Transcripts For CSPAN2 Opioid Epidemic Summit 20171031

[inaudible conversations] good morning. I am from Johns Hopkins Bloomberg School youalelcome to president ident clinton also several policy makers leading the way in Health Reform including congressman cummings both will be joining the program also in the audience the representation from the senator. Finally have a like to extend a warm welcomee to the senator that we are now proud. [applause] prod to call one of our own. We are honored to be working with the Clinton Foundation on one of the most important Public Health problems of americaa uses open 08 epidemic this is a crisis from all levels of government as well citizens. Nearly 100 every day die fromrd overdose over the past 15 years the rate has tripled in the causes are complex millions of chronic drug czar prescribed and said of lessee for alternatives w and also increasingly contaminated with sentinel and far too few people have to evidence based treatment to. So to prevent Substance Abuse disorders going back 50 years finding the nation for drug and the alcohol a counseling and advocating for the use of methadone in the programs that has been cemented with injury prevention andhe control or safety and effectiveness. So working with the Clinton Foundation in may 2014 a townnt clinton led hall focusing on injuries and deaths from prescription opioid the resulting synergy united nationalt leaders and private sector to pave the way for a yearlong effort to identify best practices. With this initial engagement in 2015 the Bloomberg School Clinton Foundation identify a path for word with a severe Public Health issue. Stealing evidence based intervention to prevent future loss of life. Despite those efforts we have a long way to go. Reaching the alltime high and despite those recent announcements of the country has not a addressed the true commitment of resources so a new report just released by the Clinton Foundation entitled the Opioid Epidemic has than tellers to redress this epidemic nowow including a optimizing the engineering solutionss as well as combating the stiff upper gulf the strategies have been known to work. Change in the course of the epidemic to implement these strategies to generate new evidence. We need your help lets please work to gather together to end the epidemic. I will introduce congressman elijah cummings. Representing the seventh district since 1996. And in the House Committee oversight reform serving on a task force of health care reformir as tout cofounder to help shape the National Policy on drug addiction and access to affordable medicatione please join me to give a warm welcome to congressman elation cummings. [applause] good morning. Good orange. Would morning. It is my honor and privilege to be here and also thanks to the dean for your kind words but more important thank you for your time. I have to do do this. On behalf of my family and certainly on behalf of generations yet unborn thanks to lou Johns Hopkins for taking good care of me. [applause] having spent almost two months in alo hospital just a few blocks from your after a heart procedure i must say that i have grown to love john hopkins even more. To the doctors and the cafeteria people everybody associated thankyou for changing the trajectory of my destiny actually appreciate that. [applause] in to welcome the of a distinguished panel on the zero pureed Opioid Crisis i am always glad to see my good friend and my mentor and a newsstand sarbanes is in the room. So the dangers that we face is more virulent now than ever prescription opioid and other synthetic drugs were more then 60 percent of the overdose last year. With 64,000 deaths per barrel if they fatally overdosed in 26 this is stark evidence of that human devastation expand exponentially. Is a bipartisan acknowledgment that the national Public Health emergency crisis does exist but in both the white house and congress so their own zero voa Commission Led by governor Crist Christie and to declare a National Emergency so as all of you know, to have a Public Health emergency which is a good first step but does not allow any additional federal funding to confront this crisis headon. And also recommended Something Else they authorize the secretary of hhs to negotiate lower prices with a lifesaving drug to reverse the effect of opioid overdose and i am surere we will hear more about that from that start advocate. Right now our people cannot afford and that is why live 50 house members to send a letter tor President Trump asking him to adopt this recommendation we begged him. Andhe he did not even mention the word in his announcement last week. And with those congressional republicanss with every verse with Medicaid Expansion even though it provides Treatment Services to three out of 10 people suffering with opioid addiction. If were going to respond to this epidemic we need Evidence Based Research to continue that active in engagement in the public redebate. To follow those zero conditions and must ensure the companys impressive Insurance Companies to eliminate their bias in favor of opioid based painkillers we must challenge our friendship in congress to expand Public Health funding into safe care medicaid. You already we know our responses and also a test to society. My good friend from maryland does discussed this in relation to prices you know, when you sit wish i have come up with that . Because it is so true. The cost of doing nothing to eat that. [laughter] think about it. The cost of doing nothing is not nothing. The cost of doing nothing is not nothing. Repeat that over and over and over. Ladies and gentlemen we thank all of you for being here today we are an army and we will fight to overcome. [applause] thanks for yournd Leadership Forum this issue i am zero do introduce president bill clinton from the Clinton Foundation and 42nd president of the United States. Clinton establish the Clinton Foundation by improving Global Health and protecting the environment. In 2002 launching be initiative to negotiate prices for hiv medication expanding access to over 70 countries 11. 5 millions people and achievement that many thought were impossible. It with those two pharmaceutical companies to Community Groups and safety organizations and his goal to cut in half over the next five years. Saving 10,000 lives. With the Strategic Partnership with public so please join me to give a warm welcome to president clinton. [applause] thank you very much. First of all, thanks for having me back at the school of Public Health to have the Ongoing Partnership with the Opioid Epidemic and the congressmen for his remarks in said that senator was a role model in he proved that in the last couple of years when she was at the white house was a very short list was called the just say yes list. [laughter] mckewon ask her something sooner or later you would cave because she was like a dog biting your leg. [laughter] so just say yes. Player glad she is teaching here. In to fund this effort. But could have done other things with that. And it is a great school. Sold my daughter chelsea teaches Public Health at columbia is my family inhouse expert through Public Health policy and urges me to get involved when most people were not paying any attention. Mostly thanks to be here and agreeing to take action. More than 64,000 people in this country died of an overdose. And if that is confirmed and theres no reason to believe it will not be more people diedd of opioid related drug overdoses then those dead from the age crisis at the peak from the related homicides. Opioid death is now the leading cause of death for americans under the age of 50. In had lost a loved one in relearned a great deal from these families one of them had a son working for hillary. Nobody ever told him you couldnt after drinking five piers. Or that might never wake up. Everybody has stories like that. So that epidemic has grown like wildfire. If those people dont know what to do. More of a human tragedy within 78 billion per year to continue to do so little is such a fractured way with this problem. Issue with that treatment in with that genuine legitimate concern leaving the people with nothing. In the little town and it was totally rebuilt because of with the new market tax credit. In trying to get them to invest that was the good news it was the most beautiful building in town the doctors to voluntarily came here from apple asia. Poland, but the of one got her medical degree from new york. But across the street one was leaving frantically is said come over here. She said i dont own any assets i sold it so what you see the only drug in townish she introduced me to a woman whose husband died from the opioid overdose in prewomen recovering heroin addicts. She said i know nothing about this but i am happy to do it. I get g whatever help i can. I am glad one of the panelist that the first Public Health problem going back to the 18th century but in many places the Community Health networks have allowed to atrophy. This is like good news and bad news in treating it like a Public Health problem. [applause] is started in the more likely explanation is killing as many people who headed nonviolent delivery chain. But the problem is the more we get in tucci pair when from from cheap fentanyl heroin and we will get those Delivery Systems so this movie comes to a theater near you would never your politics are so that brings me to the bad news. We are growing up as a country treating people as people rather than the responses that are not coordinated what we are here to do today is figure out what to do next many of you know, what the general public may not end up analysts is here to discuss the report we are releasing today from evidence to impact this is a professional way to say we know what the heck is wrong how about we do something . With a proven recommendations for combating those to effectively treat those because of the barriers to expand accessibility change the way Health Care Professionals actually talk about addiction to reduce stigma because it is a terrible problem. We have been working on this since 2012 when touche gives three packages in to get them to every highri school in america with limited production i think improving access there were debates about that. All i know is we have a lot of people dying and some of those are opioid related if you can save a life then do it. So wanted to briefly say from heree forward we have known i for a long time stigma of plays a role so in partnership with facing eviction we will launch a Communications Strategy telling people to get coverage. But once you know a couple of people we should dispense with the niceties. And we have to hammer that. To say no you wont lose your job to get help to save youre. Life for family. This samen message needs to go on everywhere in a very straightforward way. Second, we knownd lawenforcement for what you have done. With addiction and dependency experts they dont coordinate as much as they should there is at once simpleow comprehensive strategy. Or spin that maurer effectively. So we work with the institute of justice with people who come in contact with the criminal Justice System to play a role in this with those environmental spur crow so the Community Health Initiative Works we have learned weve got what we were doing it before those opioid but first it turned silent with the third highest rate of and pedestrian drivers in america because it was a city county government and now you are in within city limits and you are in the country if you cross a certain line at 60 miles an hour. Everywhere they say we need help. Sohi we will do more than we have done to build up the stake holders. But we cannot let this go. But almost we have 40,000 the warm. And then this summer over too long island to get someplace and i tried to work one summer. Andd the public golf course. There used to be a raceway. Barack kinds of people there. The 40 or 50 people. And some of those which you could guess. [laughter] it took me 40 minutes. What was other people doing in the community . But they were desperate. Ltd. Just kept under the discussion. Everybody walked away but him. And he said thank you for doing this. I just got out her free have. Rehabilitation. He told me how he was. How do you feel though . My family is supportive of that i dont want to die and i want to live. And to comehi from a family like mine. Knowing that other people are going to die. He said i know i should just be a happy. Did anybodyt ever tell you in collegee then if you mix alcohol and opioid you could die . No one person said yes. Not in any class. Whyul should we push for that . So the good news is everybody in america knows this is a big problem so there are people everywhere working on this. If you save peoplesew life and with the serious detox. And to figure are how to do that. This is a multifaceted problem. I may be wrong but if we dont do what congressman coming said we will regret that in our hearts. If we can improve and to overwhelmm the resistance. In i this tax cut to be pledged. And those who did not survive. So you shouldd feel and then you are asked to preserve the lives you dont even know. And they cannot even imagine. Thank you very much. [applause] we will ask the panel to come up. [applause] and under armor is headquartered in baltimore. A man or woman running on a treadmill. [laughter] the last time i was there are was there for two hours running on the treadmill. When i left she was still flying. [laughter] and maybe getting me to do a one to do. With the American Federation of teachers in that students in with the u. S. Constitution. [applause] in the partner from the of Clinton Global Initiative for america with the largest private infrastructure problem in the United States. And spent 12 and a half billion training them to do infrastructure work. Women have the commissioner the oldest Public Health department in the unit is states of america and then issues a blanket prescription. [applause] more than 30,000 people have already claimed so it is very important for what we couldng do instead of bellyaching about what we cannot do. And in my opinion tough as nails and always shows up for work. [applause] at last question is. If i recover something you want to said say it anyway. So first of all, to get more people me as follows . With those practical things in with all this research is somebody comes in and surviving an overdose the whole plan of action can be undertaken but what is your opinion the most important thing we can do no . To make that work give local communities . So to maximize the impact that was going to save money so useful that from me. It is whatever somebody tells you it is not the way stock trust somebody elses problem. [laughter] said to have that partnership were able to do a lot so we can get that prescription we have 30,000 people cheney trained but those that are delivering those services. So the latest numbers in the last two years every day residence have saved the lives of 1200500 with their Family Members and friends and community members. As mentioned we have to ration everysm day. I have ted thousand units but if id gotten thousand units per day that is a much the community is asking. And we know this science is there. What happened to those 1500 people . Re. As many of those are referred to further services. And with that Overdose Survivors Program that there appears speak to those to help them get into treatment but we dont have nearly enough treatment capacities. Ll have the disease of addiction can get treatments. We also need to expand treatment because saving some of life now is important but we also have to get into treatment help them. Need more resources. No doubt about it. I am convinced that people, mr. President , do things for two reasons. Or a combination of both. Either to avoid pain or gain pleasure. Avoid pain or gain pleasure. I think we have to convince our policymakers that they should not be trying to reduce medicaid. They should not a lot of people who need this treatment would be able to get it. At the same time, we see members of congress crying at intervals and on the 6 00 oclock news but when it comes time for making sure that the programs are there to help get constituents, those who live up the street from us, suddenly they get amnesia. Unfortunately, last night i called my fellow was been off for drugs for 30 years and he said and i asked him what we could do and he said something to me that i didnt think about. Elijah, in baltimore we have a whole army of people use to use drugs and in some way we need to find a way and those are the people most adamant of trying to help other people get off of drugs. In some kind of way we need to use them because theyve already been through the pain and through their pain and their passion. Pain, passion, purpose. Anonymously, we need to encourage people to be a part of that because these are people that are out there and theyve already been through it and so just some thoughts off the top of my head. To answer your question about those who are of revived we had a patient who was who was revived and what happened by Law Enforcement and what happened was next he was revived by the Fire Department and the third time is revived by a fellow user who went behind the dumpster to use drugs, found him unresponsive and had narcan with him and revived him. Where is he now, hes sober and working in life and thats the work he is doing here in baltimore. [applause] to that point, as well look, education is absolutely imperative but it has to be coupled with a Quick Intervention like narcan. What we saw, for example, is art nurses in cleveland and we are now the second largest in the United States and the nurses, school nurse in cleveland, demanded that the cleveland Public Schools actually have a supply of work on in every school. When they didnt get it they got a grant to do it and now they are getting it because this nurse actually revived a parent of the child. I tell that story because the stories are important to destigmatize and to educate and your point, mr. President , about they will build have enough pressure on the system but that pressure comes with education. For example, doctor was at our conference this summer with i call her doctor mona from talking about the issues of terms of order and opioid addiction and epidemic. I am also couple it with a stick which there are a lot of worker Pension Funds that are invested in big pharma and we are actually starting to do, frankly, what the new yorker magazine this week as wellin terms of creating some public pressure to reduce the [inaudible] and use the Public Pension Fund to figure out a way to reduce the prices of other effective moments of intervention drugs. Are there any Public School systems in the country, you know of, that actually have some policy of educating kids about the dangers of this and telling them basic things like what happens when you mix opioids and alcohol of any kind . It looks to me like what have we got to lose having the appropriate experts approve a paragraph or two that could be read to every kid in america. What have you got to lose . A lot of people i am convinced are still dying in ignorance. I think our notion here is often right and you got people who have used these opioids over and over again and finally die but there are lots of people who are being killed by the combination. This is one example but is there any School District or any state that says as a matter of policy we have run this by the professionals and we want every kid in our coverage to hear this particular message . We just got legislation passed in maryland so that we are involved and we are working with our schools to implement standardized curriculum on this topic. Its come get. If i go to one of our schools and ask if the students think that using heroine is good or bad they will all say, unless theyre trying to be snarky, they will all say here when is bad but if i ask them about prescription drugs they might give a different answer because they see their parents or caregivers every time they have knee pain, they take percocet or they have back pain they get bike in it. There is a culture that we have that you have spoken about, mr. President , about this pill for every pain culture that that pill is being used to treat physical pain, as well as potentially emotional pain and other types of pain as well. That culture has to change from the medical profession and has to change from each and every one of us in regards to prescription opioids. Didnt these kids know that if you use these things they could kill you . Or their parents . I dont know about School Systems but let me tell you one thing. When i was growing up the first overdose i ever heard of i was seven years old. That was 60 years ago. I did not even know what drugs were. I didnt know what an overdose was. All i knew was that [inaudible], one of our neighborhood guys had died from an overdose and, i think, education is important because for me my entire life ive never touched and illegal drug or none of that because i was scared. I was scared that this destiny would be ruined, i really was and still is. I dont play. But i also understand the arguments, mr. President , that is made when people say that what we want to make sure that people get the relief they need under certain medical circumstances because when i was here and give i didnt know you could be in that kind of pain. I really did not. Every morning i would get up and i was in so much pain you almost want to die. I can see where people get to that point but theres Something Else we can do and why is it that the Insurance Companies favor paying for the cheaper, addictive type drugs, now, as opposed to those drugs that are nonaddictive or least addictive but are more expensive. We are doing a lot of research on this in my committee right now to address that issue and this is a lot to this but again, i am convinced that if you tell somebody that you will die or that you will be harmed it seems to me that some of them would say no i will not do this. When i was a kid in seventh and eighth grade we actually had Health Classes and it was a different period of time and there were a lot of jokes about the nancy reagan, just say no, on drugs, that ultimately people corrected and understood. But there is someplace for having a real focus in schools on wellbeing. Frankly, i have flipped my own advocacy on schooling to start first and foremost to focus on childrens wellbeing and on powerful learning because i think we actually have to meet kids where they are. I think we should think about, in light of having the new federal policy that deemphasizes tests to really think about how we do some of these things in schooling. Childhood obesity is a issue as well. Its about how we try to focus on wellbeing and have some kind of Health Related work for kids in Elementary School and Junior High School and high school. It will be different developmentally for each of those years but its really important. It is more important going through the things we want to tell kids because that paragraph could be lost while elijah and i are talking and not listening to that paragraph. That is why i think we have to try to figure out pedagogically how to do it in a way that really goes to childrens wellbeing. I just skip the middleman and i brought my 25th grade daughter today. This is the best possible free class for her. [laughter] kidding aside, it is not too young for her to hear about it. To your comment about where they had it. My wife had a hip replacement last wednesday at the grand old age of 41. She took the time to educate our children, as she was taking herself very rapidly off the narcotic medications she needed and she explained to them and talk to them about the fact she needed them and she made sure they understood that getting off those drugs was a priority. That probably is not happening in households and shes an exceptional mother and our neighbor is the doctor so we were under supervision, to. [laughter] while she was in the hospital and im doing an organization and i noticed on the whiteboard for her nursing staff the paint protocol that had dose and pain level and the tagline was your comfort is our priority. This will be something i will bring up at the next Board Meeting is to say your recovery expert is not necessarily the priority when youve had a full hip replacement. It will be a people and as a congressman said it could be very uncomfortable and her doctor was saying you should be managing your pain to a seven. You had your hip replacement it shouldnt be at a zero but thats not the message for getting and its on the message kids are getting from us they are lucky enough to come to a session like this. Let me ask you this. How much of a problem do you believe is a part of this continued over prescription, either prescription of an opioid or a non opioid painkiller would be effective in circumstances or prescriptions in amount to great to be safe to leave in one place. How much of it is the problem is that still . If it is a problem, what else can we do about it . Is there something that private or public entities that insure lots of people can do to pressure the system to clean it up. My as a physician i have overprescribed opioids to many patients and did not realize it. In medical school and in my medical training i did not learn about the addictive potential of opioids. I just learned to say that its important to take away patients pain and we doctors want to do the right thing. We want to help our patients and if they say, i need opioids were they say i am in pain then we give it to them. That tide is turning. We are beginning to change our mindset and i am hearing our medical schools in the city and also our hospitals now changing their practices. Weve convened all her doctors, Emergency Department doctors, primary care, dentist, take about and teach about the there is another issue and its the supply side. There is also the demand side, too. As long as we have people who have the disease of addiction they will continue to seek out prescription drugs or heroin or fentanyl unless you get them into treatment. It is our recognition that addiction is a disease and the treatment exists, recovery is possible and that we have to get treatment to people whatever it is that they need and reducing the supply of drugs by reducing overprescribing. I think the answer is yes, when you have a big enough when you have a big enough healthcare insurance pool, for example, the city of new york when i was the Union President at that uft we had the entire city of new york family and we were very, very big but in the kind of negotiation with Drug Companies and when you could negotiate and with pbm and i think there is a lot to be said towards that. I think the dilemma is what the doctor just said look at what is happening with friends know. If we dont actually deal with the issues of treatment and the issues of education there is always something somewhere that is going to be there for either pain or joy and that as congressman cummings said we have to change enough of policy and education and destigmatize as you said, mr. President , to deal with the request. You know, i want to mention a word that we ought to center on and that is stigma. Mr. President , when people find out that someone is on drugs in their midst they a lot of times they look at it as a moral failing. In other words, this person just cant make decisions right or they are weak or they are looking for the easy way out and a lot of times people, by the way, are there for afraid to even come forward. They dont like the situation you mentioned yet where youre able to get someone back on their feet and moving. They will say wait a minute, i got ten people who need jobs and all with no drug problem and i got one person whos got a drug problem and may be a good employee but why do i want to restart. That is a tough one. Getting past that but in talking to the people, former drug addict that ive talked to, they tell me that basically a person has hit rock bottom. But theyve got to be able to get the treatment and get it quickly. I think that is what we have to work more and more towards, trying to get that treatment and get it complete but there is another thing we have to make sure we do and that is make sure this treatment that is given is effective and efficient because you have a lot of people putting up storefronts [applause] i dont want to mention names but there are certain parts of the city where you can ride in and you will see big signs coming and basically, get your methadone and people are going there getting a coping drug and im not going to [inaudible] but theres nothing going with that. The experts appear can tell that usually if a person has a drug problem there is something from a Mental Illness situation there connected in some way. You cant just deal with the drug problem. You have to deal with the other things. Am i right . Absolutely. We need to follow the signs. The science is that treatment for opioids exist and that there are millions of people in recovery and its combination of medications including [inaudible] with [inaudible] and also with other services because housing, for example, is healthcare, to. [applause] lets talk about that. First of all, for the last two or three comments have been very helpful. The thing i was most impressed about, the woman i met in that little town in ohio, is that she said i dont know what im doing and i want you to put me out of business. Im not going to pay for this and i got no business doing this but no one else is here. I trusted her because she said please, put me out of business. I will be glad to be your counselor in someone elses effort. What is the answer . Me is to specific questions. How adequate is the Coverage Today under medicaid . [laughter] how adequate how much does private Insurance Companies theoretically cover require waiting periods and what are the possible downsides to that . If you were starting from scratch and if you could wave a wand would you locate at least in this initial assessment of treatment and local Public Health units properly funded and staffed and accessible to Law Enforcement to Emergency Personnel and others or is that totally impractical and should people just be going to doctor offices or specific programs . My feeling is the capacity there to treat all these people if the money was there . If not, where should it be filled out . Number one, how adequate is the coverage. Number two, are waiting. Still a problem with private insurance. Number three, how is it delivered if everyone was to return. I will answer the last part first. One of the major issues we see here is even if we have enough treatments, which we dont even if we did have an of treatments and even if had enough payments, which we dont, but even if he did a major problem is that we cannot connect people to those treatments. There may be a someone ready but they are not reaching the individuals in time or they are not Getting Services where they are. What we need, for example, in our Health Department we have over [inaudible] in our city and they may go to our and are ready for treatment right now but we need more people who are able to connect them into treatment and say here are five different options for you. You dont have Health Insurance now but i can help you get there. I can physically take you to the Treatment Center if youre ready right now and i will help you do that. It is those type of connections that we do not currently reimburse for and we need to figure out. We started a program in baltimore where individuals are caught with small amounts of drugs are now going to be offered treatment rather than incarceration. Its a Pilot Program and already been very successful but its very time intensive, research intensive and currently funded by grants, not reimbursed through medical insurance so it is those type of peers speaking of peers who have been themselves walked and we need to figure out how to pay for if you had the money to pay for the connection stuff where would you [inaudible] look, if you have your standard im addicted to painkillers and this is the third time ive shown up and you got me into the hospital and you need to put me into the docs and i go through detox and detox is over and now youve got to go into real treatments. Where would you put that . Let me tell you something, mr. President. No one wants certain things and dont act like you dont know what im talking about. They dont want it in their neighborhoods. As the elected officials, and my right . It is really a hell of a battle. In the role i remember seeing on cnn where they were talking about this West Virginia town that basically was getting all of these millions of opioids and the population was 300 people. People were [inaudible] i would want those facilities where evei had the money. Then i would try to again get people who have been through it to invite other people to participate. I mean, doctor and senator are big advocates of healthy start. How the start is based on women who have had babies. They have been through it and therefore there able to teach others. If i got a drug problem and i come to you and you say man, youre just like the fellow i talked to last night was a former drug addict and you go to ricky and you say ricky, i have a problem and he says man, look, im a barber and im doing well and making money and im doing for my neighborhood and ive been where you are. Ive been where you are. Let me take your hand and take you to this place. That will make a difference. Im telling you. It will make a difference. [applause] so, dealing with let me start this week. When people have cancer they make the connection. There is a sense that cancer could affect and is not stigmatized and people try to get well. That is why the stigma becomes important to address. This is a National Crisis and born out of a lot of things you and i have talked about this before, mcdowell county, West Virginia where we were is one of the highest Opioid Epidemic users and we saw that five years ago and we said what is going on in West Virginia. The anxiety of loss of jobs and loss of hope and we have to flip the switch on the stigma and then try to figure out how to do this, i think, through employers, through medicine, the doctors and do it in a way that gets more and more Treatment Centers built and more and more information out there, in a way that is positive and proactive. As the congressman said, the cost of doing nothing is not nothing. We cant afford not to find the money. From an Economic Perspective this is what i call an unnatural disaster. Mr. President , you mentioned the figure of 78 million in Hurricane Sandy was about five years ago was 65 billion. Were talking about a major hurricane hitting the northeast of the United States and level of Economic Impact were suffering from stress. Not to mention loss of life which is like a Hurricane Katrina every three or four weeks. We cannot afford to not make this a national priority. We are worried about travel plans and laws and this academic is killing more people than International Terrorism killed more people than i was born. I dont think theres National Awareness and i dont think employers have that awareness. Employers need in terms of making a connection where do we spend our time and we spend our time at work. Its a sad reality is. That is what we do. For Hr Department and our managers and employees are not recognizing these issues to help make these connections of treating it as they would treat an employee with cancer. What is your sense of about how large employers are handling this . Is there any kind of general consensus, do they make their employers feel like they will be fired and they will be helped if they show up and say i need help . Or do they, in effect, confirm what you might call the stigma bias that they are toast if they have to fess up. My sense is that they are on this issue as to the broader issue there are a handful of companies, including large companies, for demonstrating real leadership. We saw that out of the obama bullet administration. I was in the room with 50 very large employers, coke, pepsi, fedex and a lot of people dont work for those companies and a lot of people who were with these issues work for very small employers and that is where we half to raise Public Health interventions will have to take place. I think the conversation is beginning but given the numbers i was talking about and the Economic Impact i was talking about any impact on life conversation is way behind. Is there a difference in do you think theres a difference in the degree to which stigma remains a problem in a small town in rural areas as opposed to urban areas or do you think its pretty while uniform . I think stigma is everywhere. I think it is everywhere. People have a lot of pride and first of all, to even acknowledge that you have a problem, people dont want to admit that. They just dont. Then they go throughout their lives deny, deny, deny but yet, still again, the people i talked to tell me that by the time a person is going into the medicine cabinet to use mommy pills, they already have a problem. People just assume that its almost like you are 16 yearold and you drifted into your medicine cabinet and you saw something and thought they were m ms. No. They knew exactly what they were doing. We have to concentrate on education and trying to make people realize how significant this problem can arise. When i was chairman of the committee on drugs, the Oversight Committee many years ago, we had some students come in from baltimore and we had about 50 of them to test the commercials, to test the commercials to see how they felt about the commercials. The most impact was, youll remember, this is how you use drugs and it was an egg frying and by far it was the number one commercial and a lot of it back weve got to make people realize that this is not the way. I know will be closing up soon but if cant say this, mr. President. When i look at his audience and just the idea that we are sitting here and i want to thank you by the way for doing this and for hopkins but you are all the ones who must help drive the policy. When you are the experts and you know and you got firsthand knowledge and you are the one. You have been trained for this. So, we look forward and when i sit at the podium that we are all in army and we are all in army. But you are the super experts on this. You know the impact and you know that what you do or dont do will affect generations of the unborn. Thank you. That was great. Let me say and let me ask the question i asked about the stigma. Maybe it is just my experience as being a slightly guilt ridden member of a family who has addiction in it but i believe the stigma extends to Family Members and coworkers. I believe sometimes they are the most important, depending on how bad the addiction is. A heck of a lot more people know it then the person believes knows it or they suspected. That is why the culture in the community, in a workplace, in a religious setting, all these things matter because i believe the stigma sometimes hangs around the Family Members and coworkers and others and maybe even more than the person with the addiction who wants to scream for help but is scared and they see the rest of us Walking Around wanting to pretend it aint so. Im saying this and this is a confession, not a criticism. I think i believe when this whole stigma thing is discussed you want the person with the addiction to come out but really the whole and look at all these little towns and i was born in one of these little places. It was the epicenter and everyone knows just about. Someone knows in the little places and maybe someone knows in the mid microscope of manhattan people think the places is a thousand little neighborhoods and i think that the only reason i mention it is because my view is the stigma weve got to be careful because it sounds like its only a price of the person with the problem but if you know the chief of police in your hometown does not want to put your brother in jail then and you know that you dont have a clue how to get your brother into a Treatment Program or your sister or whatever you ought to go to the chief of police and this is the message in my opinion at least having been a Family Member and onlooker of all of this on and off for 40 years we talked about statements as if were broadminded by reaching out and trying to make the attic feel good enough about himself or herself to come out of the closet but this is a bigger problem than the person who needs the medicine or the treatment or the psychological and i think that it is one of the reasons why i wanted to see this today so that there are people like you who are out there on the front lines of this that could use help from your friends here if we all get over it and this is a big deal and we would like to stop every single solitary person we can from dying. Along the way wed like to give them their life back which they have to claim. So, anyway ill get off my high horse and we dont need to be patronizing when we talk about stigma because its a delicate thing. Stigma is something that a lot more people participate in then the employers and someone in some oversight position in the attic. We are about to wrap up. Anyone else want to talk . To your point i think it is also we have a lot of different crosscurrents so for example we know that after school or Community Health care plans would actually be helpful and when they get cut it makes it harder. We know that in terms of employers we are all looking of what how we can squeeze that last dollar out of the Health Care Plan and if we are not going to actually pay for an ap program and were not going to pay for those types of things that is a plus current that hurts this. The alignment and the medicaid that you need a waiver to go to a Treatment Facility that is going to 16 beds but why have a waiver perspective why not just change the law. I think that part of it is also there is a whole bunch of things that we need to do to be consistent as opposed to having this kind of crosscurrents that basically says oh yeah, this is important but im not acting like this is important. I just wanted to say thank you for shining a light on this and the last time we were together we were to summit for americas [inaudible] and today were talking about what really is americas crisis. I dont think people understand it as americas crisis and that is your stature and your partnership at Johns Hopkins and also from someone from a town called hope. [applause] i want to close with someone who knows what she is talking about and keep in mind baltimore is not only the oldest Public Health unit in the country and its on this court one of the finest and you said even if you got a Treatment Center somewhere you dont necessarily have the transaction cost are covered and this i think is important. I want to mention this. When i was the governor of arkansas in my former life and we were the second [inaudible] in the country we early on had the highest vaccination rates for basic vaccination for kids to and under an in any state ofe country. I would like to say it was because of my sterling leadership but it wasnt. It is because we were so poor in the Great Depression and a lot of Southern States were that the government helped us build out the Public Health network and then sinc centuries later when e started suing people over vaccines and doctors we literally provided 85 of the vaccinations for little kids in my state through Public Health networks. In other words we were the connection and that is why i ask you about this Public Health infrastructure. Somehow we need to come out of this all of us with a clear idea of what kind of infrastructure we need that is not there. Not just what elijah just said because im all there with medicaid cover and we need more money for all this stuff but the Public Health infrastructure is peanuts compared to the 78 and half billion dollars we are blowing, never mind the value of peoples lives we are losing. That is what Public Health can so as a call to action for all of us to build that infrastructure but in general what we can do but there are three things we can do today but the first is recall save someones life and also change our language of the way that we speak about the issue and what i got taught about was how we refer a natural language speaking of the disease of addiction. And the third thing is that of leading to another hospital to take the lead what can we do as an employer or a union or policy maker . The things for supporting us. [applause] i just want to tell you one thing about the report and it had some very specific recommendations. That too many people all smart in america beating themselves up but then we all pick something and that the we cannot or will do. So i will take what we will do to cut out of this. So to be really good ted impressive so figure out what you can do and commit to do that what they say about those experiences and recommendations. [applause] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] hello. Were a to get started with this second panel were trying to be very respectful of of the president. [laughter] good morning. I am here at Johns Hopkins school of Public Health but also the privilege to be the director of the policies under president obama. We work with many of these people on the panel. With the old u. S. Epidemic and as the president indicated to have a multifaceted problem on the national space. To need a multifaceted response and a group of panelists here today in their own way continue to focus on this issue of various levels talking about the work theyre doing today. The of the Senior Community minister and project director at the Memorial Church here in new york city. And the director for pharmacy and therapeutics safety. And finally tim cook the ceo for that organization that many of you know,. So i will ask jim for those who have been impacted comely have been personally impacted by this and jean genet to advocacy in action of a National Group. So tell us about this group but also this great the scheme of impact so where are we now where we have made progress . And to ramp up the efforts to implement what the president said we know what works . Give us your assessment where we are now with those efforts to continue to move forward. Thanks to the Clinton Foundation and the Bloomberg School we are very excited to be working with the Clinton Foundation and to slay the dragon. I lost my oldest boy austin to this five years ago last thursday. But the soldier on because this war is so important to. And i think stories are important but to paint a . Picture i. E. Understand the Opioid Crisis is terrific and din of a larger problem that is addiction to of paul and other drugs. We must focus on opioid but to tackle this problem that is getting worse and younger there is a staggering figure of how many people die from opioid but somebody dies every four minutes. From addiction in this country. 350 people a day when we sometimes talking and it is jarring a huge airplane but also young adults bright eyed college kids that is falling from the sky every day it is like a jet. If we are concerned of the addiction crisis at dont know if they are both broken hearted enough because if you put that figure into perspective none of these are value judgments but that devastation of hurricane is. And las vegas was a unspeakable we have six of those in terms of death of addiction every day. In be simply have to rise to the occasion . This will eat us alive. And then to keep it conceptual in the aggregate in such a disconnected way we hope to get more done to connect these different parts and i could paint a picture for you that is frustrating but hopeful because if you think of the journey of a young person in this country of Early Intervention with regular health care there are clear identified problems in this report and the Surgeon Generals report with the wrong programs or the pediatricians are insufficiently trained because they only get a few hours of training in the school. Some works a lot of that does not. It is not scalable. But we know what to do. And then we simply had to stop talking and do it. So it is a National Group think of the National Cancer society to integrate the response. Should i call you reverend . [laughter] so the fate institutions have been engineers of social justice change. That it highly stigmatizes disease broke in with bad faith community. In the of the parallels of that but to talk about what you were doing how we think about that as it approaches, many people have to be kept alive and healthy. And as the call to action with this epidemic. It is wonderful to be in this conversation. To play a significant role with a community of lepers by stigmatizing or shaming. And i gave a sermon earlier this year but within hours i was receiving emails and phone calls and in that coalition where work. And has never heard that drug issue to be talked about in the sacred space. Never heard the drug issue talk about they have never heard their stories reflected with their child or their loved ones. That is significant. To be charged with making as they stand in order to do that without radical welcome and then to limit people from accessing health. And to set up a whole church and by virtue of to have the opportunity to listen to those to identify that community especially those severed particularly vulnerable. Theyre often the point of access and the mines with the most welldeveloped. So it is critical. What we have taken on is the sanctuary projects for leaders across the country and the resources and communities and then with compassion and drug policy. [applause] 01 to follow what because this is a good example of evidence what we know to be effective is a far cry from what is implemented access to sterile syringes. So what is that significant and disconnect . And in some respects. That is a multi full the answer but ominously with that immense amounts of wisdom where people who use drugs and for a very long time with this connection and collaboration is the key to addressing this issue. So those with their experience of overdosing and families but with First Responders. But with those reduction programs but in the community is those that we need to be following. Can i follow up . Here is all the right people and organizations what would shift to this dramatically is stop treating addiction as a crime. [applause] so put that into the mental and medical Health System as it should be. We cannot get past any of this unless we think every user is a criminal but they are not. Allow was to do the job to cut back supplies can be the link to the federal organizations. And then have difficulties. So let me followup bomb that as we remarked on that tremendous shift in lawenforcement we cannot incarcerate our way of the problem more partner with Public Health vote so how does that change your Health Question mark i didnt know what a Health Commissioner was. [laughter] i had no clue but then then with every Single Police officer. But 7500 uses in our area in a yearandahalf and we have a great conversation so dont give the needle to a copper co we could do spray. With those core horsey in the treatment and thoracic is real. It is beyond us. Long term care to reintegrate. Talking about investment. We get that investment back. So in terms of the major deficit and get them though Long Term Care they need . There is no two ways about this. We call in emergency but dont treat it like an emergency. We have people overdosing every week for five dying every week the get the money is not there. It isnt like treatment it is not like we dont have the resources to do it. We do have the links. And i hope we dont let that go. This is the time to shift addiction and i have been saying this for a couple of years but it takes all of you to get a hold of your policy makers to tell them to give up the money this is an emergency. It is not a waste of money is an investment of money. So to shift a little bit. And getting little to note trading on these issues and but i want you to do talk about is to clearly we want to make sure on that subscribing practice that we are under treating those so why dont we talk about either effort of the balanced approach that people get adequate access . Thanks for the invitation to be here in from the Clinton Foundation. With the National Health plan we have a tiny section of a country we try to help and for those 12 million patients we really want to make sure they receive the best care we can possibly afford and my role as to rock director of therapeutic citrate use my expertise and background to educate our physicians and patients but the appropriate madison and that is where our focus has ben. Our health plan a few years ago we have implemented guidelines around pain management. So yes i have heard the comment youre taking away the opioids but we actually augmenting chronic pain treatment and the ability to prescribe non narcotics or non medicated treatment isnt always medicine that will help you so we have significant alternative treatment and waste reduction to help people with that. We have pain psychologist who by the way i think garner underrated ill love we have i think they are wonderful but pain and not just to be fixed by a pill of lot of education is around chronic pain treatment we have a standard of guidelines we have been giving them the tools to do the right thing also Electronic Medical records does not always include the appropriate doses the all love the other reefer all options in treatments used for pain syndromes youre reminded of all the other things you could do for that patient if he did not already. We also augmented the services we want to have to help patients with chronic pain over the last 67 years that has been significant the dollar those are under one roof and our Medical Center so they dont have to have that barrier to access to go somewhere if you dont have a car. We have a lot of internal vision. The Previous Panel talked about the role of Insurance Companies i have heard from physician for scribers to say i want to do the right thing to give them physical therapy acupuncture and insurance doesnt cover those paid Management Strategies so is that the issue with reimbursements . We do have those resources but i totally endorse the and we do have those that do not practice and a half to be very cognizant of what they have for benefits they dont want to give them services that they have to pay out of pocket but that is a flaw in the Health Care System we need to expand the service is for everyone. One of the things that you mentioned previously with many diseases with personal stories or narratives has dramatically changed the way we see people. So maybe for anybody, what the uc with people that are using people in recovery . How do we use those stories to change Public Opinion and Public Policy . We talk about this in facing eviction as an illness that nobody will ever get where nobody ever has it acceptable all 40 percent of households in america and if this doesnt put us over the edge the stories will. I went to a restaurant near the hotel the server said a 30 yearold lost his life and nearly died six times and sweet little woman who helped me to print something out said i have not seen my boy in 10 years he is addicted to heroin. Item number i will see him again. Everybody knows somebody if they are honest they are probably related we dont admit it that we will get to a point for it is more than half of the country if we just get over in and get to work. Congressmen cummings talked about the potential for people of recovery so talking about the role of people in recovery whereas that relates to advocacy for many of the treatment world those who have done that it is one thing to say i will get you help but those that have been there or experience that with the crisis intervention teams for those to be the crisis intervention teams and hopefully walk them through the process it is one thing to say will get you help another to say i have been there. So that would be great and what we looked at in our area and keeping our fingers crossed. Specifically with postdoc care of you of us have stories where those two are adolescent who have the athletic injury and as the result may be longer than they should have when there was a party few weeks later the friend said you have some of . Then that leads to someone and that is how it starts. So the more that the patient needs especially young adult or college age i feed the report is 61 . So i use those stories a lot. I was pleased to see this inclusion with First Responders so if we talk about inclusion where we draw wisdom with those communities that are impacted by this. So you have this experience with the evidence that we talk about to be borne out leaded is incumbent to figure out how we can work in synergy with what theyre doing. And talking about the role of advocacy one of the things that really changed that trajectory of the hiv epidemic was angry gay men and lesbians saying we will not take it anymore to create that urgency many have felt that isnt the urgency of the National Crisis or other epidemic in how we think of harnessing the potential for accelerating change. What have mothers against drunk drivers a group of this doff moms who affected change. Those who lost a child but some of those organizations that would be great if there was a Community Grassroots of mothers or fathers to lost their children to advocate that. But advocacy for policy changes. I could not agree more. When we look at the addiction landscape a lot of organizations have good people doing good work the for complicated reasons but frankly all of these things we talk about and by the way we should not rely on government to solve this because it doesnt solve any of these problems so without advocacy or eight girl people putting pressure none of this will happen so grade williams and others on the team that are smarter than me saw that and so far we have stitched together like 700 organizations that represent 35 million americans and theyre helping us to understand to get them to write letters and getting free and that will take a much bigger group to be more cohesive but that is the answer we have to get the group of people to stay it is time. There is a movement of what my colleagues are doing and they are doing the work that many of us have resisted and telling got closer for us. Site being in that way it lends itself to the issue that yes it is a Public Health issue but also social justice that there are circumstances that make people more vulnerable to a drug related harm so it is very intersection will so we will Team Strength being able to find our way into an alliance with other movements. It is very much a Racial Justice issue for those who experience trauma or gender based violence or poverty and we cannot divide the of publicHealth Response from social justice response so all of these intersecting oppressions is essential that we are ready for the next time this happens. With the score circumstances positions will recall to the movement they figured out six or seven years ago with the data of increasing opioid was directly correlated with increasing death such as 99 of the world hydrocodone but we have 5 of the population so that made them engaged and listen but honestly the government has assisted by passing mandatory continuing Education Credits and also mandating prescription and Monitoring Program access believe me i hate having to fill out the forms for the much everybody does that is universal but that mandated search and quantities to lot from there were not aware they were doing something wrong before so there is a definite call to action. We were talking before about anger four or five people dying every week there was not a single gas but also to say who do we need to be angry at . We are angry at the wrong person for the were angry at the user because they overdose multiple times and not the dealer i have arrested nine times to get out in and goes back on the street. Were not a with the Pharmaceutical Company that buys to the doctors and society. Im angry. Good. [applause] that is displaced if we put it where it should be we could start to fix this but we hear a guy at the wrong person it is and the user that has the disease we should be angry at the people who did that for free at love when lawenforcement officers talk like Public Health officials. [applause] [laughter] looking for that sea change all of us are worried that the federal level quite honestly despite criminaljustice reform how do we keep that momentum going that this is a Health Response and not punitive . What enforcement is that that crossroads right now what i am saying is not necessarily what the majority says but a group that pushes back to say it is a crime i will treat it like a crime because my lawenforcement officer or employee of First Responder . Even for us i dont have confusion my job is to stabilize i dont care what you did i am not the judge. Trust me i have my own my job is to save lives that we argue what is our role . I say this for a tour three years it is you. You shift all policy and when you stand up to say we will treat this differently then we have no choice but to treated differently. Facing eviction has an Interesting Program restarted to hear from a lot of communities that they are lost. They simply dont know what to do about this issue so we have a Pilot Community for the we dont have a Silver Bullet but we have a best practices to bring local leaders and educators you get together to Start Talking about what is working and what isnt there are similarities but depending on the makeup we work with them to forge a plan to leave behind within one year they have a cohesive way to tackle this problem to raise additional funding or direct the funding that exist but not to the best of our highest use. It is rolling up your sleeves and getting to work. With the role of Community Many have read the book dreamland it is a great book i have gotten to know him one over the years is that the fundamental response to the epidemic is community and all of you who worked in those various sectors just reflect on your thinking of Community Coalition hoodies to be at the table . As they respond to this issue . All of us that the federal level know we have a role but what happens at the community level. Can you reflect on this . My training is pediatrics so i think a school and education and high school and college how can my colleagues educate . That dont mean to do a lecture once but consistent education that is required my students were required to take a course in economics and could not get out of that. Some of those were struggling but nobody is required to take a course on addiction or Substance Abuse but yet it affects every single child one way or another. Said to be there often that pharmacists are great asset and could be up their teaching. When we started that coalition the vision came to about one month ago we knew it would be prevention and treatment and First Responders. It had to be every part of the community. As i sat in this room for the first time we have almost every aspect of our community represented grass roots, religious groups, universities, doctor s, elected officials from the Health Departments guy was getting emotional. This is our vision and when we talk about the right people is everybody. Everybody says teardown the silos by a disagree we should stay there because they are the experts. We should have a door that lets everybody in and everybody out those are extremely important im not the expert i am not the doctor we need to share that information. Going back to what we understand to hold space and as such it is incumbent about faith communities to breach the silence and make a statement prophetically this is not an individual issue it is a Community Issue across all the violence it does not occur in isolation and thinking about a dinner with friends with the opportunity i took a few days off for myself and felt myself describing the struggles with the work and by virtue and into our conversation one half of a the couple interjected herself into our conversation. But they have lost their son about five years prior and had never spoken about it and did not know there were people that are working to ensure that nobody elses child would die from an overdose. So by virtue of to have these conversations there are some well entrenched theology. That is horribly problematic. And in the spirit of this conversation and from your perspective and that they continue to leverage change. We would singularly put this at the top of the list. So there is some inside baseball risk. And we should not underestimate that debilitating power. People do not think this is an illness if you dont think it is an illness then it is your problem why should we care . We have all had this conversation. A massive education campaign. But a massive three branding campaign to read frame how people think about that as an illness. 90 percent of people who suffer dont get treatment. And imagine if that were any other illness. Reading obituaries the was a sudden cause of death. We know what that is. Than what it is treatable we can get there but the First Baptist to get over a the stigma and shame and discrimination. Is a whole different ball game. To focus on and prevention that is where we have a lot of opportunity so education, education, educat ion my background is when we were all about antibiotic resistance we educated getting the Community Involved do we really need that . Do you really think any that antibiotic . Some of the pendulum swung the opposite way because we really did a great job at educating. That was my analogy i was going to talk about today. [laughter] but we dont have that with opioid use with the stigma and to be pain free with that expectation has to be changed through education. Stigma is blocking us right now and if we shift at of the criminal Justice System allow was to go after the right people. But much of those are redacted. And with that strategy we employ a then we have the essence to create a population that is incumbent upon the delivery of them. With a place that offers compassion with those burdens that people carry. [applause] i am actually sitting here feeling disingenuous talking about longterm recovery. I am one of 22 million they do think we have a personal responsibility to be open and public because it does change peoples mind. Want to thank our incredible incredible panel that i know there will continue to do. [applause] as codirector of the Johns Hopkins center and as expected to exceptional panels. And to extend our deepest gratitude to you in the Clinton Foundation for your leadership and commitment to address the issues to have discussed today. You mobilize the foundation to lacked in since that time you have been on the leading edge through the tireless efforts to raise Public Awareness of of crisis and as a brain disease not of behavior. Also wrote to congressman cummings and other distinguished congressmen who have joined us from around the country. Thank you for your participation. So with that Opioid Epidemic it took a lot of planning to wed not have been possible negative possible without those individuals the Clinton Foundation including those working to fight the epidemic but as we have heard the efforts of all of you in the room we have all been touched by the epidemic and should not doubt the power of our collective action. In 2011 jihadi lost her son to a heroin overdose i ask the right to share his story and she said i am always happy to have those shared the phelps and that no she keeps next to his pitcher says if love could save you you would have lived forever. Then you should not have to endure the suffering and on the one hand to the other. And as you have heard today mobilization so thank you again for all the you do. [applause] but in behalf of the centers to the distinguished panel of speakers in all the of done to address the epidemic and being here with us today. For those that our responsible to putting lifesaving tools in the in the First Responders and School Professionals across the country. So as you heard began with the first town hall were very proud to working in concert with the Clinton Foundation as we continue in our determination that many Public Health problems those overdose reflects what happens when a product that delivers benefits than harm exist in the environment to flourish. Addiction without access to treatment or to many medications from over prescribing that is a few examples. Joined by the Clinton Foundation were finding the evidence to solve the problems and the Opioid Epidemic read it was released today to provide that evidence along with specific recommendations for kozo how collectively do we turn around that alarming trend because the public is protected on the one hand but proper pain control is delivered safely. We hope today is the beginning of a new journey that moves us surely to end the epidemic so with the help of everyone here joining us on line we are confident the goal will be realized thanks for being here and joining us in the future. [applause]. A [inaudible conversations] an 5 minutes. Good evening. When i had the chance to speak at the Democratic National convention i joined activists of every background to demonstrate a simple message that the fundamental american