone. From a community health public perspective, these are analogs that are coming in, and having other options available is important.

This is total anecdotal non evidence. But what I've seen, I think you're right. Paramedics shows up, and they're gonna have different treatment options. And what I understand is police officers, for example, might be more likely to carry the nasal sprays, you know? Cause they can just carry them with them, right. Everywhere they go, and they don't have.

And they're pretty robust. And so I think I have some concern with an officer having to carry three containers of four milligrams for example, and maybe they can just carry 1, 8 or maybe 1, 8 and 1, 4 and sort of make an assessment. But I don't have any other questions.

But if you have a comment on that, you know, obviously would love to hear it, but appreciate that you did say that you think we gotta make it all available if it's FDA approved.

There we go. Yeah, I think, you know, I would never give a police officer just 1, 4 milligram pack. I think every police officer should be carrying Naloxone, and they need to have it with them.

The training is a really important part of that. You have to know that you can give another dose if it's the four milligram and it's not working, or if it works and then someone starts to fall asleep again.

And the training piece about, you have to always call 911, you have to get help, because even if someone wakes up and they seem okay now, it has a short life, short half life. So.

Thank you. And thank you to both of you for your leadership. And I think, as you've heard, this is all something that we need a lot more of. And I appreciate what you all are doing to meet young people where they are in every sense of the terminal.

And if there are ways that we can, as a Committee or I'm sure, individually, partner with you all, if there are additional things that we can do legislatively, I know that we are all standing in the ready to do that.

But most of all, we need more of this and more places more accessible to young people, I think is the mandate that we have and to do it in ways where they are and actually, some of the things that you put forward.

We're going to have a social media panel a little later here and want to kind of engage a little bit around some of those questions about what this looks like more online. But I want to thank both of you for your time.

And if there's anything either of you want to say in closing, feel free, and then we'll move on to the next panel. Thank you.

Just wanted to thank the Committee for Having us and for your time.

Thank you. All right, we will bring our next panel to individuals who have provided tremendous leadership in confronting this epidemic and especially around how we can do prevention and education. Amy Neville was a parent and the President of the Alexander Neville Foundation. And Juli Shamash, a parent and President of the Drug Awareness Foundation.

We deeply appreciate both of you being here and for your leadership. I'll turn it over.

Good morning. My name is Amy Neville. Thank you so much. For having me here today to share my story and update you on the progress of our movement to educate and empower our youngest citizens. Unfortunately, my family's story has been commonplace in America, but the lessons remain largely untaught.

At 14, Alexander was a brilliant and witty young man with a big future. As someone who held himself to the highest standards, he pushed himself to be a good student, a good scout, a good skater, a good marksman, and so many other things that he tried.

When Alex was 13, he and some friends began vaping in middle school. Later, they moved on to cannabis, a very common occurrence with teens these days. As a family, we intervened. We put better guardrails in place. It turned out that Alex had attention deficit challenges that surfaced during puberty, and he was struggling.

We met with a psychologist and his teachers, and we were making progress. And then along came Covid-19 with the lockdowns, many of the channels needed to help Alex and others were placed on hold. In May of 2020, Alex celebrated his final birthday.

Summer break began, and when he wasn't meeting with his friends at the strip mall, he was meeting up with them on Snapchat. We later learned that Alex and his friends were being connected by this popular and trusted social media app, Snapchat, to meet with drug dealers as well.

He was quickly groomed by these dealers and started trying what he believed was Oxycodone. I quickly recognized something was off about him, and I asked him if he was using something. At first, his response was no. But then, about 36 hours later, Alex came back to his father and I and explained what had been going on.

He told us about Oxycodone, and he cried about it having a hold on him. He told us he met with a dealer on Snapchat. We contacted a behavioral clinic to assist us. They needed to get back to us with their recommendation. The next day, he spent time with his dad. They went out to lunch.

He went and hung out with friends. He came home later that evening, went to his room, and that was the last time I saw him alive. The next morning, I found Alex, pale blue and lifeless, lying on his beanbag chair. His dad performed CPR while I spoke with the 911 operator and looked after my daughter.

I believe it had been maybe 10 days from Alexander's first pill to the day that he died. We couldn't understand how this could have happened so fast until law enforcement searched Alex's room and bought a little jar with a couple of fake Oxycodone pills that tested positive for Fentanyl.

This is how I learned about the illicit fentanyl crisis in the new drug landscape. To better understand what happened, we began meeting with health professionals, law enforcement, attorneys, you name it. I talked to every subject matter expert you can think of. And when it came time to create our presentations, something was missing.

And that was the youth perspective. And so after that, we started meeting with youth on a regular basis, starting in November of 2020. At Alex's funeral, we began making plans, making pleas to families to catch up with the new paradigm.

There was a lot of unfortunate lessons to be learned from Alexander's experience, and we did not want anyone to learn the way that we did. That's why we began the Alexander Neville foundation, and we worked tirelessly to educate young people on the current drug crisis and social media harms. We serve elementary school and high school students.

I'm very proud to say that we have served over 300,000 people in the last three years across this country. The lessons that I bring with me to families, schools and other organizations are youth informed. I do not create anything without input and youth approval.

They are on the front lines of these co occurring Fentanyl and social media crisis, and there is a lot that we can learn from them. Most adults today grew up at a time when teen drug experimentation did not end with death. Most parents and teachers do not realize illicit Fentanyl is in all drugs now.

Most parents and teachers do not realize how accessible and tempting platforms like Snapchat have made these dangers. How can they teach their children this knowledge without having it themselves? That situation has helped make young people the most vulnerable to this epidemic.

Most young people who consume or overdose on illicit fentanyl have no idea that they have ingested it. They bought Oxycodone, Xanax, Adderall, or something else to help illustrate that problem. We began referring to these victims as being poisoned.

For users not intending to purchase or consume illicit fentanyl, this is a fatal betrayal that is akin to the issue of purposely tainted food or medicine. Today, illicit fentanyl is clumsily mixed into Cocaine, Methamphetamines, or pressed to look like FDA approved drugs. Those who don't know better are being deceived to death.

Meanwhile, those who know are playing Russian roulette. This is referred to, like I said, as Fentanyl poisoning. By referring to Alex's death as a poisoning. It helps overcome stigma and opens doors to a conversation.

If I say overdose, I met with parents who think they do not need to listen because they do not have a drug problem in their household.

When I say poisoned parents want to know more, and that's because we are conditioned from the time we are going to have these babies in our homes to prevent a poisoning and what to do in the event of a poisoning. The second lesson is the undeniable link between illicit drugs and social media companies like Snapchat.

While it is illegal to advertise and transact drugs online, it is still widespread and they know it. Today, social media companies have become the proverbial last mile for drug distribution networks. Social media in particular. Snapchat is the most efficient means for soliciting and obtaining new clients, especially youth.

As I bring these lessons to families, schools and organizations, it is imperative that we overcome the stigma around substance misuse. I do not advocate that we just accept substance misuse, but we must accept the reality that large proportions of Americans have tried or regularly use drugs.

Not only do the studies support the pervasiveness of drugs, but the overwhelming number of drug poisoning and deaths show that the walls of denial only make matters worse.

The operations delivering illicit substance to our loved ones have not stopped because our community, like so many others across the country, refused to admit or accept that there is a drug problem. Instead, the stigma keeps families ignorant and blames the victims. Today's stigma is also keeping naloxone out of the hands of youth, families, and schools.

As overdoses and drug poisoning deaths begin to haunt more American families, it becomes apparent that this problem has become endemic in the same way that heart disease or other health issues are. That is why I advocate for the distribution of naloxone in first aid kits. The same way we distribute aeds.

Naloxone should be available in schools, airplanes, and all manner of public spaces. In fact, I'm a huge proponent for getting it into the hands of our youth. Again, it's the youngest Americans that are the most vulnerable and need prioritization. Youth, parents, teachers, administrators are on the front lines.

Essentially, they are our first responders to these poisonings and overdoses. They are our key change makers that will build a healthier and safer future. As I close, I need to reiterate that we don't have to accept drug use as normal.

Instead, we must accept that drug misuse is not going away, but we can halt the deaths and addiction via education, awareness, naloxone and like Theo said, all forms of naloxone and destigmatization. The last thing I wish to share is that in my experience with our young people, they want the truth, and we need.

That's exactly what we need to give them. Thank you.

Thank you so much. Miss Neville, I'm so sorry for your loss and thank you for bringing Alexander to the room and his spirit and sharing more about him with us as well. And what a beautiful, wonderful young person he was.

And your commitment to save lives is inspiring and greatly appreciate your leadership and you being here with us today.

Miss Shamash, thank you for having me. My son Tyler died at 19 in 2018, so I've been at this a really long time. He died from fentanyl poisoning after dealing with addiction for three years.

His was not a case of trying one pill and dying, and more people need to start being honest about their family Members addiction or will never get rid of the stigma Tyler had. Mild Asperger's and bad add. A little speck of dust would distract him from when he was young.

He would thrill seek, whether it was climbing the tallest tree, being up on our roof, or doing firework shows to compensate for the dopamine he was lacking. He started smoking weed at around 14 to self medicate for anxiety and to calm his mind.

After a while, it stopped working, so he started using harder and harder drugs, often to emulate rappers that he saw on TV or social media.

We had no experience with addiction, so we turned to experts and did everything they advised, which included spending hundreds of thousands of dollars in wilderness programs, a therapeutic boarding school, residential treatment, detox, and multiple sober livings. What we never tried was medicated assisted treatment because the sober livings didn't allow it and didn't encourage it.

My family formed the nonprofit called Drug Awareness Foundation, and we, like many other bereaved parents across the country, speak at school, schools, parent groups, religious organizations, businesses, community events and town halls across the country, basically anywhere that will have us. And we do it for free.

When we talk to high school and college students, we tell them that no matter how many fentanyl death stories we tell them about, some of them are going to choose to try drugs because they think it won't happen to them.

For them, we explain how to make it safer by using fentanyl test strips correctly, having naloxone on hand, and never using alone since you cannot narcan yourself. We also tell them where to get the naloxone and testing strips, and sometimes arrange for end overdose to come to the school to train staff and students.

In April of 2021, I asked the LA County Department of Public Health to do an outdoor media campaign warning the public about the dangers of Fentanyl poison drugs. They declined, saying that their campaigns took two years to plan and that Meth was the leading cause of drug deaths in laden.

That might have been true, but meth users know it's dangerous and people buying pills online or on the streets are not always aware that their drugs can contain Fentanyl.

I raised money from friends and family and got my own billboard, street level postings and bus ads put up around the city, and I did it within a couple months, so it's definitely doable. Recently, the Health Department did start a wonderful outdoor media campaign.

In the beginning of 2021, I tried in vain to get LA Unified School District to add two lesson plans about Fentanyl poison drugs to their curriculum. It was offered for free from a school district in Oregon.

They declined at the time, but in September of 2022 did start to allow teachers who wanted to use approved outside resources on Fentanyl, although as of April of 2023, many of the students still had not been taught anything about Fentanyl and that in my mind is negligent. The most responsive person was the medical Director at LA Unified.

In January of 2022, I spoke to her about getting naloxone in all the schools. She started working on it, but wasn't able to have the meeting with the school police to have it in their cars until May.

Finally, eight months later, in early September, they started writing up their Narcan policy to be able to obtain it from the state and get it into some schools for a pilot program. Melanie Ramos died from Fentanyl poisoning in the bathroom of her high school on September 13.

On September 22, it was announced that all LAUSD schools would have Naloxone on campuses. This shows me that when a district wants to get something done quickly, they're able to cut through the red tape and do so. It's really, in my mind, just unconscionable that it takes so long to get things done.

In January of 2022, I also tried to get UCLA to have naloxone in all of their dorms and to talk about fentanyl poison drugs at their freshman orientation.

They formed a Committee with other UC schools, but by September nothing had been decided, and I'm still not sure if they have it in all the dorms and if they're talking about it at their orientations.

The reason I'm mentioning this is not to toot my own horn or to throw anyone under the bus, but to show how long it takes to get things implemented in public institutions.

I can't help but wonder how many lives could have been saved if the public had been made aware earlier unfortunately, there will be another horrible new drug around one day, sooner rather than later, and we must figure out a way to get the information to the public more quickly and without all the red tape.

The most effective, and surprisingly, didn't take that long. Thing that I was able to accomplish was getting SB 864, Tyler's law, passed in California. And some of you here, I think, even voted for it. It says that whenever a California hospital orders a standard five panel toxcreen, they need to add a separate Fentanyl test to do it.

It came about because the night before Tyler died, he was taken to the ER for a suspected overdose. All his talk screens came out negative. When I got there, I asked the treating Doctor three times if they tested him for everything, including fentanyl.

It was 2018, and I had just started hearing about Fentanyl, so I didn't know much about it. The Doctor assured me that their standard five panel talk screen would show Fentanyl if it was in his system, because it tests for opioids. But we later found out that the Doctor was misinformed.

Because Fentanyl is a synthetic opioid, it doesn't show on a standard opioid test. Tyler died the next day in the bathroom of a sober living. And had we known he was using again, we would have sent him to a higher level of care, like a detox or residential treatment.

The law went into effect in California on January 1 of 2023, and I was able to get a similar version introduced in the House and Senate, and it's actually sponsored by our very own Ted Lew and Cindy Kamwalker.

Just like everything else I mentioned, it's just one tool of the many that we can use to try to end Fentanyl deaths. Thank you for having me and for having this panel.

Thank you, Shamash. And again, similarly, so sorry for your loss and grateful for your leadership, and could not agree more that how slow moving so many institutions and the state itself and cities and counties have been in the face of this epidemic has been infuriating.

And we know enough now, more than enough, to know that moving faster and getting people the support and the information that they need quicker is what is going to save lives. And there's plenty of information that's out there.

There's plenty of ways that we can provide education, prevention, intervention, whether it's Narcan, whether it's trainings, whether it's access to care or treatment. All of those things should be much more accessible and really comprehensive. I want to open it up to my colleagues. Mister Kalra.

Thank you Mister Chair. It's not easy to hear what you both have to say, but I think that's what makes it that much more important for us to hear it. And I commend you for taking a tragedy and using that energy to save lives.

And I know the Chair and others in our Legislature have done work in this space, particularly in regards to education, in terms of ensuring that Narcan is available, what have you. But that all starts with the work that you all are doing in pushing us and educating us.

And you think about all the young people, and even in situations where they're. Is a relatively healthy relationship where they feel comfortable coming to their parents, and you can only imagine all those that don't feel comfortable. And either way, it's such a difficult situation to be in.

But, you know, as we were talking to the earlier, the couple of folks who were on the panel earlier about how to reach youth, being able to go to your parents, or to your doctor or your teacher is wonderful.

And then on top of that, having these other mechanisms, again, that put the framework in that, look, you're not doing anything wrong. We just want to make sure that you have all the information. We want to make sure that you have the ability to respond if you're in a, put it in a tragic situation.

I really like the framing of poisoning, especially when talking to parents, because I think all of us can be in that sense of understandable delusion, where it's like, no, it can't be my kid or I, it can't be my brother or sister.

And let's get real, first of all, but also let's frame it in a way that, look, it's not about whether you or your child is doing something wrong, it's about saving their lives and putting people in a position to do that.

And yes, let's work on prevention, let's work on all these other mechanisms, but let's also be real about what's happening on the ground. And so I really appreciate you putting us in that mindset based upon tragedies you've gone through and youth you've communicated with in terms of what we need to do better.

And so I just want to thank you both for that. I think it really helps me personally kind of put my mind in the proper framework to deal with these issues.

And there's no doubt that as long as you're out there, continue to advocate for legislation, continue to advocate for us to do better, then I certainly feel more motivated to do just that. So thank you both.

Thank you.

Mister Patterson.

Great. Thank you. Well, I really appreciate you both being here today. Very sorry for your loss. And as many of my colleagues know here, you know, the first I ever heard of Fentanyl was when one of my neighbors passed away, Zach Didier.

And so I happened to be mayor of my town at that particular time and learned about it. And so since that time, authored a lot of legislation on the topic. And I think actually Superintendent Thurman mentioned one of my bills, the parental notification in schools.

And I was very excited when I was registering all four of my kids to see the notification in there because, look, as a parent, we're not going to read a lot of these notifications, honestly. But I always figured with 6 million kids, if only 1% of parents read it, that's 60,000 parents who will become educated on it.

So most individuals that I've met, including my cousin, passed away from Fentanyl as well, is, you know, none of the parents really knew about this at all at the time.

And so I wanted to say, I, you know, I'm with you on, you know, and if you ever have ideas that we can do as a state, you know, I'm always interested in hearing about those. I authored legislation. We have a couple of the joint authors up here in the past to require schools to carry it.

Unfortunately hasn't made it through the process. But I think it's a really important, there have also been efforts to get colleges to have it as well. Naloxone, that is what I'm talking about.

So, and I think, you know, the wheels of government are very slow, but this problem is evolving rapidly and we're seeing more, more things in that.

But I think at the end of the day, one thing that I'm really interested in, and if you have any thoughts, would love to know, is, you know, really just education, how we educate kids in particular, I think kids will always go out and make mistakes and experiment and things like that.

My 11 and 9 year old know already, you know, not to take things from people. You know, it's kind of a sad state, but, you know, I think it's really important for them to know that. And so I don't know if you don't have to say now, it could be later.

But if you have any concrete ideas on how we educate kids more, I'm really interested.

Well, I will tell you what's worked historically, like with tobacco and drinking, is we hit him in elementary school, and that is where we need to start having these conversations. Obviously, it's going to look a lot different than what we talked to middle school and high schoolers about.

And so that's a huge focus for us, especially going into this next year.

I think also kids need to hear it from multiple sources. So they need to hear from teachers, from parents, from their pediatricians, from their friends. The more places they hear it from, the more it will sink in.

So on the educate, you know, in class or what now, you know, when I grew up we had D.A.R.E. and I don't know, for some reason D.A.R.E. has been like dragged through the mud. I don't really fully understand why, but for me I thought that that was a pretty useful program growing up.

And I think, you know, I agree. I mean if that's something in multiple sources, I mean I think everybody should be talking about it because it's not just, you know, you're going out to smoke Marijuana or something and you'll wake up the next day feeling groggy. I mean this is a different world we live in. So.

Yes, thank you very much.

Mister Patterson.

Well, first of all.

Touch us deeply with your stories as a dad, three kids and four grandkids, and having been legislating in this space and advocating since I was elected.

And what has touched me about what you do is that, yes, you loved your children deeply, but you are here today loving other children to help in any way we can to make sure that others stay safe. I echo my, the other Patterson up here about if there's ideas or concepts, we want to hear them.

We want to move from just hearing, listening, and knowing to acting. And I think we have a strong consensus up here that we want to put into legislation solutions that we know have worked and we know will be effective, and we will be targeting and communicating with those who may not be communicating with mom and dad.

And that's why I was talking earlier about the Fresno, the fentanyl overdose rescue team that we put together in Fresno County. We have parents who lost their kids participating in it, and seeing that the loss of their child has burden their heart for other children.

And that is an act of love, even in the midst of your pain. So thank you for being here. We're listening. And as I said earlier, we want to act, and I hope that this Committee will come to terms with the fact that we're here to do more than listen.

And maybe we can have three or four good legislative ideas that maybe we can pass on to other Members in the next session. So thank you for coming and being a part of this. We're sorry for your loss. But grateful for your love of others.

Thank you. And thank you to my colleagues for their points. And absolutely, I took a number of notes from both what you both shared in terms of where we should be focusing here. I wanted to ask one question as we, our last panel that's going to come up next is focused on social media.

And, you know, it's been a bit of a theme in all of our conversations here, both in terms of the way in which these drugs are being accessed through social media and online, and also the ways in which we can use, where young people are often online and in these various social media sites as a way to engage in education and prevention.

Have you all found much of a reception from any of these companies themselves or attempted to engage with them? How do your efforts, obviously, we've spoken a lot about schools and what's happening in schools, which is a really important part of it, and some of the other places that we're meeting folks.

But what are you seeing in terms of how to meet people, engage with folks online and also actually stop the selling online.

There's so much of it that it's just a huge breach in the dam that how do we patch that up? How do we go back? That's why I think education and awareness is so, so important. We have to reduce demand. We have to put these people out of business by not seeking out their things. Right.

Or engaging with them in these conversations. Because when I talk to youth, a couple of interesting things that I learned right out of the gate. Number one is that, oh, we're desensitized to it because medications are all around societal things.

So it seems safer than going after Marijuana or something else because it's a prescription medication and they're being advertised that way. So that's one thing. The other thing was the whole grooming process I learned from these kiddos. They're not, you know, they had no intentions of trying drugs or.

But this drug dealer became friends with them in Snapchat or wherever, and becomes friends with them, tells them how funny and smart and talented they are. And our kids are vulnerable, right, because they want to be treated more grown up at this time in their life, and they fall for it. And so, you know, 25 interactions later.

So I see you have a lot of clout with your friends. You seem to have a lot going for yourself. Then they'll start to offer them things, and they think this person's their friend and has their best interests at heart, and they will take them up on it.

Another disturbing trend that is come up recently is, you know, a kid puts it out on social media, having a bad day. My dog died. I'm so sad. Drug dealer slides right into their direct messages and says, I see you're feeling really sad. What's going on? The kid tells them, my dog died.

I've had that dog since I was born. I can't imagine life without them. And the drug dealer says, oh, yeah, I remember how sad I was when my dog died. You know, I have something that will help with that. Low decision-making moments can lead to some really bad outcomes.

And then, you know, we had a, we were part of a meeting myself and many other, about 13 other parents were part of a meeting in spring of 2021 with Snapchat. Long story short, it was so sorry for your loss, we had no idea this was such a problem, which was a lie, because you could see this being warned in the media starting in early as 2017, and they chose to do nothing about it.

So I'm at a point in my advocacy work that I cannot believe a word that they tell us, and I can't trust anybody else that chooses to work with them.

Well, that's awful and unacceptable. And we've, you know, I think with this Committee, we want to find more ways to, if they're not willing to engage or address these issues themselves, to force them to.

Well, they're willing to engage. After this, you'll probably get a phone call from Snapchat wanting to meet with you so they can tell you how wonderful they are. I would not be surprised that sometime next week you get that call, if you haven't had it already.

Yeah. Miss Ortega.

Apologize for walking in late. We have multiple things happening at once. But this is a critical issue for me, something that I've been working on since I got to the Legislature. And first and foremost, I want to say, you know, of course, sorry for your incredible loss.

As a mother, I can't even fathom that idea of losing my child overnight with such small amount of something that they didn't even know they were taking.

And that's why I've been with others here just championing this issue and working hard to make sure not only do we educate our youth and our parents, but that we actually started having a conversation on accountability. And this issue with the social media companies, it's something that I've heard as I sit on Privacy, I sit on Labor.

We're talking about artificial intelligence. We're talking about social media. We're talking about privacy and consumers, but we're not talking about holding people accountable.

And actually, some of these social media companies that are creating the space that we're living in, you know, it was in one of these rooms where I think about this sentence every single night, and is the drug dealers of today are not selling drugs on the street or on a street corner.

They are selling them on our social media sites. And as a Legislator, it is my responsibility and duty to make sure that we continue to ask questions, demand transparency, and figure out a way to hold some people accountable. Thank you.

I agree with you. It's going to take lawsuits and legislation to really create that, that type of change. And the people out there doing the work are the impacted families on these. We need critical mass to make these changes. But right here in California, the California age-appropriate design code pass was signed on Governor Newsom's desk.

And of course, Netchoice, who is funded by Big Tech, is suing on behalf of them. They publicly stated that, that this bill will cause irreparable harm to these companies. They clearly do not know what irreparable harm. Looks like I can show them. I have an urn in Alexander's bedroom that can clearly illustrate what irreparable harm is.

So we are up against a lot of money and a lot of resources on their side. So it's a big mountain to move, right? And we chip away at it every single day. But we do need help. I don't know what the answer is, but I work local and on national levels for this.

Like you probably heard the Kids Online Safety Act just passed the US Senate. We're now working on the house, and so it's a long road. But that is one thing that we have, and we have to.

I think we have to have more stamina than they do, or help hopefully figure out how to get them to run out of money.

Again, I want to echo my gratitude to both of you. I know we're going to continue to work with you both to learn, but also to take action and just so much appreciation.

And again, so sorry about the loss of Alexander and Tyler, and deeply appreciative of all the work that you all are doing to save the lives of so many young people.

Our last panel is going to be on social media next, so we'll bring them up and hopefully continue the conversation that we started here around accountability and prevention. Thank you.

I'm going to bring our last panel up, and I think that we have some virtual element to this, which is on the connection between social media use and overdoses and prevention and accountability.

We have Dr. Laura Marquez Garrett, Senior Counsel at the Social Media Victims Law Center, and Dr. Meredith Gansner, instructor of psychiatry at the Harvard Medical School. And are they both virtual? They're both virtual. I've never said that, Doctor.

Okay, I'm hoping you all hear me.

Okay, Dr. Marquez Garrett, whenever you're ready, you can please begin.

Yes. And you all can hear me okay?

Yes, we can. We can hear you and see you.

All right, thank you. Thank you, Mr. Chair, Members of the Committee, as a parent and an advocate, I thank you for inviting me here today and for having these difficult discussions. My name is Laura Marquez-Garrett. I'm Senior Counsel at the Social Media Victims Law Center.

We are a small Washington state law firm formed at the end of 2021 to represent children and families harmed by social media products.

Who knew that just a year later, we would be versed not only on issues of general social media harms, anxiety, depression, addiction, exploitation, and others, but also on the deaths of American children by fentanyl poisoning at historic rates, thousands and thousands of children enough that I have been told that there is a, there are findings to the effect that our country has been put at a strategic disadvantage because of the number of children who are dying, and yet it's still happening.

Now, what is different about this crisis is that for the first time in our nation's history, children, teens, and young adults are dying at the same, if not greater, rates than their adult counterparts.

Now, in 2022, I met Amy Neville, who spoke just a moment ago, and eight other families who had lost their children to fentanyl poisoning through Snapchat. Maybe this is just a social media issue, the legal community thought. Our esteemed co-counsel, CA Goldberg, thought different. We investigated, we researched the issue.

We met with those families and many, many others. We met with Members of law enforcement and experts in the fields of technology and drugs. In October 2022, we filed our first fentanyl-related complaint against Snapchat. Now, at the time, we had been retained by 10 families who lost their children to fentanyl poisoning.

As I sit here today, less than two years later, SMVLC has been retained by more than 160 families who lost their children to fentanyl poisoning via social media. That number goes up every week, sometimes every day. These are children ranging in age from 13 to 23 years old.

In almost every instance, I think there may be four exceptions. The Snapchat social media platform was involved. In every instance, the fentanyl was being distributed in the form of counterfeit or laced drugs. For example, a pill pressed to look like Percocet or Xanax, even Marijuana.

And in every instance, these were children who had no history of drug use prior to when their social media use began. In fact, what I hear over and over from young people goes something like this. I was 10 or 12 or 14. I wanted a Snapchat because of the silly filters. All my friends were using it.

I wanted it to be popular. I'd never heard of Marijuana, or I'd heard of it, but had no interest. And then Snapchat started sending me videos of other kids smoking. It looked cool, it looked fun, it looked normal. Then Snapchat started sending me quick ads. These are the AI-driven user recommendations.

Then Snapchat started sending me quick ads for plugs, which is a term for drug dealers. Snapchat said, these were my friends. It gave me points when I sent messages. It made me feel liked. It made me feel like I fit in. I was a kid. I didn't understand, and Snapchat made it seem safe and fun.

I hear this again over and over. I wanna give one other brief example, which is in 2023, an adult Snapchat user searched for a few common drug terms to see if Snap would divert him to its public service announcement, which is what Snapchat said it was doing.

He had used Snapchat for eight years and had never seen a drug menu and had never been connected with a drug dealer. Within 24 hours after running this search looking for PSAs, a dealer messaged him with a drug menu. This certainly suggests that his simple search for PSAS resulted in Snapchat pushing out his data to drug dealers.

This is how these products are designed and programmed. Now, death by fentanyl poison, it is not something these children are seeking out. It is where Snapchat takes them, because engagement equals revenue. So I'm here today to tell the Committee the death of American children by fentanyl poisoning. It's not just someone else's problem.

It's not even just an internet or social media problem. It is an epidemic to which Sapchat has contributed more than every other social media platform put together. But there's a silver lining. This means it's a problem that you and the State of California can do something about. Because California is where companies like Snapchat live.

There are countless opportunities to legislate for the safety of California's children and to make a difference in the rate of fentanyl deaths nationwide. These aren't even extreme examples. In other industries, they would be expected.

For example, if a company knows the drugs are being marketed and sold, whether because of available technology or police or user reports, they should take those accounts down. They should provide a 1-800 number for reporting and consequences for companies that ignore the reports.

They should have effective in-app reporting mechanisms requiring them to provide a receipt and respond within set times.

I cannot tell you how many of the drug dealers in these cases kept dealing, even after being reported to Snapchat, including by police, when police said, hey, this individual, we believe is dealing drugs on your app, Snapchat left those accounts up and those dealers killed more children, including in Amy Neville's case.

Legislation could require these companies to stop designing their systems to destroy evidence on the back end. That is not user privacy. That is what Enron did in 2002. It's called obstruction of justice.

If a platform distributes to persons under 18, they should be preserving that data for six or 12 months and they should have adequate staff so they can respond to law enforcement in a timely and reasonable manner. Again, we shouldn't need laws for this, but apparently we do. Social media companies also collect device ID.

That's like a fingerprint for your phone, for your computer. Every device has one. Every time a user logs on, they collect that information. If they wanted to, they could block by device.

So if someone uses a phone to deal drugs, that phone should be out of circulation instead of what happens now, which is they open 10 more accounts on the same device.

Lastly, they could stop recommending strangers to kids, stop telling children they know these people, pushing them to connect, giving them points to meet up with strangers, literally drawing maps to find them. I understand that just shutting down one platform is not an option, even though we would see results quickly.

But there are countless other ways we can protect our children from these harms. I hope that this Committee will consider every one of them, and fast, because our children are facing an unprecedented crisis and they need our help. Thank you.

Thank you so much. And I hope you can stay with us or we're going to do both virtually. Okay, great. So we are going to have our next presenter, who will also be virtual Dr. Meredith Gansner, who's an instructor of psychiatry at Harvard Medical School.

Hello, can you all hear me?

Yes.

Wonderful. Thank you for that introduction. My name is Meredith Gansner. I am a psychiatrist at Children's Hospital in Boston. But I am also a researcher in high-risk digital media use, particularly in adolescents who have a history of psychiatric illness.

It's an honor to be asked to talk to you today about what is such a pressing topic in today's society and society's relationship with social media in particular. I spent the last 11 years studying how social media platforms can be impactful to the mental health of our most vulnerable populations, particularly children and adolescents who have psychiatric illness.

And while my specific area of interest is a relatively new one, the mechanisms by which social media platforms have been influencing behavior are not new. In fact, these mechanisms have long been known, long before we knew about Instagram and YouTube.

We know that if teenagers believe all their friends are engaging in an activity, they're more likely to participate in that activity. And similarly, we know that if teens get the impression that they should be engaging in a particular activity, they're also more likely to take part.

The so-called process of social contagion is incredibly challenging for teenagers to resist, and social media algorithms appear to reinforce this process.

These algorithms falsely shrink the diversity of online content that is available to an individual, giving users the impression that some high-risk behaviors, disordered eating, cutting, nonprescription drug use, are all more than norm than they actually are. However, despite our relatively strong understanding of the processes that influence youth decision-making.

It's been difficult to find the proverbial smoking gun that proves social media's role in drug use. And up until recently, objective measurement of an individual's social media use has been difficult, and social media platforms fade out of popularity faster than we have been able to study them.

Researchers such as myself have been collecting what evidence we can to highlight our concerns about social media and drug use and the connection between the two. For example, many of us have found that the overwhelming majority of adolescents and young adults report seeing drug-related content online.

In one recent study I performed, every single youth in a survey of almost 500 youth around the United States said that they had seen drug-related content online, and nearly one-third of them reported seeing that content a majority of the time when they were online. And these exposures can happen fast.

In a separate study, over 74% of our youth participants encountered drug-related content at least once during a single six-week period. My research also suggests that certain platforms are higher risk than others.

Tracking instances of drug use and daily social media use in a sample of adolescents and young adults in Massachusetts, our study participants were significantly more likely to report both drug-related content exposures and substance use when Snapchat was one of their most frequently used applications.

While these findings cannot offer incontrovertible proof that Snapchat caused the drug use, they indicate that specific platforms merit a greater degree of scrutiny, particularly in light of mounting anecdotal evidence connecting Snapchat and fentanyl poisonings. So imagine you are a Gen Z teenager struggling with the symptoms of anxiety and depression.

And just like so many of your peers, you've learned to turn to social media platforms as a way to distract yourself from your symptoms and to seek support from others.

Your social media feeds portray drug use in a positive light, whether from your friends or celebrity influencers showing use of drugs as a fun activity or a way to escape from your symptoms.

Your brief engagement with drug related content leads to even more content recommendations featuring drug use, which then fuels the distorted perception that drug use is actually the norm.

Thus, when you eventually get the opportunity to access drugs through social media, you may have been digitally primed to go through with such an impulsive transaction, particularly if you've been encouraged to do so by a person online who claimed to be your friend.

And if the pill you purchased happens to be tainted with fentanyl, then that single, impulsive decision can prove deadly. As a society, we need to develop a better understanding of how exactly loosely regulated social media content impacts the way that teenagers perceive the world around them.

As a physician who routinely sees the tragic outcomes of teens who have participated in online dares, engage with online strangers, and buy drugs online, we aren't doing enough.

Thank you so much for your work and for the presentation. I wanted to ask if there are any examples that you see.

I know both of you are working on this issue across the country, and if there's any examples of states that are implementing laws that attempt to address this or even what this looks like internationally, if we're seeing any examples, sometimes we look to what other countries are doing first, and particularly when it comes to regulating technology.

But I would agree that California certainly has a huge responsibility here and that if we were to take the lead on this, that it would have ripple effects. But I wonder if there's anything that you're seeing that we should be looking towards as examples of the type of regulation that should be in place.

So I will say at a high level, legislation like KOSA or the design codes will impact this, right? I mean, they will impact sort of the addictiveness of these platforms. They will also impact things more broadly where the platforms know. In fact, KOSA includes a specific drug marketing provision in it.

So I do think that the legislation that's being pushed forward right now will to some degree impact this. I'm not familiar with any states that have specifically targeted the issue of fentanyl poisoning.

And internationally, unfortunately, I think it's almost the opposite where I've had people reach out from other countries and say, hey, we're concerned this is going to start happening here. Really, the US has been hit the hardest on fentanyl poison at this point, to my knowledge.

So it is fairly unique to the US at this point, though I know there are at least a couple other countries that are just starting to see this problem.

And you mentioned an acronym that I wasn't familiar with, design codes. Is that federal legislation or is that reference to the legislation that we have here around design codes?

That's correct. So California, I believe Maryland just passed one. New York has passed some stuff, but in California, Maryland, it's a design code of state. And then KOSA or Caspa, if you will, is federal level.

And that passed or that's been proposed? The federal one.

The federal one passed 91-3 in the Senate and now it is going to the House and hopefully it will pass in the House as well.

Great. And if you could help us understand what would be the specific if that were to pass, the consequences of that for some of the issues that we're talking about here.

Yes. So that's the Kids Online Safety act. And as I mentioned a moment ago, there's even a provision in there that talks about drug marketing.

So you know that platforms have duties not to design products, to sort of take reasonable care, I believe is the language to not design products that will harm children, including drug marketing on their platform. It's not specific to fentanyl poisoning though.

And so at the end, when I spoke, I mentioned a couple of very sort of fentanyl-specific issues. When you get to, for example, the destruction of evidence on the back end, right. Over and over we hear from law enforcement, we have to get to Snapchat very, very quickly.

And even then when we serve a warrant, it's very unusual that we get back substantive things that we can use because the way the platform is designed on the back end includes, I don't know if it's destruction of evidence, if it's just not preserving.

But essentially, unlike other platforms, for example, the handful of cases that we have that involved meta platforms, those communications are discoverable typically by law enforcement. So when the warrant goes out, they see the drug dealer and the child interacting with Snapchat, it's a lot more difficult to find that evidence.

So again, nothing that is specific to those types of features, product features.

And I know there was an attempt, one of our colleagues, Ms. Petrie-Norris, had a Bill that would have attempted to address this for Snapchat, requiring them to keep some of this information. And unfortunately the Bill did not move forward. But I think this is something that we have to stay on.

And I think as both of you said, when there is such a pattern.

And really, you know, Snapchat is something that comes up all the time when it comes to fentanyl poisoning, and it's clearly the platform of choice for many drug dealers when it comes to fentanyl poisoning that we have to take particular steps as it relates to the ways in which that platform in particular is used and is so susceptible to this type of drug dealing activity that is, that is not traceable, that doesn't have consequences or accountability.

And it's a huge, huge problem that I think that we need to address. Colleagues, questions, comments? Mr. Patterson.

Thanks Mr. Chair. I'm not sure who wants to answer this, but you know, we talked a little bit. Well, we've talked about accountability here and I've supported a lot of legislation regarding some of the things that were discussed here in terms of a phone number for law enforcement, you know, timely responses.

I've supported bills in the Legislature to do that. I also think we need more accountability on the people who are actually preying on our children on social media. That's something I think we need to do a lot more of. But, you know, I get, I wanted to ask a little bit about other countries, and you did.

You got close to answering my question before I even asked it. But we are, in some ways, we're unique in the US because we have this stuff being produced across our border here, coming from China, being produced in Mexico, and coming across our border. And that is unique, I think, to the United States.

The DEA says it's the biggest threat we've ever had, in, I guess, the drug trade. But aside from that very important, unique item, I wonder in terms of other countries in Europe, and social media use is high in other countries as well.

Are they seeing a lot of the other issues that we have in terms of youth depression and things like that? Because that would help me understand if social media really is, you know, the root cause of this. I mean, I cause I think I'm very, look, I think social media needs to obviously have some accountability there.

But I just wonder if we're seeing some of the same issues there. Are there other systemic issues in the United States that are independent of social media that are causing, you know, some of these issues we're seeing with our kids?

I mean, I can talk a little bit about the worldwide mental health implications of the Covid-19 pandemic. I think internationally really strained mental health of youth in particular, everywhere. There are certainly factors that have been worsening in many developed countries for, even before the pandemic, for about a decade now.

Youth suicide and depression levels have been rising for years in the United States, but we're not unique in that. And certainly countries like Canada and Australia, Finland, Japan, they also have fairly high suicide rates and high levels of depression in youth.

I think that something both that I've seen anecdotally and that more researchers are trying to capture is maybe kind of a different relationship between drug use and, I mean, sort of broadly prescription drug use and mental health symptoms, in terms of use of drugs in treatment of mental health symptoms.

I think other countries have a different relationship at times with drugs in that sense. And there's certainly been an uptick in youth during the pandemic who really had trouble coping with their symptoms.

And as I mentioned in my talk, going online, using social media as a way to try and quell those symptoms, not really having any outlet outside of that to kind of process that and kind of seeing drugs as, okay, well, you know, prescription drug, right? Because it's not marijuana. It's not something that's, you know, more illicit.

That will make me feel better, right. That will help because that's what's needed. That's what helps when you have psychiatric symptoms. And unfortunately, right, like now, that risk is so high with the risk of fentanyl poisonings.

And I think that the connection between social media use and depression and, you know, then that leading to substance use is always going to be a murky one.

Again, it's really challenging from a research standpoint to prove to a kind of causal link of social media causing depression, especially because, as I said, many countries are already struggling with mental health issues in the youth populations. But there is this sort of reinforcement that can happen through social media platforms, right?

Like the longer individuals spend on social media platforms, the greater the risk that they're going to also have upticks and other factors of depression, decreased physical activity and decreased exposure to sunlight and poor sleep habits. That will also, you know, increase risk of depression anxiety, thereby also increasing risk of self-medication and risk of purchasing drugs.

I've certainly seen many patients who have sort of purchased drugs out of that impulsive need to quell those symptoms rather than, as, you know, a formal substance use disorder that we would diagnose. So I hope that answers your question.

Thank you. Sure. We'll take one last question and then we'll wrap up. I know we had a lot more we could say on this, Ms. Ortega. No worries.

I'll be very brief. I just had a question in terms of the research that you have. Dr. Garrett. Marquez-Garrett, we've heard a couple examples of youth being targeted. Let's say, for example, my dog passed away and then drugs started or ads started coming to you or friends started coming to you.

Do we have research related to instances or other examples like that?

So it's a great question. And actually, after this, I could certainly get your office. There's a study that was submitted for peer review recently out of UC Davis, which I think is sort of what you're talking about.

And I don't know if any others have been done, but this study, which is fairly recent, it was, they created these accounts and then they would be on for a few, like 15-minute sessions.

And what they found is when they posted even one thing that was indicative of vulnerability, the number of sort of dark and depressing videos shot up. Right. So there is, and again, I will be happy to go find that. It's out of UC Davis. I think it was probably in 2023, it was submitted for peer review.

So that testing is happening right now. I will also say for our office at Social Media Victims Law Center, we've been retained in the two and a half years we've been open, we've already been retained by roughly 3000 families.

And so I'm not a scientist or a researcher by background, I'm an attorney, but I've personally met with hundreds of these kids and parents and heard their stories, which is how a lot of what I've learned about these products, you know, we take these patterns, we see, we talk to the experts and they explain to us, well, this is how the tech is doing this.

So in addition to the UC Davis study, which you should definitely check out, because I think that's exactly what you're asking. And what that study found, I believe is, yes, these platforms know not only when a child is vulnerable and then they increase the amount of sort of negative content, but also age.

So if you go on there and say you're 40 years old, but you act like a 10-year-old, you will start getting ads targeted to 10-year-olds within maybe 2- 3 15 minutes sessions. In addition to that really are complaints and the families we talk to and children.

And in fact, we have hundreds of clients out of California that I would be happy to bring out there and meet with you all if you were willing to take some time to speak with them as well.

Absolutely. Thank you.

Sure. Of course.

I was just going to add that the research that I presented then lended itself to a four-year study that will be sponsored by NIDA, which is going to be asking kids directly if they're being approached by others online to purchase drugs.

And granted, it's an early study still, we're in our first year, so have to wait a couple years to get the outcome of that. But we're also going to be tracking the effect of content that kids post online. So whether it's sad content versus angry content and how that relates to being approached about purchasing drugs.

So more data for sure, coming up.

Well, thank you both so much for sharing with us and for your work. I know that all of us here are committed to addressing these issues. And as all my colleagues said, there's a lot of overlapping issues to be addressed here.

But clearly, if when somebody is online, they're being bombarded with offers to purchase drugs, drugs that are misrepresented and in some cases containing fentanyl and poisoning children, there's hard to imagine anything more concerning or infuriating than that, and we need all of the tools at our disposal to be able to make sure that is not happening, that people are not able to use these platforms to prey on others, especially children.

And when they do that, we have the ability to hold them accountable for that criminal behavior. So appreciate the work that you all are doing, and we're hopeful. And thanks to everyone here who is a part of those efforts at the federal level that can begin to put some standards in place.

But I think here in California, we also need to lead as well. Yeah, I think we have. It sounds like there's a California law in place that would do some of these things, and that's sort of a process that is ongoing. But it sounds like even with that, it could be strengthened.

But I certainly want to make sure we wrap up because I said that this would be a two-hour hearing and we're a little over now, but I do want to open it up for public comment. If there is any. We're just taking comment in the room.

If there's anyone who is here, we can move on to public comment, and each witness will be able to make a short statement to state their name, organization, and a brief statement on the issue. Is there anyone who is here for public comment? All right.

Seeing no other people in the hearing room, I also want to thank our virtual panel, and definitely you have partners here in California that want to work with you on all of those issues that you raise and really appreciate your time here this morning with that. Colleagues, as I said, this is our fourth hearing.

This will be the last hearing, I believe, of this year for us. When I outlined all of our hearings, I actually forgot we did another hearing which was specifically on the impact of the opioid epidemic on tribal communities.

I think for all of us, this is a critically important one where there's a lot of space for us to lead, to take action, to author legislation, to advocate within the budget, and to advocate, even with ongoing efforts that are already in place in California with laws that have already been passed.

So everyone here, we deeply appreciate your partnership and your work for joining us this morning. And I know for all of us, we're going to get back to work and hope to have a whole set of efforts that we launch together next year in our next legislative session to be able to confront these issues.

With that, again, thanks for everyone for your testimony. Thank you to my colleagues for being here and for coming early before session to be a part of this and for all their leadership on all of these issues.

And I should say even as I'm talking about next year, we have a number of important bills in front of us right now that also need to pass, and they'll be heading hopefully to the Governor's desk soon. And so we're going to keep our efforts up to make sure that we demonstrate leadership in this session as well.

With that, thank you all so much. And this Committee meeting is adjourned.