Transcripts For CSPAN Key Capitol Hill Hearings 20240622

Choctaw reservation last week talking about that. What are the sources of wandering . Is the universal service fund useful to you now and what would we have to do to improve its . Look at the federal government do in terms of funding for tribal infrastructure . Particularly for those tribes that might have more difficult the . Im thinking of the pueblos in new mexico or the tribes at the grand canyon smaller and less funding available. How were these funds helpful to you the once a helpful to the wants of we do have in these programs that we these programs that we do have are they . Thank you congressman pallone and you are always welcome. With usf funding Stable Funding mechanisms are critical. Where they have to develop the climate bank plans are land federal Funding Sources to be there to begin with. Providing funding for the structure build outs and that is critical to the longterm sustainability of these telecommunications providers. Are you using funds from universal service now . Yes we are. How does that work . How do you do it . Thats critical to the overall this is plan. Relying on that source of income moving forward, its critical. Its a longterm Business Outlook and with regards to the longterm capital told out as well. Thank you mr. Chairman. The gentlemans time has expired and the chairman recognizes mr. Shimkus for five minutes. I appreciate you all being here. I want to go to adelstein and the governor. The Environmental Review process on federal lands is a burden so have you thought through how local municipalities can do their zoning outside of federal lands and how we can marry that with what goes on there and can you comment on that . Yes some counties are great and we heard from google that those communities make it easier to get access and that is where the investment goes. A specific community arent seeing the investment they would get if they werent throwing up road locks. They are not going to have service in their backyard so we were corporately with local communities and every single facility that has been cited in cooperation with the local government but to have it be dragged out or took the work of the committee to say you dont have to get another zoning hearing to put up a 4g antenna that is party there. Increasingly communities are recognizing this. The smart ones are moving ahead in the last 20 cents 2013. There are streamlined deployment and those states are receiving more investment to get the word out about the way the fccs implementing the laws you pass. Commissioner clyburn asked us to go out the. With me ask mr. Lewis on the federal robberies because thats a another challenge. The question is can we force a zoning issue to get you guys owning a ability like we do municipalities . Senator byrd via wood the agency could keep the money they get to pay for the cost of processing it. There would be common forms and contracts by the need for more lets lishan. Theres an expectancy of lease were no so when somebody invests their. That make it governor lewis to respond. Federal lands in Indian Country has been a long issue in regards to our unique situation as the nature of indian land in regards to fracks and land interest that are just so critical and sometimes are one of the major obstacles to build outs with regards to right of ways. If we can somehow streamline that process to the bureau of Indian Affairs and department of interior that would really help out tribal infrastructure buildout in the future. My largest Congressional District is 33,000 people. When do you think google would hit that community on your timeline . Did you want to name that amenity . Im not the chairman of the committee so i dont have as much power. We have published this so we can ask mr. Adelstein said get Fiber Deployment whether its google or any provider tim picture they have the permitting process that allows for a large volume of permits to go through to make it easy for people to get onto telephone poles. So its the same type of debate with the rural or the federal land deployment. The ease of being able to have access and a timely response and its all about return on investment. So with the rural area cant make the call based upon the formula then you have to be able to dip into our u. S. Or other forms of low interest loans to make it and also time is money. Any delay and what we talked about here affects the ability for someone to go to the cap bull market can make it pitch that they will get their return on investment. That is correct as well. I yield back my time. The chair recognizes the gentleman from pennsylvania mr. Doyle. Thank you for this excellent hearing and is excellent panel. Jonathan welcome back great rodkin infrastructure comes a critical component for every facet of our daily lives. All levels of government communicate with citizens increasingly leverage the network to improve the delivery and efficiency of service. This work in partnership with Carnegie Mellon university and google is a connective platform that will integrate Traffic Cameras and information kiosk to create a Living Laboratory for nextgeneration technologies. This platform will be used to improve traffic had earned in realtime allowing Citys Department to officially predictable road wear and schedule maintenance and allow people to explore and interact with the city more effectively. Available in ubiquitous ripe infrastructure provides a basis basis for the next generation solutions. I for one and a big fan of making every tool in the toolbox available to local governments to make sure they have access to the best networks in the best platforms in order to improve the lives of People Living there there. Mr. Chairman i would love to work with you on putting together some legislation to address some of these challenges challenges. Let the start with ms. Socia. How can localities leverage shared infrastructure to increase the deployment of broadband to cities like pittsburgh to address our own municipal needs . How can we and other municipalities use what we are building to expand access more broadly and what if anything stands in the way of the municipality leveraging the infrastructure . Really interesting work has been done as you have suggested. Many of her cities are using smart infrastructure to do interesting work to determine particulates in the air and checking asthma rates and using street lights that have cameras in them for Public Safety. We are seeing a lot want that happened and i think there are barriers for cities to doing this work is well and some of them are the state regulations that prohibit their building out their own infrastructure. In some cases as was mentioned earlier it was issues of how densely populated the circumstances i am curious about the discrepancies that exist. In pittsburgh for it since i can get 500 megabits per second but it would cost me 400 a month. When we look at cities like chattanooga and kansas city and boston and other cities residents can get a dig for less than 100. Im curious maybe mr. Moffat and mr. Slinger and ms. Socia could comment on why you think these discrepancies exist. Thank you for the question. My observation would be you are right there are a wide range of economic models and its a challenge because there is no nearterm variable costs. Its a cost bus models so you see Companies Experimenting with different prices in part because they are trying to iraq but that quantity demanded will be at different prices. The challenge but obviously you tend to have lower prices where you have multiple competing networks and again it raises the questions of whether the providers are earning a sufficient return of the market share at the prices they are charging. In many cases they are not traded this is a difficult area to do Economic Research however because you will find there are a lot of companies that have different of this than profitability. I want to get to mr. Slinger. I would say if you look at the cities in which we are operating or cities we have announced we are seeing in prices drop. We now go to the gentleman from louisiana mr. Scalise for five minutes. Thank you mr. Chairman. Mr. Adelstein you talk in your Opening Statement of a lot a lot of the work thats been done to expand spectrum within this committee where we have come together to make more spectrum available and our chairman has been a great leader in that effort too. One part of that equation absolutely is expanding more spectrum and of course the other part of that is your members very few build it out and to build that infrastructure to take advantage of the spectrum. If you could share with us some of the challenges or hurdles that your members face to make the investment that they can make to take advantage of that spec and to make more spectrum available in the marketplace. Spectrum has been quite a hurdle. You saw 41 million was spent for a limited amount of spec and white tape. Better than the cbo estimate. Hopefully cbo recognizes the value of spectrum. The fact is that was a 12 increase in available commercial mobile sector. If youre a 12 increase in throughput and 700 we are down to 680 . A long way to go to build out to meet the needs of people and as i said local communities often are saying no to these facilities. We have the Business Case in rural areas as we have discussed today in the overall return on investment is difficult. We cant afford to have regulatory drag on these investments. Slowing them down making it more expensive when there is enough capital toga to meet these needs already. That is where we are at in this country and as slow as it is its immediately available when you see that same structure and reuse it. All of these burdens on federal lands and urban areas the fcc has done a great job in the committee has done a great job in trying to address that but we need to work with our partners in state and local governments as well. We have been grappling with trying to remove those burdens not just spectrum and a whole lot of areas related to Energy Production were federal land and in the local area some of those restrictions make it really hard to experience a lot of the economic opportunity. Thanks for that answer. Mr. Moffett in your analysis if you could share with us some of the similar challenges where some actions that may be congress or the fcc can take to further expand the opportunities for wifi broadband . As i said earlier i think there are opportunities can connect america funds and making those available to a wider range of companies who are bringing broadband to rural areas but there is an overarching question here and it relates to the question that Ranking Member issue asked earlier about what are the bright spots . If you think about this is the larger value chain of microeconomics breathing from the content companies and internet providers to the infrastructure providers where the bright spots are is clearly outside of infrastructure. The App Developers and the companies are earning extraordinary returns. There is a very kneejerk and familiar regulatory impulse to say lets try to protect the companies that are making high returns from the ones that are making low returns. As an economist thats a very odd structure. Final question mr. Slinger when google fiber was being deployed its been reported you all were able to work with local governments and maybe some expedited approval processes so that not just you but other entrance were able to move things through quicker. He could talk in general about the ability for government to take more of a regulatory approach and how it the regulation in the sense of helping expedite the expansion of technology has helped you and helps others to develop even more broadband . Im going to go back to the fiber check list which we published in 2014. Some of our major areas obviously are having access to the poll to make the poles ready. One thing that has been suggested was if municipalities took a proactive step in doing Home Maintenance while they are doing Home Maintenance get rid of the old wires that arent needed that would allow new entrants google fiber or other entrance to get in quick lien attach it poll. That is one thing that would really help and policy and access to their rightofway. Theres more we can do with federal highway to make sure no one is ripping up a road to construction repaving that we putting conduit that anyone can use. Those are smart things that allow new market entrants and also lead to more competition. Thanks for your answers. The gentleman yields back the balance of his time. Unfortunately we are going to have to pull this to a close because we are down to four minutes left in the vote. This is not the last hearing. We expect to continue this work Going Forward in your testimony has got us to a good starting place. We have a lot of followup to do. There are members that didnt get a chance to ask questions. We do have information to submit for the record including from cca tech freedom and mr. Olson i believe you have a document you want to articles on broadband deployment and with that i am afraid we are going to ms. Matsui to want just a minute or two . Just a minute or two. I was curious i want to ask mr. Slinger some questions. I find what youre talking about very interesting because i look at this and what you say is all very important that about deploying broadband infrastructure and im from sacramento so we have wonderful areas that are doing great rings. Im looking at a particular area and are sitting that is economically deprived and we have a light rail station thats going to be completed their with fiber. But yet we have schools and libraries that are deprived and people there who have no access. If we were to do something they are and i dont know whether we can have a special project but im looking at this for economic development. Is that something that we can provide access that you say that you need . Is that something that you were somebody else can take on as a project working with us because im trying very much to help this area. They feel very deprived looking at the rest of my district that feel like they are on the move and they are not on the move and i want to get them on the move. Is there something we can do there . There is a lot that we do earlystage with all the cities we look at to make sure they have the right kind of Digital Inclusion plans in place to make sure the cities have a focus on it and again there is no silver all it. We want to make sure that all providers and local Community Groups take this on and add fiber and the technologies to make sure people understand the relevancy of the web and hopefully get more people on line. Thank you very much and thank you mr. Chairman. Thank you. We will have to call it to conclusion. We have votes on the house floor so thank you to all of you for your testimony, your counsel and we look forward to being back in touch with you as we move oregon to others who have ideas for the congress and now we can expand access to affordable broadband broadband broadband across the country wherever it is not. I understand we have some tribal letters for the record as well from mr. Lujan which we are happy to accept and what that he will adjourn. [inaudible conversations] that same subcommittee is holding another hearing today this time on overall federal Communications Commission operations. Witnesses include the fcc chair and the former sec chair. Fcc chair. The cspan cities tour working with our cable affiliates look that cities across the country. We are learning more about the literary life and history of augusta, georgia. We are sitting here in the Augustine Museum of history. About 10 years ago, a decision was made to do a military display that was permanent to honor jimmy dias. He is the only person ever to have earned the purple heart and the medal of honor. He would probably say he was not he would not deserve it. He never talked about the Carnegie Medal. People knew him well and i told them to tell me about the Carnegie Medal that he won when he was 19. They didnt know anything about it. It is a piece of humility we can all learn from. We also visit the boyhood home of our 28 president woodrow wilson. President wilson moved to augusta as a child. He moved to this house when he was three. His very first memory was in november of 1860 before he was four years old. He was standing on the front gate in front of the house and two men came by in a hurry with excited tones of voice. They said Abraham Lincoln has just been elected president and there is going to be a war. Young tommy ran inside and asked his father what this war was about. We think it is remarkable that his very first memory was about another president , Abraham Lincoln, and about another war the civil war. Wilson would have to leave the country the world war i. See all of our programs from augustus saturday at noon eastern on cspan2s book tv and sunday afternoon at 2 00 on American History seat American History tv on cspan3. Cabinet officials returned to capitol hill today to testify on the iran nuclear agreement. The House Foreign Affairs Committee Hears from secretary kerry. That is live at 10 00 a. M. Eastern on cspan3. Now, combating Prescription Drug abuse at the state level. This is part of the National Governors Association Meeting held over the weekend in white Sulfur Springs West Virginia. It is an hour and 20 minutes. Gov. Beshear good morning. We will call this meeting to order. This is a joint session of the health and Human Services committee and the Homeland Security and Public Safety committee. Joining me is vice chair of our committee, governor bill haslam of tennessee and i am pleased that we have been able to come together with the Homeland Security and Public Safety committee for todays discussion regarding the nations opioid crisis. I want to thank the leadership of the other committee, governor rick steiner of michigan, Governor Terry mccollum of virginia for partnering with us on this very important topic. There are a few administrative tasks to perform. The briefing books of this meeting were sent to governors in advance and include the agenda, the speaker bios, and updates, the proceedings of this meeting are open to the press and all meeting attendees. Please silence your cell phones. Seated at the table are Committee Legislative directors melinda becker, Justin Stevens you can see them after the session if you need copies of the materials or further details about any of the issues that we just got today. Before we go into our formal presentations, i want to turn to heather who is the staff director for the health and Human Services and the Homeland Security and Public Safety committees or it heather and her nga colleagues will provide updates on key federal and eight issues. Heather since the winter meeting, we have made progress on a number of priorities of the health and human heiresses and homeland committees. We advocated actively for an extension of the Childrens Health Insurance Program which congress did extend in april for two years until 2017 as part of a larger deal to overhaul medicare payments to physicians. That extension maintains existing Program Flexibilities and plan funding levels for states so that was a key priority we were able to a college for you. We have also been engaged in discussions to improve Child Welfare systems. At the same time the Homeland Security and Public Safety committee has been working with congress to maintain Army National guard personnel and prevent the further transfer of apache helicopters from the Army National guard to the active army until after congress has time to consider the recommendation. Currently, the house and senate are conferencing their respective bills. They plan to have a final bill sometime in the fall. Nga has been advocating that the senate bills provisions which would retain additional personnel for the guard and prevent the further transfer of apaches until 2017 be included in that final bill. In addition to National Guard matters, the committees have been working to promote the states role in cyber security. That is those are the two main priorities i wanted to really cover from the federal relations perspective. Im happy to answer anything afterwards. I would now like to turn to my colleague. We will start with frederick who is director of our health division. Frederick i wanted to give you a very brief update. We continue to be very busy. We have had well over 20 intensive projects going on across the country with hundreds of your leadership staff in all the states. There are two projects i wanted to highlight for you. The first is medicaid transformation policy academy. This is our very intensive work with three states, alabama, washington state, and nevada. We are working hand and glove with the states to negotiate broad new medicaid authorities. It would allow governors to have more flexibility in the way they pay for and deliver services in medicaid or it we are very close to agreement with at least one state. We are working hard to negotiate billions of dollars in upfront investment from the federal government for the state and medicaid dollars. Its very powerful work. We plan on providing you with a very victorious report in february during the winter meeting. Jenny wright during the winter meeting. In addition, we will be releasing a roadmap for all states. It will allow all of you to use a new process to get to yes with medicaid waivers more quickly. We are also launching our next round of super utilizer work. This is work aimed at the highest cost, highest spend medicaid patients. They are spending millions and millions of dollars and have terrible outcomes. Double states around the table are going to be working with us on that project. That will be for the next year and a half. We already did two years and had pretty impressive results. In that project in particular, Prescription Drug abuse, opioid abuse, heroin addiction, have come to light as a very strong component to the reasons that these folks and of using a lot of services and costing a lot of money and having terrible outcomes or it todays discussion is very relevant, both from a cost and quality perspective. If we can tackle this problem we will be able to solve one of the most important issues facing state medicaid issues. Heather now we will turn to jeff macleod who is director of our center division. Jeff my division has worked in close collaboration with fredericks division in developing Strategic Plan for addressing opioid abuse. Governor hickenlooper and governor bentley and governor chamblee governor shumlin have been active members. To provide guidance for states on how to address this problem we put out a brief three years ago on strategies states can adopt and we published a second issue as a followup to that. Currently, we are partnering with the urban institute to develop a guide for states on how to incorporate a valuations in their work. States can better assess the success and an sure interventions are having the intended effect. The problem of Prescription Drug abuse have been grabbing headlines, but Substance Abuse in general is a serious problem with real constitution with real consequences for children and their wellbeing. We are launching a new policy academy on improving child safety preventing child fatalities. In addition, my division will be working again with frederick and his team to build on the success of the policy academies and the momentum that i think there is nationally on this issue helping states develop programs for dealing with the use of heroin. According to the centers for Disease Control and prevention three out of four of heroin addicts begin on prescription pain pills. Our distinguished speakers today will bes speaking about will be speaking about this issue more indepth. Please dont hesitate to reach out if we can be of help. Heather we will stick around afterwards to answer any questions. Gov. Beshear lets turn to the topic of todays joint Committee Meeting which is opioid abuse. Its a Major Public Health and safety crisis that affects all of our communities in every one of our states. Because of the rise in Prescription Drug abuse and in heroin abuse, Overdose Deaths now surpassed Motor Vehicle accidents as the leading cause of death in the united states. Heroin deaths have increased especially quickly, nearly tripling between 2010 and 2013. Kentucky has its problems in this area. We have long been plagued with high rates of drug addiction both to prescription painkillers and Illegal Drugs like heroin. Over the last few years, two things have happened that are giving us more hope and confidence in the future. One, we passed and implemented a couple of wide ranging and multipronged programs that attack the problem from every angle, including treatment education, Law Enforcement, and health care. Secondly, what we are finding is that our stakeholders are working together like never before, both inside and outside of our state. In 2012, we passed what we call house bill one, which targeted Prescription Drug abuse and misuse. We ran a bunch of pill mills out of the state. We required our medical professionals to use our statewide electronic prescription monitoring system. And we allowed for better sharing of records among agencies in kentucky and other states. Earlier this year, this addiction situation is akin to a game you attack it in one direction and it pops up somewhere else. We have seen tremendous progress. But now, heroin is raising its ugly head and is killing even more people than Prescription Drug abuse did. Earlier this year, we took a similar approach in our legislature on heroin. We passed senate bill 192. This bill increased prison sentences for heroin traffickers, but it also helps us identify addicts that can benefit from more treatment than from lengthy prison stays. I think we have all figured out that we cannot incarcerate ourselves out of this problem. We have expanded addiction treatment. We have allowed local option Needle Exchange programs. We established a Good Samaritan provision to encourage friends of overdose victims to call 911 and get help. Last month, i announced the allocation of 10 million for a eight programs aimed at fighting and treating drug abuse, including programs to help inmates, pregnant mothers improve prosecutions of drug dealers, help Public Advocates drop alternative sentencing plans, and expand Substance Abuse treatment at the local level. Governors all across the country are leading similar efforts to address the opioid crisis, bringing together Law Enforcement, criminal justice professionals, Health Agencies providers, and other Key Stakeholders to develop and implement comprehensive strategies. The health and Human Services Committee Held a session on state efforts to combat Prescription Drug abuse during the 2014 winter nga meeting. The committee has since maintained a focus on Prescription Drug abuse, bringing Lessons Learned from states to inform policymaking at the federal level. At the most recent nga and winter meeting, governors approved a new policy that calls on the federal government to work with the states in developing a comprehensive National Response to Prescription Drug abuse. Todays discussion reflects the reality that we are no longer confronting an epidemic of Prescription Drug abuse by itself. But an alarming resurgence of the use of heroin. Recent federal Data Confirms that the link between rising rates of Prescription Drug abuse and heroin abuse go together. Indeed, almost half of those who used heroin also abused or had independence on prescription opioid painkillers, making them the number one risk factor for heroin use. Next week in kentucky, we expect to hear positive news from an evaluation of our efforts to change the landscape of Prescription Drug abuse. But we still have a long way to go to fully address the opioid problem and the recent spike in heroin. I look forward to todays discussion and hearing from our panelists about additional strategies that we might be able to implement in kentucky. Im going to turn it over to Governor Snyder and ask if you would like to make some opening remarks and introduce our guest. Gov. Snyder i want to start by thanking you and your other Committee Members for the great work you have been doing on this through the health and Human Service committee. Its important. I also want to recognize my partner in the leadership of the Homeland Security and Public Safety committee. We work well together on a number of issues, including cyber security. This is also an issue thats critically important to all of us as governors and citizens. This is a great venue to have a discussion. I want to thank everyone coming today in terms of the other governors, members of the audience, and distinguished panelists. I look forward to learning today and being stronger and better thanks to the knowledge you will show us. This is a major crisis and that is the attitude we need to take towards opioid abuse whether it be Prescription Drugs or heroine heroin abuse. In michigan, we found it to be a tremendously growing problem. To give you some perspective, as i travel michigan, i often ask ask people what the Biggest Issue they face is. Two sheriffs pointed out their greatest problem was Prescription Drug abuse. Thats the starting point of all of this. We need to do more. Last year, we passed a bill dealing with opioid antagonists where we actually have our emf people carrying that with them to address the problem. If you have to use that, its much later than it should be. We need to do more in terms of education, prevention, treatment, and the Public Safety side of this together. Thats why doing a joint meeting is particularly important and i am proud to be here. With that though, lets get to our distinguished panelists and learn from them. I look forward to this because in michigan, i have created a task force this spring that will lead into a legislative and other packages of actions to be taken. This couldnt be more timely in terms of hearing from people who are experts. I am proud to say we have a very distinguished panel. I am pleased to introduce congresswoman mary bono. Among the many accomplishments during her 15 year congressional career, she founded the congressional Prescription Drug abuse caucus and cochaired the congressional addiction, treatment, and recovery caucus. Now a principal at a Consulting Firm and cofounder of the collaborative for effective prescription opioid policies she maintains a strong commitment combating Prescription Drug abuse and promoting recovery. Thank you for being with us. Also with us today is dr. Debra houry. In her role, she leads the cdcs efforts to advance Public Health approaches to preventing Overdose Deaths, working closely with states. Prior to joining cdc in 2014 she served as vice chair and associate professor in the department of emergency medicine at Emory University school of medicine, as well as associate professor at emorys school of Public Health. Thank you for joining us. Lieutenant detective patrick glynn, who is a Founding Member of the Norfolk County Prescription Drug Monitoring Program and director of the quincy program. In 2013, he received the white house advocacy for action award for bringing Law Enforcement and Public Health together to disrupt the cycle of drug use, crime, and recidivism. Congratulations for your fine service. Welcome to all our panelists and im looking forward to the discussion. Gov. Beshear lets start off with congresswoman bono. Ms. Bono good morning. Its wonderful to be here with all of you and to see my former colleagues. Thank you for testifying before my committee a couple years ago, governor beshear. My gavel was very light that day and im without one now. I want to thank all of you for taking an interest in this topic. Im honored to be here to share with you my thoughts on the opioid crisis. I applaud you for focusing on this epidemic and i encourage you to throw everything you can at it. Countless lives hang in the balance. The hushhush nature of opioid overdose death has for far too long been preventing the serious Public Health issue from receiving the urgent attention it needs. I am here with you today as both a former elected official who spent almost a decade focused on Prescription Drug abuse, but i am also a passionate parent and family advocate who has personally wrestled with this issue. My introduction to this problem started in my own home. As a fulltime working mom, i knew my son was grappling with some issues but i didnt understand what they were. One day, i received a call from my son who said mom, i need your help. I have become addicted to pills. You can imagine how that felt. I still thank god for that call and i consider myself to be one of the lucky ones. I grieve with the many parents who werent as lucky as i was. That phone call was just the beginning of a very tough road for our family and it was a journey that we made public by doing National Television interviews. After that, my office and i became somewhat of a beacon for other parents going through either the grief of losing a child or pleading for help. To this day, i credit my son for his courage and compassion for speaking out himself and for allowing me to do the same. I have developed a very passion for our youth and their susceptibility to addiction when they face the powerful drugs we have all seen happening too often. We joined forces to create the Prescription Drug abuse caucus. It continues to grow in numbers. Many solid strategies are emerging to deal with this crisis, and there is not one i have read about that i disagree with. They are widely agreedupon strategies such as the realtime Prescription Drug Monitoring Program, research into personalized medicine, and Good Samaritan laws. I support them all. But i focus my thoughts on a few other things. First, in addition to promoting communitybased education, it cannot be overstated that there is a need for strong messaging from leaders like yourself about the dangers of Prescription Drug abuse. We hear so much about avoiding gluten and cigarettes and artificial sweeteners and more but we are simply not hearing enough about thinking twice before we pop a pill. The medical Community Needs far greater education about the diversion of these powerful drugs as well as the disease of addiction. I know the new terminology, but i cant break away from saying addiction and addict. For quite some time, there have been some who have denied any role in the epidemic but that thankfully seems to be changing. Physicians and other providers are on the front lines of this issue. Providers, particularly those who treat a High Percentage of patients suffering from any form of pain, must have the latest treatment guidelines, including the use of monitoring tools for high risk patients. Secondly, we need to finally and fully overcome the stigma associated with recovery. Those in recovery needful need full support from their family, friends, society. Recovery needs to be easily accessible with affordable options for anyone seeking help. Core 12 stands for comprehensive opioid recovery using the 12 steps. The notion we can get somebody into rehab and they will emerge 30 days later fixed or cured is not the reality. It takes seriously hard work and dedication for both the individual and family. If a relapse should occur, it should be seen in the same way we look at the recurring cancer. Its sad but true. It should not be stigmatized and we should reach out to anyone who needs support. That recovery should include doing all we can to promote and establish recovery schools and sober housing for college students. Once a young person can leave rehab, there should be safe and supportive options for them to enter. That support should last a lifetime. I would like to invite each one of you to participate in the unite to face addiction rally. You can find out more information about it at facingaddiction. Org. Recovery deserves celebration, not stigma. The last point i will make concerns cpop, the collaborative for effective opioid programs. Law enforcement, Treatment Centers, medicine manufacturers who are striving to make treatment safer and tamper resistant. The collaborative seeks to stem abuse. We need an important meeting of the minds in order to advance solutions. I invite each one of you to join us, we could really use your help and support. Each one of you should ask how the many many federal agencies who are charged with controlling drugs could allow this to happen on their watch. The caucus could really use your support with that. I once saw a really good video about the pill problem in florida. Imagine that 100 dead dolphins washed up on our beach every day. People would be outraged and demand action. Now imagine that continuing day after day, year after year, but this isnt about dolphins. Its about our kids and families. Imagine them washing up on our beaches. We must throw everything we can at this epidemic. Thank you for listening and i stand ready to answer your questions. Gov. Beshear thank you for your work, congresswoman. Its important. Next, lets hear from dr. Houry. Dr. Houry thank yall for inviting me here today. I would like to mention that for our agency, this is one of our top priority areas. As somebody who has been on the front lines over a decade in an Emergency Department, i have witnessed this epidemic growing and changing. I have seen the patients faces. The work we are doing at the cdc in partnership with you, i know we can make a difference. In the year 2012, there were 259 million prescriptions for opioids. That is enough for every single u. S. Adult to have their own bottle of pills. As we have seen that increase in death, we have seen it quadrupling during that time so with the increase in prescriptions, we have seen an increase in death. Sometimes, pictures tell the story better than words. The picture im about to put up, i want you to watch. Look for your state and watch the changes. Red is not good. You can see the rates spreading across the country. Dark red is the highest. You can really see how this epidemic has spread across the nation. It does impact other areas more than others such as the southwest and appalachian regions. Every state has experienced a significant increase. Earlier this month, cdc released a report on heroin. Its important to realize why we are seeing this increase. Its because of opioid painkillers. People who are abusing opioid painkillers are 40 times more likely to be addicted to heroin. If you think about it, it makes a lot of sense. It has the same effect on the brain, so people that can no longer access opioid prescriptions will look for something that is easier to obtain or even cheaper. By focusing on opioid prescribing, we can impact the heroin epidemic. There are often unintended consequences. As seen earlier this year in indiana in scott county, the hiv epidemic, 170 individuals newly diagnosed with hiv because they were injecting opioid prescriptions. Although this is an extreme example, it can happen in any community in the united states. States are poised to respond to this and must be ready to respond. I wouldnt be here if i didnt think we can make a difference. I am very optimistic that we have the tools we need to have an impact to really curb this epidemic. We did this for car crashes. Overdoses have now exceeded car crash deaths. Thats because overdoses are going up but we have also seen car crash deaths go down. This was a concerted effort, working with different agencies. The cdc will use the same approach we used for that for opioids. By monitoring the problem, looking for where those high Risk Communities are, what are the risks and protective factors we need to identify those most at risk and identify a set of interventions and take them to the state level and share best practices across states. I am very excited that next month, we will be announcing our Prescription Drug Overdose Prevention for states program. It builds off a Pilot Program we had this past year. 16 states will be receiving 750,000 or more for the next four years. We will be working closely with these states to improve their Prescription Drug Monitoring Program so they are easier to use, more realtime, and will work with Health Care Systems in those states whether it be the Medicaid Program or around guidelines to make sure things are implemented for safe prescribing. What we learned from the pilot year is to have flexibility for states. We have built in a Rapid Response project so states can target specific communities, do a communication campaign, or enact surveillance. Our hope is to be able to make this a national program. We are excited to have the opportunity this upcoming year to work with these 16 states directly. We know this is the right approach. If you look at statebased interventions, we have seen that when new york required prescribers to use a Monitoring Program, there has been a 75 decrease. In florida, when they began to regulate pill mills, they saw a 50 decrease in opioid deaths. We will also develop chronic pain opioid prescribing guidelines which will be targeted for primary care physicians. This will give doctors tools to know when it is appropriate to prescribe these medications and when its not and how to do it in a safe and effective way. What can we all do with this . I think there is a lot. We are already seeing a lot of these great practices. One is to promote best practices in opioid prescribing states. I know some states such as oregon has already been implementing this through medicaid providers and arkansas has been working in thethrough medicaid providers. And arkansas has been working in the Emergency Departments. When our guidelines come out in 2016, it would be fantastic if states would use these in their state Medicaid Programs, workmens comp. Programs, or other regional Health Care Systems. In addition, encourage authorities to stop the work for outlier prescribers, whether it be the state medical board or Law Enforcement. Finally, really improve well informed opiate prescribing by making Prescription Drug Monitoring Programs easier to use. Again, as someone who has had to use one, there is a long way that we can do to make them more userfriendly and more effective. You can work in your states to do that. I look forward to having further discussion with you at the end of this panel. Below is my Contact Information so we can talk about how to reach out to your states directly. Thank you. Gov. Beshear thank you, doctor. Our final presenter lieutenant , glenn. Lt. Glenn thank you, and it is an honor to be here. I bring greetings because back from two major stakeholders. I bring those back because in 2009, no other way to describe it i believe we took the , bull by the horns and came out to say that we had an epidemic in the city of quincy. I can describe exactly what we did with that and how it blends into what is happening today. What we ended up doing is we refocused and took a humanistic approach. We did change some of the terminology, and it was difficult to do. In the past we would call a person junkie, abuser, etc. And we arrested them. We are still arresting the dealers and traffickers. We changed it from junkie to family member, we personalized it. From an addict and abuser to a substance disorder. We go back and forth with the terminology, i know. With overdose, it is a poisoning, it has an adverse affect on the body. We have a treatment for that, no locks on nalaxone, or narcan. Hopefully we can get the person to recovery. We do not think everyone is going into treatment, but as i said from the beginning, in order to go into treatment, they have to be alive. That is what we try to do in the Law Enforcement field, get the person to be Emergency Department for treatment. We came up with this prevention treatment, much as the governor spoke of. Enforcement, yes and no. Yes, we are out there arresting, we are not soft on crime. We are arresting the people who are dealers and traffickers. We do have a Good Samaritan law that was amended in 2012 which prevents the arrest of the individual or someone aiding them in assisting or calling 911 for help. We know in the past that we would show up to the scene and have a dead person sitting in a chair or lying in bed with their identification in hand and there was no one else there. That life could have been saved. Theres no doubt about that. We want to try to do that and reduce the fatal overdoses. We collaborate with the parish. I stole that phrase from bill braden. We have to collaborate in this issue. Orally will perish. Or we will perish. We have seen the deaths in the streets now. We collaborate with the department of Public Health in massachusetts outreach programs, Police Officers such as myself other Law Enforcement agencies and administration. We went to the table and spoke. The beauty of that is we went back to the table again and we continue to speak and we came up with this program. The department of Public Health allowed us to enter into the Pilot Program, which was the first that allowed Law Enforcement to administer nalaxone. We will show you the results in a few minutes. This is how we work well together. It is the Quincy Police department, the department of Public Health. These people who are overdosing and dying belonged to someone they are brothers and sisters, mothers and fathers. Some of the statistics you have already seen, so i will go past that. The map that the doctor showed up there, im glad that massachusetts was represented. Unfortunately under that aspect. In three people died every 2014, day in massachusetts as a result of an overdose. I think we will be up to four or five in 2015. That is every day. Some of the results here this is a little crowded, but what i wanted to bring out was the statistics. We started in 2010. We had 47 deaths in the city of quincy. The following year, when we introduced the nalaxone on the street, we reduced the deaths. The myth that was there that if you are a Substance Abuser you will come to quincy because we have naloxone we have not seen that. People would push the envelope and use more because we have nalaxone we have not seen that. In fact, at the time of the slide we were about 7 repeat clients, meeting that someone reversed more than once. That is a very low percentage. We are very high in the percentage of the successful reversals. We are running at a high 90 on reversals. It was administered to 433 individuals and we have reversed 416. Those are individuals who we gave an option to go into some other treatment. Or at least, we turn them to their family alive. Weve gotten a number of telephone calls and letters thank you for giving my son back, my daughter, my wife, my husband. That in itself is amazing. A quick story. We have a vigil every year. A woman came up after the vigil and said, you did not read my name off. I said, that means you are alive, thats good. She said, i know. 17 months ago i overdosed and a Quincy Police officer reversed me. I overdosed again about a month after that, and i was reversed. At that point, it was her tipping point. She went into treatment and has been recovering now for 14 months. That is a success, when someone can come up and say that we were able to turn that around. Again, where prescriptions are coming from. I know this is in your material, as far as prescribed by doctors and providers, over 71 came from a family or friend, meaning that there are too many drugs out there in the medicine cabinet, we want to get them out of there. And properly disposed of. It goes to the impact of the prescribing issue. Become an risk of opiate overdose the common risk of opiate overdose is obviously the age group. We have a huge influx between 1726, and then mid 40s on up. There are many drugs involved, it is not just heroin. There are other drugs on board. Naloxone will work only with the opiate family. These next two slides are probably our flagship slides. They demonstrate what the opiate does. The simplistic explanation aware it attacks the receptors in the brain until the respiratory system is nonexistent and you die. You are in an overdose stage you are not breathing. Youre going to die unless theres some type of intervention. Along comes the officers, fully trained, administers nasal nalaxone. It removes the opiate from these receptor in the brain. Lets breathe again. The brain starts breathing again, we have the reversal. Off to the hospital for further treatment. Documentation will be provided for counseling, and so forth. Hopefully the individual will go into counseling. Again, we are not naive to think that everyone goes into counseling, we know that. We have to give them a chance. On every Police Cruiser that was one of the orders that i did have on , the side of the Police Cruiser, it says protect and serve. There is not a comma there that says except you, you, and you. We protect and serve all. We hope to get them to the hospital for further treatment. There are two formulas, one is a nasal spray, another is an autoinjector. There are some samples being passed around now. They are very similar, the same medication, different loads. The autoinjector is a very simple, much like the epipen. If people are familiar with bee stings and so forth. Im always ask, why do you do it . I have to go against the grain and say, why not . We are all First Responders and if there was someone with an anaphylactic shock, we would use and at the pen. If someone was in a diabetic emergency, we would provide some kind of sugar product to them. If someone is in an opiate overdose the antidote is narcan. I never saw the big deal as far as being able to implement the program, get it on the streets to help citizens. This is our job. Im just a cop. Who has been around a while. I have seen people overdose and die within families, generation after generation. A lot of good people. This is not just for the addict, the Substance Abuser, there are people who are accidentally selfmedicating and over medicating who this will work for also. That is how we protect our community with one more tool in the box. I want to thank you and leave you with a few thoughts, multidisciplinary approach. This is a disease and not a crime. We do have to work together. Theres no doubt about that. I always like to leave on more of an uplifting note. We did have a reversal two years ago, the Boston Red Sox when they won the world series. We were in boston helping them why are you laughing . [laughter] we were helping with some traffic issues, an individual rarobyino boston Police Officers. And said, i know you have naloxone, my girlfriend is overdosing. She was around the corner. They went, administered, ems arrived and took her to the hospital. That is the perception that the public has now of the police that can help, not just enforce laws. We will enforce laws also. We are looking at this as a disease and have done that since 2009. I think that is great. I do not think we have to worry too much about the world series parade this year in the quincyboston area, but you never know. We are always prepared. Thank you for your time. Gov. Beshear thank you, lieutenant. Lets open things up now for discussion. First, let me call on the vice chairs for any comments or questions that they might have. Chairman . Gov. Mcauliffe thank you and i want to thank all our panels for being here. I want to thank mary. After your service in congress you chose where to spend the , rest of your life and you chose the commonwealth of virginia, i appreciate that. A good low tax state. I do want to thank you for being here today. I wonder thank you for being here today. In virginia, we have done obviously very similar to what the other states have talked about. A couple of things that we added to our legislation, one on naloxone. All of our First Responders have access to naloxone, but we also had to protect them civilly so that they could not be sued. It is very important because it was a hesitancy for many First Responders. Without Civil Protection the other thing we have called for is a dramatic increase in our drug courts. Obviously we no longer look at this as a lawenforcement issue, we have had to take a holistic approach to it. It is about health care, communities, saving money to keep people out of prison. If we can get into treatment earlier, the better off they are going to be. I want to thank my secretary of Public Safety who is here with us today. He headed up a 32 Member Task Force to address these issues. My question to you, dr. , if you just read the cdc report, it says the increase in heroin is coming from the least likely folks that you expect to be heroin additcs. My question is are there Different Things that we need to be doing in intervention earlier are we putting the resources and the right area and how do we help our Law Enforcement deal with this epidemic . Dr. Houry thank you for the question. I actually read your task force report. Dealing with heroin as well as opiates, there are three things to focus on. One is stopping them from ever being addicted, that is keeping the prescriptions off the streets. 1825yearolds are not the ones were seeing abusing the opioids as much. The slide that the chief showed, a lot of people are getting these medications from family members, that is one way they can access them. Safer prescribing. The second thing, for people already addicted, increase medication assisted treatment. That way we can help , them really treat their addiction and get off the drugs. The third thing is naloxone. Making sure that the First Responders have access and the Good Samaritan laws will really help with that. I think it is important to look at what we can do to stop people from getting to that. Nalaxone will reverse and overdose but if we can prevent , them from getting to overdose, that is what i think is the ultimate goal around prevention. Thank you. Gov. Haslam i was struck at what you just referred to and and patricks comments of 71 coming from family or friends. Break that down a little more for us. How much is the original prescriber an accomplice . How much is it being taken without them knowing . Tell us more about that, and any other insight as far as things you have done to collect unused prescriptions. Anything that might be helpful. Lt. Glynn as far as the 71 the prescriptions were legally written. The issue that comes into play sometimes is that people dont always follow the directions on the prescriptions. Usually they stop when they feel better. They put them in the medicine cabinet. Friends come over, they take them out, sometimes pill parties, you have no idea. Looks like a bowl of chocolates. People will start taking pills out of them. Other than that, there are prescriptions stolen out of medicine cabinets in open homes when Real Estate Agents have open homes. It is one of the Fastest Growing areas of stolen prescriptions during those times. No longer is someone walking out with a flatscreen tv, they go to the medicine cabinet and leave with pills. It is not all on the pharmaceutical companies or the prescriber, it also is selfawareness and taking care of those prescriptions. The second part of your question on what have we done with the excess prescriptions. Weve done take back days withd dea. We have a return box where people can anonymously bring in unused prescriptions and we destroy them. We have two a year when we turn to clocks forward and back. Refresh your batteries in your smoke detector, turn in your prescription. The public has been very receptive. We also have senior pickup days where we go around to the Senior Citizen buildings and pick up unused Prescription Drugs also. We are not forcing them to come to the station or wait six months or so forth. Gov. Malloy thank you. I just wanted to share a couple of things that we have done in connecticut. We did pass a comprehensive opioid bill that requires the doctor to check on the Computer System before they write a prescription, it is mandatory. Also education requirements on the subject, making sure that opioids that are tamperresistant or consistent with systems to make it less likely that they be abused by that person or subsequent acquirers. We had done our narcan bill in respect to ems, local Police Departments and troopers. I can report that as of five days ago in the current year, 36 calls for service, 37 persons receiving medical who were in medical distress. 34 persons regain consciousness and survived as a result. This is just from our state police. In the bill i previously referenced, we are also making a it possible for anyone to go to a pharmacist, explain the situation at home with respect to abuse, and receive narcan to have it available to administer themselves in the home setting. We think that will increase the usage. Let me just say something. 3637 states have more people dying of drug overdoses than they do in car accidents. Think how much money we spend in making our roads safe, whether its snow removal, writing tickets, or having troopers on the streets or local police. We do everything we can to prevent those. We are now seeing increases in death as a result of primarily opioid and heroin abuse, and we just have to step up our game. Thats what were trying to do in the state of connecticut. I think this opioid deterrence proposition, where we might have to spend a little more to make sure this is available is an important thing to do. One other thing two other things i would say. We have worked in new england three years in a row, new england governors have worked together to break down some of the problems. What we found is people who doctorshop do it in multiple states. If youre not talking to your neighboring state, youre missing the point. We saw that in particular with respect to hartford and springfield, sprinklered being one of the largest cities in massachusetts springfield being one of the largest cities in massachusetts and hartford in connecticut. The number of folks who were doctor shopping in both jurisdictions was remarkable. The information was not being shared. Having a better sharing system i will give you a for instance. Connecticut had an opioid sharing platform with 16 states, but none of the New England States participated. We had to break down that wall. We also reached out to the eastern premieres of canada. We understood that number one, they were incentivizing the prescription by medical policy of opioids that were not tamperresistant. Just the opposite of what you want to be doing. And, there were people in maine and New Hampshire and vermont, and i presume elsewhere, who were also coming across the borders with that tamperresistant, going there and coming back with tamperresistant. These are some of the things that you might want to be aware of. Lets do everything we can. The final thing, just because of our age, i missed deborahs comments so if you have said this already heroin is purer than it has ever been. You do not have to shoot up. It is cheaper than it has ever been. Both of those points may have been made. This is the third point of that. People are dying on their first usage. We are having it happen on a regular basis. Young people think they are going to live forever, think they can tolerate anything. They experiment with heroin and if there is not someone to administer narcan, they are dead. Were seeing 18, 19, 20 21yearold. We see people at their 21st birthday parties die on first usage. We see them in graduation parties from college die from first usage. This is a real problem because of the purity, the expense and because young people think they will live forever. When we were growing up we all thought you had to shoot this up and you would be a junkie in a week. It is a very different proposition and it is so cheap. A final point on opioid abuse people are age are the fastestgrowing abusers because we are having knees replaced and hips replaced. How much is prescribed is important. You have a tooth removed, there is no reason for a doctor to write a 30 day perception for an opioid. Even if it is tamperresistant. No reason for it. Come back. If you still have pain after you have a molar removed after three days, come back to the office. Stop writing longterm prescriptions. Gov. Beshear other questions or comments . Gov. Fallin i agree with governor malloys points. All on point. We do all the things that were just mentioned. We also have drop boxes throughout the community. We all worry about national security, isis, terrorism, cyber security, but the enemy within the nation is the addiction issues of our population and how it is ruining lives. Whether it is children ending up in department of Human Services custody because mom and dad cannot take care of them anymore, a school child having trouble learning and they are falling behind in school. Once again, mother and dad may not be available or someone may be in prison, maybe grandpa and grandma taking care of the kids. Because the parents have an addiction issues or are not available. It could be those living in poverty, those who are not in the workforce. The statistic in america now is 62 of the people who can work do work. There is a large portion of our population that do not work at all. Those who work and pay taxes have to help fund those programs and help those people. This is a bigger National Debate about how we can create a stronger america. But we are weak right now and we have threats around the world. The enemy is within ourselves with our Substance Abuse and drug addiction problems. We need to have a National Debate, besides the things mentioned which are all great points. Is working with the judicial systems, judges, and those who are involved in Law Enforcement, in particular. That if someone has a Substance Abuse issue and is not someone we are scared of, that might harm us in our homes, a friend relative, an acquaintance who has an addiction issue, do we put them in prison for 20 years . With hardened criminals so that they come out worse, or do we help that person address the core issue, which may be an addiction issue to Prescription Drug abuse hopefully not heroin, but it is a reality. How can we do things better with our criminal Justice System to be smarter on crime, yet tough on crime . For those that way are scared of t and we want to keep from harming our communities. How can we get people treatment . In oklahoma, i have encouraged people to look at how to get this Substance Abuse treatment if they are just not criminals but people with a problem. I am trying to remember the new word substance challenged . Not Substance Abuse, what do you call that . Lt. Glynn Substance Abuser . Substance disorder. I think sometimes we get caught on terms to much, we go back and forth. Some parts of the country do not want to use the term addict. Or relapse. Gov. Fallin substance disorder. But working with the criminal Justice System, it costs money putting someone in prison. We know the outcomes when someone serves and present longterm. We want to keep those who are dangerous to the community locked up, absolutely. But how can we help family members, colleagues, as you were identifying addict versus a son, a daughter, a mother, a father colleague, friend, who , has an addiction issue how can we change that dialogue in america to help people who have an addiction issue . It is one of our biggest challenges. It is weakening us as a nation. We have bigger issues like terrorism and things we are really worried about. But we have a weakened society because we have so many people addicted as you show on your map , and dying because of those things we are weaker as a , nation. Gov. Mcaulin mary, you talk about Public Awareness. Tell us what you think the best practices are. How can we do a better job of raising Public Awareness . What states do a good job . This is the key issue, get people to understand the issues and get them involved. Mary thank you. I noticed your state was one of the better i look to you for ones. Some of the answers. I have some personal thoughts, they may not be politically correct, but i will say them. And then i will speak to governor fallin and her questions. In this time of the legalization of marijuana, i think that kids are hearing some mixed messages. They hear that pot is ok, it is safe. But i think that the overall message right now on drugs altogether for the youth is warped and more people should say, this stuff is stupid. We are not hearing this message. It is just stupid to do it. The just say no campaign that the first lady reagan, many people said it was not successful, but we need Something Like that. Where people are saying it is stupid to do that. We are not hearing that. Even the legalization fox on marijuana, have that. In my opinion it is stupid. I will be one of the people to say it. Im not popular with some of my kids friends, but i say it everywhere i go. And we have arguments at the dinner table. It is important. I congratulate your state to be one of the less transitioning two deep red. But to governor fallins there point. Seems in the Recovery Community that they are enthusiastic about the comprehensive recovery addiction act. I am fine with that. It is gathering a lot of steam. Tremendous bipartisan support. Within that bill, there are sentencing guideline reforms. Congressman brenner is the cosponsor in the house, so going through the judiciary committee, and the sentencing guidelines are in there. We need some more support to get to the mark of level. With the priorities of the country right now, it is hard to get senators and congressmen to focus on this but we are doing , our best. With this bipartisan nature, i think we have a really good chance at it. Again, the notion is that people with Substance Abuse disorder should be treated, not incarcerated, and i think that is one of the foundational points in the bill. I would be happy to send that to your office and see if you can weigh in with your delegation and maybe want to cosponsor the bill. Gov. Beshear dr. Houry . Dr. Houry we worked with kentucky and operation unite and a social media campaign. It is about changing social norms and getting aware that it could be your neighborhood neighbor not some scary picture , that you are used to seeing. It is all society. We have people telling stories of how they recovered from addiction. It is hopeful. You can see your neighbor, your colleagues in that and it is just getting the message out there more with those stories of recovery and also the stories of loss. Stories of children that they lost due to addiction. And then attaching that to how to get help. Gov. Beshear governor tomlin. Gov. Tomlin we have had some successes and we continue to strive just as much. But we have had successes in closing down these drug mills, by requiring reporting and changing the rules, i agree with governor malloy that one state cannot do it. I know that kentucky and West Virginia have worked together to try to share information so that you do not have people crossing borders into another state in getting prescriptions and bringing them back. One thing that we have seen is a decline in prescription jug abuse, but it has moved to heroin as you indicated. We have pass the bill because of the increase of hepatitis c and hiv cases, we have started to implement Needle Exchange programs. Because i think a lot of people would get that as promoting drug abuse, but i think once you get it, if you are using drug needles, state will pay to treat you for many years to come. One of the other things we found out is that five years ago we , did not have the communitybased Treatment Centers that we needed around the state. We have been able to work with the legislature to now have a lot more communitybased services. A lot of them was really needed for women and children. Those are now in place and most of them are and we continue to try to expand those services. Because people really didnt if they wanted to get off of drugs, they really didnt have a local help to get it or the whereabouts to go and get it in some places. So i think that those will continue to be helpful to us. And also in the next 30 days we will have a statewide hotline, if you need help and dont know where to go or who to talk to to allow people assistance or to availability to get help and i think people get to the where point they dont know where to turn. It is up to us to be able to supply that to people who have a sincere wish to get clean and stay clean. I think that it is something all of us will need to contend with for a long time. It is not something that we can eradicate in 35 years. We will continue to monitor it as the availability of different drugs come about. Weve got time for one more question. Governor hutchison . Gov. Hutchison what a great topic. I want to upload my former colleague for sharing her story this morning and dr. Houry and detective glenn for your leadership and in many areas could i wanted to make a couple observations. I understand the seriousness of this issue and the message that we have to treat them as people with addiction problems, but also crime problems. But i would encourage you to and i think that you do, but recognize the Important Role that Law Enforcement plays. Whenever people have in an addiction problem, it israel that they say, i have an addiction problem, i need help. It is generally when they are confronted by Law Enforcement officers that they first confront their addiction. And in drug corps graduation, it it is usually the person bancfirst, the Law Enforcement officer that put them on the path to recovery. It is the balance that is so important. I think Law Enforcement sometimes gets beat up on the head that they are the part of the problem, rather than the solution. The other point dr. Houry made was at the role of the state medical boards. If there is any Lessons Learned across the state, because medical boards are independent and they are made up of physicians. They have a serious response responsibility whenever you have a physician who has prescription abuse problem and the disciplinary action that they take. If there are any good examples or models as to how these boards address this, i would be certainly interested in that. And finally, im familiar with methamphetamines and the length of time needed for treatment but if you have somebody in drug treatment court, what is the optimum amount of time for recovery for someone with opioid abuse . 30 days is not enough, 60 days is not enough. What is the recommendation . I know that i raised a couple of different issues, but maybe dr. Houry, you have a comment . Mary bono im not a physician but from everything that i am hearing there is no set time for , opioid recovery programs. The biggest mistake is that thinking that theyre going to go in for 30 days and 30 days later there out in their fixed. My honest opinion is that it is a lifetime of recovery. That once they have any sort of substance disorder, they battle it for the rest of their lives. That is why Early Intervention and prevention is key. It can be, depending on the motivation of the individual, it can be sooner rather than later. But you made a very important point and are too final thoughts i like to say. Everybody in the addiction world pretty much recognizes that for someone with Substance Abuse disorder my term is an addict. To seek help, they have to hit bottom. To hit bottom means a lot of Different Things to a lot of different people. That could mean losing your job. That could mean crashing your car. It could be a whole list of things. Intervention from Law Enforcement, god bless them. But then that person hopefully would recognize that their life is not Getting Better and ive got to get treatment. It is important. I think you for the work you i thank you for the work you have done early earlier. This is my last filibuster. There is hope for addiction and people in recovery. There is a fantastic book out there right now called fearless. It is a story about a young man who is addicted to cocaine and methamphetamine and uppers and he went on to beat that addiction. And he became a member of seal team six. If you can become a member of the most elite warrior fighting group and unfortunately, he was killed in action, but his story was extremely powerful. As detective glenn was saying, it is life we are saving. However much time it takes for thank you. Lt. Glynn i want to thank people. 30 days is great, but that is just one prong in the multiprong have to go down. But there are number of relapses that we have understand. That is my failure. As far as drug court goes, they graduate probably 1015 people and a lot of them falter as they go down that road. The judge has absolutely no problem putting them back in the house of correction. They actually joke about it at graduation. How hard it was to go through and judge so and so put me back in jail, but that was a turning point for me. One quick example of the fact that they did belong to someone, a couple of years ago i received a package at the police station. It was nicely wrapped, it was the holiday season, christmas time. I had one of my detectives go into another room and open it. [laughter] they brought it back to me and it was from an individual that i had arrested a number of times. It was a christmas present. It was pajamas. They were very nice pajamas. I had to think that it took that person to a point to see me as a human as i saw them as a human. As i look further on, i kind of chuckled because there was a security tag on the leg of the pants. But the thought was there. [laughter] the thought was there. That was one of my biggest tipping points also, to think of everybody as a person that has multiple issues, some more severe than others. They are still clean and sober after three years. That was one of those steps that maybe they had to accomplish to show some of their appreciation. It wasnt just appreciation for me, but for Law Enforcement in general, stating that we were out there helping them, but also we are enforcing the laws also. I just one of the close with that statement. Dr. Houry that is hard to follow. But in response to the state medical boards, we will look to share this. I think there is good and bad that the doctors face when it comes to state medical boards. We certainly want the state medical boards can work around those that are prescribing too much, but doctors also worry about if theyre not prescribing enough that patients complaining go to medical boards. We need to ensure that doctors are safe from that. I do not have a happy story to share. It is difficult when you are on that front line and someone is asking for that prescription to say no. We really need to help to empower doctors and give them protections through the state medical board, to say no when it is not appropriate to give that opioid and have that difficult conversation with the patient. It is easy to give in and say here you go. Then you do not have an unhappy patient. Then you have that 10 minute conversation. Ive done that. Ive referred patients before to pain clinics. But that is tougher to do and i think that we need to have these conversations about people are aware of the growing problem and how we can make a difference. Thank you. Gov. Beshear we will close out the session. I want to thank everybody for participating in this. It is obvious that this is a fundamental problem in our society that is not going to go away. Unless we stay focused on it from state level as well as federal level, it is just going to get worse. If no one in your family, or no one in your extended family, or no one of your friends has ever been affected by this, consider yourself lucky and take a deep breath and say quick bear because it is going to happen. It is everywhere now. I want to thank the mga for focusing on this. This is something we need to say focused on and continue to learn from each other because there are a lot of good things going on out here in the different states. And when we passed our legislation we pulled from a lot , of places. We did not try to reinvent the wheel. We wanted to make sure that we were trying to cover the waterfront. I cannot stress enough how it takes everybody, every stakeholder in this to make this work. It has to be a huge amount of stakeholders in this. Lets give a round of applause to our presenters. [laughter] [applause] any closing comments . Very well done. Very helpful. Thank you. That was fabulous. I want to thank you, mr. Chairman. I know that this is a last meeting. For all of us, you made us proud to be government is. Governors. Gov. Beshear thank you. We will stand adjourned. [applause] the cspan cities tour visit cities across the country. We are joined by comcast to learn the literary life and history of augusta georgia. He was awarded the Carnegie Medal at the age of 19. He was also awarded the medal of honor posse for his actions in world war ii. We are sitting in the Augustine Museum of history and about 10 years ago, a decision was made to a Permanent Military display to honor jimmy dais. When i did my research on the book, i want to over 9000 Carnegie Medal recipients in the last 100 years. The 3500 or so metal on the medal of honor recipients in the civil war. He was the only person ever to earn both awards. He went almost for sure say he did not deserve it. He may point out to somebody else who was more deserving than he was. He was very humble. He never talked about the Carnegie Medal. When i interviewed people who knew him and i did the book a long time ago, people knew him well. I said, tell me about the Carnegie Medal that he earned when he was 19. They do not know anything about it. I know a lot of medal of honor recipients through my years. Most of them will tell you that i did not deserve this medal. It should have been given to somebody else. It is a piece of humility that we all learn. I think he wouldve been in that category. We also visited the boyhood home of our 20th president woodrow wilson. President wilson moved to augusta as a child when he was just a year old, lived in another house. He lived in this house when he was three. President wilsons very first memory was in november of 1860 before he was four years old. He was standing on the front gate out in front of the house. And two men came by in a hurry with very excited tones of voice and said, Abraham Lincoln has just been elected president. Theres going to be a war. So, young tommy ran inside and his father, what was war . What did that mean . Why were they so excited . We think it is remarkable that his very first memory was about another president , Abraham Lincoln, and about another war the civil war. Of course, wilson would have to leave lead the country through world war i. See all of our programs from augustine on cspan 2 and put tv on cspan3. On the next washington journal, former secretary ray lahood talks about the congressional efforts to fund the highway fund before money runs out. And Megan Mccarthy discusses the current legislative and legal challenges facing the health care law. We will also take your phone calls to look for your comments on facebook and twitter. Washington journal his life every day on cspan. Is live every day on cspan. Cabinet officials return to capital capitol hill to testify on the iran nuclear agreement. They hear from secretary kerry and treasury secretary jack lew. That is both live at 10 00 a. M. Eastern on cspan3. 15yearold Catherine Figaro was nine when she watched her parents being arrested in a televised antiimmigration raids. Recently, she sat on a panel of undocumented immigrants and activist, talking about the sheriffs handling of arizona immigration laws. He has been elected six times as sheriff of the county of arizona, which includes the state capital of phoenix, the location of this years net roots location conference. Hello, my name is Carlos Garcia. This panel is called the people versus arpaio. we have an amazing panel. These have been the people who have been fighting against him for a long time. We are going to start off today with a small video. It is important to show the video not only because it showcases one of our own panelists, but it is also showing a little bit into her private world and who she is. Youll be able to see a little bit. There are some clips of the chain gangs, jails, and what he has done to our community. And also the filmmaker of the film this is just a trailer. She is in the room. And the fulllength film will be showing tomorrow at 9 00 a. M. In room 223 and catherine will be there as well. I want to invite everyone there. If you want to see the full film, join them tomorrow. We going to go ahead and get started and it is about a fiveminute clip for the movie. [video clip] breaking news coming to us right now. The Sheriffs Office is currently executing a search warrant. 25 different employees all possibly could be illegal immigrants. Todays operation is the seventh investigation by the Sheriffs Office for employers violations. Mr. Arpaio i know how to solve the problem. You arrest them. Why do i get all of the heat because someone does something wrong and i use the word punishment, which no one else will use . Why should they not be punished . [crying] she is catherine figeroa, the phoenix girl whose plea to the red is not good. What is happening . Did you stay with her . Catherine my aunts catherine no, just yesterday. Today, i think i am going with my other aunt. There is only one reason it is you. Im 90s is old 90 years old. I will vote as long as i am here. Can i be the sheriff at 90 . Most older people are afraid of children and afraid of people who dont open a the law because those people are nasty. They have to be punished. The issue of immigration has become a source of fresh contention our country with a passage of a controversial law in arizona and the Immediate Reaction we have seen across america. 20 other states are considering similar legislation. This law does not fix the immigration problem. It adds new problems. Mr. Arpaio law or no law, we are still going to do our crime suppression operation and continue enforcing illegal immigration laws. We are at 35 tonight. Now they are going to go to jail. We are scared to go out. If they have to hide, i have to hide. [speaking spanish] today, you will hear testimony on how it affects children, communities, and families. I will begin with catherine figeroa. I would like to send a message to arpaio. Im in washington for a reason because i want it to stop. Mr. Arpaio i am taking a little heat on my crackdown on illegal immigration. The u. S. Justice department launched an investigation. Who do they think they are . This is my hate file. They get pretty nasty. Shows you how volatile this whole situation is. Is it taking . I dont know. Speaking about the department of justice eric holder said , there will be some responsibility. Your thoughts . Mr. Arpaio maybe it was not a correct remark to make. I work for my reputation and no one is going to take that away. Witness tampering destruction , of evidence, financial fraud abuse of power. This is the most out of control Law Enforcement in america. No one from the mexican on the street to the residing judge of the criminal court is safe. I kept thinking that maybe i would see my parents when i got back home. [speaking spanish] [crying] [speaking spanish] what do we want . Justice when do we want it . Now i want justice. No matter how it turns out, i want justice. Period. With our blood, sweat, tears. Get out of my country i dont want anything that happened to me to ever happen again. [crowd chants] [applause] carlos welcome, everyone. My name is Carlos Garcia and im the director. What we are going to do today is have a conversation with the six folks that are up. And we are just going to do a series of questions and then we will open it up for questions from people in the room. I also wanted to recognize the parents of catherine who are also in the room. They are here and you saw them in the video and for their fight and continuing to support their daughter to be up here. I wanted [applause] we can get started with catherine and ask for the question of what it was like. What is it like looking at the video and seeing what happened and in that moment, what was a bit like to see your parents being arrested on tv . Catherine it was really hard. I felt alone like i was in a completely different world. I knew i had my family members with me, but it was not the same. I knew that i had to fight for them no matter what just how they fought for me. They always wanted a good education for me. They are everything to me so i knew i had to fight for them. It was really hard. I was scared i would maybe never see them again. I was scared that if they got deported, i was going to stay here alone. That nobody would want me because i wouldnt have any parents. I felt like people werent going to like me. [crying] i was really scared but once i started hearing about things i could do to help my parents, i did them, i fought for them, and i did everything so i could be with them again. [applause] we are all very proud of you. Carlos thank you for sharing. The former state and gubernatorial candidate has been fighting for a long time, one of my mentors who has been here for us in fighting for the whole time. I want to ask you, why did arpaio do this . What were his political objectives and what was going on . Why did he start doing this to our people . Let me take a few seconds to tell you how inspirational for those of you who were not here as this unraveled, this was arpaios first televised worksite raid and what catherine had to go through is to see their own parents taken away. What inspired catherine, she then in turn inspired all of us in the community and i want to recognize her and her parents. She fought to get them out but once they were out, they continued the battle to make sure it doesnt happen ever again. [applause] what inspires arpaio . What makes him who he is . Obviously, some of the words are easy. He is a racist pig, etc. , etc. I think there is a certain perversion,