Transcripts For CSPAN State Efforts On Prescription Drug Abuse 20140223

The first president of the United States, obama, got his start by beating Hillary Clinton in iowa. George w. Bush is another one. The last two president s of the United States launched their campaign in iowa very effectively. In the first halfhour we focused on the issue of medical marijuana. One of our viewers, from vivian host do you have a stand on this issue . Guest we do not have it. A bill was introduced in the legislature, but it was not met. It failed to meet the first final deadline. It will not be debated this year in iowa. Host mike is joining us from muscatine, iowa. Guest good morning. Regarding caller good morning, regarding medical marijuana, my son had a brain hemorrhage when he was 16. Host i am sucked guest i am sorry to hear that. The hospital did a great job of saving his life, basically. Within six months after the surgery he developed epilepsy. We have just had a continuous of all different kinds of medications to try to resolve his epilepsy. We finally found something that worked, but it has a side effect of rage, anger, and depression. Then you have to give him antidepressants. Those dont work. Those have terrible side effects. The only thing that really works for him is marijuana, and it works great. Unfortunately he cannot get it in the state. We go right across the river and get it legally. Do you have anybody in your family that has a medical epilepsy, that marijuana relieves . I do not, but the mayor of West Des Moines does have a Family Member there. There was an article about this in the register. I have heard this. Obviously i was a president at des moines university, a medical school. But i do not know all the details of these kinds of conditions. I do feel for your son and for your family. Like anybody, you want to try to do what is best for your Family Member when you have this kind of situation. Back to the issue of health care and your interaction with Kathleen Sebelius and the president as well, do you find that the white house is flexible in the implementation of the Affordable Care act . Giving you the flexibility you are looking for for implementation . To fight for had everything. It was very frustrating. We kept them informed, i met but hhselius early, dragged their feet. Hadhought we should have the waiver before the first of october and of course we did not get it until december 23. We have never been able to get to the information, the people signed up on their website, that has been a total disaster. We have tried to do the best we can, but it is rate frustrating. We have worked and negotiated with them in good faith, but we have not felt that we got the cooperation that we deserved. I have spoken to a lot of other governors and there is a general feeling among the governors that this whole process of waivers is very slow, difficult, cumbersome , some states have gotten waivers, others have been denied waivers for similar requests. Host daytona beach, florida, good morning. Governor, i have studied ethanol for some years. For every dollar that you put into producing switchgrass, unit nine dollars in energy back. For every dollar that you put get 1. 30 inu only energy back. It takes an enormous amount of water to make ethanol. I think you are going on the wrong track with ethanol. It damages our cars. Guest does it . We havent all are just doing it for your own benefit in iowa. Say this. Me just we are now going to the next generation, cellulosic ethanol. You mentioned switchgrass. You can make that. That is the stocks, the cobs and things that are left over after the corn kernels. There are a lot of things that can be done. I think the Renewable Fuels have a bright future. All you need is a flexible fuel vehicle and you can use any amount of ethanol. Brazil has completely eliminated their dependency on foreign oil. They use ethanol very effectively. They make it from sugarcane more now from the National Governors Association Meeting with the problems of scripture and drug use abuse in the oftes the problems scripture and drug abuse in the states. Governor regally able to prescribe narcotics [laughter] the knowledge to do that yet. I resent the implication. [laughter] ll seriousness, they do great work. They worked with seven states to develop a strategic action plan and some of the best practices for states. They will send share some of their findings. Governornt to thank beebe for joining us as well. Thank you. Thank you for the great work youre doing chairing the committee. Is is an issue we all know affects all of us trade this is not just facing vermont, but every single state is facing in one way or another. Have dedicated my entire state of the state to the challenge we are facing with opiate addiction. Theas been writing about speech, but continued to say that i never would have given it. Im glad you did. [laughter] thank you for the endorsement. I can tell you what is happening in for mott, and i know we are all facing this challenge together. A 777 increase in 250 addiction, and a increase in heroin addiction. Whatis the beginning of can turn into heroin addiction. To do as lots of work governors to talk about how to face this challenge, and how we do it more effectively. I sometimes find that when we talk about it is that if oaks wonder why it is so important to governors. Governorsrtant to because, first of all, we know that those who convicted to have a lifelong challenge, a lifelong battle that they face. That destroys their lives. When they talk to their mom, dad, brothers, sisters, it you will find out it is rice family lights. And from the taxpayer standpoint, it destroys your pocketbooks. It dries converse or a she, and vermont is an example, we have seen our corrections budget double in the last nine years. We are now spending more on and we are in education onrections then we are education. The taxpayers have a real interest in getting this one right. Ommon would say our rockc humanity as a common interest. More people become productive members of our work force. That is what this is all about. I want to thank the governor for his leadership in helping us to address this as the healthcare crisis that it is. I look forward to the panels discussion Going Forward in the session that we will discuss today. Thew understand that governor from colorado and from alabama have done great work on the presentation that were about to hear, i year to the great governor from alabama yields to the great governor from alabama. Thank you. Thank you for serving with me as cochairman of this particular study that we have done within the states. Isscription drug abuse devastating to our communities across the country. To grasp this growing Public Health crisis is a key priority to governors. To reduce misuse and abuse, nga drug academy in 2012, which i had the privilege of leading with john hickenlooper. States, including alabama, colorado, arkansas, new mexico, oregona, and organ developed comprehensive or donated strategic action plans for reducing Prescription Drug abuse. The policy academy focused on Six Strategies in particular. Number one, making better use of Prescription Drug Monitoring Programs known as pdmps. Number two, enhancing enforcement coordinating operations, providing specialized training and strengthening existing laws. Number three, ensuring the proper disposal of Prescription Drugs. Number four, and leveraging the state as regulators and purchasers of health care services. Elting partnerships among key stakeholders, and pull toix, using our promote Public Education about Prescription Drug abuse. Both health and Law Enforcement approaches, states can restrict access to Prescription Drugs for illicit use, but we must ensure access for those who legitimately need it. States have begun to take significant steps, and they have done the following things. They have passed legislation, they have developed Public Awareness campaigns, they have conducted trainings for providers. Agencyve started cross and regional initiatives, and they also have formed partnerships with universities and the private sector. Alabama has the highest drug ugerdose has the 26th dry overdose mortality rate in the United States. According to the cdc in 2012, alabama had one of the highest rates of scripture and painkillers of scriptur prescription painkillers per thousand people. Nationally, rates have doubled in 29 states in 1999, and quadrupled in four of the states. They have tripled in 10 more. Since the conclusion of the policy academy, we have undertaken three significant long legislative nonlegislative endeavors in alabama. First, we applied for, and are in the process of receiving a grant to support a Prescription Drug abuse prevention Media Campaign. Once fully implemented, we anticipated this grant will allow us to conduct a statewide Media Campaign on the a drug abuse, misuse, and divergence. Want to educate alabamas legislators about the benefits of current Prescription Drug abuse legislation and potential benefits of expanded legislation. We want to develop and distribute materials and all of our school district. We want to present current information about Prescription Drug abuse in at least three statewide conferences or professional mediums and we should be at clipped to analyze and measure the efficiency and measure them against alabamas efforts to this initiative. Secondly, alabamas board of ethical examiners approved a regulation change requiring state licensed paying prescribers, that includes me, to register for the Prescription Drug Monitoring Program. This change is important because forill increase importance good doctors to become aware of patients abusing Prescription Drugs. We have also developed a Marketing Tool for alabama that will highlight the need for prevention and the efforts of the nga policy academy and garner the support of private sector partners. This toolkit will show individuals and groups how they can support our prevention efforts through funding, collaboration, and resource sharing. We took legislative action recently to address this issue as well. Ande bills were passed approved by the legislature and i signed them into law. First was the Prescription Drug abuse the virgins package that Prescription Drug Monitoring Program bill which clarifies language for the board of medical examiners to regulate the use of a Monitoring Program individuals who receive controlled substances and the names of the medical professionals who prescribed them. Designate can now members of their staff to access. He database on their behalf this also grants the Medicaid Agency the ability to access the database and check Prescription Drug abuse by people enrolled in medicaid. The Pain Management bill, the second bill, increases the regulation of Pain Management clinics where drugs are prescribed for chronic, nonmalignant pain. It also gives the alabama board of medical examiners subpoena power to investigate those clinics when needed. To operate those clinics, one must have a medical director who is a physician licensed in alabama. Clinics providing Pain Management service must divide Pain Management registration from the board. With certain exceptions, this bill requires clinics for Pain Management services be licensed in alabama or by businesses registered with the secretary of state. Passed a piece of legislation and i signed it into law that we call the doctor shopping bill. It establishes a criminal penalty for patients who doctor shop for Prescription Drugs. The bill makes it a crime for patients to get Prescription Drugs by deceptively stealing from a doctor he or she had received the same or similar Prescription Drugs from another physician during a concurrent time. Is anvicted, the offense class a misdemeanor, which is punishable by up to one year in jail. If the patient is convicted four times in five years, the offense becomes a class c felony punishable by up to 10 years in jail. Addition, the office of Prosecution Services and the alabama District Attorneys Office with the assistance of several of our other state agencies will continue to educate legislators, physicians, and the public on the benefits of maintaining and extending and upgrading these laws. Under therly physicians direction, pain relievers and other Prescription Drugs bring muchneeded comfort to Many Americans will stop their abuse is a serious and growing threat. As a physician and as a governor, i understand the importance of fighting Prescription Drug abuse will stop these were designed to help us address this problem while also protecting the rights of patients. For myto thank you again opportunity to be here and be on this discussion today and to tell you the experience we have had in alabama and the work we have had through this policy academy. I look forward to any policies that may follow this discussion. Thank you dr. Governor. Governor hickenlooper . Think you as well, dr. Governor. Its like a major major or dr. Dr. [laughter] you, governor bentley, for your leadership and hard work. Thank you for putting the time and effort into this committee. Did tell you im not sure i would have had the guts to give an entire state of the state speech about an epidemic of addiction and overdoses and suicides. I thought it took a great deal of courage and i talk about all the time. Governorrd from bentley, this was designed for each state to develop date wide coordinated action plans to reduce Prescription Drug abuse. Some of the common lessons came out again and again and are highlighted in a brief that the nga is releasing today titled reducing Prescription Drug abuse, Lessons Learned from and nga policy academy. A simple a stimulating title, but still worth reading. About somee to talk of the lessons we can use and go over the six key lessons governor bentley described and then lay out some of the Different Things the states are doing. As is true for many statewide initiatives, leadership matters. It is the leadership of our in thisy and leaders case, the medical community, to step up, take responsibility, and be willing to be part of a solution. We set the Public Health and safety agenda, but we need their support to make sure we can ensure accountability and coordination and get objectives achieved. Focus onon, we need to changing prescribing behavior, and other words, how doctors are prescribing medicine. One example here is our colleague in oregon partnered with their universities to train prescribers on effectively managing chronic pain, this means creating protocols so you are not overprescribing. I was at the dentist and probably too much information, but i had a root canal. Forcinge literally opioids on me and i said i dont need any. Its going to be fine. But there has to be a lot more intentionality about how our entire medical profession uses painkillers. In kentucky, the Governors Team develops training courses to meet continually continuing a medication requirements, another good idea. In addition to that training in leadership, disposal is a key and we need to ensure it is both convenient and cost effective. One of the statistics i had no idea of knowing and had never heard before was people abusing Prescription Drugs, 75 are taking drugs prescribed to somebody else. That is very sobering. One of theter reasons i said i didnt need prescriptions was because i had some from a couple of years ago. Dr. Bentley is going to grace the fact that those pharmaceuticals would still be effective, but i went home and had three different prescriptions sitting up in my closet lock box that i obviously had not looked at and it wasnt paying attention to. We had to take the time and look at that. We have specific days where you can bring your excess prescriptions and get them safely disposed of but we have to figure out a way for that to be done more frequently and so people are aware of it. In arkansas, the governor expanded drug collection gaveghout the state and priority to the parts of the state that did not have them. Thing everykind of state should be taking. We need to increase the Prescription Drug Monitoring Program. Begin with a one Governor Campaign against acronyms. Pbm not going to call them ors because i can never can member what they are called but Prescription Drug Monitoring Programs arent effective tool for collecting and analyzing prescription data. It is a mouthful. Thell just call it Monitoring Program. With connect virginia, the Health Information exchange, they use that database to help monitor Prescription Drugs. 17 other states are part of an effort to begin sharing data which leads lines, to a surprisingly high amount of abuse. In the policytes academy are promoting greater awareness about the dangers of Prescription Drugs. In alabama,tley they had a program which i was very impressed by where they had all ages and demographic groups and used billboards, tv, cable, social media and did an integrated some a coordinated campaign. Treatment is essential. We need to think through how to use our limited resources and target highrisk occupations, but there are clear studies that show if you are going to limit opioid use, there is the potential that you are going to lead to an increase in heroin use. Heroin is cheaper and in some places, more accessible. Finally, in order to accomplish all of this, states need to ensure they have access to immediate and timely data to be able to drive policy decisions and evaluate the work in realtime. All of these are important lessons as we continue to work. I encourage you to read the issue brief. Of i will take a couple minutes to say a little more about what we are doing in colorado. Academy we had one meeting in colorado and once our meeting,ted the policy we ran it by our colorado experts and tried to recruit their best inking. We did not have the information at that time, but we were ranked the comments here say we were ranked number two worse. Someone is doing a good job trying to obscure what we were saying. We were 49 in terms of Prescription Drug abuse will stop we found out after we convened the group that we had 200 experts from state agencies who try to get every system impacted and got our medical society on board. We travel is we accomplish goals in key areas, Prescription Drug Monitoring Program on the data surveillance and treatment. The second meeting, we brought in National Experts and had nga staff help us prioritize what we could get done in a year. Tocreated the colorado plan reduce Prescription Drug abuse and partnered with our medical, pharmacy and working schools in colorado, our Colorado School of Public Health to house a plan. This became the consortium to prevent Prescription Drug abuse. Fundsave already raised to support the work with our Good Relationship with the Attorney Generals Office and had a large settlement of restriction drug litigation. We were able to leverage a Million Dollars in Public Awareness fund will stop we had two pieces of pending legislation directly related to reducing Prescription Drug abuse. Prescription drug enhancement bill will align our monti are Monitoring Program we had a program that was killed. Every time we set regulations in colorado, we kill them and they sunset out. Privacy legislators had concerns and issues. A small group of pharmacists and nurses wanted to bring it back but it was a barebones project. This is not an easy policy change in colorado. We had to make sure we had the timewhile at the same protecting hip of privacy law. The Prescription Drug monitoring tasks tows delegating register delegates and provide notifyited reports to pharmacies and prescribers of potential problems and requires Monitoring Program registration but not mandatory use. It allows us to use the program data for Health Care Coordination and requires daily uploading of data from pharmacies to the monitoring which is a change of some significance. The House Administration take back bill the title is not my it establishesp a program to take back and dispose of unused medications, it is not as robust as what the governor has but i think we will get there within the next year. To finalizeagency rules to take back controlled substances. This bill creates the necessary infrastructure for a permanent take back. We have had some significant outcomes in the last several years. Colorado has gone from number two worst, 49th up to number 16 worst, which really would say 35th. 40 92 35th is a pretty good jump in 18 months or in one year. And ouraced on the data approach like any state was the front and we try to try the best things to get the greatest returns on. Inclusive of many stakeholder groups and in many cases did not get exactly what they felt was best. We got a program everybody brought it every buddy bought into. The program name came from three things getting broad stakeholder agreement, compromise, and getting leadership from our medical communities, having them take a strong role. Problem required a coordinated approach will stop when you get to this level of challenge. There is a lot of work still to go. We still have a high rate of overdose deaths. Our treatment capacity is relatively low compared to other states. We see a rise in heroin use coming as a result of people getting introduced to opioid and Prescription Drug abuse. I think we will continue to create the infrastructure and support that this work can be sustainable and have maximum impact. I look forward to discussing the challenges the other governors are seeing in their states around Prescription Drug abuse and around potential solutions as well. Thank you for that chance to speak. I would like to welcome chair alan. I would like to turn this into a freeflowing discussion. Let me ask you to put your doctor hat back on and help us understand when governor hickenlooper said 75 are described to someone else, help us understand what is going on. From a the root problem doctors perspective. Ofi really think education prescribers is essential. Whether it be dentists, physicians, vegetarians, anyone who has the ability to have this car right here, which is the key that unlocks the prescription for all narcotics will stop all narcotics. It is very important we do these type of Education Programs in the school and double school and veterinary school. There are some who art ors practitioners who could prescribe certain types of narcotics but education is key the ones who prescribed the drugs, thats the key that unlocks everything. Imwas in practice governor right now, so i cant practice medicine, but when i was in practice, one of the things i never did was i never printed my dea number and state narcotics number on my prescription pads. Many will have it printed on their prescription pads all thought thats the key that unlocks everything because that prescription pad could be very easily forged and narcotics could be obtained will stop i would always handwrite my prescription number. Thats just a simple thing so if youre prescription pad is stolen, they cannot use the key that unlocks the prescriptions. I guess what i cant understand is how anybody smart enough to have one of those cards doesnt already grasp the problem. What is missing . Wax i really think what is missing is spending time with patients and thinking through the process of how you prescribed evocations, whether it be narcotics or antibiotics, whatever it may be. Is a lack of attention and i its a say this, but lack of attention on the part of prescribers on how you handle that patient. Patienteed to give a 100 more tab 10 . There is no one that needs that. Except there are a few situations like in our pain clinics and by the way, we need to make sure pain clinics and we have an alabama make sure they are regulated and which are they are truly staffed by those specializing in Pain Management. I think it is just the fact that some prescribers just dont think rationally when you are giving this very dangerous drug. Was taking you would use your ho your whole state of the state determined to devote to a single issue and i was also surprised that vermont would have that kind of problem. If you asked me to pick the states, i would not have picked vermont. Help us understand whats going on there. I think he goes to it governor bentley just said. Let me be clear. The problem in vermont is no worse than it is in the 49 states, but one of the differences is we are unaccustomed to it in vermont all stop therefore we want to find a way to deal with it better. But lets be candid about this. And the fdaoved approved oxycontin, we approved opiates in pill form. Lets just get right down to it. Reason we have seen a 750 increase since 2000 is because thats just about when the fda approved oxycontin. As governor bentley just pointed out, there are providers who are asked for nearly responsible and there are as many who are not as responsible who in the words of alan greenspan, perhaps step out with irrational exuberance and we are paying for it. Heres the problem in vermont. Forget our hearts for a minute and just think about our this ise math and how functioning on the street. I talk to more vermont kids and moms and dads who had their kids or whoever we talked about opiate addiction, people think its a low income problem. I hate to pop the bubble, its and everybody problem. Every background, every race, every Political Party here is the challenge. The economics of this in my state or click this you get a date did to oxycontin or other opiates that are fda approved. Right now, if you are addicted, you can buy a pill of oxycontin for 80 a pill will stop you can buy a bag of heroin for 20. 20 for a bag of heroin is a lot of money. In can grab that same bag new york or boston for five or six dollars a bag. This extraordinary economic incentive for folks living south of us to bring the stuff to vermont because the return on investment is better than anyone is making in this room. That is how the economics work. For the addict, it is still cheaper to shoot heroin. Thats the right and chilled dynamic. Lets go to the human element. This is everybody. Yes, if theres someone like Philip Seymour hoffman who we all respect and admire and wish you were still on this earth, but ive got hundreds of philip in vermont whos are equally compelling will stop we tend as a society to think about heroin addiction and opiate addiction as less sympathetic than we would in other diseases. To be candid about this. If your mom or dad Smoke Cigarettes or get cancer, we dont say are we really going to help them out . We are going to invest lots of healthcare dollars to get them better . And care about them. They may not have made the dontst choice, but we necessarily bring the same compassion and approach to this disease. And it is a disease. What i try to do in vermont is brought together my health care providers, my judiciary, my social workers, my prevention we talked to them all and its helpful. Justthing the governor mention here registries and educating doctors to stop passing out five of these that make your patient come back and get more, dont pass out 80 of them. We are all trying to that, but its not going to be enough. The next ordinary addictive drug. You get into this one and you are sentenced to a lifetime struggle that is debilitating him a destructive, destroying, awful future. That is what it is. It is an awful disease to get. Once you get it, you got to feed it. Heres the challenge i have learned opiate addicts are the best myers and the best liars you will ever meet all stop they just want to keep using. Thats what this disease comes to. They will steal from the moms and dads, their own families, they will destroy their families and their lives just to get the stuff. Gettingis our chance of them into recovery as opposed to the person suffering from cancer . There is a problem theres a very small window to actually move folks into recovery. The most likely chance you have when they are actually going to stop the denial is when they have hot about. Lights are the blue flashing and Law Enforcement has done their work and they are down and out. This is a problem in vermont i have a huge waiting list for folks who want opiate treatment. Even if you are at the point reason have autumn out and i want to build a better life, im saying to folks and other folks have this challenge, im sorry, you got to wait. I talked to when get from a great farm family, 10th grade at goes to school and his friends offer him and oxycontin during an exam. He takes it and became an addict hard, fast and long. 20e years later, hes ripped grand off from his own family. Theyre mad and upset that they should be helping him get better. His mom finally gets to the point where he wants treatment, he she calls my Treatment Center and says the Treatment Center says is easy was i will. Shes an honest mom and said no. She said sorry, weve got a waiting list if he is not suicidal. So shes smart and picks up the phone and says my son is suicidal and got him in. Now hes varied and has two beautiful kids and is working on the farm and in recovery and continues to be in recovery successfully. Waiting listsat do not work. I invested the dollars to clear my waiting list. Second problem when we bust these folks and they bottom out, thats when you most likely to get them in treatment. Our judicial system is working against them. Why . If your state is like mine, it can take three months or four months between a moment of crisis and the point that they come before the judge and say im here and ready. Thehen, they are back on streets, theyre back in denial, back ripping my taxpayers off to support that habit, all the terrible things we did not want them to do, their back and running up more charges and creating more misery and grief for everybody. So what we have done is we are about to change our entire approach to this all stop our prosecutors will have the authorities to immediately blue lights flashing, immediately yet a third party assessment, does someone we should be scared of . If so, theyre going into the clinker. Or is this someone we should be mad at or disappointed in but hope for recovery. If it is a yes on that, we will say to them listen, weve got treatment, weve got wraparound services, Mental Health and job training. Weve got all the other things and were going to get that to you now. If you succeed and recover never seely, you will a judge and never have a criminal record. In thinkinga change about how you approach this. One, andu win at that spending 50,000 a year locking it costs me 123 a week to put them in a most extraordinary treatment row gram you will ever see. Those are some of the things were doing. Weve got to outthink how were doing it. We are losing the battle. Its a winnable battle and one thing governors need to do is Start Talking about it because no one wants to talk about it. I keep saying we are perfectly willing to politely avert our eyes to this crisis on main street and then we fight and fear Treatment Centers in our backyard all stop weve got to do better. The best ideas or thoughts you have its everyones problem. Thoughts yous or have or stats you have already taken. I will throw that open to the whole group. Governor, im a little unclear as to the source. Source for primary these ascription drugs. Are these from medical prescribers over prescribing or is it a secondary market . Is it patients or individuals who are unlawfully acquiring the drugs via a legitimate medal provider . Fax i think you put it in the right hon logical order. It is doctors overprescribing. Then the secondary market develops and people acquire it illegally. You talk about that and the purpose of this academy and i dont i know i cant accept especially because of the , but itte discussion just seems logical that you would go to the medical providers and make it part of their annual education. It seems very simplistic to say dont overprescribing terms of the number. Circumspect ase to who you are providing this for. I dont want to use governor hickenloopers example but why are we prescribing so much that individuals have 2, 3, four bottles sitting in their shelves . I think it goes several ways. I think it is lack of education and taking inking through the process that has to be addressed from the prescribers standpoint. It has to be that because the prescribers are the only ones who can legitimately prescribe these medications postop there may be pharmacists out there dispensing them and shouldnt obviously physicians, dentists, nurses right fishers, whoever has the ability to prescribe the narcotics, you are the first one who has that key that unlocks these Prescription Drugs. We are talking about Prescription Drug abuse here, which may lead to illegal drug abuse. Educate and i dont believe we are doing a very good job. Ourur training programs, nursing schools, everyone related to medication who has that ability to give medication, i dont think we are doing a very good job. We get too many of these particular type of medications and then some of that medication is left. Children are able to get those out of the cabinet just like governor hickenlooper said. He has some of these in his house right now. You should have never said that. [laughter] it needs to be education on the part of those who receive the medication, and once you receive them, you need to destroy them and get rid of them. Education lot of going on here. In alabama, we passed laws on dr. Shopping and all of this, is exactlyr shumlin right this is a disease. Once it becomes addictive, we need to treat it as a disease and if we can treat this problem as a disease, we will have a lot less people in prison. If we can rehabilitate some of these individuals, then we certainly need to that. It all still goes back that even the cost of health care and the prescription of these drugs still goes back to those who have the ability to prescribe them. I think education is so important and i dont think we are doing a very good job of that right now. I know we need to improve that in alabama and all parts of the country. I can tell you its the most important thing we can do right now. Oxycontin, why would you give it when some lesser pain medication will do the same thing . Ive never written for it in all my life and i have actos 35 i usually dont even give a narcotic. I just tell them its not going to hurt. [laughter] i dont want him for my doctor. If you wrap the incision very tightly, it wont hurt. It still goes back to education. That is the first thing. Governor bentley hit it on the head. Theres nothing i can add to that except a problem i have is a border state candidate. The manufacturer of oxycontin has changed the hill formula so that now when you crush it, you cant abuse it the way you used to. It turns to a gel which makes it orh more difficult to snort shoot it through a needle. It turns into jelly that cannot be pulled up in a syringe. Our challenges is that canada has not adopted that policy. The governor has a letter i hope we can get kind just on a bipartisan basis that has the National Governors association urging the canadian government to please adopt the same policies so that you can no longer as easily abuse it. Ofare having an influx crushable, snort a bowl polls from the north where the formulary changes have not been adopted. I appreciate your work on this issue because advocates wouldve the most important issues. Big issues i would like to see a show of hands of people who have known someone or have a coworker or relative or just an acquaintance or friend that has some type of Prescription Drug abuse in this audience . Anybody known anybody . Itre are a lot of us and strikes all stratas of economics, races, religions, wealth levels, what ever, professional level, when this issue of Prescription Drug abuse, which in oklahoma, we have a terrible problem of Prescription Drugs kill more people than regular drugs in the state of oklahoma. When i look at the paroles that come across my desk and different offenses, maybe as robbery, assault and battery, no matter what it might be, there is typically a drug offense in there. If you look at the people who drop out of high school, people in poverty, people that are homeless, theres a whole societal effect on drug abuse within our society that i think this issue is such a big issue not only for our state but for our nation that it requires a call to action from our governors, those of us in communities and society in the medical profession to step up and work with the governors, those who are with the pharmacies to step up and work with the governors are for those in Law Enforcement to step up and work with the governors, and even those who are in our judicial system to step up and work with the governors to address what i think is a National Crisis and that is drugs that are ruining the lives familiesinly ruining anyone who has known someone or had a relative who has had some kind of drug issues, there is lack of the nativity, lack of trustworthiness. If you have other had an acquaintance that had an issue and you need them and you let them in your home, you got to watch your own home, the danger of loss of life as he believed might have Prescription Drug abuse problems and they dont realize they have taken 10 bills all the sudden because they are so looped out on something. It is educating Family Members, andedical profession certainly we have wonderful doctors doing the best they can. But we also have some bad actors out there. We have doctors overprescribing because they are making money and doctors turning the system for medical procedures that people dont really totally need. Because they are making money off that also. Then you have the pharmacies. Certainly police are watching people in no our problems. There are different pharmacies in oklahoma where if you go to, you can have some good success take all ofoing to those with a great men and women and our medical profession that care deeply about this issue. Certainly with Law Enforcement and in our sentencing guidelines, there is a way we can be smart on crime but tough on crime. If someone has a true substance getting them, crisis intervention to get them to get into the right kind of surface, if they are criminal, they are criminal, and if they are it them into a Substance Abuse row graham will stop if , perhaps weng issue should step forward and put our money where our mouth is. Then tracking is something all of us governors can work with our legislators to basically legislate under tracking of whos going to get these Prescription Drugs so we can stop the doctor shopping and pharmacy shopping that goes on so frequently in our communities and where do you dispose of unwanted Prescription Drugs and those do come up and i think a lot of states have Great Programs where you can put those things. There have been times when i thought i need to throw that prescription away but what do you do with it . You dont want to put it down the toilet. Bringing everyone together, having a National Call to say this is a big epidemic not only for individual states the for the whole nation, it certainly can destroy lives. Thank you for the work youre doing. A couple of things we brought a guy on to the department of health who had been chief of staff at what of our major hospitals who basically began to work with the medical profession and came with a lot of great ability. He started tracking those prescribers who are outliers and prescriptionse goes beyond that to help identify them. The credibility of this dr. Came to work and then used the data to outline over prescribers has been helpful. I have been very hard on prescribers. The vast majority of physicians and dentists who prescribed do it correctly. Believe education still for those whore go beyond somewhat what they should prescribed. They are not bad people, they just need to be reminded of how much they need to prescribed and why they need to prescribe certain medications, so it needs to be that. Like thesehronically outliers who chronically prescribe what i think is in an unlawful way, they should have their license removed. Thats how you deal with it. When you take that license away from them, they are not going to prescribed them anymore. State say this about the or of medical examiners in alabama, they are very tough and do areally clamp down and good job on these outliers we are talking about. Thats the way you handle those who continue to do what they shouldnt do. Take their license away so they cant do it anymore. Unique aiding that has happened in our state, there is a dock her who has had a lot of problems over surgeries that probably were not needed according to patients and the medical association and problems with prescribing a lot of pain pills. But the other side of the coin is even though the board has sanctioned them, and he has had several lawsuits i patients, he is gearing up with a lot of attorneys to sue the other people for libel. Interesting you have seen the reverse effect of the doctors coming after everyone else, including the licensure board that tried to sanction him. Which is a problem. We have a couple of items to address. Does anyone want to add something to this . Hasink governor shumlin something about the next that. Inc. You for your work and i would like to thank governor emily and governor hickenlooper for leading the way. I am pleased to announced the nga will be building on this discussion. Can we figure out what were doing collectively and expand the important work of the governor in the state by launching a second policy academy to help state mobilize effective responses concerning significant drug abuse. Governor sandoval from nevada and i will have the pleasure of leading this effort as cochairs and am looking forward to working with governor sandoval on that will stop we will have ending from the center of Disease Control and prevention and leading experts will assist comprehensiveg a land for five states, coordinating strategies that combine health care and Public Health outcomes. Weeks, there will be a request release from all of we governors from our offices and i encourage all of you to apply because this is a great opportunity to take what we are talking about here and figure out how to turn it in to policy that works and solves this problem we are facing. I am looking forward to working with the nga and the other governors on this and governor, i yield to you, my friend from nevada. First and foremost, thank you for the opportunity to serve. Impressed by your passion expressed today and thank you for your leadership on this product. Isis extraordinary and knowing to save lives and will make a difference throughout america. That is a tremendous amount of leadership and i think we can continue to do the hood work so thank you. Of updates. Couple would you like to go first . I would be happy to. Know thatead, we all in the year ahead, theres not a lot happening in congress. Appropriations is online and we will be watching where wings go as we move ahead. Care, and has been a controversial year and i expect that to continue. The good news is the work on this committee and work on , he gives usdrugs something to work toward. It is something for governors to lead and be proactive going into the next congress. Many ofte finance and the former chairman is now the ambassador of china. Overor wyden now takes finance. We look forward to building a relationship as we move toward recommendations on making sure the federal government knows how they can build upon its rather than replace it. Any update from the state level . Thank you very much, governors. We want to give you a bit update on all the hard work all of you are undertaking and the way in which the National Governors association is supporting network. Binder, youin your can look at the role of governors right now and there are summary stories about what governors are doing and frankly, greator shumlin do such a discussion about the role all of you have to bring together these disparate resources and have a really construct the conversation. It is absolutely changing health care in this country and its very inspiring. Worksre idea here if this is that there are three main movements governors are bringing together. Everyone thinks about governors as purchasers. You are the largest purchasers of health care in the state. But in fact, governors are the largest purchasers of health care supply. Governors can actually build a supply of health care that drives toward high quality and i think you see a lot of interesting things going on in workforce where governors are in to develop more strategy andkforce there is obviously a lot of work going on with regard to regulation. It cuts across all of these areas. A great jobmlin did talking about the way he is attacking this problem with Prescription Drug abuse as a regulator. As a convener, this is the most our full roll the governor has. You can bring together not just your own program and regulations but you can bring the right at Industry Award and stakeholders. Right now anding it is very powerful. Within the center, we have worked very hard to develop a vision of where governors are putting their time and energy and looking to drive toward a lessmore efficient, much costly Delivery System and we have identified six core focus areas. We talked to a lot of experts in their six core areas we have identified. They all undercut and support each other, so its a little semantical to talk distinctions, but we are probably spending half of our time on health care transmission writ large. This is helping all of you grab the rings of the Health Care System in your state to drive toward a new Delivery System. We have lots of providers who dont have time to spend with their patients and these are the kinds of changes we are talking about. We are doing a lot of work with medicaid and Health Insurance folks lookingth at using medicaid as a lever. Using medicaid to drive a signal, thats probably one of the most popular ways we are seeing at driving health care signals. A lot of this has to do with allowing providers to find as midlevel providers, you can find highquality care and provide teambased care. Area we areh is an very busy on in a couple of different ways. One is looking at traditional Public Health issues around moms and babies, making sure our Public Health resources that you as governors have built for years. As this migration is occurring. There is a lot of knowledge, but it is a totally different universe. The, as you guys know, economic support for these systems has been waning over the years. As industry starts to think about how we move these populations, we have to think about how we build support for Public Health, so if your agency is creating Smoking Cessation programs and thats going to supporting Health System migrating to population health, there should be an economic benefit for the delivery of care. Data analytics is also a really busy area. A lot of folks think of it as a secret sauce and we are at it we now where our systems are becoming very powerful and highlighting for all of you here fory area a key area outcomes are terrible and we can actually change their lives and reduce their costs and we have a Great Program that is all about that. We are working at looking at the data right now and its not ready but we are going to get there but we are going to find the spots where you can find a populations whose lives you can totally change and thats a pretty magical moment. Health isehavioral absolutely relevant to this discussion. Can unleash payments and if you do more and think what is best for patients and how we make that a reality and significantly reduce costs. Here a list ofe activities governors are asertaking will stop governors are working hard, we have a varied projects going on. Perfect. Thank you. Think you everybody for coming. Thank you everybody for coming. Thank you for your leadership. With that, we stand adjourned until we see all of you again in nashville. [applause] [captioning performed by national captioning institute] [captions Copyright National cable satellite corp. 2013] i as legs as the governor is clearly room it is the end of this session. If you missed any of this session, like the one on jobs or the Early Childhood education discussion with arnie duncan, you can find all of those online at cspan. Org. We will be continuing a discussion on Prescription Drug abuse in just a few minutes, but first a look at the week ahead on the cspan networks. Governor mike beebe is going to remain in washington, d. C. Tomorrow, he will be discussing health law in his state with Kaiser Health news. His was the first state to get money from medicaid to purchase private Health Insurance for low income residents. We will have remarks from the governor tomorrow, live at 8 30. Congress comes back into session this week after one week off for president s day. We spoke to a capitol Hill Reporter about what is on the agenda. We are joined by pete [indiscernible] from the hill, with a look at what is ahead for the house and senate. Insurance,h flood how does the proposed house bill deal with what the Senate Passed a couple of weeks ago . We do not know yet. As of friday afternoon it is still being written, but we know that House Republican leaders inc. That the bill goes too far in getting further reforms that were passed in 2012. We assume that House Republicans want to provide some sort of rate relief to homeowners and businesses who will see rates go up as part of the 2012 bill. That right now we just have a general outline. We will see it over the weekend, probably. One of the challenges for regularly watching the house here are those unfunded mandates. You are writing about a bill next week dealing with that. What would it do . This goes back 20 years, to 1995, when Congress Passed and bill clinton signed a bill meant to reduce unfunded mandates, orders from the government through legislation or regulation that say that you must do this but there is no money to do it and it costs states and local government a lot of money. They passed a law in 1995 to limit those. Republicans now say that the clampdown needs to be made ieper, that the government is finding ways around the law. They will be including more independent agencies to attempt to find ways not to throw rules and regulations back at the states without the money erie it we understand the house may take up a bill dealing with the irs. The headline says house gop to go after irs. What are they proposing . A lot of Different Things. Looking at a more expansive version of these bills next week, republicans are reacting to the targeting that the irs did on conservative groups. They are going to have a bill that says let me back up, the irs is developing a regulation saying that they will codify rules and put them in place for certain political groups. One of the bills, the big one next week from the house that stops that regulation from taking place, until they investigate the targeting scandal, a couple of the bills are just transparent, saying that they are taxpayer issues. Where does your money go . How is it being spent . Is kind of like a payback week for the irs. We heard all last year that they were going to take it up next week. Still, your most recent article deals with the Supreme Court case. You tweeted about it saying that the house will try to gut the decision dealing with eminent domain. What was the decision . What does the house bill propose . This got people angry across the country. Not everyone disagreed, but a lot of people said that the Supreme Court is making it too easy for the government at all levels, local, state, and federal, to take property away if they decide to some other owner might do more with it, economically. You wentne knows, if to high school, that concept of eminent domain, where the government has the right to take property for certain public uses. The Supreme Court said that it is a valid public use to take the property if someone else can provide more revenue with it. That is something that a lot of conservatives really opposed. This was almost 10 years ago. See next what we will week is basically a prohibition. They will say that the government cannot do this, call it a public use to move the property from one owner to another. They passed something similar in the next the last congress and it never went anywhere. It keeps conservatives motivated, but whether it goes based on theis relationship between house and senate these days. Dave camp is set to release more on these tax changes. Any kind of breadcrumbs in the ideas of what will be in that package when he announces it . We know that it is something that camp really wants to do and it will probably involve corporate and marginal tax rates. The goal here has been said that they should reduce the rates on everyone, but with more people pegging it is less complicated and it can have the same amount of money or even more, if tonging the system helps promote growth. It will be something along those lines. We are already talking about elections, it seems like none of the people want to get something going, it requires a lot of hard decisions. This is not the kind of thing people want to hang onto before running again. On the two issues generally coming out of the senate, the extension of Unemployment Insurance benefits and raising of the minimum wage, during the president s day resource recess have either of those move forward . We know that they are talking and at this point i would guess that it is too early to guess on what would happen next week, but harry reid even tweeted today that they were one vote away from advancing the Unemployment Insurance bill. So, we know they are working on something, but it has been such a divide between the parties over how you pay for this thing. Really, neither side has a watch on it. Onknow that they are working it. In some ways we think that it will take longer, but we know that they want to bring something up. You can read the report and follow pete on twitter. Thank you for the update. Any time. Aboutew more Details Congress this week. The senate is in tomorrow at 2 00 eastern. President will read washingtons farewell address. At 5 00, the schedule and Jeffrey Maier to be a u. S. District court judge in arkansas. And a vote to move forward on that at 5 30. In the house, tuesday, hills to delay scheduled Flood Insurance premium increases. Also a delay on the debated irs rules. We just heard about the Political Activities of some groups that get tax extensions. The senate is live on our content companion network, cspan2. Deal is completed, it puts comcast at the nexus, the center of every may every major media policy debate we will have. I think esc fcc should block this merger. This is why we have antitrust laws, to block these kinds of deals. For most americans a deal like this seems unthinkable. That it has gotten this far really says a lot. Is no there really condition that is good enough to let a deal like this go through. Transactions are frequently used as a way to shape markets. So, there are a lot of conditions that could be laced on the countrys largest internet provider. It net neutrality, a buildout for the president s connected education initiative, upgraded internet access. There are a whole host of things that are similar to conditions the comcast agreed to three years ago when they purchased nbc universal. I could see it in seriously considered at the sec as something that they would approve, but with a lot of conditions. Twice the impact of a comcast Time Warner Cable merger, monday on the communicators on cspan2. Former rhode island congressman, patrick kennedy, talked recently about his struggles with addiction during a panel on Prescription Drug abuse hosted by the Clinton Foundation at their Third Annual Health matters conference. The moderator of the discussion , er doctorvis stork and cohost of the tv program, the doctors here for they will talk for about 40 minutes. Please welcome to the stage, Emergency Room Physician dr. Travis stork and the Mental Health and prescription abuse Prevention Panel members. [applause] i am dr. Travis stork for those of you who do not know me. A lot of people know me as the host of a Television Show and what a lot of people dont realize is that in my real life i am an er doctor. This is important because i truly believe that what we can do today is help save lives. Consider this in the next 19 minutes while we sit before you, someone will die from a Drug Overdose that is preventable. All of these deaths are mental. We call them accidental but in many ways they are not accidental at all. That is what we will be discussing today. I want to encourage anyone who is watching at home and streaming this, we would love you to become a part of this situation. You can tweak a question to us at healthmatter2014 and i would like to get you involved with an initial question. The question i have for all of you is, what is the most Common Source for people who abuse Prescription Drugs to obtain the medication . Is it they got it from a drug dealer or a stranger, they bought it from a friend or relative, it was prescribed by one dr. , or obtained free from a relative or a friend . You can text or tweak your answers to us. We will give you the results later and the correct answer. Without further ado, i would like to welcome my fellow panelists. We will go down the line starting with congressman after kenn