Consent, those of you planning to stand can stand. Health chair of the nga and Human Services committee. I want to welcome you to this conversation about an issue that the nga has been engaged in in a big way for the past several years. I think its fair to say that every governor of every state has met dealing with this particular issue a significant and priority import and priority of their work, and thats certainly been true in massachusetts. I didnt run for governor to work on this issue, but it has found me. Wherever a campaigned, iran into people who talk to me about it. Their stories, frankly, broke my heart. Pastthe course of the several years, working on a bipartisan basis with the legislature and others, we have made some progress in dealing with this terrible epidemic. In massachusetts, after ofrs and years and years increases, opioid prescriptions, the firstfinitely for time in a long time in 2017, we had a 30 reduction of prescriptions, overdoses leveled off, and deaths dropped. Now, the way that was referred was positiveople but muted. The reason is we have so far to go, so much more to do. After bad news, every single year for year after year after year, people did take some comfort in the fact that this could have gone like this a trend like this for a long time finally started to go like that. A lot went into that. Todays conversation is to talk about whats working and where should we go next. Some of the things i believe have worked, others im sure will add to that. It would be the following. In in massachusetts, we now require everybody graduates from medical school and social Worker School to take and pass as of their core curriculum, a class in opioid there in pain management. If you are a driver, as her continuing education, you have to take and pass a course in opioid there be in pain management. We are also the first of a limit in on first prescriptions. Ours was seven days. Dramatically upgraded and certified our prescription monitoring them. Result of that, we finally got to the point where the fast majority of subscribers were working on that system and using it as a Search Engine every time they wrote subscriptions. In addition to that, got to the with a good start giving decent information on their own prescribing habits relative to their peers. We also created programming for our middle schools and high schools. Also created, as part of our annual them for all athletes come its common coaches, and inclusion of a discussion about opioids the protective and negative, along with discussions about hydration, concussions, and all of the rest. That is the prevention side. On the achievement side we added 1100 treatment beds, increased states funding by about 60 on a variety of addiction based programs. We may treatment a much larger of our folio than it had been previously. Of the other elements we pursued on a pilot basis that isned out to be effective, recovery coaches in some of our , to engage in discussions with both who overdosed to see if they could not talk them into moving into treatment. Most of the folks who played that recovery coach role are people that have been in recovery themselves, and turned out that their ability to reach out and speak to people who just overdosed, was the powerful. Cases we saw as much as 80 of those who were contacted and touched by this program finds their way into treatment. I do not mean 80 got out of treatment, but the bottom line is the first time we found a that really seem to help people pursue treatment as a possible option for them. With respect to what is next, we filed legislation that is currently before our legislature, that is called the care act. To take this whole notion of recovery coaches and turn it into a unified clinical program. To create a credential process for it and make it a fundamental part of the way we deal with addiction. Especially opioid addiction where a recovery coach can be a big part of helping somebody stay on the Positive Side of their treatment as they battle their way out of this terrible addiction. The legislation also includes of assessment and service planning, and also for it will have us engage with the folks in the pharmaceutical community. To provide the very small number of opioids that you might want to make available to somebody who had their wisdom teeth out or had a minor gum surgery or Something Like that. For that is a lot of the conversations we have had with prescribers is 30 days. That is the lowest thing we ever do, 30 days. If we can create a delivery model that makes it possible to give somebody the to were three to deal withed, whatever the particular pain is coming out of a minor procedure, we might be able to take a lot of this stuff off the street to begin with. The final thing i will speak to is fentanyl. In 2014 fentanyl was present in about 30 of Overdose Deaths in massachusetts. In 2017 it was present in over 80 . Fentanyl, thefor success we have had in reducing Overdose Deaths would have dropped dramatically more. We canple truth is that do a lot of things and prevention and education, and i believe we are, you do a lot of things on treatment and recovery, and i believe we are, at we have to come together chase this fentanyl issue a lot harder than we are chasing it now. We are going to hear shortly from the newly confirmed health and Human Services secretary azar, and participate in a roundtable discussion. Before we get there, i do want to give the vice chair a chance to offer some of her thoughts on what has worked and where she thinks we need to go next. Governor brown . Thank you governor baker for that introduction, and thank you for your leadership on this issue. I also want to say thank you to nga for its continued focus on this critically important issue. I am looking forward to hearing from all of you in a few moments. I am a good hear how other states have made progress through and cementing creative solutions, and what struggles our states share in common. Many americans who feel the end of the Opioid Crisis every single day. We cannot ever look at opioid abuse and isolation. The affects of addiction ripple into family members, friends, colleagues, and our communities. Oregon, 60 percent of foster children have parents who struggle with addiction in general. 25 have abused opioids. Year we lose dozens upon dozens to death by overdose. This is a tragedy demanding action. Part of the reason opioid addiction is so insidious, is that it still carries too much stigma. We have tos crisis let you know it is ok to come out of the shadows and that they have the support of their community on their side. We must focus on prevention, treatment, and recovery to turn the tide on this epidemic. Right now the government recognizes the problem, but is overly focused on the punishment. Must do this by increasing access to of treatments and doing away with failed first policies. We must be creative and bringing forward alternatives that work. In origin, we know that to reduce the chance of relapse after overdose, we can make sure treatment and support is immediately available. Like governor baker, without them forward on legislation that includes and programs that would dispatch recovery mentors, highly trained people in toovery themselves, Emergency Rooms to connect with a project immediately and act as a friend and navigator on the next steps on the road to recovery. I am pleased to say we had so many people testifying in favor of the legislation that we did not have time to hear from all of them. I look forward to our conversations today, and to hearing from you on what innovative strides you have made in your own state. Thank you. [applause] thank you very much, governor. That was a coast to coast overview. We are very pleased today to be joined by the newly confirmed the secretary of Human Services. Of us have had a chance to speak to him about this issue during the brief time he has been on the job, and the best is this is not somebody who is new to this issue. He comes with a wealth of knowledge and information about what it means to all of us, and to the people we serve and represent our communities. He is bringing what i would describe as not just enthusiasm, todd of knowledge and professional experience to this. He is somebody who is no stranger to the role. I am looking forward to having a chance to see some of the recommendations we made to don a grand scale and a National Level. Thank is somewhat secretary for being with us today. We really appreciate it. [applause] thank you governor baker and Governor Brown. I would like to express my gratitude to both of you, and to all of the governors who have gathered here today, for your leadership on this vital issue. Todays turnout reflects the level of commitment to this crisis we have seen from governors across the country, and from both these in your involvement and and deeply valued at the federal level. We applaud your work on many different fronts where you have fought this crisis, from establishing and improving drug monitoring programs, to expanding treatment options, using Community Resources to connect people to treatment, state governments and local communities have taken leaps. Todayrateful to be here to share how we see our role and complement to an empowering this great work you have already been doing. Of you know, President Trump has made the Opioid Crisis a top priority. Declared this a National Emergency last year. Trump and his administration recognize that it is not the federal government is on the front line of this battle, it is all of you. Your Law Enforcement officers, your teachers, your school counselors, your doctors, emts, nurses, and faith partners. We are dedicated to empowering you and your allies in this fight. It brings unique powers and resources of the federal government to bear in empowering those on the front lines. Many of you may already be familiar with the strategy. The five points are data, overdose reversers, and access. After running through the strategy, i want to highlight a couple of pieces of news from the fda that underscore our commitment to advancing particular access to effective addiction treatment. The first point is better data on the epidemic. We have to understand this crisis in order to stop it, which is why hhs is working with states to support more timely tablet health data and reporting. The cdc works with your state Health Offices and local corners and monitoring overdose data. The strategyrt of is Better Research on in and addiction. We clearly need more tools to help us win this fight. The potential advances that we and in theat nih private sector, like nonaddictive killers and new methods of treatment, are incredible. Get closer to reality, we look forward to partnering with states and nurse, to understand how these can best be into practice. The third is a management. We need to do a better job of addressing the form of eight in america, which is why hhs wants to ensure that everything we do promotes healthy evidencebased methods of pain management. Continuing tod to work with you on disseminating best practices. Fourth is better targeting of overdose reversing drugs. People in communities across america are alive today because of the progress that has been made in making drugs available when and where they are needed. Committed to working with you to ensure communities have access to these lifesaving drugs. The fifth part of the strategy is better prevention, treatment, and recovery services. Know that directly providing the services often falls on state and local governments and nudity Groups Community groups. Of you know, the president s budget proposes 10 addressin funding to the Opioid Epidemic and serious mental and list it. On top of 3 billion in planned Opioid Funding that we hope will be in the appropriations in march. Budget includes a range of different investments. Million for Substance Abuse treatment. It also takes the state target and response grants to one billion dollars per year. We look forward to building a base of experience from these grants, and hearing from you about how you have used this money. One particular potbelly want to emphasize for the 2018 grants is that states have a wide range of options for using them. Vouchersudes treatment. Americans of faith have taken a leading role in the compassionate approach that we are for this crisis, and we eager to support their work however we can. Top of the grants, we have released guidelines to ofelerate the approval Substance Use waivers within the medicaid program. Three of which we have already granted this year for indiana, kentucky, and louisiana. That if youto note have a waiver requests with us, and you have particular waivers of this kind, we can also andamline pulling those out working directly for more expedited approval around those does notwaivers, so have to be caught up in broader waiver discussions. So what works . Medication assisted treatment. Supporting access to medication assisted treatment. Part of the title of todays session is whats working . As i said, hhs is dedicated to advancing our understanding of what does work when it comes to Public Health challenges like opioids. We already know some important facts. One of them is this. Medication assisted treatment works. The evidence on this is for luminous and evergrowing. One study from massachusetts found that survivors of assisted on medication treatment, along with appropriate there and social support, reduced future chances of death by more than 50 . That is a remarkable number of lives saved, and speaks to the number of lives we could be saving by expanding access to treatments that work. Hhs has long been dedicated to promoting awareness and access to medication assisted treatment. We still have a long way to go. Just one third of Substance Abuse thems across the country offer medication assisted treatment. For many people struggling with addiction, failing to offer medication assisted treatment like tried to treat and a infection without antibiotics. It is simply unacceptable. Under this administration we want to raise that number. It will be impossible to turn the tide on this epidemic without doing so. We know that there is sometimes a stigma associated with medication assisted their. Even one who requires longterm treatment, is not an addict. To return toicine work, reengage with their families, and regain the dignity that comes with being in control of their lives. These outcomes are literally the opposite of how we define addiction. Citizens who commit to treatment are role models. Thats why i am pleased to announce the fda will soon release two new guidances that will help improve the quality of provide access to dedication assisted treatment across america. As some of you may know, several months ago the fda approved the first ever monthly injection, using what is known as a deep injection, long use in psychiatric treatments. Need a shot once per month, rather than every day. They also could be more feasible and rural settings, where the Opioid Crisis has hit especially options couldment be especially sparse. Guidance will help determine what kind of evidence is needed to gain approval. Options could besuch as regarding how quickly the drugs distributed into the bloodstream. The second guidance we are pleased to announce ok more stable and Creative Designs of medical assisted their studies. As just one example, guidance will create correct a misconception. Toearchers will be invited develop new measures for evaluating the effects of and 80 nat matns formulations. Will complement work elsewhere at hhs to deepen our t worksanding of how ma and how access can be expanded. As one example, an effort was announced last fall to update Technical Assistance for the grants, by moving towards a more personalized model release of state access to local expertise when and where it is needed. Elements of our work, not just treatment access, collaboration with all of you is key. Crisis requires new levels of the nation across all levels of government and sectors of society. We are always listening closely to you. In fact, i am pleased to say that many of the recommendations in the report reflect much of the thinking going on in our department, our action plans, and we look forward to engaging with you further. To leavehought i want you with is that i chose to highlight our efforts on medication assisted treatment to treate this the Opioid Epidemic not as a moral failing but as a moral challenge for every single american. Of leadershipind in this room and in the white house. Can recognize the challenge of opioid addiction for what it is, and work to empower and heal our fellow citizens. Thank you all very much for the opportunity to be with you today on this critical issue. [applause] thank you very much secretary. I want to thank you again for joining us and for your remarks. I would now like to turn the microphone over to the norm, who is a reporter for the Los Angeles Times was done a ton of coverage in health care. Many wellknown people, i want to thank you for being with us and for your participation today. Grexit thank you, thank you governor baker for the imitation to participate today. Outset isay from the have some trepidation about accepting the job of moderating this discussion. Have 26yearold daughters and im sure they would tell you i do a terrible job in soliciting their opinions. As the title of todays discussion indicates, the focus andly here is on specifics on specific strategies and lessons learned. I know many of you are doing Amazing Things and to take on the many challenges that are inherent in this Public Health crisis. I have a few questions to get us started, and im sure there will be many, many comments from you. Me say from a housekeeping perspective, i will make a plea that our time is limited, so please try to keep your comments succinct so we can hear from as many governors as possible. I thought maybe we would start into anng a little bit issue that governor baker raised in his opening remarks, and that is the efforts to get at the supply of prescription opioids, which obviously happened late the conclusively to the development of this epidemic. Been working on this subject for some time and have had a good amount of success in trying to control how these prescription painkillers are bidding distributed. I thought we could try to talk about some of the things you all are doing on that front, and the success youve had, lessons you have learned and want to share with your colleagues here. I dont know who should do this by reseau hands, but razor hands of you would like to share something. Would you like to start . Sure. First of all, ever baker and brown, thank you so much for joining us. This is a big problem in pennsylvania. It is an epidemic. I liked your looking at this for what it really is. Part of it is to the issue of the stigma is that we are not looking at it as a medical issue that it really is. Things that has worked in pennsylvania in a bipartisan way is to limit descriptions. Work with medical societies, medical schools, to reduce the prescription of opioids to people. Really, and short order, helps reduce the amount of opioids. Die from joint overdoses, and there are thousands in pennsylvania every year, in 80 of them the gateway drug is a Prescription Drug. If we get the medical profession to work with us, we can make progress in reducing the ingestion of opioids. Know you arei trying to get at the duration of the prescriptions that can be written for pain. You want to talk little bit about your experience in arizona . Sure. That is really began. This is a real issue in arizona as well. We have lost more than 800 people to opioid abuse in the last 18 months. And 453 4500 overdoses babies that were born addicted to opioids. We also noticed that in one of our smaller counties of less than 200,000 people had for doctors who had prescribed over 6 million opioids in the last 18 months. Once we had that information we ready to go above and beyond the executive order, which happened the previous year, which limited the amount of opioids the governmentfunded and paid for. Went into a special session with our legislature on one of the first mondays in january, and on the thursday of that week we were able to pass the most of the road, and aggressive pieces of legislation in the state of arizona and some time. With a unanimous vote, republican and democrat, house and senate. Opioids, and also adjust people that had real chronic pain, because we did not want to the rug out from under any of them. We took away the opportunity for dr. Shopping. We try to look at treatment and recovery education and prevention in a very thorough piece. We are going to have this population that is addicted, we have to address how we can become avoid becoming addicted in the future. It is a fiveday limit in arizona. Studies show addiction happens after the first day. Iran for attorney general in 2008. Ini ran for attorney general 2008. Folks are saying opioids are becoming our largest problem. We deemed it the invisible epidemic. We took a number of steps on educating and recognizing many of you had to be safe. Educating folks and our medical community. Greater education overall and our communities. Supply was a significant issue and what we found is that most tend to import Prescription Drugs. We did some stuff of Law Enforcement. In 2008, people would get upset on other drugs but if was pills, nobody would pay attention. Today, we have the lowest absolute death in the last decade, in the last 15 years in montana. We decreased our Prescription Drug deaths i 45 since 2009 which was our peak. That does take an education and we still have to work on it. Handts also on the one where we have a much better hold on it and we did and have found as you squeeze one side of the increasese are seeing all across our state. The me follow up on that. I know many states have found success in trying to limit the supply of these drugs but an argument has been made that this does push some of the use into the darkness. Thats been a criticism that some of the medical community have had. What are your experiences with that . In arkansas, we have a. Rowing opioid challenge overprescribing of use and deaths. Methamphetamine is still our number one drug issue. I do think you have to look at this comprehensively. As the administration puts more money into education efforts, they should be broadbased, recognizing the fact that if we get control of the Opioid Crisis, theres going to be Something Else out there. Balancedge has to be and our enforcement efforts have to be balanced as well. Wasme followup on what talked about in terms of the drug takeback program. The partnership with the private sector is very important in this effort. I want to applaud walmart and sams club that as of january 1 of this year are starting to put the patented powder substance that they are distributing with their opioid prescriptions. If its a schedule to prescription, they have dispose rx that goes with that package that allows the consumer to be able to safely dispose of it and not keep it in the cabinet until there is a takeback program. It is consumer friendly. I want to applaud them for doing that. You want to talk a little bit more about the challenge fund unintended consequences. Percent pacifics 85 or 86 of people addicted started on prescription medication. Once they are addicted, they will seek a way to feed that addiction through any means available. It may not stay as a Prescription Drug. It may move to hair when, cheaper versions, now fentanyl which is becoming increasingly deadly. If you squeeze that balloon and make it less available, the person who did not have the addiction the first place isnt going to go out and start a math as an alternative to not been able to get no opioid. To that extent, i think its important to understand there is no amount of money and theres no amount of beds and theres no amount of programming or government ideas that are going to fix this epidemic of the bottom end of the funnel. If we dont close off the top end of the funnel, the number of people falling into addiction, we are never going to solve the problem. Had over 1400 people overdosed last year alone. This is not a good statistic. Lethality of the drugs being used is higher than ever. 350 9 million opioid pills were prescribed last year in kentucky. 79 pills for every man, woman, and child. We are not in that much pain. I dont think any other state is. You may find we are not an outlier on this front, unfortunately. We are not being serious enough about solving this problem. Its not a function of if we fix this or fix that. We must get and i want to come back quickly to him a tease to mats people have lost someone due to a drug overdose. They lost something irreplaceable. Any to be the table. The people who produce, the people who need to the people the enforcersibe, and since in sirs, all these people need to sit down at the table at the same time. There is no wrong person in this instance. So many people want to vilify a certain element of the equation. That its a big problem and it is truly epidemic. Its now a threeday limits on the initial prescription. Cdc says addiction spikes after the fifth day. People are likely to become addicted. You want to understand it, read dreamland. Is soarmacodynamic effect different than other drugs. Its why we arent able to get our arms around it. ,e also have to understand theres a lot of other things out there. We are going to get to m. A. T. In a second. If you are not asking your Emergency Departments in your hospitals to put into your Prescription Drug monitoring programs, which you probably have, the number of people brought in for overdose, please do it. I think you will be amazed that its not being included. Prescribingtoring but you will be missing a terminus amount of information if your not asking Emergency Departments to load in the information about the people who come in. Not just the ones who die. Theres no question that the root of this problem is Prescription Drug overuse and misuse. Finally, this country in the states are waking up to that fact and now youre seeing prescription limits and Prescription Drug monitoring programs. You are seeing more interstate us making sure that people dont overuse prescriptions. It has driven people to street hair when. It has driven people to fentanyl laced heroin. It shows us that although it is a good thing to cut down on the prescription overuse because it is helping to prevent people from getting into the substance disorder to start with, we still have a massive problem out there that isnt going to be cured by limiting Prescription Drugs. Thats why we have to get into the treatment effort. Im heartened with the secretarys comments today about medication assisted treating. Is thing we cannot Forget Health insurance coverage. Of the people who present to our Emergency Rooms in North Carolina have no coverage whatsoever. No medicaid, no medicare, no private insurance. We have to close this Health Insurance coverage gap so we can make sure people get access to treatment and individuals react to treatment in different ways. Individuals respond positively differently to different kinds of treatment. We have to remember healthcare coverage we are talking about this issue. As states look at this, we have to remember that. I do want to get to treatment. Let me put this question out here. Interest inen some using alternative pain medications that are not opioidbased. Some of your states have been fairly aggressively looking at this. Talk aof you want to little bit about the potential there and what has been achieved so far in trying to provide alternatives that dont provide a path towards dangerous addiction . I issued a declaration of emergency and i got to year, nineday legislature pass. Every two weeks we have a cabinet Member Meeting and one agenda, the Opioid Crisis. We have invited the doctors into this. They have to a part of the solution. Report howquired to much they dispense on a much more frequent basis than they would like to. That was not welcomed but the problem is not welcomed. They are part of it. No one can be left out of this. This is one of the best things we do. To talk about this issue. I have never had this topic discussed. The start of that, my only goal was to get more out there. How do we build off of what somebody does . Thank you for this panel. Theres a full table or we can all take something away that someone else is doing. Thank you very much for this forum. Along the lines of another with takeaway, like all the other governors, we have been focusing on this is a whole government approach. Doctors, nurses, pharmacists, dentist, get them all in a room and ask if theres in the private sector solutions. What can you do right now . All these institutions have Electronic Health records. The Largest Health care provider in the stable to their software and when you into a pain prescription the first thing that came up was the narcotics. You have to page down like three pages to get to the nonnarcotics. Without any government intervention, they flipped the order to the nonnarcotics at the top and reduce the size of the initial prescription and the next week their prescriptions went down by 20 . I think thats a quick one for everyone to chase. The secretary talked about the importance of having role models for recovery. Say that we are very fortunate to have the first lady who courageously last year started talking about her own path to recovery. She is celebrating 16 years in recovery this week. To have someone like that in our state, the outpouring of people coming forward, only one in nine people seek treatment. We just got done talking about license professions, they are in license professions. If you have an issue, you will lose your profession. Some of the people we have lost in our state are in the medical profession. They are the ones that in the brian the illegal street drugs because they did not want anyone to know. We have to drop the shame and stigma and be proactive about it. Its going to take courageous role models. There are brave people that can show up and stand us that. [applause] the applauses for the first lady. She is right here. [applause] i could just say one thing about this alternatives issue. We brought a whole bunch of people who know a lot about this topic into talk with us. People are doing a variety of things. But there is not, i would argue, so far, a systemic approach. The point made about the way this stuff is organized and some thehe online tools, one of things we found out is the ambulance folks came to us and said the preferred choice is an opioid, not tylenol or ibuprofen. For the ride when they pick people up. Part of the reason is it works really fast. Some of the other stuff takes longer to take effect. There were also some financial and organizational incentives to pursue the opioids. We said, thats our regulation and we will change it. Which we did. It made it possible for the part to pursue alternatives in the dead. What public and private care in massachusetts has started to do is make physical therapy, acupuncture, a whole variety of massage, a whole friday of alternatives to managing pain available to people as alternatives to just a bottle of pills. I do think that has potential. I think its one of those things it will require a Big Community to change the way they have behaved for very long time to get there. That will probably take a while. Lets get to treatment. Its been a challenge to expand the availability of treatment. There is a good news and bad news story there. Protocols thatly work and yet not enough people can get them. Who wants to go first . You taken on that challenge and brought in the availability of treatment . Back in 2015, a previous governor to me came forward and talked about this in his state of the state address. Lieutenant governor of the time. Opposite party. Sitting there wondering if it was the opposite approach. He was right and we got out ahead of this. We have the hub and spoke program. I know california has taken off on that as well. Its been extremely youthful to us. We expanded on that after i took office. Trying to provide more treatments centers. Its essential that we have the Treatment Facilities available. When someone decides they want treatment, you better decide you have it for them. We only had we had 700 people in one county on the waiting list to get into treatment. Waiting for months. And we lose them. We have been able to reduce that. Working with the private sector in order to do that. Have no waiting list at this point in time. Now people are coming forward more. Thats something we will have to continue to monitor. You would like to hear anything more, i am happy to share it with you. Risk was very receptive. I know time is short. I like to hear some time for anyone who has suggestions. Its the fourlegged stool. Side, what are we if weon National Level . Have any ideas, we are all ears. With respect to the axis question, one of the things to get this issue is changing the culture and helping people versus putting people in incarceration. We had a Small Community in our Upper Peninsula that we have now adopted for every state police post in the state. In to any Michigan State police post to read they will connect you to an angel to heat to get you treatment. Thats a major statement about changing the whole culture to show that Law Enforcement can be a positive partner to help solve these problems. Other lawaging enforcement agencies to do the same thing. Oftentimes, when they are ready to get treatment, they dont know where to go. You can walk into a state police post and get help. Clearly expanding access like you did in vermont doesnt come free. It takes money. Who has found money to do that . If you havent, how come . This is one of the reasons why things like at 1115 waiver matters. It affords states more autonomy. We have long been barred from using medicaid dollars which a lot of these folks are covered by medicaid. Been precluded from using these dollars for treatment. These are the kind of things that can be removed by this waiver. Its one of the things we have done. We have increased the number of beds by over 1000 . That sounds impressive but when you start with a tiny number thats easy to get to. The money is there. This is a health care problem. We spend a lot of money in Behavioral Health. The key is how do we connect people . Do people know who to call . If they call their local facility and are told theres not a bad and they have to wait six months, do they know what the backup is . We put together a program with a 1800 number. That willlive person connect them to any open available bed in the commonwealth of kentucky. This is something that probably doesnt exist in your states and a dozen hours. We have a dont let them die. Com website. We have psas. Contest we are doing in conjunction with one of the largest Media Television stations in the largest media market where we are paying thousands of dollars in prize money to teens to develop the ads. This is how we are going to reach people. We have to be real about this problem. Thousands of dollars in their ability to get this broadcast with a seven figure media by behind it is the kind of thing we need to be doing across the lines. We are getting near the end that we have a little bit of leeway. We can keep the conversation going. Let me add my observation. I think it is a crisis in all of our states. As we have met with our own doctors, we have asked why are you prescribing and their answer is we did not know. To usformation was given that this was not addictive. I think we will see litigation. Did than facts know that this is addictive . Required and you talked to put warning labels on the medication to say this is highly addictive. Database. So created a i had kidney stones a few weeks ago. When i finally got my regular general practitioner dr. , he knew what the surgeon and what the doctor prescribed to me in the emergency room. He knew what my meteorologist had done in the medic tatian he had prescribed. He did not overprescribed something. You cant doctor shop. Cant say you have pain and they say you are ready have percocet, were not going to give you anymore. Sharing that information in the database will help us a lot. I think our doctors are learning. They are now looking and being trained to be made aware. What are the alternatives going to be . What happened to good old ibuprofen and tylenol . I think the doctors were led down a pathway. I think that shady now. I think we all have roles to play. Beeninly things have suggested on the treatment side. There are partial formula for success. I would like to make one final comment. Ngae to thank in ga and governor baker and Governor Brown. I know everybody at this table is grappling with this and its the number one, not just health crisis, but the number one crisis were all going to be faced with. In maryland, i have been focused for four years. I was campaigning for governor and in every small town i ask them what was their number one problem facing their community . Every single town from the old from the intercity intercity to the suburbs, opioids was the number one problem. I set up a task force. We came up with tons of recommendations anew but it did all of them. Are the first state to declare real state of emergency and we stood up the same way we would for a national disaster. Ourut half 1 billion in small state into this fight and we have done almost everyone that every 1 everything that everyone here is talking about. We started to bend the curve down on prescription opioid abuse and overdoses. We are bending the curve down on hair when overdoses. The one thing we havent talked h about, fit in all fentanyl we are behind the curve on. In our little state despite all those efforts, we had nearly 2000 Overdose Deaths last year. Thats more than firearms and traffic accidents added together. Down theof us bringing use ts of it, that no fentenyl uses up. This is coming in from china. Addressing the problems out there is important. Go after this new coming way that is much more dangerous. You. Ank governor baker, Governor Brown . Can i give you the chairs prerogative to reflect a little bit on what youve heard . Going forward, once on the agenda . Your federal partner isnt here anymore but he talked a little bit about the troubled square into this issue. What border states need . What more do states need . I want to thank Governor Hogan for any miss on a high note. [laughter] i guess i would start by saying the following. Conversation the around the table. Everybody is pulling this one is hard as they possibly can. A lot of the things that we are all doing are the sorts of things that i believe over time, if we stay with it, can make a difference. Governor scott talked about that this was raised in 2015. It was it is now 2018. This is not an issue that will go away in 2019 or 2020 or 2021. We will have to stay on this. We will be adding many more beds. This whole notion of recovery coaches and creating a credential model for them so they can be the consultative ally and advocate on behalf of people. Its going to be incredibly important. Of soberied hundreds homes in massachusetts which turned out to be an effective tool. Helping these folks find an opportunity for work. Many have lost their jobs with done toto the damage the life they had been living before they fell into this terrible place. If we take our foot off the pedal, we are to have a huge problem. I also believe that almost everything we talked about are things the final government could do and could leverage in a big way. I would love to see secretary a czar the secretary and the other members of the ministry should to become partners with governors. They have tremendous capacity to support us and to help us in ways that go way beyond what we can do on our own. The fact that he talked about putting money into studying medication assisted treatment so people can figure out what the best approaches are going to be for helping people depending upon their presenting symptoms and circumstances, but as a talked about in my remarks, this fentanylissue tihis issue is one where we will have to be aggressive. Its changing the game with respect to almost everything we are trying to do. I think it is a place where we all have to step up. We have all been affected by this. We all have family members and friends. Devastationself the on our families. I am proud to see the work everyone is doing treating this as the Public Health crisis it is a and focusing on education, prevention, and treatment. I think it is important on a broader scale that we remove the stigma for people to access treatment also win the Mental Health arena. To make sure we are comprehensively addressing Behavioral Health and our health care systems. In terms of the federal government, for me our population has about 95 of the adults covered. If we want to make sure people are able to have access to Substance Abuse treatment, they need tough access to health care. Some making sure the federal government partners with us is key to making sure we can get people into treatment and get them into covering and provide the support they need to lead healthy, productive lives. Thank you for all of your hard work. I look forward to working with you. So much. You i want to thank you for spending time with us and bringing your expertise to us. Thank you. Thank you. [applause] hello. Hello. Welcome. Conversatio e] [crowd chattering] [indiscernible conversation] announcer we will have more from the Governors Association today when the meeting continues with sessions on innovation, education, and the care of veterans. There will also be a keynote from the president of ghana. Underwayhen it gets today at 9 45 a. M. Eastern. As cspan, live every day with news and policy issues that impact you. Coming up, david brody talks about his new book the face of donald j trump, about the spiritual journey of donald j trump. Then, talking about the russian president son and the first year in office. Then, discussing the recent shooting and the push for gun control legislation. Be sure to watch cspans washington journal this morning. Join the discussion. I rebuke the cancer. I can only see it from her perspective. I have a lot of people pray for me similarly and as a christian i believe christianity has a long tradition of divine healing. So i certainly do not think it is not possible for god to heal people. Discussingon q a, the memoir everything happens shea reason, in which reflects being diagnosed with stage four cancer at the age of 45. It is really gone, right . Theres no pain in your stomach, right . How it israel. You can see how quickly he moved from praying for her to his conference confidence in himself as the vehicle. Then, the moment he says she is definitely healed. His very geometric approach to faith healing is one i often found to be somewhat manipulative. At 8 00 p. M. Night eastern on cspans q a. Next, the look at relations between china and taiwan. This is just under an hour
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