Transcripts For CSPAN NGA Winter Meeting On Combating Opioid Crisis 20160220

Gentlemen, thank you for being here. Mr. Herbert thank you for having us. Mr. Mcauliffe thank you very much. Gentlemen, what do you plan to bring to the table . We will ask on behalf of the governor and what we are doing on the war on terror and Economic Opportunities and particularly, the role of states going forth. The role of states have a particularly important role, and we would like to foster relationships not only with the white house but also with the congress. You have been focusing domestically and locally on the opioid crisis. Mr. Herbert we have had governors reach out and see if they could help with abuse of all kinds of drugs, Substance Abuse and that is an area where we have significant concern and we recognize that the states are probably best suited to reach out with education aware awareness. We are trying to help people to get to the root cause of their criminal activity. Healthso involves mental courses to help get to the root cause and avoid having criminal behavior is that of just warehousing people to give them the effect of treatment that they need to have. We want to let our viewers know that they can join the conversation as well to ask any questions to governor gary herbert and Governor Terry mcauliffe. Republicans, democrats, and independence, you can each dial into your own lines. You can also respond on twitter. My question for you now, governor mcauliffe, the big news in South Carolina and nevada as well. You have been a longtime friend and confidant of both bill and Hillary Clinton. What do you see happening right now for the Clinton Campaign and how concerned are you about this surge for Bernie Sanders . How should their campaign be concerned about this surge for Bernie Sanders . Mr. Mcauliffe first of all, we have only had two contest, Hillary Clinton won in iowa and newie sanders won in hampshire. In nevada, i think it is going to be very close. Hillary clinton has a significant lead in South Carolina. Then we have 10 states, including virginia, and i think hillary will win a vast majority of delegates on that day. On march 15 that will be the end. So we have a number of delegates between march 1 and march 15. I believe hillary can statistically say that she will have enough delegates to be the nominee of the Democratic Party. First contest, there is a lot of press around them, and we can go through over half of the delicate crits half of the delegates and i think at the end of the race, we will see it had been a vigorous race. Indonald trump wins today South Carolina, i think he is probably well on his way to the nomination. I think anything could happen. Listen, we still have a couple of campaigns, we have a long way to go. I chaired hillarys campaign efforts, we went all the way to the end. We went to the last couple of primaries and caucuses. Governor mcauliffe, you sort of skipped over a little bit of what is happening in nevada today. It was supposed to be the start of Hillary Clintons firewall is more presented of of a broader population in terms of the national demographic. If this is a close call, what do you think this means for clintons momentum Going Forward . Mr. Mcauliffe i think it is going to be a very close call. If you recall eight years ago, senator clinton won nevada. Tight, itg to be very was very tight then and it is going to be tight this time. Clybourn has just come out to endorse Hillary Clinton. That is very strong for us in South Carolina. Say, these first four bank are very important, but we have to get to these big states that are more representative to the rest of the country. Nevada is a more presented of because of the latino population, South Carolina is more representative for the africanamerican communities, but listen, this is a long haul. We have a very competitive race and we are going to do it again this time. Governor herbert, you have not come out in support of any republican candidate yet. What you looking for . Mr. Herbert i was hoping a governor would emerge. I am partial to governors because they havent because they have experience in the executive branch. These others can be pontificators who just kick the who justntificators kick the can down the road. Somebody who has experience in a governors office. But i can tell you listening to terry talk, all of this monday morning quarterbacking, what should have taken place, what is going to take place, i think this election has some flaws in it. I know that iowa and New Hampshire should be first, but i wish we had rotating regional primaries were everybody had a chance to go first and we could actually shorten the campaign time. It would be less expensive. I think the people of america would be more focused. I think people would have an opportunity to participate and play. Rather, we have this contest where we have weeded the people out and i dont think that is a contest that the American People want to see, and i think the Republican Party and the Democratic Party alike need to get together and say, is this really the best way to select a president . I think this would be much better for the American People. Lets turn now to our phone lines. Judy is in indianapolis. Go ahead with your question or,. Ler i was calling about the governor in michigan. I understand the governors are in a meeting, and what are you doing to stop your colleagues from poisoning american citizens in the United States . Because it is really almost like the tyrants in africa. The president s in africa who take money from their people and have their constituents living in terrible conditions, this is america. All right, that was judy from indianapolis. Let me see if i can answer that. I note Governor Rick Snyder from michigan and i know he is a good man. We are good have Congress Kind of look at what happened and what would it wrong and what we need to do to fix the problem. Again, i understand the importance of water. I live in a state where water is a very scarce commodity, and so water is really the lifeblood of utah. So i recognize the challenges that we face in michigan. I know that the governor is not here because he is in fact helping to address the issue. He is going to be getting to the bottom of it. Day, each of each governor is responsible for his own state and his staff and the people he surrounds himself with and the mayor of the local county commissioners and the elected officials, it is not something that we have primary cause of for telling him what to do or what not to do. There are many governors in the sovereign state of michigan. Our next caller is jacob from california. Jacob, go ahead . Caller i want as the democratic governor about emails . The meeting of the National Governors association is called to order. I want to thank everybody for joining us today. I am charlie baker. I am the governor of the commonwealth of massachusetts, and im also the chair of the committee. We are joined by the vice chair, New Hampshire governor maggie hassan. My directions say to my left, but you are obviously to my right. Please see our legislative director after the meeting if you have any questions. Today marks the third time the governors have come together at an nga meeting to discuss the opioid crisis. Importantof the most challenges facing our state. Im not going to bore you on all of the facts and the statistics because we have other folks who have agreed to come to speak with us today. I do want to leave most of the time for our guests. We have divided the session into two panels, the first one will focus on the impact of opioid abuse and how the governors can better support those who are coping with a loved ones addiction, and then we will talk to our federal Industry Partners who will discuss how they are ramping up their efforts to tackle this crisis. Before we go to our first presentation, i want to give governor hassan a chance for some opening remarks. Ms. Hassan thank you, governor baker. In New Hampshire, we certainly recognize that opioid addiction has changed the way that we have done things, and it requires that we make some changes at a pace that is faster than many people are used to. But we also know that doing anything less is unacceptable and midst Public Health and the safety crisis that claimed the lives of more than 400 granite last year alone, three lives in the city of manchester on thursday night. That is why we have continued in New Hampshire to continue to Work Across Party Lines on a comprehensive approach that supports Law Enforcement and strengthens prevention, treatment, and recovery, including the authorization of our bipartisan extension plan. That is essential to expanding treatment capacity. This epidemic is reflected in the governors priorities for addressing the nations opioid crisis, something we will be discussing further in todays session. Working hardrs are to tackle opioid abuse in their states, this is an all hands on deck moment, and we cannot win this fight without the critical support of federal partners and the private sector. Our recommendations of governors includes identifying addiction, expanding access to treatment, and the lifesaving emergency overdose treatment nor can narcan. Of ourhe case in many states, some will say that we cant afford this additional investment. S believe that we cant not afford to make this expansion. Come together to underscore the importance of private sector leadership in changing the way that we treat pain and addiction in this country. Prescribing medication isessively or just in case not acceptable and continues to fuel the Opioid Epidemic. Today, the National Governors association is joining with the American Medical Association to combat the opioid crisis. We agree on Pain Management and Substance Abuse education beginning in medical school and continuing throughout a providers career. We believe that state Prescription Drug Monitoring Programs are an important tool. N addressing opioid abuse we also agree on closing the treatment gap and expanding access to narcan to save lives. Full to dr. Nk Patrice Harris of the American Medical Association thankful to dr. Patrice harris of the American Medical Association and all of our speakers today. Mr. Baker thank you very much, governor hassan. It is now my pleasure to introduce our first speaker. Can tell you this, anyone who has ever been to one of this next speakers meeting is never quite the same. Compelling, they are tragic in many cases, and they are hopeful in others. And are, by far, moving, joanne, it is wonderful to have your today. Ms. Peterson thank you so much. Mr. Baker push the button. There you go. Thank you. Ms. Peterson thank you so much, governor baker. Thank you so much for all of you who are coming here today to talk about this in or miss this enormous epidemic. My own family has grappled with my sonon over many years today is in longterm recovery and i couldnt be prouder of anyone on this earth. He lives a great life, so recovery is very possible, and i would just like to begin with that become with that because a lot of people can find coverage. So i did start this really 15 years ago. I didnt ask to. And i wasck by this blindsided by this. This was really going on for many years in the late 90s with the 80 milligrams oxycontin the was out there and they were so available. The schools were not prepared, teachers, police officers, communities, no one was prepared , and it just sort of seeped under the doorways of all of these homes, and it really just took some time to figure out what was going on. This crisis was going on for way too long and it has evolved and changed over the years but one thing that is definite is that it has grown every year, every day, and the death toll rises to startling numbers every year. Our groups in massachusetts alone, in just the past few months, some of our families have lost two kids, not one, but two. We had one family out in the western part of the state who just buried their daughter and now they just buried their son two weeks ago. This is an issue that affects every state, it affects every community, and he chooses people. We dont choose it. To be from grateful the state of massachusetts where governor baker and secretary sutter and so many in our state have worked so hard, including director botticelli in his position now and years back. People are talking about it now. The stigma is finally changing. It is still there, but it is changing. But i can tell you firsthand when you have a son or a daughter you are watching on a daily basis lose their life, lose their dignity, lose everything, and you are just trying to reach them and you cant, that drug is so powerful. With a it begins prescription from an injury in sports, which is very common way that it starts, or if it begins with an experiment, either way, it can become a way of life, and the family tends to be forgotten a lot of times. In theht see them Emergency Rooms sitting there for 12 hours begging for a bed, only to walk out later knowing that there is nowhere for their son or daughter to go, and to go with one eyeht open, knowing that they will run out the door for the first chance that they can get, and knowing you can get a phone call that they will die tonight, because you know that that powerful addiction is calling their name. You know they cant help it. They run out the door. They go get more. Unfortunately, lately, a lot of times they are buying something that they think is heroin and it turns out to be 100 sentinel. Few parents that have gotten their medical seminar reports back recently and it says 100 sentinel. So im speaking for families today. My family, your family, everybodys family. I am asking the medical community when they write out a prescription to think about it like somebody would think about gun safety. A prescription pad can be a very, very dangerous thing. It is necessary. People need pain medicine. That, aslly aware of many people are, but you shouldnt be prescribed things without asking questions. You know, do you have addiction in your family . Are you in recovery . Or even being educated, this is an opioid, lock this up, dont leave it in your medicine cabinet. To beow, it needs protected, there need to be better education in schools, realworld prevention, it should be in science classes, there should be something taught to children that is called addiction where it changes their brain. Narcan is a very powerful tool. We are the first parents has been ablehat to pass out narcan in our 23 chapters across massachusetts. Parents who are trained to give out narcan. We have had over 80 saves. Those are Family Members saving other Family Members lives. The most important piece is calling 911. We are there to help them try to get treatment. That is were the problem can really begin, once you save their life, you know, it is really tough to get a bed. It is getting better. There is a lot of work that is being done that we are very grateful for, but there is that gap. There is opioid addiction, it takes a long time, you need longterm treatment. I can say that from seeing i soften watching somebody suffer. That myself and seeing somebody suffer. And dayeen it, day in out, and over and over. Maybe in the end, people will get their lives back. I would like to mention siblings and families. They are a really underserved population. They dont get a lot of attention with her parents are so busy trying to save that loved ones life. And it is not easy to just let go. If your son or daughter had diabetes and they werent taking their insulin and they were ing chocolate to cookies it in chocolate chip cookies and just drinking soda, you wouldnt just let them do what they needed to do, they need treatment, and they need to manage their addiction. And that is what we are here to do. Educated,dy is grandparents, ands and uncles grandparents, aunts and uncles, friends and neighbors, thisy be able to quash epidemic that is taking over our country. If we dont get a handle on it now, what is going to happen in 10 years . I think about all of the orphan children out there. There are tens of thousands of children out there that are now orphans, they have no mother or no father. There are grandparents out there who are trying to take care of children and they have spent their retirement funds. So i urge everybody to learn as much as they can about how they can help their state and i am honored and i thank you very much for allowing me to be here today to speak for the families. Thank you. [applause] mr. Baker so joannes little organization, little startup, has 23 chapters in massachusetts, so that tells you how prevalent this organization is. I used to say when i was campaigning for the governor ship, i couldnt have a meeting with 20 people without having a number of them as a part of this organization. Massachusetts, in 2014, there were 1300 people who were affected by this, which is 14 people per day. 14 people a day. There are a very few things that i can think of where it has adept death toll of 14 people a day. We talk about the difficulty associated with the treatment process and the treatment pattern. We did a study of everybody who entered a detox organization in massachusetts, and about 40 of them were in a detox facility at least four times over the course of one year. We clearly need to get better at this and there are plenty of places in health care where we used to just accept the fact that kids with asthma got hospitalized and we used to accept the fact that people who got diabetes got hospitalized and we used to accept the fact that people who had congestive Heart Failure got hospitalized, and then we realized those were failures on the part of the Health Care System when some of the got hospitalized. When you look at the hospitalization rates, especially preventable hospitalization rates of chronic conditions and preventable illnesses in the past 15 years or so, you know, hospitalization rates crashed. They crashed because people came up with far more effective ways of treating people within a community setting. See is one where inh is to somebody on the provider side, addiction side, where this is one where i am anxious to see somebody on the provider side, the addiction side, where a solution can be prevented. Does anybody have any questions for joanne . And again, thank you for your testimony. You talked about this in your state of the state. I believe you were ahead of the curve on this. Is there anything you want to share with joanne . For just want to thank you your courage, because i believe the challenges we are all facing in this battle is the stigma, and when moms come up and tell what you just did, it just lists families who are taking care of these kids and all of the tragedies we know about because you had the courage to speak out. So i just wanted to say thank you. Ms. Peterson thank you. Let me just add one small thing to that. Overt ino be more addressing this. Too often, there is stigma associated with this, and people want to keep this under wraps. Just yesterday, we broke ground on a facility in kentucky that is going to be front and center, that is intended to serve those who are wrestling with exactly what you described, and it will be literally right there were people can see it. It is not tucked away in the recesses of a Health Organization somewhere, it is a 190 bed facility. It is crucial that we spend resources and money. In our state, a state that is very capacity strained on many fronts, we are dedicating 60 more dollars than we did even last year in addressing this problem and in each of the next two years, not really because we have those dollars, but to the point it was made earlier, you cant afford not to do it, and that is really the rub. And one thing, and i have to apologize because i am going to step out here in a moment but i will be back, and we talked about this, unless we are truly, truly serious, and it goes back to what are we prescribing, we know how unbelievably addictive these drugs are. If we are serious about addressing it, we have to be seriously willing to consider whether or not these drugs are prescribed double in this le inry prescribabe this country. And until we do that, we are not doing anything but playing a shell game. This is going to be affected by all of the conversations that we had afterthefact and we really need to ask ourselves this question. Mr. Baker any other questions or thoughts for joanne . Governor hassan . Ms. Hassan i would add my thanks, joanne and you, and one of the things that have happened in New Hampshire in the last year is that when there is an overdose death, now families even in the obituary have been coming forward so that when people are reading the obituary, people can understand what has happened, again to remove the stigma. Learninghing we are from families and people in recovery have been so brave in telling their story is that in addition to the treatment to get somebody clean, the Real Technology meant in recovery is really a Longterm Management of chronic condition, and we need recovery resources, not just treatment resources that are ongoing. Really important piece andducation, so i thank you so many of the other families for being willing to take this front and center. It is really important. Ms. Peterson thank you. Agreeker i especially with that. You speak for thousands and thousands of people who may not have the courage to tell their tale and their story, so thank you for joining us again today. Ms. Peterson thank you. Mr. Baker so lets talk again about foreign policy. We are pleased to be joined by michael but a chilly, who is from the great commonwealth of botticelli, who is from the great commonwealth of massachusetts. Thank you for your leadership. Want to thank all of your statement to talk about this epidemic. I want to thank joann peterson. A veryown joann since long time at all and i could not be prouder of the work you have done and the way you inspire all of us to do this work on a daily basis. We know making progress on this epidemic requires a multifaceted and response. When you have to be doing a wide variety of things but we also need to coordinate our work at the federal, state, local levels to make progress. The kind ofll know magnitude of overprescribing and prescription pain medication as a key driver for this epidemic. Thank dr. Harrison for his recent call to action, to getging physicians training inappropriate prescribing but we continue to pursue mandatory prescriber education. We think this is an area we can work with the governors requiring legislative action from congress. 11 states require some level of mandatory education and i would encourage governors to look at this as part of their stay response. The cdc will be finalizing prescriber guidelines which will help decrease overprescribing of opioids. In addition to inappropriate prescribing, we know the vast majority of people, 70 of people who start getsing pain medication them free from friends and family. How we think about Drug Disposal becomes important at the federal level. Walgreens is announcing they will be putting disposal kiosks in over 500 of their stores nationwide. We think theres an opportunity for federal action and local action to expand drug take back day. As governor baker talked about having vibrant Prescription Drug Monitoring Programs and an accessible strategy. We now have 49 states. We also know we have to have good, highquality programs able to share data with electronic. Ealth records we continue to work with ahs. We have 30 states able to share data across state lines. Utilizephysicians to the information in those states. Many states are mandating their prescribers to look at this database. Both governors talked about the fact we need to expand treatment. We know we have many people who are not able to access treatment. We know treatment by and large andtill acute and episodic it doesnt provide for the full continuing of care. Administration over the past few years the president has been increasing funding. He travels to West Virginia in october and heard from a parent like you, joann, and it knowledged despite all our efforts, we still had a big treatment gap. Keep afford a 1. 1 billion proposal for fy 15 to close the treatment gap and make sure states had a continuum of care and to look at all those rehabilitation and discovery options. This is in addition to our other efforts to look at expanding the expanding treatment distribution. Expanding utilization of medication and treatment is particularly important. We know from all of the evaluations that when people with opioid disorders are on medications with all the recovery supports that they do arebetter than those who not on these medications. These medications are often underutilized. Toneed more prescribers prescribe them. We are working on looking at how in a prudent way we can look at lifting the current cap of patients. There are also interested in working with congress and governors to moderate the current legislation. Part of the president proposal for this year was to put 10 Million Dollars into demonstration grants to look at Nurse Practitioner and physician assistant prescribing. Many of your jurisdictions have been in rural parts of the country where we dont have physicians and need to continue to focus on expanding access particularly in underserved populations. This summer, health and Human Services put out a grant announcement to support expanding Community Health centers because we know thats a prime opportunity to look at getting people care. Reversingof overdoses has been an important priority. I came from a straight betting the first Law Enforcement andrtment in the country missing a huge uptake. Have 36 states that have introduced legislation to look at expanding treatment. When the two nature not just whot responders but anyone has witnessed an overdose has naloxone. Weve also seen a tremendous response from Law Enforcement in this issue not in terms of just producing a versus overdoses but working with Community Members and affected people in terms of getting them into treatment. Theres a police chief in massachusetts who started an Angel Program and their officers look at getting people into care and its been huge. I can see changes from our officers to know we cannot arrest our way out of this problem. We have to have a more human and compassionate response and it can go a long way to diminish the stigma if people feel free to ask for help. Continued to focus on is looking at what the opportunities are through Grant Programs because we know the no lockslocks on own the other area that becomes seentant is we have dramatic increases in the bible hepatitis as a result from injection drug use. Many of you so what happened in indiana this summer that had 185 people in a county of 9000 affected with hiv as a result of injection drug use. After decade, congress repealed the federal ban on federal funding for syringe Access Programs and we have states that passedd reading legislation that allows people access to clean syringes. This has been a tragic example disease. Tious health not just a public issue but we know the impact it has had on Law Enforcement and we need to continue to work in partnership with Law Enforcement. We see great examples of Law Enforcement and Public Health working hand in hand on this issue. Not only are we seeing overdoses as they relate to Prescription Drugs but weve seen dramatic heroin overdoses. We have to work with our Law Enforcement to reduce the supply. We were happy to announce additional funding for our high intensity Drug Trafficking area to work both with Public Health and public safety. This is one of the president s top priorities. Many of you heard to him or for work as an opportunity to with you and congress on this epidemic and he recognizes the magnitude and urgency and looks forward to not only a more robust federal response but how we can work in partnerships with governors and state. Mr. Baker thank you. We are going to work our way through the other folks generously agreed to be part of this panel and open it up to questions. Dr. Harris. Dr. Harris thank you. ,overnor baker, governor hassan on behalf of the physician and student members of the American Medical Association, its a privilege to be here and share with you solutions for ending our nations Opioid Epidemic. Dr. Patrice harris. Im a practicing psychiatrist from atlanta and the chair of the ama task force to reduce opioid abuse. Medical societies across the nation unequivocally understand that this is an urgent Public Health epidemic. We believe its our professional and ethical responsibility to help bring an end to this epidemic, which has claimed the lives of more than 200 50,000 americans since 1999. Tens of thousands of people are dying preventable deaths every because of opioid misuse and overdose, including heroin. More than 78 every day. This is not acceptable. Together, we can end this epidemic. Understands the many causes of this epidemic but let me focus on the one where a physician can have the most immediate and meaningful impact. Today, i will highlight five recommendations from the ama task force to reduce opioid abuse. A call to action that the ama president sent this week in a special email to hundreds of thousands of physicians, residents, medical students nationwide. Every we want to urge physician to register for and start using their state Prescription Drug Monitoring Program. These tools are not perfect but they can provide Important Information that can help physicians care for their patients. The result of a National Survey released thursday found nearly dmpsf physicians said p helped them become more informed about their patients prescribing history, including whether that patient is receiving multiple prescriptions for multiple health care professionals. Urges physicians nationwide to enhance our training around safe prescribing practices. The hippocratic code reads i will remember there is art to medicine as well as science and that warmth, sympathy, understanding may outweigh the surgeons knife or the chemist drug. If i believe in medication will not be hopeful, i will tell them whether its an opioid, an antidepressant, antibiotic. Our prescribing decisions must. E judicious let me be clear that many patients do benefit from opioid therapy from both acute and chronic pain and when a physician determines an opioid is called for, the ama report the patient receiving the lowest effective dose for the shortest effective duration. This National Epidemic presents many challenges, which is why we need to work collaboratively to ensure that policies designed to help dont unintentionally hurt. The ama understands there are too many pills and the publics hand. If we enact policies that overly restrict access to necessary pain relief, we may be pushing people to other nonmedical, undesirable alternatives. Tohave to Work Together strike the right balance. The ama is urging every physician to cope describe naloxone to patients at risk for overdose. , governor hassan, manyany here aware of the lives saved by naloxone. The ama has worked closely with state medical societies to enact more than 20 new laws that require greater access to naloxone. There are few state legislative efforts that have had as much access and naloxone we are proud of what we accomplished. We strongly encourage all governors and state without naloxone access to introduce and enact ama model legislation that would help save lives from overdose. Physicians can also do more. If we see a patient at risk for overdose, we need to call prescribe coprescribe naloxone. The fourth and fifth recommendations focus on treatment. Thank you for coming today. Torge everyone here today join us to speak out against stigma. Patients in pain and patients with Substance Abuse disorders deserve care and compassion. We applaud your efforts to increase access to treatment in your state. Patients in pain and patients with Substance Use disorders are patients. They are not fakers or junkies or addicts. There are people who need our help. Dehumanizes and demeans. It does nothing to treat and cure. Administrative barriers also do not help treat our patients and its distressing to me when i hear my colleagues say they a patients physical therapy approved or behavioral therapy was denied or arer nonopioid therapies subjected to yearly limits or other administrative barriers. We need to Work Together to ensure policy supports optimal treatment and break down barriers to nonopioid and nonpharmacologic therapies. We need to Work Together to support policy and changes in practice that will have a meaningful impact. Broad nationalut efforts. Last october, i was proud to represent the ama and stand with the president in West Virginia. And commit to achieving several key goals to end this National Epidemic. Onhave a measurable impact increasing the use, to enhance decision education, to increase access to medication, and to increase physician coprescribing of naloxone. We support increased funding for states to enhance their ability to provide Overdose Prevention and treatment. This National Epidemic needs. Ore of this type of commitment we all know money alone will not end this epidemic. The nation Opioid Epidemic is unacceptable. Physicians must not only take responsibility, we welcome that responsibility and we welcome your continued partnership in this effort and thank you for the opportunity for me to be with you today. Mr. Baker thank you very much, dr. Harris. So, dan. Walgreens has already been mentioned. As an innovative player in the space. Would you care to expand . I would love to. Good afternoon. My name is dan lewis, the ional director of affairs Pharmacy Affairs with walgreens. We are talking about solutions. Im happy to talk about what walgreens will do. Its always nice to talk about doing the right thing. Twofold from the pharmacy side. Drug disposal. When medicine is left in the home and a medicine cabinet and forgotten about and a teenager comes in and starts to say lets try some of this, we need to get those out of the medicine cabinet. If someonehing is does have an opioid addiction and faces a problem where they needs to benaloxone readily available to reverse verse that and get the person the help they need immediately before we get them back into treatment. Weare trying to provide what can the pharmacy level, a comprehensive solution to really deal with the fundamental problem of getting the medicine that shouldnt be on the street off the street and when someone does have an adverse reaction, making sure we can put that naloxone in the hands of the caregivers as soon as possible. Stigma most people face coming into your local pharmacy, that is where we are trying to go. We are trying to be that solution. The two key things are the safe Drug Disposals. We will have 500 of these receptacles built into the walgreens in 39 states. The rollout will start on the west coast and we will work or where cross. Work our way across. When you have a group of distinguished governors here and you say 39 states, why not 50 . What is going on . Is today. My ask how can you help us get the 50 states as soon as possible . Some of the hurdles arent big hurdles, its somewhere stuck in epa. We can fix those things with your help and we can take the time to make them happen. We can condense that dramatically if we can Work Together. Without ane prescription will be and 35 states by the end of the year. We have a few states already starting to roll out. With the remaining states. One of the obstacles we face on the naloxone issue is we have to have an arrangement, either a Standing Order with physicians, protocol. Some states dont have that. We need your help to work on that so we can do that. The how fastou things can work. We look and say this requires a waiver. We get the waiver from the state and it says if you want to have a receptacle in your stores, you need to. The waiver but the waiver said it can only be for Law Enforcement like a police station. Community pharmacy wasnt there. Working withe days governors staff and were able to get a new waiver and staff so our process is in place. It went from a state that will probably have a problem to being part of the process. As my wife always says, you know the right time to ask. Why the big issues on naloxone is, a lot of the times and and they rolls out say we want to have a Training Program and we agree but if you used a statebased training know howut we dont effective its being and if , where we timeline have an Online Program already there, we can send it to our pharmacist, electronically record. It expedites the timeline. There was almost 48,000 deaths from overdose. 60 of those were opioid related. This is the plan today, where we are headed. We roll these out over the course of 2016. They want to have a dialogue and conversation about a solution. , again, this is mainly a focus on establishing protocol. If you have one protocol for all pharmacies in the state, you statehave the whole available quickly but it recalls a single protocol. Because there will be states out there who say how do we fix our red to green situation . Relations director of , weput together information will certainly be willing to work with any of you to expedite this process and make sure these two vital programs will be available to all states as soon as possible. Muchaker thank you very and we appreciate your leadership on this issue. That said, i want to give my former colleague and my friend and her dreyfus from message Andrew Dreyfus from massachusetts to talk about what they are doing about this issue in common law. Mr. Dreyfus thank you, governor. I am pleased to be invited back to address the Health Care Committee and this time by my own governor. I know that governors across the country have displayed extraordinary leadership on this issue. Governor eaker has faced this issue with Unusual Energy and conviction. Our neighbor and New Hampshire has brought a Similar Energy to this issue. Im here to speak on behalf of the Blue Cross Blue Shield system and talk about our commitment to this issue but also describe the lessons we thened from the first in nation Breakthrough Program sponsored by Blue Cross Blue Shield of massachusetts. Collectively, the blue system covers 105 million members. Thats one in three americans. We are the only insurer to offer Health Coverage in every zip code in the country. Ties todeveloped deep every local community in america and we know firsthand the devastating toll of this epidemic and thats why we are here today and want to work with you to drive National Awareness and develop solutions that can be implemented nationwide. I will discuss these issues in a bit of detail. First, the blue system lands to tap into our industryleading data capabilities to give the more complete picture of the prevalence of addiction and the impact on the entirety of the Health Care System. Given our vast network, we believe we can offer unique insights. Second, we want to educate americans on the impact opioid use and how to prevent it. We are partnering with abs to produce a documentary that will help people identify the early signs of addiction and how to get help. We will reach millions of americans through national and online distribution. We plan to unite our resources by bringing together our top executives to ensure we are sharing our best practices in reaching our members and their communities. In addition to these national initiatives, individual companies are on the ground in local communities making a difference every day. Shield of blue western new york has a program called painkillers kill time a campaign that increases awareness of painkiller use by providing resources to the medical community and resources a middle including School Curriculum and a 24 7 hotline. Has arida, florida blue Prescription Drug Monitoring Program curbing doctor shopping by asking providers to record when the controlled substance is dispensed. Blue cross blue shield has a comprehensive Care Management program to factor in a wide range of approaches, including inpatient homes. I want to tell you about our planet massachusetts. In 2012, recognizing the thating problem in seeing too often our own members were getting prescriptions inappropriately, we convened a group of experts, physicians, addiction experts, pharmacists to look at the problem. Our goal was to develop an affordable, Accessible Program for pain care but to reduce the risk of addiction and reduce the dev version of Prescription Drugs. The program had a few key features. Opioidfor every time an was prescribed, there should be a treatment when between doctor and patient that considers nonnarcotic treatment options. We ask a Risk Assessment for addiction resigned by the patient. And open with agreement between the patient and the prescriber outlined the expected behavior of both parties. Fourth, we said a single pharmacy chain be identified to use for all opioid prescriptions perhaps most importantly, we put in place a Prior Authorization Program for all new short acting opioid prescriptions and for all acting opioid prescriptions. After three years, leasing the number of opioidbased medications decrease in estimated 21 million doses. Thats 21 million doses. The number was so high after the first year, i asked my team to validate them again and again. Weve seen a 50 drop in longacting opioids and a 25 drop in short acting opioids. Limit to no access on pain for those patients who need them. Our responsibility does not end with reducing the supply of drugs. We are committed to finding new and innovative way to treat our members. We hired an expert in addiction medicine. She works with physicians and other providers in our network as well as our customers and numbers. In 2014, we launched a new program. Those members who have opioid or other addiction issues or other Mental Health problems who choose to participate have traditional and nontraditional treatment and interventions including 24 7 access to a care manager, counseling, living skills training, Family Support groups, copay assistance, and transportation to and from appointments. Where meeting our members they are. Last year, we moved all barriers for Behavioral Health admissions. We believe admission is necessary. Our members will be admitted without any administrative hurdles. , we now contact our members while they are still in the facility to identify care and gaps in their ensure they understand the treatment plans after discharge. Im proud of the work that the blues have done and continue to do so in the areas of Mental Health and Substance Use. We look forward to continuing these efforts in the best interest of our members. Thank you. You, andrew. Ank thank you for your leadership on this. Questions from the governors . Governor shumlin i want to thank all the panelists for their helpful suggestions, comments. Chaired sandoval and i this Committee Last year. We had a very similar conversation. I am encouraged by the bipartisan acknowledgment that it is up to governors to act and make a difference on this issue. We have a huge opportunity. I think theres some reason for hope. This ad has just voted out a bill and will go to the floor. We will get some bipartisan, federal cooperation, some good things. Im interested in the Blue Cross Blue Shield report from Andrew Dreyfus. I would ask my fellow governors this question but i want to preface it by expressing some frustration. We are all doing the same things in our states. We are building out treatment, lifting the veil on the stigma and treating it as a disease instead of a tron, criminal justice reform, getting naloxone so people stop dying in the streets who shouldnt be. We are spending resources. I can tell you from someone who got up there early on this one, my frustration is not that much has changed in vermont and i bet you will find this if you do all the things we are doing, youll find the same frustration. We have to ask the question, why are we here . What has changed in america . Why do we have all these folks addicted to painkillers or heroin or both . I think we are hesitant as elected officials to look at how we got here. I think we have to. How did we get here . What has changed . In congress when i testified recently after three u. S. Senators were working hard on this issue. Two senators said well if we built higher walls on the mexican border, we would keep out of the drug dealers that are burning in this cheap heroin. My response was we have had drug dealers on our borders for as long as ive been alive and we probably always will unfortunately. But what has changed . Why are they doing so well when they really werent able to sell heroin in these quantities 20 years ago . Lets answer the question. The drug dealers on the south american border that our biggest challenge. They are a big problem but it is our drug dealers that are fda approved selling this stuff in every pharmacy in america. There isnt a governor here that doesnt know that. I started looking at the history of this. In the 1990s when the fda approved oxycontin, we have to remember im supposed that it to our medical community that the manufacturer of oxycontin told doctorsiders nurses, across america we finally have a nonaddictive painkiller. What a dream. Started passing it out and a lot of folks got on it and became addicted and i think a lot of providers started going this doesnt seem to be working out right. This is the history we dont talk about much but purdue and the manufacturer was taken to court. Three other executives were charged with lying to physicians that they had information that this was addictive but told vermonters it wasnt. They paid a 70 million fine. No one went to jail. Worth of 11 billion painkillers that same year. Math is tough for some that last time i checked, theres 1000 million in one billion. My point is we all talk about how we can spend more resources fixing the problem and we arent willing enough to look at the global challenge. In 2010, we prescribed enough oxycontin in america to keep every adult in america high for a month. Sold 250 million prescriptions of oxycontin. 250 millionn have people in america. The fda just recently and i say the fda is part of our hydro a they approved couple of years ago, which is oxycontin on steroids. You can shoot it, snorted. Snort it. Its important to note there are the 13 Member Advisory Panel voted 113 do not approve hydro because it will be a bigger problem in oxycontin but they did it anyway. Approved, they oxycontin for kids. You cant make this stuff up. I i get i will ask this question. If we know the Blue Cross Blue Shield program in massachusetts is working, why wouldnt we say andgovernors to the Human Health Services committee here, lets figure out what the protocols are. In my state of the state, i said lets limit for minor procedures in vermont the number of outkillers but you can pass to 10 and if you need more, he will get more. Im not a doctor, i shouldnt be doing this stuff but im trying to start a conversation. Similar baker did a thing in massachusetts. All my doctors come out and say what is this governor talking about . We have people with chronic pain. What does he know . I can say i plead guilty but you are doing such a good job of it with your medical degrees. Prescriptions in a year. I dont need to be a doctor to know that is not ok. People in america that die every day from this. Guy that put a bomb in his boot and got on a plane and it didnt go off and we started taking our shoes off in the airport. Millions of people take their shoes off because of this one guy. If this was a terrorist threat, imagine what we would be doing. Imt we as governors going to the comments of governor bevans in kentucky. We probably dont agree on anything politically is my guess and fairness. [laughter] shumlin but we agree on this stuff. We need help and the Human Service committee in a bipartisan spirit will put together the prescribing protocols that we recommend for all 50 states. Figure it out. Lets come up with a suggested list of protocols and as governors, lets drive them through our states so we go after the source, the root of the problem that led us into this crisis. Until we do that, they will be a huge resistance. We have a lot of friends with us. If i asked them to race raise your hand if youre working for a drugrelated company. Just out of curiosity. How many . See. They are concerned. They are good. They want to help us. If we can enlist them to take on this problem, we can solve it. We can build Treatment Centers for the rest of our lives, get all the naloxone and buy up more. We can change attitudes. If you are going to get hooked on this stuff and we know how we pass it out, like candy. And you know you can get a cheaper form, which is heroine, people are going to keep doing that because its such an addictive drug. Responsibility, lets take three weeks and come up with protocols. Governors we are going back to our states and we will say we will get a lot of hits for it. Got on vermont radio right away. What does he know . We have people with chronic pain. Of course we do. No one links someone in chronic pain thanks someone in chronic pain should be in chronic pain. So lets do it together. Im asking members of this panel, how could we put together a list of prescribing protocols we could all embrace that would make a difference instead of dancing around this . I go backnemy to the beautiful comments of joanne peterson. Ive heard more stories like hers and so have we all. You know what we do . Thats so heartwrenching in the so afraid heartwrenching, so horrid. Here. E pressure is a few years ago, the combined pharmaceutical industry spent 235,000 per member of congress lobbying for their views. Sorry, 435,000. If governors can say listen, we are above that and we will come up with protocols and make a difference. Do we want to do it . Do we have the courage, the heart to do it . [applause] thank you, peter, and thank you to all our presenters. Im sure dr. Harris would probably want to engage with us on how you reach of that. I too propose we had a standard for emergency room prescribing that would be five Business Days worth and then you have to go to your physician. It got a lot of pushback. I would note there is the other business interest of looking at this, which is the dealers. When i learned things from my Law Enforcement, who have been and often in small places, they will respond to overdoses of people they know and sometimes the same person who has overdosed multiple times. Our First Responders have been extraordinary and getting up to speed. What they tell me if the drug areers target states that outliers for opioid medicaltions, where the data shows a lot of doses are prescribed in a particular state. Thats where the drug dealers go because they know that those patients will become perhaps heroine buyers later. So, this is a confluence of interest that is powerful and we need a multipronged response to. The one other comment i wanted to make, which is not directly related to that but im so pleased to hear of everything walgreens is doing. Other pharmacies in my state. Right aid in New Hampshire is doing the standing prescriptions so any Family Member can go in to a rite aid in New Hampshire and get narcan. I know cbs is doing a lot of work on patterns of prescribing that is important. Is doing a lot of work on patterns of prescribing that is important. Mr. Baker the motion on the floor from governor shumlin would be that the health and Human Service committee produced shortly a set of protocols of off perhaps the Blue Cross Blue Shield model with input from others for ratification by the guidelinesin place around opioid prescribers. Governor shumlin well said. The motion is on the floor. Discussion is open. I want to make one point to follow up on governor shumlins comments. The u. S. Represents 5 of the World Population and consumes 80 of the worlds opioids. There is something fundamentally flawed with everything i know about this issue. We have been pursuing a bipartisan basis a series of reform initiatives to deal with the front end, which is what governor shumlin. Its pretty broad and comprehensive. Sore trying to do something you dont have to do it all on behalf of the rest of us. Thats the motion. Interested in further discussion. Im sorry i ducked out but it sounds back something we are back. This isnt a game. There is literally not enough withyer money to deal joannes 23 locations. It isnt enough. There is literally not enough money to come along and clean up the mess. We have to find the source of the problem and address it and the problem is many headed. There is a big difference between sympathy and empathy. Sympathy is when we hear a story like this and maybe not of us have personally experienced it and we feel sorry for her and our stat and moved to but its quickly fleeting. We have to be empathetic and increasingly, its affecting the lives of people in this room and beyond because it knows no boundaries, no party. It transcends partisanship. We have to get to the root cause of it. To askre not willing ourselves why, there will be 1000 good reasons why somebody would have an issue with what im about to ask that why do we prescribed opioids over the counter . If we are to willing to ask ourselves that question and have a frank conversation with people who are medically qualified to sit around the table and have an honest discussion about it, we are never going to get to the root of the problem. Its economic. Lets not kid ourselves. There are two sides to that. Its Economic Issues that cause people to find themselves moving down a path of addiction. Its a desire for certain things economically that cause her to and things to be put out there. The way with the way the system works. I will reiterate one thing. The solution will have to involve the people who develop, sell, profit from, and approve these drugs. It has to. Speaking for myself also as a nondoctor, we do have a play pulpit. We have a certain amount of authority, and ability to move the needle of discussion. We need qualified, thoughtful, trained people to sit down with us and have an honest dialogue about what we are doing in america, to america, and what we will do for the future of america. Because we are losing not only one generation, we are losing a second generation. Alone. Speak for kentucky there used to be there were grandparents try to raise their grandchildren. Those same people are trying to raise their greatgrandchildren. We cannot afford to lose two generations. This will require even more it would kill me as you said two years ago, shame on us, ifryone of us, shame on us those of us who are in a position to do something about it find ourselves sitting here two years from now or even a year from now having this same conversation. Mr. Baker thank you, governor. Ms. Anderson. Addington,to virginia for the sentencing of the three executives of purdue and back again, a mother stood up and she had her sons ashes in a small casing and she held them up and said it took me 11 years to conceive this child and your company one year to take him out. Everybody back then, that was there outside it was sea of people a with pictures of their dead children outside in the rain and it was the most horrifying days ive ever had. Saying that been that this is an epidemic. This was 2007. It just grows and grows and i agree with you, there arehumlin, that so much work being done, which is excellent. We are all doing so much work. There are so many families coming forward and getting involved and advocating but the bottomline is that there are other things that need to be seriously looked at. , we aren norfork county involved in the district a lot of the unintended debts are not only all of and heroine, its these other pills that are being prescribed. A lot of times, people dont even know. Theyre are just taking them. They send them home to their parents with these prescriptions and they are giving them to them. Those are a lot of the deaths as well, mixing the drug. I just think it would be nice if. Verybody came together i had been in a minor car accident with a friend and we went to an emergency room and the first thing they did was write me a prescription for oxycontin. I had to say no three times. Said right out in front of my friend. This is the good stuff. I couldnt believe it and of course, my friend had something to say about it. Say i had to say we dont need that drug. And dont think it is even the fault of the doctors, i think you probably really believed i would be in pain the next day but i had to say no repeatedly and i did not fill that prescription and thats something that really seriously needs to be looked at. Many parents when they bring their kids to Emergency Rooms and they go home with that prescription, sometimes they dont even know what an opiate is. Tore has to be education your normal citizen that might end up in the emergency room to if they are inbe recovery from alcoholism or something. You can have aat prescription for percocet might trigger something. There has to be education. I think the key to making this thing work is not to vilify anybody. What has been done has been done legally. Many people can look in the rearview mere and reinterpret this however they want. We can try to retroactively apply current thinking and current ideas to whatever had been the case in the past and every one of us will lose if we do that. To put cards on the table and people have to look at it by looking out the windshield and not the rearview mirror. There have been several times already lord knows our state was on the receiving end of a sit from a particular company mentioned several times. We cannot do vilify people at this point. Lets find solutions and go forward. Lets figure out the cause and find the solution. The same companies we will book to vilify for this issue are the same companies who have done things that frankly have made this the greatest nation on earth to live in, who have made Pain Management and medical treatment like it is nowhere else on earth to do better. Frankly, there are people funding so much of this event and things like it. Lets be honest. We need to not vilify or make enemies of people but all of us sit down and come up with a frank solution. Before you run, i would like a vote on governor shumlins motion. To repeat it, i will do the best i can. Chairman, im not a member of the committee but i would support it if it comes before the rest of the body. Mr. Baker all those in favor of governor shumlins motion say aye. Have it. My goal will be to put this in front of the mga and iowa in front of august and get it approved. Meantime, we will work on putting it together and make sure we can better amongst ourselves. I want to thank our panelists that came here today for engaging and prompting this very helpful discussion. I didnt want to end the discussion given our motion without noting that some of the pressure on our medical opioidsy to prescribe for Pain Management has to do with the fact that it is very hard for some of their patients. O get to treatment we have areas of our country where it is very hard for somebody who has had a workplace injury, a farm injury to get to a provider or get to physical therapy. We have an access to Health Care Issue in this country that makes Pain Management outside of prescription practice difficult. Shouldnt doay we i just voted for the motion peter made. Its a reminder that this is also a symptom of a country that has very uneven access to health care and something i think we all need to continue to work on. Thank you. That should be part of the recommendation. Again, dr. Harris, gillian joanne, michael, andrew, thank you for your presence and participation and leadership on this issue and take you to the committee and we look forward to having a proposal we can take to the board in july. Thank you. [applause]