Transcripts For CSPAN Opioid Crisis Hearing At Johns Hopkins Hospital - Panel 1 20171202

Afternoon, everyone. Welcome to hopkins. I have the distinct pleasure of welcoming you all to the institution. As the president ive often had the immense pleasure and privilege of working closely with congressman Elijah Cummings on a variety of issues and we are grateful for his steadfast leadership nationally and on behalf of his local constituents we are lucky to count ourselves among those hes represented from more than two decades. We are honored to be a part of the house government reform committees efforts to find Meaningful Solutions to the Opioid Epidemic. Thank you all for being here today. It is no secret that we are in the throes of a crisis that has reached Epic Proportions throughout the country, and baltimore is no exception. In 2016, weve averaged nearly two fatal opioid doses in the city per day. This is a problem in need of thoughtful answers as both an anchor institution and steward of health care for the local communities, hopkins takes the problem very seriously. We see firsthand the devastation fielded by Substance Abuse disorders. Here and at th desist or hospito the east, the number of opioid Overdose Patients seen in the Emergency Department doubles last year doubled. This is a part of our reality. So, what are we doing about it . As an academic medical center, we are addressing the issue of research to Clinical Care and education. First, research. Hopkins research runs from bench to bedside starting with the original identification by doctor solomons mitered in the 1970s to the multitude of Clinical Trials that are conducted in the behavioral pharmacology unit on the campus. We are working hard to make an impact. The Clinical Care we are working on two fronts, treating the disorder that already exists and preventing future addiction. An addiction to the treatment units. Its addressing Mental Health, social services and family needs and we have specialized programs targeting pregnant women, youth and adolescence. Perhaps just as important as treating, we are working aggressively to prevent the pathways of Substance Abuse from opening. Theyve implemented guidelines of the opioids such as limiting the dosage o of the first prescription particularly after surgery and eliminating automatic refills. While patients are in the hospital we have team of specialists work with them to find alternate modalities of treatment and we provide access to the locks on fo luxor for pah disorders visit. Though we havent stopped there in the third part of the mission of education. As educators we are working to ensure the next generation of the physicians and providers is to practice his treatment and prevention by incorporating them into all aspects of training. We realize the work were doing is one piece of a complicated puzzle. The Opioid Epidemic is after all a Public Health crisis that requires a systemwide approach. Among the partners is John Hopkins School of Public Health. The Bloomberg America Health Initiative launched last fall with a generous gift from being Innovative Research projects partnering with communitybased organizations and working with policymakers around the country to implement evidencebased comprehensive solutions and beyond the hopkins campuses, we rely on the expertise of so many other healthrelated institutions and businesses from the Baltimore City Health Department to the local pharmacies and our elected leaders. So i look forward to todays testimony from a dedicated and edwarandinformed group of Important Group of witnesses. I am confident that your work will move us forward to achieving solutions. Thank you. Now i i am honored to yield the floor to the mayor of Baltimore City mary catherine. The plus [applause] to the esteemed committee, thank you it up to the congressman. Everybody knows at this point that we are in a crisis. Opioid addiction, we are suffering here in baltimore but the nation is suffering and its important that we pay close attention to what we do as it relates to the individual suffering from this and the communities that are being destroyed by it. We know that in Baltimore City we have a big problem and we know that we are part of a larger problem with the governor whwho convened a group to look t this particular issue and we are focused on not only making sure that people dont get involved with drugs but doing what we can to keep people from overdosing. I have one of the greatest healthcare sugars in the country whos really focused on this particular issue, so again i want to welcome you all here and i know that this panel will continue to deliberate over this issue and i look forward to hearing the results of the panel so we welcome you to baltimore but more importantly we understand the importance of your work. Thank you. Now i have the distinguished honor of bringing before you the governor of the great state of maryland, where governor. Thank you so much. [applause] thank you mayor and governor christie as you know who chaired the Residents Commission on the opioids and i want to thank the congressman cummings, ruppersberger and all of our members of the house for coming here today to baltimore. We thank you for holding this hearing in the city of baltimore and the state of maryland and also want to thank all of you in the audience for being here today and who have enough interest to be here this is a National Crisis and something ive been very passionate about for about four years. When i first decided to run for governor i was traveling in maryland and every single town and community i was going to indict thinvite the task of locs what is the number one issue facing your community and it didnt matter whether i was in Baltimore City or urban areas or wealthy suburbs of Montgomery County and washington suburbs and it didnt matter if i was in a small group county the answer was always the same in every place i went they said the number one problem we are facing his heroine and opioids and it came as a shock during the campaigthat during thecampaign g folks involved in addiction and Police Officers and we got everything we could. Soon as i was sworn in as governor whe one of the first ts i did in january of 2015 is put together a heroine and Opioid Emergency Task force chaired by the governor and hundreds would testify. We came out of that with 38 recommendations all of which we implemented and it continued to get worse no matter what we tried. We became the first state in america to declare a real state of emergency just like we went for a Natural Disaster and it is a national disaster. So far this year in our state 1180 people have died of overdoses in maryland. In almost every single day people are dying. This has now evolved, we have leveled and reduced the number of deaths from prescription opioids for the First Time Ever we flatlined heroine overdoses but we have a 70 spike in front of fentanyl. As we try to be aggressive on this issue, its constantly involveit constantlyinvolved int it and i want to thank governor christie for his work because it isnt just a Health Crisis but its impacting into tearing apart families and communities from one end of the country to another and its going to take it all hands on deck approach. Federal government working with the state and local governments along with people in the private sector in hospitals. I want to think hopkins for hosting us today that i want to thank you for your interest and say that i called on the federal Government Back when we did our State University and said federal government ought to do the same thing and that would be my recommendation to the committee to have federal funding, and i would say this is the most important problem facing the country so thank you and im going to turn the floor over to the chair man who is here. Thank you so much for being there. [applause] thank you, governor and Johns Hopkins for pardoning the inconvenience and appreciate the seriousness of the issue that brings us here. The committee will come t to orr without objection the chair is able to call recess at any time. We are in the hometown and because he cares so passionately about this issue we are going to recognize you first for your Opening Statement. Thank you mr. Chairman. But i cannot come into this hospital without saying thank you to hopkins for saving my life. I spend 60 days here this summer and a lot of that was here in this building. I see a lot of white coats out there and others. Thank you for what you have done. I want to begin by thanking the chair man for calling todays very important hearing bringing the Oversight Committee to baltimore i also thank my colleagues for coming to baltimore and certainly my colleagues who represent baltimore along with me and doctor ruppersberger. Ive been in the congress now for 20 years and ive seen a lot but ive never seen as many members attend any since ive been in congress. Today is a remarkable turn out and the fact that the Opioid Crisis is a National Emergency that doesnt discriminate based on politics. It affects red states and blue states and every state between. So im extremely grateful for the request to bring the committee to the road to investigate the devastating effect of this very difficult problem. I also want to thank doctor miller for your hospitality. The work you do makes a huge difference in the committee and around the globe. We are honored to have you in our prisons and of course i think our witnesses, governor Chris Christie doctor alexander. Thank you for testifying and for all that you are doing to help us save lives. A year and a half ago at the committees first hearing on this issue either warned that so many people were dying and communities into that we could no longer ignore this emergency. Today the centers for disease ce control and prevention estimates that more than 64,000 americans die from drug overdoses in 2016, an increase of more than 20 over the year before it last year alone was higher than all u. S. Military combined. Every 20 minutes someone dies from an opioid overdose. Todays hearing lasts for two hours, half a dozen families who have lost a parent, a sibling or a child to opioids. We have the reports, years of talk and no it is tim now it isr action. The American People are looking for us to take action, looking to the president and the congress they are asking what are you going to do. Governor christie and the other members of the commission on drug addiction have given us a group with dozens of recommendations and now it is up to us, republicans and democrats, local officials, researchers, drug companies, Health Providers on the ground and families of the communities. We need to Work Together to end this epidemic. Something we can do right now to help prevent addiction and save those who already have this disease, for example, we can assure that every Single Person who need needs the lock so it hs its. The commissions report highlights the importance of equipping First Responders including Police Officers, Fire Departments and Public Health officials. But heres the challenge. Drug companies have continued to hike up the price of this 45yearold drug and have been forced to ration it. In september the members of the house of representatives are sending a letter urging President Donald Trump to negotiate lower prices just as the Commission Recommended that unfortunately we never received a response. The president should act now to make sure it is available at a reasonable price whenever and wherever it is needed. We also need to ensure that every affected person has access to an effective treatment. According to the commission and i quote today only 10. 6 of the youth and adults who need treatment for the substance disorder receivsubstance disord. Only 10 . There is no way to end this crisis if those affected are not being treated and if we do not act now. To do this, we need funding. Last month President Trump declared this epidemic a Public Health emergency that didnt propose any additional funding to combat it. We cannot fight this epidemic without equal to the challenge we face. This is a sad truth, so finally we must recognize and acknowledge the many factors that people at risk. Woefully inadequate support for our children and vulnerable residents, worsening the economic inequality, lack of opportunity and profound disparities of the criminal Justice System. We cannot solve the crisis until these risk factors are addressed. With that, mr. Chairman, thank you and i look forward to the testimony into taking action on it and i ask for unanimous consent. With that, i will yield back t the. Back stronger than ever, so thank you all governor christie and past and present governors witnessed a drug epidemic in the history. It kills more americans than homicides in car crashes combined. It is a staggering reality, two out of every three overdoses in the United States involve opioids prescribed to believe and manage pain. Over 33,000 americans die from an opioid related overdose in 2015 which is an increase from the year before. In South Carolina where i come from, theyve suffered more than 100 opioid related overdoses in 2015 and while the numbers are fewer when compared with those like baltimore behinwith baltimy member in the statistic is a lifwife with loved ones and friends, potential aspirations we have a tendency to use numbers and governance in our line of work that the victims are rough numbers. We can cure diseases the past generations lived on. We can put people on the moon but we are struggling on how to respond with this epidemic. I guess we need to start with how did we get here. There are illicit uses for these drugs. One is unlawful and the other is legal. Physicians have a role to play for certain. These drugs are not available legally. What are the pharmaceutical alternatives, is there overprescribing, sufficient information shared to avoid the misuse and abuse, frequent exposure and access to painkillers lead to intolerance, Substance Use disorders to intensify the methods with or without the help of the physician. It is growing exponentially on the illicit side of the equation they have high potent pills to the market to be placed through an resulting in the drugs so lethal theyve been called a grave death to describe the risk associated with every single injection. Opioid related overdoses are deadlier than the hiv aids epidemic at its peak that predated it. Theres there is a plethora of s to be asked in the use of substances. Also prosecutor doctors. I want to make sure they are evicted going to the source of the issue outside the course of a professional medical practice. Are they monitoring and sugars with less addictive outreach for patients or the states regulating the homes that can move patients in and out of treatment physically for profit and these are the questions people want answers to all across the nation. Almost everything seems capable of being reduced to political exercise i genuinely hope that this epidemic is above that. I hope its about protecting those especially among the premature, especially the premature death of a young wife with no political or ideological victims and the perpetrators, addiction is addiction, heartache is heartache. The issue to me comes down to those seeking a solution and those who profit off of other peoples addiction and pain. Its not just those across the Healthcare System is also the disease of addiction that is permeating and threatening in some places within the country the very fabric of the communities. At the same time, the pain is real for the homebuilder and mr. Cummings district for mine with an immense vaccine. How do we solve this epidemic. Theres a provision aspects of the treatment aspect of education aspect, punishment aspect and oversight aspect. The president signed an executive order for governors and attorney genera attorneys gd a professor to recommend policies for the federal response of the epidemic. The commission finalized recommendations for how the federal government can help the stakeholders and stave off the emerging threats. Today we will have an opportunity to highlight and appropriately so. Weve also examine the state and federal partners and how they can assist with and learn from the efforts that are occurring here. The devastating statistics may leave us feeling like we just left the starting line. But our country is resilient, we have resources, compassion, i think we have a commitment to win this battle with opioid and opioid addiction so i want to thank all of the witnesses. Governor christie, you are the great governor of the state of nestate ofnew jersey as i mentiu you are also a former United States attorney, so you are uniquely unjust for your presence today that the ability to undertake this vitally important responsibility and with that, you are recognized. The president asked me to chair his commission on the opioid and drug addiction in the country and we worked together on to join that commission. That is an important place to start. Theres much that divides the political dialogue in the country right now that makes it difficult to get things done. This can often be one of them. I read the obituaries and in none do they designate whether the person was republican or democrat, they are a son or daughter, husband or wife, mother or father so i hope what we do today will help get this problem the ability to rise above the partisanship we have in the country today. It is the publi publichealth ec of our lifetime. Everything fails in comparison. It is everywhere in america. People are dying each day. The most powerful and allergy this means we have a september 11 every two weeks come every two and a half week. I want to ask all of you that the committee is invading our country killing citizens every day. What would you be willing to pay to make it stop . We dont ask that question and the reason we dont in my view is because we still believe that it is we are making a judgment of the people who are suffering and dying and making judgments on their families. Every time i go to a Drug Treatment Center in my state and i ask someone whos been mistreated tell me your story, within the first two minutes they say to me im from a good family. And my response is why would you think that i would think otherwise . Because the stigma attached every day makes people believe, but somehow we believe this is a choice. Who in this audience has not made a bad decision in their life . We all have. Many of us are fortunate that decision was to use opioids were we might be in a very different position than some people are today. Addiction is a chronic disease if it needs to be treated as such. Thats why im glad the president has declared that the publichealth emergency. I last checked it was at 66,000. We need the funding to make sure that the administration has at their disposal the resources they need to implement the recommendations of the commission has made. Let me be clear this is a epidemic that didnt start on the corners of Baltimore Committee started in doctors offices and hospitals across the nation and while some of it is done by folks boast of no intent and they are not educated on this issue. Its every state in the union we are not educating future doctors in versus on the dangers of these drugs. [inaudible] how is it they can have a license and not be required 64,000 people died last year. For people who are terminal beginning march 1 of this year they are down 15 from march and a number of pills is down 20 . Those restrictions work and should be instituted. Granting for the oldfashioned antiquated researching the institutes of mental disease it says that if theres any hospital Healthcare Provider more than 16 beds those folks cannot be reimbursed because they are a state psychiatric hospital. What this means is there are thousands that can provide the treatment that the Ranking Member recommended in his remarks to states have been asking for this ability for four years. They will be coming to receive their waiver within the next six months for people who need drug treatment and these are folks that are the neediest in our society. We need to increase and we need to decrease the influence of the pharmaceutical industry. Right now they only get their education by those producing the pills they were prescribed. As the chairma chairman is thata former prosecutor and that makes me a little bit skeptical and because im from new jersey at makes me cynical. Itif the only education positis are getting is to prescribe these polls and then in 2015, 259 million prescriptions were written in this country enough to give their own bottles of 30 pills, 259 million. 4 of the worlds population and we consumed. We dont think thats where the problem started said it began with prescription opioids. We need an alternative because it is the chai chairman said, is real but that is where they should be spending their money, not on paying doctors. That is why we brought together all of the executives in the country in new jersey and those that agree partnership they would work with the nih to come up with two Different Solutions to the problem. And more alternative treatment. We have three in the country and there should be more. They could address the positions if they are not moving forward. They need to be the ex apartments for moving forward with to make sure we work in partnership to get these things to market as quickly as possible. The consumer that wants to avoid the addiction that would be more helpful. Insurance companies play a large role in this house of. Why dont you change the regulation and make sure. Middleclass folks that have Employer Provided Health insurance and right now most of them do not. 70 are regulated so we say why have they not stepped in . They dont have the authority to do it for Mental Health act they do not allow the department of labor to find an Insurance Company who isnt treating the addiction and they dont allow the department of labor to investigate the companies a it s the employer by employer. How ridiculous is that . We encourage them to give the authority and responsibility to find Insurance Companies that are not treating addiction with older diseases and to give the secretary of labor the authority and responsibility and not have to go employer by employer when we know they cover thousands of employers. One robust investigation is a lot easier to staff than 2,000 little ones. We have the largest criminal Justice Reform in the last few years and one of the things weve done what does this mean exactly when you come in not as a dealer or actor but the nonviolent you are now required by law to treatment, not to ja jail. The judge decides you are not utilizing the opportunity given to you they will send you to jail but youll get the chance first to go to treatment for every Federal District in the nation to be committed to dealing with the drug problem in this country and to give those families and those aspects that are suffering because hes helped and an opportunity to get better. Im a former prosecutor and im in favor with your standing in the Street Corner in every town and city in the country were standing in a hospital or dr. s office. If you run a pellmell you should go to jail just like it should dealer on the street, but it will not solve this problem by incarcerating addicts and we must get them the treatment they need to have the tools to recover. In new jersey we are the first stagstate in the country to cont a state prison to give to a Treatment Facility. So, now in the final year of incarceration who have a problem they transfer to the state prison facilities we have other properties in new jersey run by a Certified Company working in conjunction with the department. All these things are recommended for states and we are proud of governor baker, governor cooper, attorney general bondi and professor beyond the commission and work and a completely nonpartisan manner to make these recommendations and i hope the members of Congress Work with the president and hold the administration and each other responsible for getting something done on this issue. Thank you. Im happy to take questions. We will now recognize the governor from maryland for his questions. Thank you, governor christie. I want to as i said to you and foforthe hearing and now this excellent report, i want to talk about maloxone. They talked about dropping a man right in front of the hotel and i said whats going on and they said this happens all the time, we see people who may be at a party and they have an overdose and they dont know what to do. I use this as an introduction to maloxone because as you know its been used to save lives and to get your report you said price increases of the various forms continue to create affordability issues as well as organizations from stopping maloxone at the levels necessary to rescue people from the overdose. Is that correct, governor . We recommended in the report that the governance, starting with the federal government should ban together the purchasing power to make both at lower prices. Theres no reason you shouldnt be able to do this and they also recommended a report you prescribe an opioid for accessing. Two pills every four hours is good, poor pills might be better so its not just a person suffering from addiction but also unintentionally misused in the home and the folks that live with them if they have an overdose it is easy, to push his of a button in the boston globe. Testifying in a few minutes the thing that i think bothered me so much about nays maloxone is that the price was jacked up at the very time when the First Responders and others were trying to get it because they saw the effectiveness. Did you have discussions . We did not in terms of the pricing issue. What we did talk about is the concept of the purchasing and their willingness to consider. So we did talk about that with the manufacturers and thats why we urged the report is something that can be done and they recognize that the commission emphasized the responsibility. I noticed it was in the interim report but i didnt see it in the final report. It shouldnt be read as exclusive, it should be written together. Weve made 65 recommendations, so these recommendations should be added to the final report. Im glad that you clarified that. My last question is can you discuss this report at length, can you discuss this maloxone recommendation and what response did you get . I havent discussed this specific issue but how important it was for the ball enforcement officers and First Responders but we could get into the price in my conversations that i have had that conversation with other members of the administration. The gentleman from maryland. This is a very publicized thing and its still very publicized. Have you looked at other countries who perhaps didnt have the opioid problems that we have where they had like no problem i think england has a big problem could you comment on the criminal Justice Systems and how they deal with possession or the sale of opioids in other countries . What we looked at was and availability perspective and the difference between this and the others is the extraordinary overprescribing of the drugs. Part of it quite frankly this pain as a vital sign a fair everybody has a smiley face on their lack of pain so what is going on is to give you a whole bottle of percocet. At the very base of the problem is the availability of the medication. How they even get access in other countries who dont have this problem. The commission can be very helpful in that regard. [inaudible] i dont know the exact number if you have a pvs position to this within three days is why they said it is no more than three days on the initial prescripti prescription. When you talk to people d who ty say they are addicted . I will tell you that, there is a young woman and i have spoken to literally hundreds of people across my state in Treatment Centers about this i will tell you one young woman who was part of our public Advertising Campaign in new jersey suffered a knee injury and used her first bottle of pills t for this young woman who was a college graduate, had a first job and within the first week she went from being employed in her own place to live, 60 days having lost her job, kicked out of her apartment and living on the streets in new jersey. I will get one more question. In vietnam i understand heroine was somewhat widely used in something has been said about how it wasnt used when they got back into the United States which would be a little bit inconsistent in the idea, could you comment on that . There are people who can use it Recreational League and not become addicted so we have to be careful about using the phrase always or never because you are dealing with human beings with different genetic makeup, different psychological kneeca kneecaps. They tell you its this as well as a science. What i would tell you is four of every five start with prescription opioids and we are talking about the same compound. In terms of its ability to become addicted. If you wonder where the lighting system is, its right there. Although if you do have one more question. One of the things on treatment some people feel it is ineffective, can you give us your opinion of what constitutes an effective treatment what constitutes as an effective treatment is anything that isnt evidence they seemed so we shouldnt be operating theoretically here with sufficient information across the country on what works and what doesnt. It works for most people the fact is though its the state regulatory bodies across the country who need to be very vigilant about regulating what happens in the Treatment Centers, and there are places in this country where there is a lot of fallacious treatment. I dont want to be the first to say it is flawed in all different areas where there is money to be made. It doesnt discount the value of the treatment. Whawhat thiswhat it says is ince need of the regulatory bodies with prosecutors who are ripping off people by giving a false hope for treatment. The gentle lady from the district of columbia is recognized. Thing you very much and i want to thank the Ranking Member for this hearing and seeing q. , governor, for coming in your forthright report. The last congress and the last administration did come forward with a billion dollars, but we see no slowing you down in this epidemic and in my own district which isnt considered it tripled in just two years. This notion of a National Emergency versus a Public Health emergency and i know, governor christie, the report indicated it wathere was a national emerg; is that not the case . It could be addressed one of two ways, a Public Health emergency in the safety act. Who would administer the funds with the department of health and Human Services and the stafford act would be administered by fema, having had a little bit of experience with fema. [laughter] i would just tell you i dont believe based on my experience that is why we made that. Its the best alternative because i can tell you the recommendation in the Public Health and safety act in an Emergency Fund would have a greater sense of expertise on how to deal with this issue. I can see that they make a difference otherwise. This region that we are now just have a summit and at the te governor declared a National Emergency or state emergency. I am trying to find whether it would encourage congress to come forward but you indicated what was necessary and your remarks were complete with versions of funding one way or another. You asked in the beginning of your testimony what would we pay a terrorist, for example, who invaded the country and making that analogy i is that this has done. What this has done. You called for public funding, but the sit here and congress frankly lost the focus. We are not sure whether the government is good t quick to bt open and therefore nobody is thinking about this if you forced us back to the front burner of the congress of the United States which hasnt funded anything since the last administration and additional fun thing. With all due respect i think that the Congress Needs different wording to focus its attention. If you cant tell from 64,000 die each day for the Public Health safety act, then i would say to both sides of the aisle you need to reassess what youre doing and i recognize the last congress put in what was needed. In new jersey this year year 30 million of state money. 500 million. So quite frankly i am not impressed with the state of new jersey is dedicated a 34 billiondollar budget you are dedicating half a billion dollars just to increase the available treatment of the training, maloxone, all of that is being supplied by the state localities. Now we need help from the federal government and i want to be clear it is a National Emergency sent to two different ways. [inaudible conversations] now we can hear you. Did the clock start now . It just started. We are restarting. Dont go there. Is worth at least 15 seconds. I just want to go back to something that we brought up with my colleague from wisconsin about, heroin and if the initiator versus the prescription for painkillers and what we found is that opioid addiction is initiated by painkillers like oxycodone and hydrocodone has actually gone down from 42. 4 for oxycodone, to 28point 24. 1 and 42. 3 for hydrocodone to 28 but in the case of heroin is the initiator its gone to 33. 3 in 2015. I think we are on two tracks here governor that i think the medical community has to address but also that Law Enforcement community has to address. Now question. The report talks about that. Theres no question we need to make sure and i think i said this in my Opening Statement that as a former prosecutor they are spreading throughout our community. It has to continue aggressively. I dont think, theres no reason we cant chew gum and walk at the same time. We also need to acknowledge the treatment as a part of what our Overall National government and State Government is a fraction of what we spend on enforcement and so i want a threelegged stool to operate that i wanted to be education Law Enforcement treatment but right now as long as that continues will continue to have this problem. You will not find me being opposed to stricter enforcement but we must draw a distinction in my view. Those people in the criminal Justice System need to be dealt with differently. I also think we need to look at this in a holistic manner. I dont know anyone who doesnt know someone either a friend who has a family member. Across his every boundary that you can think of race, gender, income level, profession but one of the interesting things is that doesnt get talked about his family structure. When you take a look at that 68 of the population is either married or widowed yet that only represents 20 of the overdose death whereas the never married and divorced population is about 32 but they represent 71 of the opioid deaths. I would like to see us do a deeper dive into that and start looking at the ages in those categories. I think that its got to be part of the discussion, the overall breakdown of the family and how that is contributed to this. I think has a father of four, married for 31 years i believe we are doing something right, at least we are trying to put they also want to be careful about this as well because there are plenty of folks who are in the situation i am to wind so wind up having children who wind up at the did. Part of bowie said in the report is there is not one Silver Bullet to fix this problem whether its the issue you raised her treatment so i think everything has to be considered and looked at as what is leading our country to consume its something that happens across a country that is encouraging us. I dont want to mislead anybody that theres a Silver Bullet because there is not. For my own personal experience one of my childrens classmates tremendously talented of africanamerican artists died from an overdose and one of my Board Members from a think tank iran i sat in her living room with them while local authorities moved the body of their son. My last point mr. Chairman if i may is taking a look at the drugs prescribed through tricare through the va. I have gotten information from people about their tremendous numbers of drugs that are sent out that these people dont need need. This is a huge issue in alabama. It gets back to where we started the overprescribing of medicine. If you would like to address that. A large part of the diversion so thats why we are advocating a Good Partnership with the private sector as well places like walgreens and other National Pharmacy chains that are setting up kiosks in all of their stores for people to dispose of the unwanted or unused medicine. A lot of times what happens is a young man or young woman they dont use the entire prescription and they say heck i might as well try this or worse there is great guy you on the streets for this. In every way it impacts this crisis and thats people who overuse of themselves and also people who use it but dont know how to get rid of it safely and as a result they want the painting around and its available for diversion to either other users directly in the home or spitting sold outside of the home. I do want to mention one other thing if i could at the va. We took a visit as a commission to the Veterans Hospital in cleveland and bera been some extraordinary things and lowering the opioid use by veterans with alternative therapies and other ways to deal with this issue for vets and the report secretary shall consider spam to that for the very reasons we talked about. They are offensive to want to take the stuff that they are in real pain from injuries from protecting our country. Thank you mr. Chairman. The gentleman from missouri is recognized. Thank you governor christies for your testimony today. While we have made critical games in coverage as a result of the aca we still have work to do. We need to make sure that the aca parents in requirements would require that Insurance Benefits for Mental Health care be comparable to those of physical health care. I guess thats why i recommend the dll must have the authority to investigate Insurance Companies. Let me quote the report that says the Commission Found that there are commercial insurance barriers to medicaid and assisted treatment despite the fact the treatment is evidencebased and largely successful. Would you agree that all the insurers both private and public should work to remove barriers . Thats the law of the country. This is the frustrating thing. Congress passed the Mental Health and addiction. The act but for reasons that are beyond me is the executive branch no ability to enforce it and so i dont want to be again cynical but where counting on the Insurance Industry to cover this treatment. That is required and theres no reason for not doing it for my view is as a this a former prosecutor the law should be followed. If congress will in the president s will is to treat a physical ailment than the law should be enforced. We need to put more teeth into it. He asked for this authority. He said if you give me this authority i will use it and chairman gowdy i think the secretaries of former u. S. Attorney deserved with me during the bush 43. I am convinced that someone with his background and experience as a prosecutor in miami on this issue would be helpful and i urge congress to give him the tools. Thank you for that response. Represent the state of missouri and im proud of a lot of things but one issue that im not that proud of is that we have a patchwork for pdmp in missouri. It may go by county or city. Its not really statewide and is not effective. Talking to Law Enforcement in missouri they tell me that its really become a pill mill and its an attraction for users as well as physicians who want to make profits off of it. Tell me how is missouri, how do they compare to the rest of the nation as far as being a problem for Law Enforcement . Its the worst state in the nation. I appreciate. We need to be critical of our state. Its stunning that there are states in this nation that dont have a Prescription Drug program and they are not sharing that information with their neighbors. We know the people go from state to state to be able to feed his addiction. They can use the pdmp and if someone comes than presenting with symptoms if they go to pdmp aunt a dozen, two dozen, three dozen prescriptions from other doctors. Missouri is a state that is the sole outlier on this issue and one that is damaging the health on the safety and welfare in my view of the people of missouri. I appreciate hearing that and i will make the effort. With our legislature and governor to reinforce and tell them how much we need to get our act together. Final question hhs and cms now get down to the tough work of implementing some of your commissions report and i understand that they are calling for states to apply for waivers from from the imd exclusion. New jersey and utah just got a waiver of proof but as i understand that cms has insisted the waivers or budget neutral so cms is asking for states to fund fund, to find cuts elsewhere and underfunded Behavioral Health systems to pay for treatment and residential settings. To me that doesnt reflect the urgency of this epidemic. Can you talk to us about how new jersey dealt with its . I think we are finding areas and this is part of the governments responsibility is to find where spending is not being given so i think its a good start. They think once we become convinced at the state level that we have done what we need to do in terms of cost savings the administration will have to make the next decision which is made budget neutrality from it. That is our ultimate recommendation but i can tell you a new jersey that governing is about choosing and i do believe i can make the choice as governor that are necessary to make it available almost immediately. There will come a moment when you are cutting at the end not the fata when that happens and i think the broader imd exclusion that needs to be considered by the. Thank you for your response to my time is up. The gentleman from kentucky is recognized. Thank you chairman gowdy and governor christie thank you for being here today to discuss the growing crisis of Substance Abuse in our country. The Opioid Epidemic is a particular challenge for my state of kentucky where deaths rose by 12. 4 last year alone. Appreciate your work on the president s commission of combating drug addiction and look forward to working together to make progress on this issue for the American People. My first question is i would like to discuss the issue of fentanyl which attributes to nearly half of the Overdose Deaths in kentucky last year. Fentanyl is what will take this crisis to its next geometric explosion because the strength of fentanyl is so beyond normal street heroin that the first use can lead to death and often does. Its a lethal that Law Enforcement officers come to crime scenes where they have to be careful in terms of how i deal with the crime scene. In the report we make it very clear that this is a chinese problem and we have urged the president and secretary of state to make this a priority with the chinese in negotiations that they are undergoing right now. China is where most of the of fentanyl and carfentanil is coming from. More times than not we have found we recognize an increase in Border Security not just the Mexican Border with the United States Postal Service. The United States Postal Service is the leader in stopping these drugs. These drugs are being mailed them to the United States and fedex and ups. We are not having the level of enforcement we need into your point before congressman this is one of those areas where i think we need to be able to step up our efforts. The Postal Service and bog doj to make sure we are stopping this stuff from coming into the country but we also need to make very clear to the chinese. You are sending this into our country to kill our people. There is no other purpose for this drug. This drug in any foreign country in my view that is willfully allowing this to be done is committing an act of extraordinary aggression on our country and if its met with the right diplomatic response by the and secretary of state. I appreciate the work you have done along with the administration on seeing a recent crackdown on the chinese manufacturers and im looking forward to working with the committee to see what more we can do through the internet and postal system to try to prevent that. Through Legislation Congress has worked to provide more support and flexibility for the states on the front lines of this battle. What advice do you have for congress on how best to support state and local efforts to combat the Opioid Epidemic both now and over the longterm and i know you mentioned the billion dollars that didnt go very far and was divided up among the states. What advice do you have for congress . First off i think if this battle is going to be one it will be one with the federal government and State Government acting as partners and the State Government taking the lead. The problem in kentucky is that different than the problem in new jersey and the problem in maryland is different than the problem in missouri. These are state circumstances depending upon all the different ways that you will go go about enforcement or state ranging from the treatment availability. Our view is that there should be accountability block grants to block grants should be sent to the state dealing with the crisis and congress should be demanding accountability in return for the block grants. If i am given a block grant is a governor i say to you is the best way to spend this money is x and it shows a decrease in deaths if i show the decrease in depth i should continue to get my funding enough i and if i dont my funding should be reduced. As governor to be accountable for what im doing. With respect to congress is a difficult job to be able to individual programs that are necessary and effective in all 50 states. I believe we have to trust the governors. I dont believe they think its a bipartisan issue. Theres a democratic or republican way to combat this. I really do believe this congress is serious about dealing with this they need to sit down with the governors. They all come to washington in february. I wont be there but the rest of you will be and the fact is we have to sit down and say this is what they need and Congress Need to put demands on the governors. We will be partners with the avail help you fund this and what Accountability Measures are you willing to give up so we can be accountable in the financial situation we are in and that this money is being spent in a way that affect the destabilize. That is determining that her. When deaths go down we are succeeding. Hymn thank you governor and i yield back. We want to be good stewards of the government and we want to be a good steward of the next panels time so to the extent we get it done before the red light comes on that would be great for everyone and with that i would recognize my friend from michigan. Thank you mr. Chairman Ranking Member cummings and thank you governor for being here. You know there is a thing that in government if you want to know my priorities follow my budget. Many of the organizations receiving funding through the community Mental Health block grant to the Substance Abuse and Mental Health services and these findings provide the wrap around services. We are talking about the axis to the drugs but those of us in this room and those who have been on the ground with the snow putting those services to transition and nurture a person out of addiction back to a healthy life training, rehabilitation, Case Management comes to the Substance Abuse and Mental Health services. Unfortunately the House Appropriations bill which we will vote on this month proposes cutting funding for the community Mental Health Services Block grant by 141 million. And our president s budget proposes cutting it by 116. I read your report. Thank you for it but you strongly recommend and urge congress to do their constitutionally delegated duty and appropriate sufficient funds funds. Being in congress and being a former mayor and to the local government king held accountable for my budgetary decisions iam perplexed that we can have this commission having you appointed and yet what we do in our budget would cut the legs out from under this program. They need you to know in your leadership and in your recommendation to this bipartisan body this agenda of this budget that cuts the thing that we are saying that we are so passionate about, we have statistics that i wanted to say in michigan we have enough drugs like you said in United States to give every person in the state of michigan 1. 8 prescription, 1. 1 prescription which is 84 opioid pills for every resident in my state. Thats how many prescriptions we write. But if we really want to make a difference, if they live we want to get them off of this i need you to comment on that. I made very clear in the report. We believe there needs to be a greater financial commitment at all levels of uber. There are other things we can do as well it should be doing. Increase medical education, increased requirements and continuing education. There are a lot of things we can do that we dont. We do not sufficiently fund these programs now and we also recommended a report that there needs to be in a dilution of all the different programs. There are literally dozens and dozens of programs we have looked at. How effective are they . I can tell you the gao two reports during the Obama Administration that were not being effective and we know that from the number of deaths. There are a number of things that need to be done. Some of them are good and some of them maybe were not. Then theres going to have to be additional funding. We have made that very clear and i made it clear to the presence of my direct conversations with him. Whenever congress has asked me about this i say there is no avoiding having increased funding to deal with this problem. The question is how and you guys need to make that call. Mr. Governor and to the panel we often hear repeal and replace and the Affordable Care act and i equate that to you having a cadillac and you dont change the oil or you dont rotate the tires and then when the when the car doesnt operate you say that the car is inefficient and you just throw it away. The Affordable Health care act provides essential Health Benefit services that actually directly go to the Mental Health parity part but all we talk about is repeal and replace. A old you are comfortable talking about this but im very comfortable. It is time for us to have a real discussion on this. We have talked about the lives we are losing and we are so compassionate and our hearts break when we read these obituaries that we must do the work and i want to be that voice in the room while we are talking about this. The action in these to be taken needs to happen. Its not good enough to get a Mission Together and Mission Together and write an excellent report if you dont fund it and if you dont look at the Affordable Health care act that has those essential services that we are saying eliminates how we are going to do it. Thank you very much. My red light is on. [applause] the other thing i would say to you is we need to remember that my position on the Affordable Health care act has been clear that i will just say this. The Affordable Health care act ensures a fraction of the number of people that private Health Insurance in this country ensure and yet congress is not allowing Mental Health and addiction. He could be enforced. The fact is that they have tens of millions of americans who work hard every day and are able to obtain Health Insurance through their employer and pay for a good part of that as well and then not getting the benefit of the lawn party either. Its not just the Affordable Health care act. We are not enforcing that to private insurers. If you want to talk about a feelgood these of legislation the Mental Health and addiction. He acted as a feelgood piece of legislation because all you do is ask would you please do this and if you dont theres great penalty, we know what happens in those circumstances. I would say we need a broader discussion about this is not just about people who are covered by a ca. Its also those people who have been covered through private insurance for very long time who are not getting the benefit. We should have enforce that law the day we passed it. It should include all of that. Professor raskin. Mr. Chairman thank you and governor christie welcome to berlin to want to first of all thank you for the passionate intensity of your leadership in this commission and the way you have clearly absorb all of the lessons and a powerful way and i want to thank you for the comprehensive nature of the recommendations that are in the report which include messages for us in congress and i very much take your point about empowering the secretary of labor to akamai hope thats one of things that will come out completely from todays session but also they are a there are series of recommendations across the federal government the Department Education Department Just as the national Highway Traffic Safety Administration hhs and so on. I know you are a springsteen fan. Who is the boss now . In other words who is in charge of implementing all of these recommendations across the federal government in being the leader in making sure that these things come to fruition . First and foremost the president has to be the leader. Hes the person who empowers the commission and hes the leader of the executive branch of government as his responsibility and the constitution to make sure that the laws are executed so the buck stops at the president of United States and im confident that the president is serious about this effort and will pay for the research necessary to do it. And i just followup on that point pics i follow your work very closely. He came out with the Commission Report at november the first i think it was, earlier this month. Did you have a discussion with the president and his advisers about everything that is in this report and talk about what the next steps are . What became of that meeting . Is there an Opioid Crisis czar in the white house now . Should there be one . As the governor the czar can sometimes get overplayed. The president needs to give direction to his hhs secretary but if you look at the representations you are right as all across government. Thats why at the hearing of the Deputy Attorney general and they have the secretary of hhs and the acting secretary. We have the secretary of labor the secretary of veterans affairs. All those individual that officers need to be empowered to take a section of the report that is there is and report back to the president on what hes doing to implement it. Sirak is a governor you know if everyone is responsible, no one is responsible. Will we have tweets about people kneeling during the playing of the National Anthem and we have tweets about who got the americans out of china. I havent seen any tweets about the Opioid Crisis of an oc that kind of passionate intensity of leadership that we need to do with what you describe as the equivalent of a 9 11 every two weeks in the United States of america. Let me respectfully say this. Before this presidency didnt see a National Commission on this problem. This problem didnt just start on january 252017 for this problem was happening for years before this and neither president obama nor president wash empowered a National Commission or recommendation and there were no restrictions on the National Commission or recommendations. This president declared a National Emergency. This president is the one who got the grant waivers to this president is the one who has taken leadership on this. Im talking about constructively moving forward. They have got to make sure that there are dozens of recommendations here. How do we make sure that they actually get into practice . There are few ways. The president of the United States should require men and women who serve in the cabinet offices who are covered in this. Reporter reporter him on the progress they are making and implementing the report. I dont think your repression of the person sitting in the executive Office Building sending out a mouse with all due respect to the governor i higher cabinet people. They are cabinet people that were most departments but more importantly what they have seen from this president is hes the first president who has ever debated as to this to this level and he deserves praise for that. I know its fashionable in love for corners to be critical and ive been critical myself but i also think its right at this moment in time in this regard and he will be held to account for what he produces. I would also say that congress has to step up as well and its not just the presence responsibility but every person sitting appeared every other member of the 35 if you know about this problem. You dont need my report. What you know was that people are dying every day. I would say what are members of congress doing as well to demand that this be done to exit that happens then therell be a cacophony in that city which would force action from me executive and the dash. Thank you mr. Chair. The gentleman from vermont. I will try to be quick in light of your admonition. Number one governor christie greetings from governor shumlin. He gave the state of the state in 2014 totally dedicated to the Opioid Crisis in many of my colleagues wonder why in the world could do that and then he started the analogy this was a huge problem in their state. Second we need concrete actions. There is bipartisan concern about this issue. There is bipartisan conflict about spending on just about anything that you outline some concrete things we could do. For instance if we can appropriate money which i would be in favor of the many people here would be we can at least deal with it drug company ripoffs and you acknowledge that increase that is worth of becoming an enormous burden on our local communities that are on the frontlines of trying to address this. I want to ask you this question and then i will stop. The adl outcome is that congress would step up and find the areas where we can act that would make a difference like addressing the cost issue in the prescription issue. My question to you is what would be your advice to this committee knowing we are divided on many issues but we have a common concern about this horrible scourge in our community. What are the three things you would recommend for us to do . You are asking me to take 65 recommendations and boil them down to three. Im pretty good but im not that good. I would just say this, that the first thing we need to make sure we do on the supplyside is to nip this fentanyl and carfentanil problem in the bud. 64,000 is going to look like the good old days aware and direction with the chinese on this needs to be unequivocal and our ability to invest in making sure we are stopping this as best we can from coming into our country. Fentanyl and carfentanil is going to make heroin and prescription opioids look like childs play. Secondly is the issue of education of our medical community. I include pharmaceutical companies in this, about the dangers of these drugs and having a Real National conversation on the benefit of using these drugs has to happen. With this many deaths and i understand the pain is real and the chairman is right we need to deal with that and get to work every day for the people who suffer from chronic pain but i can tell you we are losing that fight. We need to try to have a conversation and get them to the fact that these are killing people in third i would say we have to Fund Treatment in this country. He does have to. I was safe until carfentanil and our on Law Enforcement has to be strength in American Education with china who see it as an attack on our country but secondly we need to work on medical education because our medical community is not educated enough on this issue across the country. Thats what i also recommend, treatment of folks in rural areas who cant get to a position. Its very important to do and lastly we have underfunded treatment in this country going to make sure its more available available. When 10. 6 of the people who need treatment are getting treatment you need to do better in a few [inaudible] thank you very much. I yield back. Just one question. This is one of your finest moments and i really mean that. And ive got to ask this question because i think its critical. How can you governor with your passion and your full understanding and embracing of this issue how can you help us bridge the gap between republicans and democrats so that we can get something done and i dont mean to put you on the spot but i mean its a critical moment and when youd said what you just said about fentanyl we have got to do something and you seem to have pulled it all together to come up with a very balanced report so that we can be effective and efficient. I appreciate the opportunity and im not burdened by your question. The fact that i will take any role that leadership and the administration wanted to play as a private citizen in 49 days to be able to continue this fight. Mr. Cummings this is something that began to be a passion for me in 1995 when is a local county official who was brought to a Drug Treatment Center in my county for adolescents and i saw what was going on there and the priest who started this Treatment Facility said to me at the end of my visit chris is something youll want to be involved in for the rest of your life. In 1995 is 32 years old. My life seemed a lot longer than it does now. Why will i be involved with this for the rest of my life . He said you just walk out of place where god makes miracles happen on earth. From out moment on mr. Cummings i have been hooked on this problem and saving lives. I have worked as republican governor. Everyone of my 2920 days in the Democratic Legislature get the package that we have on this is passed overwhelmingly bipartisan majorities and i gave my state of the state in 2016 on this and package of reforms to ensure pharmaceutical companies a pass within 30 days and it was fine. Im happy at any time sir by the incursion of the chairman, a few to come and speak and meet with anyone and my relationship with the president which goes back 15 years to encourage people to say this is the new waters edge in our nations conversation. We have to end the politics here. We have to compromise with each other and there are things that my side i will have to vote on that they have some concerns about and there is some flexibility and trust the folks on the side of the aisle may have to give the governors which you are not normally accustomed to doing that i can speak to that directly and you have my word that i will not only speak up publicly but i will play another role. Any role you gentlemen want me to play. When he needs to hear the truth he comes to new jersey not just did play golf. Lets put it that way. The gentleman from maryland is recognized. Thank you mr. Chairman and thank you for the opportunity to sit down in the hearing today. Governor thank you for your testimony and thank you for the report for the commission which i think is outstanding and has a myriad of great positive recommendations that we need to prioritize so we can make forward progress. I think a lot of the Building Blocks are there. We are very proud of the efforts here in baltimore that our Health Commissioner who we will hear from shortly has undertaken for institutions like Johns Hopkins and others are undertaking to change the trajectory on this. Its obviously a heavy lift but these recommendations will help. I want to echo congressman cummings concerned about making sure naloxone is available in the way that it should be and there is not pricegouging going on around that. Think it needs a closer look. I was able on i want to thank you for the recommendation about coprescribing naloxone. We are able to get included in one of the bills that was passed last year the comprehensive Addiction Recovery at a project on coprescribing of naloxone to examine best practices around that. We thank you for that. My question is this. I would imagine that you dont think yet that the sense of urgency that needs to be in the country around this issue is there. But its changing and as i move around in my district and im sure this is the experience of others, not only are you hearing about these tragedies that raise your awareness but you are also hearing people say things like you know i went to my doctor the other day i went to my dentist and they gave me a prescription for this oxycontin or Something Like that in all he really needed was tylenol. So patients are starting to step back from this. Something is getting to them. There is beginning to be a level of Public Awareness around this. When will you look at the situation based on your experience and being involved in this commission and what will you see it . What will be the indications to you that the level of urgency is where it needs to be among policymakers that the level of education and awareness out in the public is where it needs to be . Is a psas coming across the airwaves in a way that matches you know at election time in a swing election somewhere . Visit the president getting a briefing every monday morning on what the status is with all the steps are being taken with respect to addressing this crisis . What are the indicators that you are looking for to say to yourself we are starting to get it . Congressman thank you. Ive been asked this before. Someone in our remarks i forget which member talked about this epidemic being a greater number of deaths than the that make aids crisis at the peak of the aids crisis in the United States. I was a young adult and here is what i think. Where are the march is . I remember the aids epidemic and i remember marching in every major city in this country and in washington d. C. If people marching say the government must do something to find a way to stop the death and in this crisis there are many many many more people impacted them the aids crisis yet we have no march is. I will tell you that i think we have begun to remove the stigma of this disease and the people that are impacted are willing to show their faces in march and demand from their government a response. I believe they will march today because they are ashamed to march because they dont want to be identified. Im talking about mass numbers, they dont want to march. They dont want to be identified identified. But something happened to their family, to their loved one. Thats why we have recommended a national Advertising Campaign beyond psa put out so you in new jersey and this year you will have spent 50 million on an Advertising Campaign to remove stigma and let people know how to get treatment. 50 million of state money and the reason we do these things, the want people to be stigmatized anymore for this and to avoid treatment and avoid asking for help and we need to demand that something be done about this. I will tell you one quick story. My mother was addicted to nicotine preaching against smoking when she was 16 years old and she smoked for 55 years and she tried everything she could to quit and she couldnt. She inevitably was diagnosed with lung cancer at the age of 71. Nobody said to me well your mother was smoking for 55 years. Shes getting what she deserves. No one said that. People said we are so sorry for your loss what can we do to help . Did she go to this hospital or that hospital plex they came and visited her. They encouraged her and i felt no shame in telling people that my mother had lung cancer caused by smoking. If my mother was a heroin addict would i do the same thing . And what all those people who come to her innate in recommended treatment and help . With my dad had been willing to ask for that . I know word spring urgency to this one barriers go away and people demand that congress and the president of government along with their private sector find treatment to three people who are addicted and to find ways to not get addicted in the first place by alternative medicine. I will believe it when people are marching in showing their faces and when that happens we wont know we are on our way to a solution and thats why i firmly believe in my heart its a stigma thats causing death every day almost as much as the drug itself. [applause] the gentleman for maryland is recognized. Ranking member cummings thank you for having this hearing and to all of our members from both sides of the aisle welcome to baltimore. Governor and i want to acknowledge dr. Nguyen who has done a lot in the baltimore area. Governor think you were in the right place at the right time. You were in local government. You were a prosecutor. You manage a major jurisdiction. I really appreciate the fact that you made this one of your highest priorities. When you leave office probably wont dominate your life for a while. There are a couple of suggestions that you have though to make sure we pull all of this together. The first thing we have a major crisis you got to identify the problem. I think these hearings we understand with the deaths brought the country as a National Issue and not just an urban or rural areas cometh everywhere. The part that im interested in and one of the issues we have to deal with is clearly money. We have to have that. There has been a lot of money put into this. There other areas as far as treatment and doctors, nurses and Treatment Centers on all those types of things but i know in your report which said that report. I havent read it that i have heard it not been briefed on it there are a lot of recommendations and when you have that many recommendations you have to pick priorities. I think for us to get to the level those of us who are appropriators we are going to have to find out what your recommendations are for money especially for the federal government. We have to have a number and i would hope that your committee or your staff or your committee can start putting together a port through the second king there is no question congress maintains the power of the purse but in the situation the president who has within his power as president to free up funding as well. Im glad the president has made this a priority but we have to follow through. With your relationship and i didnt know you have known the president for 15 years and thats even better in with your tenacity in your experience in all the areas i have talked about it like to know what your plan would be to work with his advisers, his administration to make sure we find out where we are as far as the money. Our governor and i praise him as Governor Hogan has dedicated 10 million for the next five years for this epidemic. This is not a partisan issue. This cant be the case so my question to you is first thing can you decide what their recommendations would be as far as funding is concerned and when we find that number we will work with you. To find a way to get Congress Fund this issue and also the president. Governor lawrence made a comment about quds verity there. We are going to have to find a way to get him to make this a high priority to go forward and what we need to do. Two things. I think when you say my staff i want to be clear by chief of staff in the Governors Office is the main staffer. We were not given staff on this i will tell you the work you see in that report is the product of the commissioners. We did not get into amount of money quite frankly its up to to do that. We set up the priorities that we believe are very important and we believe every one of those are important. I know from personal experience they governments choosing but the choosing needs to be done by the government and the congress. We filled out all the things that we think need to be done and nearterm and longterm. Now its up to the leadership of the congress and the president along with appropriate cabinet members to sit down and to say how do we implement this plan . How do we want to do that . I have done this stuff is the governor. I believe you are the ones who have the authority and the responsibility to do it. Im happy to identify the problem and identify solutions and bring a practical opinion to it but i dont believe its in my well to talk about how much. I respect what you have done but you are the man in the snow snow if you cant do that nobody can. You have the expertise. Youre an advocate and you have committed but if you dont have the money is not going to work. We need you to be not only the advocate we need you to be the lobbyists. We will work with you. Democrat and republican staff i guarantee you the Appropriations Committee on the house side will come together but we need your expertise and your epic is the especially when it comes to this president. As i said to mr. Cummings and chairman gowdy i am and will continue to be available to all the folks on this committee and other members of congress who care passionate of this issue to give you my advice my counsel in my opinion it to be an advocate. Im going to continue to be an advocate no matter who is in the congress and no matter who is in the white house. Ive been an advocate on this issue for 22 years and i will continue to be an advocate on this issue because my heart i believe the more Important Role of government is to protect the Health Safety and welfare of the citizens and this is right at the core of that. I dont know but like the phrase lobbyist but i would be a advocate for this. I will continue to be. My time is up but i will reach out to your staff to find a way we can start working on the numbers and the endgame. Look forward to insert. The gentleman from maryland yields back. Governor thank you on behalf of everybody for not just being here and sharing your perspective today but for the hard work the commission did. Im last when it comes to questioning and i want while we appreciate the audience it is here no one is in the Upper Echelon in terms of engagement and i want think of a broader jury. Our fellow citizens that have heard about the epidemic, perhaps someone close to their family who has been touched by it or live and breathe it every day. As i listened to your opening you can put physicians and one of three categories by the vast majority of physicians are incredibly well intentioned and welltrained and welleducated than they do it the right way for the right reasons and then you have a group that is equal in intentioned but they lack the education on it and you made reference to continuing Legal Education and continuing medical education. There is that group and i dont know how big it is. Our perspective is swayed by the prosecutors. There is that group that is profiting from peoples addiction and i dont see that the version cases being prosecuted like i did in the olden days. Did you all find it . I dont think you are missing it. I do think there has been over the course of the last decade or so a deemphasis on that. And i think its a mistake. I also think mr. Chairman to emphasize one issue is to deemphasize another. In new jersey for instance we have criminal Justice Reform that has lowered our population more than any state in the country. Get our crime rate is down significantly in our state. That doesnt mean that i dont want to see my attorney general continue to aggressively pursue the drug dealers in our state who are killing our people. I think that sometimes jumps the department for which we have both been members of. If you are in the criminal Justice Reform the cant be if youre in favor of prosecuting criminals you cant be for criminal Justice Reform. The federal government for the last decade has dropped the ball in these cases and they think its contributing, not causing the contributing to the problem that we have today. Thats why im not in aber of shortening enforcement interdiction. We need to continue to do that and i share that opinion with general sessions and i believe he understood but that message has got and that can only come from the attorney general the Deputy Attorney general. You and i both know the u. S. Attorney is like king and the captain of a ship odyssey. Sometimes the radio works and sometimes maybe it cant hear. You need to make sure the radio is working on this one and the attorneys are not given an option. From their boss the attorney general of the United States that these are important cases to do. It doesnt lessen our commitment condemn the chinese on what they are doing to user foreignpolicy totals tools and it doesnt mean we dont think that education arent important and we talked about that today but in conclusion might perspective if we dont Start Talking in the middle schools about this issue we will lose them. To think my 11 and 12yearold daughter havent been spoken to about this issue. Predominant clarification so they step up to the plate and start educating our kids on things we need to do. So in these cases we need to do then to slow the supply. This is the bipartisan nature of it weve got to get rid of the barriers on this issue against the other. We can and must do both i want to mention one kind of issue there at the end and address what kind of barriers did you find in the alternatives that are not addictive, pharmaceutical alternatives butt are the barriers to having the research developed order to market . That is the single biggest barrier as a part of your to see which ones are most effective and allow them to go to the market. New jersey has more pharmaceutical companies so the role that they play in the country i am an advocate reminded they have a social responsibility to go along with the bad and purely on the basis about the profitability in my view to walk away as a Corporate Citizen in the country. So the right compounds ge rate e right money spent and all i heard from them the biggest concern was an issue is this the best way to spend that money for their shareholders and that is a concern that the need to have in the Economic System but they also have that social responsibility as well. Would you trust them to say they need to be developed but each one is a potential to be nonaddictive pain relief and medication assisted treatment and they agree to submit the compound but we need to do it now so that they have the funding to complete the best job and thats going to help significantly as a pain reliever that is nonaddictive but effective. You mentioned the phrase social responsibility. One of my favorite who was also a public defender would have been fortunate to have him. I saw sometimes in the state system others would opt for straight up probation because it was easie easier but that isnte clients interest. It is easier on the grand strategy then sending them to encourage their clients to get help as opposed to the next three or four months of remaining an addict. Unless we took a baby option. Your option is due to treatment or go to jail. Now its kind of a chimp or encouragement. A lot of people opposed to. Ive never met an addict who is ready. I have a great friend of mine that sat there and argued that he didnt need treatment, he was fine. I know thats happened in my state you can go to Drug Court Treatment of in my mind its not the older men and womenits working out at the audience of t their lives are hopeful again for the restoration of a life which theyve almost given up on. Why i advocated for every district in the country is because ive watched it change lives and so have you. Its filled with people who would be better off treated as it comes down significantly. They would rather spend less than on other issues with time limited resources. Its because we are treating the folks that have this problem like they have the disease and not a moral failing. I know mr. Cummings would want to thank you as we transition. [applause] thank you very much. The cost of doing nothing is never nothing to and now weve got to act. Thank you. [inaudible conversations] [inaudible conversations] Senate Passed the gop tax bill. The final vote was 5149. Senator bob corker was the only republican senator to vote against the bill. No democrats voted for it. It plans to lower the Corporate Tax rate from 35 to 25 starting in 2019. It will also temporarily cut tax rates for family members and individuals until 2025. The house and senate must meet to reconcile their separate versions of the bill. The must approve compromised version before he goes to the president for his signature. Before departing for new york city this morning, the president spoke