Transcripts For CSPAN Opioid Epidemic Summit 20171105

This is about 2. 5 hours. Bloomberg school of Public Health and baltimore. This is about two hours. Andadies and gentlemen, online viewers around the world, good morning and welcome. I am alan mckenzie, dean of the Johns Hopkins Bloomberg School of Public Health and i would like to stand by extending our special welcome to the president of clinton who you will hear from in just a few minutes. Also joining us today are several policymakers. They include congressman cummings. They will be joining us in the program to rip an audience are maryland delegate Antonio Hayes and senator ben carsons office. Finally, i would like to extend an especially warm welcome to senator murkowski who we are now proud to call [applause] who we are proud to call one of our own. Thank you so much for being here. We are indeed honored to be working with the Clinton Foundation to bring you todays summit on one of our most important locales problems americas Opioid Epidemic. It is a National Crisis which demands involvement from all levels of government, public and private organizations as well as individual citizens. Die from. , every day, overdose. Few years, the death rate has tripled and the causes or complex. Noncancerth chronic pain or prescribed opioids instead of safer, less addictive alternatives. Heroin is more available and increasingly adulterated with fentanyl. Too two many people few people have access to evidencebased addiction treatment. The Bloomberg School leadership in preventing and treating Substance Abuse stretches back nearly 50 years. We funded the nations first graduate Training Program for drug and alcohol counseling and ever get it for the adoption of methadone in federally funded Treatment Programs. That leadership has since in cemented in the founding of two centers. For injury prevention and control, and the other for drug safety. Our collaboration with the Clinton Foundation to address though. 2014 ton in may address the opioid crisis, began in may 2014. We focused on the rising rates of injuries and death from opioid. We United National leader from academia, government and the private sector, paving the way for a yearlong effort to identify best practices. This initial engagement in 2015, the Bloomberg School and the Clinton Foundation produced a document that identified a path forward and framed the problem as a severe Public Health issue, calling for scaling out existing evidencebased prevention to prevent future loss of life. Despite such efforts however, we still have a long way to go. An alltimes reach high in 2016 and the numbers keep rising. Despite recent announcements by the white house, our country has not yet embraced and addressed a real need for urgent action and a true of. Commitment of resources. Byew report just released the Bloomberg School and the Clinton Foundation, entitled the Opioid Epidemic, from describedo impact pillars to combat the Opioid Epidemic including optimizing Prescription Drug treatment, monitoring programs, advanced Engineering Solutions as well as combating stigma. These strategies work, they have been shown to work. Today, you will hear from from experts and advocates working on the epidemic by further implementing and developing these strategies and generating new evidence. But we need your help. Please, let us Work Together to stop the deadly epidemic. Introduceed now to congressman Elijah Cummings. Born and raised in baltimore, congressman cummings has represented maryland seventh Congressional District since 1996 and is now the ranking minority member on the House Committee of government oversight and reform and serves on the task force of health care reform. As cofounder and chair of the congressional caucus on drug policy, he has helped to shape the National Policy on drug addiction and access to affordable medication. Please join me to give a warm welcome to congressman elation cummings. [applause] rep. Cummings good morning everyone. Come on, we can do better than that, good morning everyone. Morning ] rep. Cummings it is my honor and privilege to be here and also thanks to the dean for your kind words but more important thank you for your time. I have to do do this. On behalf of my family and certainly on behalf of generations yet unborn thanks to you, Johns Hopkins, for taking good care of me. [applause] having spent two months in hospital just a few blocks from here, after a heart procedure i , must say that i have grown to love john hopkins even more. To the doctors and the cafeteria folks, everybody, associated with this campus, i thank you for changing the trajectory of my destiny. I truly, truly appreciated, thank you. [applause] i truly appreciated. I am honored to join former president clinton and dean mckenzie in welcoming our distinguished panel to this summit on our nations opioid crisis. Certainly always good to see my ood friend, my mentor and i will always call her my senator, senator koski, and i also congressmanhat baines is in the room, we are glad to have you as well. The danger we now face is more virulent more than ever. ,rescription opioids, heroin fentanyl, and other synthetic drugs were involved in more than 60 of overdoses last year which resulted in 64,000 deaths. Let that sink in. 64,000 deaths. Here in maryland, at least 2089 people, fatally overdosed in 2016. 66 in 2015. This is stark evidence of how the dangers and human devastation are expanding exponentially. There is a bipartisan acknowledgment that a national Public Health emergency crisis does exist. But resistance remains. In both the white house and in congress, to taking bold action. Early this year, the president s on Opioid Commission led by governor Chris Christie recommended that the president declare a national emergency. As all of you know, last week, the president declared a Public Health emergency, which is a good first step, but it does not unlock any additional federal funding to confront this crisis had on. Head on. The Commission Also recommended something else, that the president authorized the secretary of hhs to negotiate lower prices for naloxone, the lifesaving drug that reverses overdoses, of opioid and i am sure you will hear a lot more about that from the doctor who has been a staunch advocate of expanding its usage. Right now, our people on the front lines of this epidemic cannot afford to stock up on naloxone. Ledh is why last month, i 50 house members in sending a letter to President Trump asking him to a doctor this recommendation. We begged ask him, him. Unfortunately, the president did not even mention the word his announcement last week. Finally, as you all know the , president and Congressional Republicans have spent years , years, trying to repeal the Affordable Care act, and reversed the medicated tension, even though medicaid provide Treatment Services to three in 10 people who struggle with opioid addiction. If we are going to respond to this epidemic, we need your evidencebased research and your continued active engagement in debate. Ic we must encourage the president commissions own recommendation to expand the availability of naloxone and reduce the cost. We must press Insurance Companies to eliminate the opioidbasedvor of in killers and we must challenge our friends in congress to expand publichealth funding, preserve medicare and safeguard medicaid. Finally, let me say this, you already know that our sponsor to this publichealth crisis is a test for our community. It is also a test for the entire society. My good friend from maryland, congressman john delaney, has expressed that applies directly to this crisis. Expressions those they hear something and, i wish i had come up with that. T is so, true i think about this all the time, these words, because there are so true. He says, the cost of doing nothing, is not nothing. Tweet that. [laughter] of doing nothing is not nothing. Let me repeat it. The cost of doing nothing is not nothing. Repeated over and over again. So, ladies and gentlemen, i thank all of you for being here today. We are an army and we will going to fight and we will overcome. Thank you very much. [applause] host thank you very much, lessessman coming congressman cummings on your leadership on this issue and those inspiring words for us today. I am thrilled to introduce and welcome back to our School President bill clinton, founder and for chair of the Clinton Foundation and former president 42nd president of the United States and former chair of the Clinton Foundation. After leaving the white house in 2001, president clinton established the Clinton Foundation to build more resilient communities by improving Global Health strengthening local communities, and protecting the environment. In 2002, he launched the Foundations Initiative to negotiate prices for hiv and aids medication to extend access to 11. 5 Million People in over 70 countries. An achievement many thought was impossible. Using a similar strategy, president clinton negotiated National Partnerships with two pharmaceutical companies to provide a predictable, affordable supply of naloxone to community groups, Public Safety organizations, and schools and universities. His goal, to cut Prescription Drug abuse deaths in half over the next five years, saving approximately 10,000 lives. This could be done through Strategic Partnerships that raise consumer and Public Awareness, advanced business practice chains, and change and very importantly, mobilize communities. Please join me and giving a warm welcome to president bill clinton. [applause] pres. Clinton thank you very much. Thank you. Thank you very much. First of all, dean mckenzie, thank you for having us back at the Bloomberg School for Public Health and for the Ongoing Partnership we have had in confronting the Opioid Epidemic. I want to thank congressman cummings for his remarks and his leadership on this and many other issues. He said senator mikulski was his role model and he certainly proved it the last couple of years. Barbara was on a short list we when barbara was a senator verymaryland, she was in a short list that we kept at the white house, it was called the just say yes list. [laughter] because when she asked for something you knew sooner or , later, you were going to cave in because she was like a dog writing your leg, you know . [laughter] time, wee a lot of would just say yes, and we could all go back to work. [laughter] i am glad to see her here teaching. To d like to say yes and thanks to two other people. One is Mike Bloomberg for funding this effort. He has got a lot of money, i know, but he could have done other things with it. He was a great Public Health mayor of new york and this is a great school. The other person i want to thank with our foundation, who is not here, is my daughter, chelsea who teaches Public Health in , columbia and is my family in anythingee expert on regarding Public Health policy. She urged me for years to get involved in this one most people were not paying any attention to it. I would like to thank was we all of you for being here and agreeing to take action. Latest provisional 2016, morehat in than 64,000 people in this country died of drug overdose. Well over half of them were opioidrelated. If this data is confirmed, and we have no reason to believe that it will not be, that means that last year more people died , of opioidrelated drug overdoses than the numbers of deaths from the aids crisis at the peak before it was treated, then from gun related homicides, or from automobile accidents. Opioidrelated deaths are now the leading cause of death for americans under the age of 50. Someoney all of us know , in the family, has lost a loved one. Have five friends who have lost their children. Frome learned a great deal these families. Had a son who was working for hillary when he died , and had worked for me. Programhe law and nba at George Washington university. He was a very smart man but no coulder told him that you stop after five years and taking after five beers and going to sleep, the you cannot wake up. Everybody has got stories like that. And now we know the epidemic has grown like wildfire in small towns and rural areas with no Public Health infrastructure, where people dont know what to do or cant do it if they know. It is not only a human tragedy, the cdc estimates that the cost is more than 78 billion a year, to continue to do so little in such a fractured way on this problem. Costs, criminal justicerelated costs, addiction treatment, lost productivity. Yet, for all the noise made about it, the externa efforts and the genuine legitimate concerns, and the extraordinary efforts being made people with nothing. And i mean i was just in ohio about a year and a half ago, a little town in southwest ohio, and i was very proud of looking at it, because it was totally rebuilt, it was an early 19thcentury town all the beautiful buildings were renovated because of investments secured partly under the investment tax credit, the last completely Bipartisan Initiative i signed to give people who invest in small towns and rural areas with high unemployment income. That was the good news. The good news further was it was that the most beautiful building in town had been given over by the city to doctors who voluntarily came there that they could act as in appalachia. Oh, it was beautiful. There was a doctor born in poland who got her medical degree in new york who was places,n one of those but i walked out and across the street and the woman was waving frantically at me, please come over here. I only hold one asset of any value, a used car. I sold it and rented that office and what your being is only Treatment Facility we have in this town. She did introduce me to a woman whose husband had just died of a heroin overdose. The poor mans version of opioid addiction as we travel down, and three women who are recovering heroin addicts. And she said, look, i am happy to do this. I know nothing about it. I get whatever help i can, and it is all we got. I am glad that one of our panelists is the head of Public Health in baltimore, which had the first Public Health program of any city in the United States, going back to the late 18th century. Though, Community Health networks have been allowed to atrophy, or never expanded to embrace this mission. This is like a good newsbad news story to me. The good news is that it is the first drug epidemic where we act like a grownup country and treat it like a Public Health problem instead of a criminal justice problem. [applause] pres. Clinton it is a good thing. Some cynics have said that it is because it started in a small wentof worldwide people, into epidemic phases before it spread to the cities. There might be something to that but i think the more likely , explanation is that this is the first epidemic we have had killing this many people that had a nonviolent delivery chain. The problem is, as well know, the more we get into cheap mexico,grown in andested by farmers, fentanyl, the more likely we are to see more violent Delivery Systems as people fight over turf for guaranteed money. Thiss coming to them movie is coming to a theater near you, whoever you are whatever your color is, whatever , your politics are. And that brings me to the bad news. It is a Public Health problem and we recognize it. Good for us. We are growing up as a country we are seeing all of these people as people. The bad news is there is a , woefully inadequate Public Health response that is not harper lee coordinated with Law Enforcement, with the treatment committee, with insurers, with you name it. So what we are here to do it today, is figure out what to do next. The next panel after ours, what were going to do is try to identify what many of you already know, but the general public may not which is where , are we right now, what is being done that is good, what are the gaps . Then we go to the second panel. Our panelists are here, and they will discuss the report we are releasing today the clinton , Health Matters initiative along with the Bloomberg School called from evidence to impact. Sort of professional way of saying, we know what the heck is wrong, and we know what we need to do, how about we do something . There are proven recommendations in this report for combating the epidemic, from allowing physicians to effectively treat those suffering from addiction much better than some of them are allowed to now, because of all of the barriers, you know, to expanding coverage and accessibility of proven helps, like naloxone. To changing the way Health Care Professionals and employers an advocates actually talk about addiction, so that we can reduce stigma and get people out of the closet quicker, because it is a terrible problem. We have been working on this since 2012 as dean mckenzie told you. We have made some good progress, i especially want to thank for offering to give free packages of naloxone to every college campus, and to get them to every high school in america, as they can, with their limited production. They have been great partners. I think improving access is still important, to naloxone, i know there are debates about that. All i know is we have got a lot of people dying from drug overdoses and most of them are still opioidrelated. And if you can save a life, you ought to do it. So, i went to just briefly say three things we will do from here forward and then bring the panel up. First of all, we have known for a long time that stigma plays a major role in preventing individuals and families from seeking treatment or accessing provision sources. So in partnership with facing will launch ai communication strategy designed to tell people to get over it. [laughter] now, the proper Public Health word is to empower them, [laughter] but once you know a couple of people who have lost their kids, i think we should dispense with the niceties. This is nothing to be ashamed of, it is a health problem. We have to hammer that. And employers need to hammer it and they need to say no, get you will not lose her job, bullheadedre to to save your life, your family and your kidss future. We need the same message to go out everywhere in a very straightforward way. Second, we have known that Law Enforcement, and cheese, thank you for being here, and for what you have done. Criminal justice and addiction and dependency experts share similar goals, but do not coordinate as much of the should, they do not cooperate. We do not have one simple comprehensive strategy even in places where you can take the money being spent and end it more effectively. And spend it more effectively, so we have to work with the institute of justice to reduce opioid overdoses by people who come in contact with the criminal justice system, by having more simultaneous contacts with everybody else who can play a role in this. Finally, our Community Health Initiative Works in several counties in america today, and communities. That what weed thought we were doing, when i started this, i thought we were going to going to all of these laces and say, the biggest Public Health problem we have issueefore the opioids blue up on this, was Childhood Obesity, please come and help us. But we said that first, we would ask the people there, and it turns out, where i am going when i leave you, jacksonville, they have the thirdhighest rate of deaths of pedestrians by drivers in america. Did you know that . Because it is a city county you are in this city, all of a sudden youre in the city limits, and now youre in the county, and you continue driving. You dont notice it. So if you cross the line, you walk into a car driving at 60 miles an hour. The point is, we had to adjust our strategy in all of these communities. About everywhere, they say that we need help with this. So we are going to do more than we have done to build up coalitions and stakeholders. Every other issue, we are getting everybody involved to fight together. We cannot let this one alone. I will give you one example and i will introduce her more effectively in a moment, but Randi Weingarten is on the panel and the American Federation of teachers also represents i think, 40,000 nurses, a lot of them. And kids are in school. This summer, i will never get this as long as they live, but this summer, hillary and i, we normally go out to long island, as far out on the island as we can get and find a place so our grandkids can come play with us, and our daughter and soninlaw, they come and we have a good time. And i try, once a summer to go out to this wonderful old public montauk. Se called it used to be a raceway in the 1920s. It is still great, and there are all kinds of people there. Ordinary people that are not rolling in the dough. I get off the course afterwards or 50 people just disappear and the start they just appear and Start Talking to me about various things, some of which would guess. [laughter] pres. Clinton but it did not take long to get to this. We are talking and it took me 40 minutes literally to get away from them, they wanted to know, what were we doing, what are these people doing, and most of these people were from long island and they were desperate. Some of them were from elsewhere. There was one really goodlooking young guy with big eyes, and his eyes kept getting bigger during the discussion. 19 years old, and everybody walked away but him. I said i have got to go and he said, i want to thank you for doing this. He said, i just got out of rehab and i did not think anybody cared. I do not think anyone cared about it. So i asked him how old he was, and he told me. Said, well, how do you feel about it now . He said, i think i will be fine. He said, my family is supportive, and i got a lot out of rehab, and i do not want to die, i want to live. But he said i think it is a , shame that you have got to come from a family like mine to be able to afford the rehab i have. Why should i live, knowing that other people are going to die, just because they do not have a family like mine that can afford it . This is a kid and he says, i am happy and i know i should just be happy, but he said i cannot get over the fact and i said, let me ask you something. Did anybody ever tell you in college or in high school, that if you mix opioids and alcohol and you go to sleep, you could die . Just that one simple thing . And he said no, not once, not in any class. Why shouldnt we push for that . Just for example. So, the good news is everybody from the white house to the smallest farms in america knows this is a very big problem. The good news is there are lots of good people everywhere who are working on it. The bad news is that it is still not very well organized, for a lot of people is not properly funded and if you save peoples lives with naloxone, if they are serious, you know you have about one hour before you get them to hospital and start serious detox. Then if they are serious, you have to put them in rehab. Then you have to figure out how to do that, if they interacted, in some way or another the criminal justice system. It is a multifaceted problem, and we have to do this together. I may be wrong, but i believe that if we do not do what congressman cummings said, we will regret it for the rest of our lives. But what i think is that this may be one of those if they build it, they will come. If we build it, they will come. If we can prove that significant numbers of people, lives have been saved, we can get the money that we need. We will be able to overwhelm the resistance. I would far prefer someone take the tax cuts i am being pledged and spend it to save the lives of people like that young man that i saw, or the five that i knew who did not survive. So, you should feel, in a funny way, privileged to be here, because you are being asked to turn the tide on a great problem that will preserve the lives of people you dont even know. To do things you cannot even imagine. Thank you very much. [applause] pres. Clinton thank you. I want to ask the panel to come up here. Tom geddes, the ceo of plank first, industries, who is also the chairman of the board of a local hospital and is very interested in all of this. [applause] associated with one of the Great American success stories, under armour, headquartered in baltimore. I recommend you go there. It is very humbling, when you walk in, all day every day there , is a man or a woman or both, running on treadmills because they test to see how long the Running Shoes will last. The last time i was there i was , there for two hours and there was a young woman running on the treadmill at about a five minute mile. She was flying. And when i left, she was still flying. [laughter] and i thought about applying for a job to test the durability of shoes on old people. [laughter] they would finally get me to do what i need to do Randi Weingarten as i said, is the ceo of the American Federation of teachers. And i would like to say a couple is firstabout her, she of all, a former teacher whose students repeatedly won state and National Prizes for their expertise in the u. S. Constitution. [laughter] [applause] pres. Clinton and she is a partner and has been in the Clinton Global Initiative for america, and she and the construction unions organized the largest private Infrastructure Program in the United States. They raised 16 billion and they have committed 14. 5 billion. They have spent 12 . 5 billion and created 100,000 jobs and trained 900,000 people to do infrastructure work and did not cost you one cent. [applause] and i think that is important. Wen, the commissioner of health and the city of baltimore, she runs the oldest Public Health department in the United States of america, and that she i believe, was the first person in america to issue a blanket description for naloxone. [applause] said, 30,000 people have already claimed. So, it is very important that we do not overlook the things that we could do while we are bellyaching about what has not been done. And congressman Elijah Cummings opinion, is amy guy you ought to just say yes to because he is thoughtful, smart, tough as nails, and he always shows up for work, in a very good way. [applause] so, we will begin. Ok, i am going to ask you questions, and then if i do not cover something you would like to say, say it anyway you react [laughter] imagine you are rubber murkowski, asking for fans money for some technology project. [laughter] what you think the most important thing to do now is to get more people to act on this research . I am interested in practical things that can actually help millions of people. We have all of this research, we know, and if someone comes in the wholean overdose, plan of action can be taken if there is somebody to do it, and some way to find it. But what in your opinion, each of you, what is the most important thing we can do now to ite what we know and make work in local communities . With what we have. It is ok if you say that we need more money. But, if we take the system we have, we want to maximize the impact, what is the most important thing we can do . Was going to say money, but he stole that one from me. Clintons laws of politics is that whenever someone tells you it is not a money problem, theyre always talking about someone elses problem. [laughter] well, for us in baltimore, we are very glad to have the partnership of many people in this room, we have been able to do a lot with limited resources by changing policies that we can get the blanket prescription for narcan out there. We have people trained, but it is not about only getting people trained, it is about people we are delivering the services to, so i am it happy to report that the latest numbers in the last two years, everyday residents have saved the lives of nearly 1500 of their fellow Committee Members just by delivering narcan to their Family Members, friends, community members. That is the very tangible we havent able to do. Cummingssome and mentioned, we are being priced out of the ability to do that, we are having test ration the naloxone that we have every day. If i had 10,000 units today, i could be out of them by the weekend. That is how much our community is asking for it. Existing scale up interventions that we know already work, because we know the science is there in terms of treatment. Happens to, what those 1500 people, the ones you brought back . Many of them are referred to further services. Our hospitals now have an , herese Survivors Program is who often are in recovery themselves, speak to those who have overdosed and help to connect them to treatment. Our problem is that we do not have nearly enough treatment capacity. Nationwide, only one in 10 people will have the addiction of disease and will get treatment. So we have to expand treatment, because saving someones life now is important, but they also have to get into treatment to help them in the longterm. Rep. Cummings we do need more resources. No doubt about it. People, mr. Ed that president do things for two reasons, or a combination of both. Either to avoid pain, or gain pleasure. Avoid pain or gain pleasure. I think we have to convince our policymakers that they should reducetrying to medicaid, they should not there are a lot of people who need this treatment, they would be able to get it. At the same time, we see members of congress crying at the news,ls and on the 6 00 but when it comes time for making sure that the programs are there to help their very who livests, the ones up the street from them, suddenly they get amnesia. That is very unfortunate. A fellowt, i called who has been off drugs for 30 years. I said, ricky, what should we do . The very question he just asked. He said someone to me that i did not think about he said, elijah, in baltimore we have a whole army of people who are we used to use drugs. Some kind of way, we need to find a way those are the people who are most adamant, if you have noticed, in trying to help other people get off drugs in some kind of way, we have to use them, because it have already been through the pain. From their pain can their passion, to do their purpose. Come on now pain, passion, purpose. Narcotics anonymous, we need to also encourage people to be a part of that. These are the people who are out there and have already been through it. So, just some thoughts off the top of my head. Mr. President , to answer your question of people who are plan, wender dr. Wens had a patient who survived, and the happened was that second time he was arrested by the Fire Department and the third time he was revived by another user who went behind the dumpster, who found him unresponsive and revived him with the narcan. Now he is working, and alive. That is the kind of work that dr. Wen is doing here in baltimore. [applause] point, to that education is absolutely imperative. what we saw for example, is that our nurses in cleveland, we are now the second largest nurse unit in the United States and the School Nurses in cleveland demanded that the cleveland Public Schools actually have a supply of narcan in every single school. When they did not get it, they got a grant to do it. Now, they are getting it because this nurse actually revived a parent of a child. Becausetell that story the stories are important to be stigmatized and to educate desktop destigmatize and educate. Your point mr. President about they will build if we put enough pressure on the system, the pressure comes with education. Wen was atple, dr. Our conference this summer actually i call her doctor mona from flint talking about the issues of water and in terms of opioid addiction and the epidemic. Stick coupled it with a which is there are a lot of Funds Pension invested in big pharma and we are trying to do frankly what the new yorker magazine did this week as well,. Creating public pressure to reduce the prices. As use public Pension Funds a way of trying to figure out how to reduce the prices of narcan and other absolutely effective intervention drugs. Clinton are there any other Public School systems in the country that you know of that actually have some policy of educating kids about the this and telling them basic things like what happens when you mix opioids and alcohol of any kind . It looks to me like what have we got to lose by having the appropriate experts approve a paragraph or 2pac and we read by any Public School kid in america at the opening of every Public School year . What do we have to lose . A lot of people, i am convinced are still dying in ignorance. I think our preconceived notion here is often right, you have people who you see using opioids over and over again, and then they finally die. They overdose as addicts or they trade down to heroin or fentanyl or something and then they finally die. But there are lots of people who are being killed but combination. This is just one example, but is there any School District or any state that says, it is a matter kid incy, we want every our coverage to hear this particular message . Dr. Wen we just got legislation passed in maryland so that we are in Baltimore City for example, we are working with our schools to implement a standardized curriculum on at this topic. It is complicated. When of our schools and ask if the students think that using her win is good or bad, they will say, and as they are trying to be snarky, they will say that heroine is that. But when i ask them about Prescription Drugs, they might give me a different answer, she cant they see their parents or caregivers every time they have knee pain, they take percocet or they have back pain, they get back and in. There is a they get vicodin. There is a culture that we have that you have spoken about, mr. President , about this pill for every pain culture that that pill is being used to treat physical pain, as well as potentially emotional pain and other types of pain as well. So i think that culture has to change, from the medical profession, and it also has to change from each and every one of us, with regards to prescription opioids. These kidslinton do know that if you use the things they could kill you . Or their parents . When i was growing up, the first overdose i ever heard of was when i was seven years old. I was seven years old. That was 60 years ago. I did not even know what drugs were. I didnt know what an overdose was. All i knew was that lenny waone of our neighborhood guys had died from one. Importantucation is because for me, my entire life, i have never touched and even evil drug, none of that. You know why, i was scared i was scared that my destiny would be ruined, i really was. I still am. I do not play but i also understand the argument mr. President , that is made when people say, that we want to make sure that people get the relief they need under certain medical circumstances, because when i was here in hopkins, i will tell you, i did not know you could be in that kind of pain. I did not really. Every morning, i would get up and so much pain, you almost want to die. So i can see where people can get to that point, but there is also something we can do. That is something were looking at in our committee, which is why do Insurance Companies andr paying for the cheaper activetype drugs, come on now as opposed to those drugs that are nonaddictive, or at least addictive, then are more expensive. Than are more expensive. We are doing research in the community right now to address the issue. This is a lot. But again, i am convinced that if you tell someone that you are going to die, or youre going to be [indiscernible] it seems to me that some of them will say no, i am not going to. O this Randi Weingarten when i was a kid, in seventh and eighth grade, we had health classes. And it was a different. Eriod of time, there were a lot Reagan Reagan the nancy just say no campaign that ultimately people corrected and understood, stop stigmatizing at that point in time. But there is some place for having a real focus in schools on wellbeing. Built my owne advocacy on schooling, start first and foremost with a focus on childrens wellbeing and then on powerful learning. Because i think we have to actually meet kids where they are. I think we should think about and might of having the new federal policy that deemphasizes test, to really think about how schooling. Of this in childhood of the city was one of them. But it is about Childhood Obesity was one of the issues. It was about how we focus on it and have some kind of healthrelated work for kids in elementary school, Junior High School and high school. It would be different, tha pedagogically, obviously, but it is really important. I think it is more important, unfortunately, at the beginning of the year, going through the list of things you want to tell kids, because that paragraph could be lost like elijah and i are talking to each other, but not listening to the paragraph. That is why i think we need to try to figure out pedagogical how to do it in a different way that really goes to children check a wellbeing. I skipped the middleman and i brought my daughter today. Not tooaside, it is young for her to hear it. My wife had a full hip replacement last week at the grand old age of 41 and she took the time to educate her children as she was taking herself very rapidly off the narcotics that she needed. She explained to them what she needed them, and made sure they understood that getting off the drugs is priority. That is not happening up a lot in households, she is an exceptional parent. Was in thehe hospital, and i am doing disservice to an organization that i am involved with here, i noticed on the white order for her nursing staff, the pain payocol, where she had to level out of 10, the tagline was your comfort is our priority. Priority. T is our this is something i will bring up at the next board meeting, comfort should not be the priority when you have a full replacement. It is going to be uncomfortable, and as a congressman said, it can be very uncomfortable. The doctor was good in saying, you should be managing your paint to us heaven. You should really be managing it to a zero, not seven. That is not something that we hear a lot. Pres. Clinton let me ask you how much of a problem do you believe is a part of this continued overprescription . Either prescription of an opioid nonopioid would be effective in some circumstances, or prescriptions and amounts that are too great to be safe to leave in one place. How much of a problem is that still . And if it is a problem, how much can we do about it . Is there something that private or public entities that ensure lots of people can do to pressure the system to clean it up . When my confession as a physician is that i have prescribed opioids to too many patients are not realized it. In medical school, i did not learn about the addictive potential of them. I just learned as mr. Gaddis was saying, it is a way to take away pain. Doctors want to help their patients, so if they say that they need opioids, or that they say i am in pain, we give it to them. That tide is turning. We are beginning to change our mindset. I am hearing our medical schools in the city, and also our hospitals changing their practices. We have convened our doctors, our er doctors, to teach about the addictive potential and tell them why we need to decrease. Trying to overprescribed but i think there is another issue. There is also the demand side. As long as we have people have the disease of addiction, they will continue to eat out Prescription Drugs or her wing, or fentanyl, unless you get them into treatment. Our recognition that addiction is a disease, that treatment exists, recovery is possible, and we have to get treatment to people. Whenever it is that they are ready. Were also working on reducing the sum apply of drugs by reducing overprescribing. Reducing the supply of drugs, by reducing overprescribing. Randi weingarten i think the answer is yes, when you have a enough Health Care Insurance pool. Like for example, the city of new york, when i was the union uft, we had the entire city of new yorks families and we were very big in negotiation with Drug Companies when you could negotiate with them, and with pbms. I think there is a lot to be said toward that. The dilemma is, as the doctor just said, look at what is happening with fentanyl. If we dont actually deal with the issues of treatment and education, there is always something somewhere that is going to be there for either pain or joy. That, i think is congressman cummings said, we have to change enough of policy and enough of education and destigmatize, as you said mr. President , to try to deal with recourse. Mr. Cummings you just mentioned a word i think we all need to center on. Stigma. You know, mr. President , when people find out that there is someone on drugs in their midst, a lot of times they look at it as a moral failing. In other words, this person just cant make decisions right or they are weak or they are looking for the easy way out. A lot of times people, by the way, are therefore afraid to even come forth. The employer will say, wait a minute, i have 10 people who need jobs and all with no drug problems and i have this one person who has a drug problem, may be a good employee but why do i want to risk that . That is a tough one. Getting past that, but in talking to, the people, former drug addicts i have talked to, they tell me, basically a person has to hit rock bottom. They have to get that treatment and get it quickly. I think that is what we have to work more and more towards, trying to get that treatment and get it quickly. But there is another thing we have to make sure we do. Make sure the treatment that is given is efficient. You have a lot of people [applause] peoplemmings a lot of putting up little storefronts. I am telling you, i dont want to mention names but there are certain parts of the city you can ride in and you will see big signs, basically, come get your methadone. I think people are going there, getting a coping drug, but there is nothing else going with that. The experts up here, the doctor can tell us better, usually if a person has a drug problem, there is something, a Mental Illness situation connected somewhere. You cant just deal with the drug problem, you have to deal with the other thing. Am i right . Absolutely. We need to follow the science. Thathe science is treatment for opioids exists, there are millions of people in recovery and it is a combination of medications including methadone, with counseling and other services. Housing for example, is health care too. [applause] pres. Clinton first of all, im glad, the last three comments i think have been helpful. The thing i was most impressed about that woman on that in ohio, she said, i dont know what im doing. I want you to put me out of business. Said, i have no business doing this but no one else is here. I trusted her because she said, please, put me out of business. I will be glad to be a counselor. What is the answer . Let me ask two questions. How adequate is the Coverage Today under medicaid . [laughter] mr. Clinton how adequate, how much do private Insurance Companies theoretically cover this, require waiting periods, and what is a possible downside to that . And if you are starting from scratch, if you could wave a wand, would you locate at least initial assessment in treatment in local Public Health units, preferably funded and staffed in and accessible to Law Enforcement and others or would you, or is that totally impractical and should people just be going to doctors offices or specific programs . My feeling, is the capacity there to treat all these people if the money was there . If it is not, where should it be built out . Number one, how adequate is coverage . Number two, are waiting periods still a problem with private insurance . Number three, how would you deliver it even if everyone was covered tomorrow . Well just go. I will answer the last part, first. One of the major issues we see here is even if we have enough treatment, which we dont, but if we did, and even if we had enough payments, which we dont, but even if we did, a major problem is that we cannot connect people to those treatments. There may be someone who is who is ready why . Linton because because they are not reaching the individuals in time or they are not Getting Services where they are. What we need for example, in our health department, i oversee the Needle Exchange program. There are needle and at over 20 sites in the city. Someone may say, im ready for treatment now. We need for more people to be able to connect to them and say, here are five options for you, you dont have insurance right now but i can help you get there. I can physically take you to the Treatment Center, if you are ready right now i will help you do that. It is those types of connections that we dont currently reimburse for and we need to figure out. We started a program in Baltimore City focused on diversion. Individuals with small amounts of drugs are going to face treatment and not incarceration. It is a Pilot Program that has been successful but it is time intensive and resource intensive. It is currently funded by grants, not reimbursed through insurance. It is those types of peers who have been there themselves, walked in the shoes of the people we serve, we have to figure out how to pay for. And connect it to treatment. Mr. Clinton if you had the money to pay for the connection stuff, everything you said, where would you lodge it . The ultimate, look, if you have your standard, i am addicted to painkillers, this is the third time i have shown up, naloxone saved my life, you got me in the hospital so you need to put me in detox. I go through detox. Detox is over. Now i have to go to real treatment. Where would you put that . Whos going to provide that. Everywhere i could put it. But let me to you something, mr. President , the problem is, no one wants certain things in their neighborhood. Come on now, dont act like you dont know what im talking about. [applause] rep. Cummings they dont want it in their neighborhood. As the elected officials, am i right . It is really a hell of a battle. I remember seeing on cnn where they were talking about this West Virginia town that basically, was basically getting these millions of opioids and the population was 300 people. So people were flocking there. Of course, a lot of the 300 had problems too. I would want those facilities all over the place if i had the money. Then, i would try to get people who have been through it to invite other people to participate. The doctor and senator, big advocates. This is based on women who have babies. Womeny start is based on so they had babies, have been through it so they have been able to teach others and encourage them. If i have a drug problem and i come to you and you say, just like the fellow i talked to last night, my friend, ricky. A former drug addict, 30 years off. So you go to ricky, i have a problem. Man, i am a barber, i making money, im doing well. Im doing it for my neighborhood. I have been where you are. I have been where you are. Let me take your hand and take you to this place, that will make a difference. Im telling you [applause] rep. Cummings it will make a difference. So, let me start this way. When people have cancer, they make the connections. Because there is a sense that cancer could affect all, it is not stigmatized, people try to get well. That is why the stigma becomes really important to address. This is a National Crisis. And born out of, you and i have talked of this before, mcdowell county, West Virginia where we work is one of the highest Opioid Epidemic users and we saw that five years ago and we said, what is going on in ohio . In West Virginia . The anxiety of loss of jobs, loss of hope. We have to flip the switch on the stigma and then try to figure out how to do this, i think, through employers, medicines, doctors, and do it in a way that gets more and more Treatment Centers built and more and more information out there in a way which is positive and proactive. As the congressman said, nothing if not nothing. We cant afford not to find the money. From an Economic Perspective this is an unnatural disaster. Mr. President you mentioned the figure of 78 billion of annual Economic Impact. Hurricane sandy was 65 billion. We are talking about a major hurricane hitting the United States level of Economic Impact we are suffering from this crisis. Not to mention the loss of life which is like a Hurricane Katrina every three to four weeks. We cannot afford not to make this a national priority. We are worried about travel bans and walls, this is killing more people then International Terrorism is. I dont think we have the awareness that the people in this room have. I dont think there is national awareness, or employers awareness. In terms of making connections, where do we spend our time . At work. The sad reality as americans, we do. And if our managers and employees are not recognizing these issues. They are treating it not like they would treat employees that have cancer. Mr. Clinton what is your sense about how large employers are handling this . Is there any kind of general consensus, do they make their employees feel like they wont be fired and they will be helped if they show up and say i need help . Or do they in effect, confirm, what you might call the stigma bias by making them think they are toast if they have to fess up . Tom my sense is, there are a handful of Companies Including Large Companies that are demonstrating real leadership. We saw that under the Obama Administration with the fair business pledge. I was in a room with 15 large employers, coke, pepsi, a bunch. Theyre upfront on these issues. A lot of people dont work for those companies or work for large employers. A lot of people who are struggling with this work for small employers or not at all. That is where these Public Health interventions will have to take place. I think the conversation is beginning but given the numbers, the Economic Impact, on lives, it is way behind where it needs to be. Pres. Clinton do you think there is a difference in the degree to which stigma remains a problem in small town and rural areas as opposed to urban areas or is it uniform . I think stigma is everywhere. I think it is everywhere. You know, people, have a lot of pride. First of all, to even acknowledge you have a problem, people dont want to admit that. They just dont. Then they go throughout their lives, deny, deny, deny. But yet still, as again, the people i have talked to tell me, by the time a person is going into the medicine cabinet to use moms pills, they already have a problem. You assume, your 16yearold just went into the medicine cabinet and saw something and thought they were m ms. No. They knew exactly what they were doing. We have to concentrate on education and trying to make people realize, how significant problems can arise. When i was chairman of the committee on drugs, the Oversight Committee many years ago, we had some students, mr. President , come in from baltimore. We had maybe 50 of them from baltimore to test the commercials. To test the commercials. Just to see how they felt about the commercials. The one commercial, all of you will remember, they said, this is when you use drugs, this is how your brain looks. It was an egg frying. By far it was the number one commercial. A lot of it, we have to make people realize, this is not the way. I know we will be closing soon. I have to say this, when i look at this audience, and, just the idea that we are sitting here and i want to thank you, by the way for doing this and hopkins. You all are the ones who must help drive the policy. You are the experts. You know. You got firsthand knowledge. You are the ones. You have been trained for this. We look forward, when i sit at the podium, we are an army. We are an army. But you are the super experts on this. You know the impact. You know that what you do or dont do can affect generations yet unborn. Pres. Clinton thank you. That was great. Let me say why i asked the question i asked about the stigma. Maybe this is just my experience as being a slightly guilt ridden member of a family that has had addiction and it. That has had addiction in it. But i believe the stigma extends to Family Members and coworkers. Depending on how bad an addiction is, a heck of a lot more people know it then the person believes know it. Or they suspect it. That is why the culture in a community, in a workplace, in a religious setting, all these things matter because i believe that the stigma sometimes hangs around the necks of Family Members and others maybe even more than the person with the addiction that wants to scream for help but they see the rest of everyone Walking Around wanting to pretend it aint so. This is a confession, not a criticism. I am telling you. And i think, so i believe when this whole stigma thing is discussed yeah, you want the person with the addiction to come out but really the whole, look, all these little towns. I was born in one of these little places that is supposed to be the epicenter of this epidemic. Everybody knows everything. Just about. Somebody knows. In these little places, and maybe somebody knows in microscpe. Everybody thinks manhattan is such a big place, littleally a 1000 ones. I think, the only reason i mention this is my view is, this stigma message, we have to be careful because it sounds like it only applies to the person with the problem. But if you know the chief of police in your hometown, does not want to put your brother in jail, and you know that you do not have a clue how to get your brother in a Treatment Program or your sister or whatever, you ought to go to the chief of police. In my opinion at least, having been a Family Member and onlooker of all this on and off for, i dont know, 40 years, we talk about stigma as if we are all being broadminded by reaching out and making the addict feel good about himself or herself and come out of the closet. This is a bigger problem than the person who needs the medicine or the psychological counseling. It is one of the reasons i wanted to do this today just so we could, you know, a lot of people like you who are on the front line of this and could use a little help from your friends here, if we all just get over it, this is a big deal. We would like to stop every single, solitary person we can from dying. Would likee way, we back,e them their lives which they have to claim. Anyway, i will get off my high horse. We dont need to be patronizing when we talk about stigma. As though it is a delicate thing. Stigma is something that a lot of more people participate in them the employer or somebody in some oversight position and the addict. Were about to wrap up. Anyone else want to talk . Anything you have to say, say it. Just to your point, i think it is also, we have a lot of different crosscurrents. For example, we know that after school or Community Health care plans would actually be helpful and then when they get cut it makes it harder. We know that in terms of employers, we are all looking, i will put my employer hat on, we are looking for how we can squeeze that last dollar out of a health care plan. If we are not going to actually pay for any ap program or those kinds of things, that is a cross current that hurts this. The alignment, the medicaid, you need a waiver to get this to go to a Treatment Facility that is more than 16 beds. Why have a waiver . When i just change the law . Change that law . I think part of it is also, there is a bunch of things we need to do to be consistent as opposed to having this cross current that says, this is important but i am not acting like it is important. I just wanted to say thank you to you sir, for shining a light on this. The last time you and i were together was at the summit for americas promise. Here we are talking about americas crisis and i dont think people understand that. To have someone of your stature withat Johns Hopkins, thank you. To have someone of your stature in partnership with john top tens, thank you. [applause] clinton i want to close with somebody who actually knows what shes talking about. [laughter] pres. Clinton keep in mind, baltimore is not only the oldest Public Health unit in the country, on this score, one of the finest. As you said, even if you got a Treatment Center somewhere, you dont necessarily have the transaction cost covered. This i think is important. When i was the governor of arkansas in my former life and we were the second poorest state in the country, we early on had one of the highest vaccination rates for basic vaccinations for kids, two and under of any state in the country. I would like to say it was because of my sterling leadership. [laughter] clinton it is because we were so poor in the Great Depression and a lot of Southern States were, that, the government helped us build out the Public Health network. Then, a century later, when people started suing people over vaccines and we literally provided 85 of the vaccinations for little kids in my state through Public Health networks. In other words, we were the connection. And so that is why ask you about the Public Health infrastructure. Somehow, we need to come out of this all of us with a clear idea of what kind of infrastructure we need that is not there. Not just what elisha said, which i totally growth. You know, i am all there on medicaid covering it, and we need more money for all of this stuff, but the Public Health infrastructure is peanuts compared to the 78. 5 billion we are blowing, never mind the lives we are losing. So, talk a little bit about that. For a relatively modest amount of money, could you do good if you had that . Absolutely. Savedhing, Public Health your life today, you just dont know what. [laughter] pres. Clinton oh i do. [laughter] we just dont know it. Pres. Clinton i agree. I am fortunate in the city to work with senator mikulski and congressman cummings and so many who have helped us with doing things that are very difficult with starting Needle Exchange. More than two decades ago here in the city. People said things like, isnt that just going to make people use more drugs . But what we have seen is that, the percentage of people with hiv from iv drug use has disses has decreased from 67 to 7 from 1994. That is what Public Health can do. So i would say, as a call to action for all of us in building the Public Health infrastructure and in general, sometimes the Opioid Epidemic seems so big, there are three things we can do today. First, learn to use narcan. We can all save someones life. Your been such a great champion of that, mr. President. Second, change our language. Change the way we speak about the issue. The director botticelli, he taught me a line about how talking about the way we can reframe our own language around speaking about the disease of addiction for example rather than talking about addicts, simple things we can do to make a difference. The third thing we can all do is think about, what is in our wheelhouse . If we are in a hospital, instead of leaving it to another hospital to take the lead, what is it we can do . Or as an employer, what is it that we can do as an employer or union or policymaker . I thank you for supporting us in building our Public Health infrastructure and raising awareness for the issue. Pres. Clinton thank you. Lets give a big hand. [applause] pres. Clinton they were wonderful. I just want to say one thing. The next panel is about the report that the Bloomberg School and our community did. The report had very specific recommendations. The purpose of that is my ongoing obsession with this issue, which is that, too many smart people in america spend too much time meeting and nothing happens. Is that we all pick something out of this that we can and will do. That is why i began by mentioning the three things we will do. I urge you, this next panel is really good, really impressive, really active. So figure out what you can do and commit to do it as a result of what they say about these recommendations and their expenses. And there experiences. And their experiences. Thank you and bless you all. [applause] [indiscernible chatter] goodbye, mr. President. Until we meet again. Goodbye. ] ndiscernible thank you. Thank you. Got a get a pen. [indiscernible] could we have one more picture . President clinton sure. We have to get the room cleared out. [indiscernible] hello everybody. We are about to get started with our second panel. Trying to be very respectful and not upstage the president. [laughter] that would not be a good thing. Good morning, my name is michael botticelli, im here at the John Hopkins School of Public Health, the dean gave me a fancy title which i will not say. I also have the privilege of being the director of the white house Drug Commission under president obama. In washington we worked with many of these people on the panel and many people with the Clinton Foundation in terms of our response to the Opioid Epidemic. As the president indicated, this is a multifaceted problem that manifests itself on the national, state, and local level. We need a multifaceted response and we have a tremendous group of panelists here today who have been in their own way continuing to focus on this issue at various levels. They will talk about the work theyre doing today. Let me introduce them. To my left and your right, erica paulette. Who is the Senior Community minister and project director at justin Memorial Church in new york city. Someone from newtown, ohio, who ive had deep rutledge of working with for a long time. Next to him is dr. Forrester, director for pharmacy and therapeutic safety at midatlantic medical group. Finally, jim hood, the ceo for facing addiction, an Organization Many of you know. Let me start off, i will ask jim to start. Jim, like many parents, who have been impacted by this, we heard very personal stories today. You are one of many parents who have been personally impacted by this. And kind of out of your grief you changed that into advocacy and action by leadership of a National Group called facing addiction. What will you tell us a little bit about the group that also this theme of evidence to impact. Where do you see where we are now in terms of where we have made progress but where do we need to continue to ramp up efforts to implement what the president said, in that we know what works here. Give us your assessment in terms of where we are now and the kinds of efforts we need to continue to move forward. Thanks, michael. Next to the Clinton Foundation and the Bloomberg School. Thanks to the Clinton Foundation and the Bloomberg School. In some very nice words from president clinton. Raising addiction is very excited to be working with the Clinton Foundation and trying to make greater progress and signed this dragon. Yes, i did. I lost my oldest boy, austin, to this horrific thing five years ago last thursday. In so, you know, we soldier on because this work is so important. , i think stories are so important. I want to paint a very quick picture and then also kind of paint a landscape. I understand the focus here is the opioid graces, as it should be. It is horrific. But it is also the tip of the steer within a larger problem which is all addiction. And other drugs. This is not to diverge, we must focus on the opioid thing but we ultimately have to tackle this whole thing. It is just getting worse and it is getting younger. There is a staggering figure many figure about how people die from opioids. Someone dies every four minutes. That figure is probably understated. Somebody dies every four minutes from addiction to alcohol and other drugs. Ish people every day. It is jarring. That is a huge jet, a huge airplane. It is often young adults. Bright eyed college kids, maybe they are going to europe to do international studies. That is a freaking jet falling from the sky every day. Somehow, this country, at this point everyone is concerned about the addiction crisis. I dont know if they care enough. I dont know if they are broken hearted enough and maybe we have to get from statistics to absolute grief. You put that figure in perspective and none of these are value judgments but the first panel mentioned the devastation of hurricanes. I mean what that animal did in , las vegas is unspeakable. Yet we have six las vegas in terms of deaths from addiction every day in this country. Somehow we dont rise to the occasion and we simply have to rise to the occasion or, as president clinton said in an earlier speech, this thing will eat us alive. So, our work, michael, to try to keep it conceptual, president clinton also mentioned in the aggregate, the country has gotten so little done and also in such a disconnected way. We hope to get a lot more done and part of that is to connect all of these different parts. I could paint a picture for you, i will be brief. I could paint a picture both frustrating but hopeful because if you think of the journey of a young person in this country from prevention to Early Intervention to their interaction with regular health care, there are clear identified problems. They are in this report. There in the Surgeon Generals report. There are problems with prevention. The wrong programs, we dont go to where the kids are. Pediatricians are insufficiently trained. Doctors who overprescribed because they only get a few hours of training in med school. Some treatment works, a lot doesnt. It is not scalable, affordable, not integrated with the health care system. Too much of a criminal justice response in the country that has to be shifted. Longterm aftercare is not what it should be. We know what to do in every one of those boxes, we just dont do it. We just simply have to stop talking about it and do it. In the larger sense, facing addiction, is a National Group, think of it as the american cancer society, to try to integrate private sector response to this crisis. Thank you. We can follow up on that. Erica, let me ask you a question. Should i call you reverend or, ok, thank you. Our faith institutions have long been engineers of social justice change in the United States and particularly for highly stigmatized people with highly stigmatized diseases. And like, i cant, you know, when you think about the Faith Community response to the hiv epidemic, a lot of us have talked about the parallels of that. Talk about what youre doing. And i think i want to go back to what the doctor said in terms of how we think about Harm Reduction. Many people are not ready to seek treatment but we know we have to keep them alive and keep them healthy. So, why dont you talk about your work and the Harm Reduction approach is you are taking but also kind of the call to action to other faith communities in this epidemic . Great, thank you so much. It is wonderful to be invited into this conversation. Communities of faith have played a significant role and we have in essence, created a community of lepers by stigmatizing and shaming folks. And we have, what the church does is, as important as what the church doesnt say. I gave a sermon earlier this year on the gospel of Harm Reduction. Within hours, i was receiving hundreds of emails, phone calls, encounters with folks in the church and community, in the halls of Harm Reduction coalition, where i also work. People said they had never heard the issue talked about in a sacred space. They had never heard the drug issue talked about and imagined with a compassionate response. They had never heard their story reflected in those rooms. They had never heard their child, their loved ones, and their self, called the love it. Called beloved. That is really significant. The church is called to make a space and a place. In order to do that we need to extend radical welcome but we need to make sure that we are examining and tearing down barriers that limit folks from accessing help. I work by virtue of doublebelonging, at Memorial Church as well as Harm Reduction coalition and as a virtue of that double belonging have had the opportunity to listen into both spaces and to identify a deep need that communities of faith, especially in communities that are particularly vulnerable to drugrelated harms, they are often the points of access. They are often the ones with the most welldeveloped social networks. It is really critical. What we have taken on is the space in sanctuary project where we work on mobilizing faith leaders across the country to be able to speak prophetically to the humanity of people who use drugs, to be a resource in their communities and for their congregations as well as being able to advocate for compassionate drug policy. [applause] i want to follow up on that. Because this is a good example where the evidence of what we know to be effective is a far cry from what has been implemented. We have known for example, access to sterile syringes and even naloxone are proven intervention strategies. What do you see as the significant disconnect between kind of the evidence of what we know and why we in some respects and in some places in the country are still debating this . There is a multi fold answer in there. Quite honestly, there is an immense amount of wisdom, expertise, experience, people are doing this work. People who use drugs and their loved ones have been saving each other for a long time now. It really is, connection, collaboration, is really the key to addressing this issue. And in doing so, it is going to be connection with folks who have lived the experience of overdose, drug use, with families, with the First Responders, on the site at these overdose encounters. And that we really need, and you know, this includes Harm Reduction programs, which are constituted largely of folks from these same communities. And, you know, if the community, people with, people who are the experts are the ones we need to be following. We need to be taking our charge from them. Can i follow up on that . Sure. Yes, it is very important. Here is one of the things i think would shift. One of the big things we need is funny. But one of the big things that would be dramatic would stop would be to stop treating addiction as a crime. [applause] take it out of the criminal justice system, put it into the mental, medical system. We cant get past any of this until we get past the point where everyone thinks every user is a criminal. Allow us in Law Enforcement to cut down supply. To be the link to other organizations and i think we would see a dramatic shift. Until the public stops seeing this as a crime, it will be difficult. Many of us have remarked on the tremendous shift in Law Enforcement. Youre not the first chief wary we have heard say we cannot incarcerate our way out of the problem. We have to partner with the Public Health folks. How does that change your work at the local level . They best friends are Cincinnati Health commissioner i and another. I work with them asked as of late. We work at commissioners to push out narcan to every Single Police officer in cincinnati. Doses. 00 7500 uses in a year and a half. We had a great conversation. We are dealing with cops. Do not give a needle to a cup. We have the spray. We push the spray. My closest cohorts in treatments is a bad part of this is we inform the families. For us it is real. We know we cant solve this ourselves. We need the people that can get people into not just treatment, but care. Longterm care so they can reintegrate back into society, get jobs, have their life back. What we put it on the backend and get our investment back . What do you see at the local level in terms of the major deficits . You talk about how to get people into treatment and the longterm care they need. What is the biggest need your Community Faces . I am just going to say straightout, it is funding. We call this an emergency. We dont treat it like an emergency. We have 50 to 70 people overdosing every week in our area. Four or five people dying every week. Yet the money is not there. We have the people. It is not like the community to someone to help. We dont have the resources to do it. We dont have the doctors, the ones that can go into the community. We dont have that. If it comes down to money, we have an opportunity to have that. I hope we dont let that go. This is the time and moment we can shift addiction. I have been saying this for a couple of years. It takes you, all of you need to get a hold of your policy makers and tell them to give us the money. This is an emergency. It is not a waste of money. It is an investment of money. Thank you. Calvin call my want to shift a little bit. The doctor, and a very confessional moment, talked about as a physician he got very little to no training on opioid prescribing and Substance Abuse issues. Part of our efforts now is this balanced approach that i really want you to talk about. We really want to make sure we are diminishing unpaid prescribing practices, but not have the pendulum swing so far in the other direction we are under treating pain again. Talk about your efforts to reduce opioid prescribing, but still ensuring people have adequate access to Pain Management strategies. Thank you for the invitation to be here among all these distinguished colleagues, and president clinton and the Clinton Foundation. And the Bloomberg School. Kaiser permanente is a National Health plan. Although we are not in the entire country, we have a tiny section of the country we try to help. For those 12 million patients we really do want to make sure they are receiving the safest and best care we can possibly afford. What my role is as director of pharmacy and therapeutics is i try to use my expertise and background in educating our physicians and our patients regarding safe opioid prescribing, but also importantly the management of chronic pain. That is really where our focus has been. About six or seven years ago across our health plan, which is present in eight states and the district of columbia, we have implemented guidelines around chronic Pain Management. As well as a opioid prescribing. Yes, i have heard the comment you are taking away opioids from people and they will be in pain. No, we are augmenting our chronic pain treatment and augmenting the ability to prescribe nonnarcotic or nonopioid treatments. Nonmedication treatments really. It is not always medicine that will help you with your pain syndrome. We make use of significant alternative medicine treatments. Exercise, weight reduction, simple things that can help people with back pain for example. We have pain psychologists that that areby the way, way underrated. My daughter is a clinical psychologist in training. I think they are wonderful. We have to understand pain is not just going to be fixed by a pill. It is going to be a combination of factors. A lot of our education has been around chronic pain treatment. As well as safe opioid prescribing. We have standard of guidelines for treatments for opioids. Certainly we have given our physicians many tools to do the right thing. Physician support in our Electronic Medical records does not only include how to prescribe appropriate doses for short durations, but have all the other specialist referral options and other treatments that can be used for a particular pain syndrome. Even at the point of care you are reminded of all the other things you could do for that patient, if you didnt already do it. We also augmented the specialists and the services that we want to have to help patients with chronic pain. Over the last seven years that has been significant. The resources we have internalized. All those services are under one roof and a Medical Centers so people dont have to have the barrier to access, to get outside, to go somewhere if you dont have a car for example. If youre at the Medical Center and its all in one place, you can get there. So, weve had a lot of internalization as well. Let me ask you a question. The Previous Panel talked about Insurance Companies. I have often heard from physicians saying they want to do the right thing and not prescribing opioid, and look at giving folks physical therapy, acupuncture, and often have an insurance roadblock. Insurance does not often cover those nonpharmacological practices. I am lucky to practice in a setting where we have those internal resources but i totally understand. I have friends and family that are physicians who do not practice in a setting like i do and they have to be very cognizant of what the patient has as far as their benefits. They may want to give them certain services, but they know that patient will not do it because they have to pay outofpocket. That is one of those flaws in our health care system. We need to expand services for everyone, in all lines of business for all of our health care plans. One of the things many of you mentioned in the Previous Panel and i think with many diseases and people the role of personal stories and narratives has dramatically changed the way we see people. It is not a disease about us and them. But its all of us. Maybe for anybody, jim, erica, what you see is the role of people with experience in this . People still using, people in recovery, parents affected by this. Kind of, you know, how do we use those stories to change Public Opinion and Public Policy . I am happy to take a brief shot. We talk about this in facing addiction. Im being a little euphemistic. But we talk about this as an illness that no one will ever get, no one ever has it, and no one ever had it. Except for about 40 of all households in america. Clearly the statistics do not put us over the edge. Stories will. Stories will. Its stunning, i got here late last night and went to a restaurant in the hotel. It was empty. The server asked why i was there. Within minutes he told me he was 30yearold guy and nearly died many times for now he is on a great course. I needed someone to help out at the hotel. A sweet little woman said, are you going to this thing . She said i have not seen my boys years. Oy in ten he has been addicted to heroin. I dont know if i will ever see him again. This thing is all around us. Everybody knows somebody. If they are honest, they are probably related. We dont talk about it or admit it enough, but we will get to a point where it will be more than half the country. It would be better if we just got over it and got to work. Lets talk about this. Congressman cummings talked about the Untapped Potential for people in recovery, people affected by this. Maybe jim and others can talk about the role of people in recovery could play in terms of changing peoples opinions or how it relates advocacy. One of the things we are trying to do is use peer mentors. We are trying to many are training people who have been there and done it. It is one thing for me to say i care i will get you help. It is another thing for someone who has been there and experienced it. I would think one longterm goal that would be great is having Crisis Intervention Team sick a lot to the mentally ill. Peer mentors would be like a Crisis Intervention Team. They could come out and hopefully walk them through the process. It is one thing for me to say i can get you help. It is another for someone to say i have been there, i am at, here is where im at, lets go. Thats one of the actions we could take. Hopefully fingers crossed is something we can work out. I use stories when i teach physicians, specifically post health care with surgeons. A few of us have stories where you may have seen a patient, and adolescent or young adult with an athletic injury in college or high school. As a result they were put on opioids for a while. Maybe longer than they should have. Maybe they held onto those after they were done and kept them in their drawer. When there was a party a few weeks later, their friends said you got some oxies . Lets go. Letsthat in your drawer, go. And that leads to someone having an overdose. That is how it starts. Prescribing too much, more than a patient needs, especially young adults, collegeage 61 opioids is wasted, drawer. A and that leads to trouble. I use those stories a lot. I was pleased to see the inclusion of First Responders in necessary groups to engage. I would also say as we are talking about stories and inclusion and talking about where we draw wisdom and ways in to communities most impacted if it is necessarily led by folks who have had this experience. I mean, the evidence we are talking about is being born out of their experience and their work with one another. It is really incumbent upon us to listen into those spaces and figure out how we can work in synergy with what they are we have talked about the role of advocacy. One of the things that changed the trajectory of the hiv epidemic was a bunch of really angry gay men and lesbians who said we will not take it anymore and really created an urgency around this. Many of us have been doing this work and felt like this has not had the urgency that other natural crises or other epidemics have had. Maybe you can talk about either the role of advocacy and how we think about harnessing the potential for accelerating change. Look at mothers against drunk drivers. It was a group of, excuse my language, pissed off moms who affected change. There is not a Large Organization like mothers against drunk drivers. It would be great if there was a Community Grassroots that grew into a National Level of mothers and fathers who could advocate, not just to change the public image of the user, but for policy change. I could not agree more. When we look at the addiction landscape, there are a lot of organizations with good people in them doing good work. For complicated reasons no one ever built a movement, created critical mass. All these things we are talking about as we look to government by the way, we should not rely on government. Government does not solve any of these problems. They can help. But no one has ever build a movement and without advocacy and anger and pressure on politicians, none of this will happen. Greg williams and others on our team who are vastly smarter than me saw this, and in two short years we have stitched together Something Like 700 organizations. Some are relatively big. They in turn represent 35 million americans. They can help us understand how we can turn the switch, get them angry with a short fuse. It will take a much bigger group. We will have to become even more cohesive. That will be the answer. We have got to get a large group of people saying it is time for this stuff. Erica . There is a movement. I look at the work that my colleagues have been doing. They have been doing the work that many of us have resisted doing until it got closer for us. I think in that way, the frame that really lends itself to this issue is that, yes, it is a public help issue. Public health issue. It is also a social justice issue. There are circumstances that make particular people more vulnerable to drugrelated harm. In this way it is an incredibly intersectional issue. I think we will gain an immense amount of strength by being able to find our ways into alliance with other movements. This is very much a Racial Justice issue. This is very much an issue for folks who have experienced trauma and genderbased violence. This is very much an issue about poverty. We cannot divide the Public Health response from the social justice response. Addressing all these intersecting impressions will be really, really critical to ensuring we can that we are ready for the next time another crisis happens. Until these core circumstances and such are addressed, we will not make a move on this. I think physicians were called to this Movement Since we lived in a cave. They found that six or seven years ago when the data for increasing opioids directly correlated with increasing deaths, and statistics such as 99 of the worlds hydrocodone is in our country where we have 5 of the population. Things like that may physicians make physicians engaged and listen. ,honestly the government has assisted us by passing mandatory continuing Education Credits that is necessary in some states. Also mandating we mandated it before they did restructuring monitoring process. Even prior authorization. I hate having to fill out forms. Everyone does. That is a universal thing. But when some statemandated prior authorization for certain doses and certain quantities of opioids, that did a lot to engage physicians that may not have been aware they were doing something wrong. Over the last several years there has been a definite call to action and physicians are definitely engaged at this point. We were talking about anger. I told the story. I said 50 to 70 overdoses every week, and it was not a single gasp. We need to figure out who need who we need to be angry at. Right now we are angry at the wrong person. We are angry at the user because they overdosed multiple times, but not at the dealer that i have arrested seven or eight times that puts it back on the street. We are not angry at the Pharmaceutical Company that lies to doctors, lies to society good. We have two angry people. We need you to be angry at them. Our anger is placed in the wrong place. If we put it where we should be, we can start fixing this. We are angry at the wrong person. It is not the user. They have a disease. The brain is affected by the substance. We should be angry at the people that did it for greed. I love it when our Law Enforcement officers talk like Public Health officials. [laughter] i am hanging around you too much. [applause] we have seen great sea change among Law Enforcement. All of us are worried at the federal level that despite pairing drug policy reform with criminal justice reform, we might be backsliding so how do we keep the momentum going at the local level to ensure this is a Health Response and not a punitive response . Lawenforcement is at a crossroads. What i am saying is not necessarily what the majority are saying. There is a group that is pushing back and saying, wait a minute, this is a crime and i will treat it like a crime. We are arguing within our own realm. A lawenforcement officer or First Responder . This issue has blurred the lines. Me, there is no confusion. My job is to save lives, period. I am not the judge. Trust me, i have my own sins. My job is to save lives. The in Law Enforcement are arguing about, we in Law Enforcement are arguing about our roles. This is where the public i have been screaming it for years it is you. You should all implement policy that we, federal, local, county, state officials do. When you stand up and say we will treat this differently, then in Law Enforcement will have no choice but to treated differently. Building on that, its an Interesting Program we initiated. We started here from a lot of communities that they are lost. It is not a criticism. They simply do not know what to do about this issue. We dont have a silver bullet. We have some knowledge, some best practices we can pedal around. We bring together local leaders, Law Enforcement, faith, parents, educators. You Start Talking about what is working in your community, what is not working, what are the gaps. There are some similarities but depending on the make up of the community they are different. We are working to forge a plan that we can leave behind so within a year or so they will have some cohesive way to tackle this problem in their community, and to raise additional funding or redirect funding that exists but maybe is not going to the best and highest use. There is nothing glamorous and no magic, but its rolling up your sleeves and getting to work. I want to follow up on the role of community. You have probably read the book dreamland. A great book. I got to know sam over the years. One of the lines he uses that i steal from him is that the fundamental response to the Opioid Epidemic is community. I think all of you who work in various sectors of community, maybe just reflect on your own thinking about community and community coalition. Who needs to be at the table . What is important for them to think about as they respond to this issue . All of us at the federal level or used to be at the federal level know that we have a role, but ultimately it is what happens at the Community Level that is important. When you say that, my training is pediatric medicine, after i went to pharmacy school. I think of school and education. Middle schools and high schools and colleges, how can my medical colleagues go there and educate. I dont mean just do a lecture once on third period and some kids dont even show up. I mean having consistent education in the school be required. All my kids are out of high school now. They were required to take a course in economics in high school. They could not get out of that. Some thought it was easy and some struggled, but they had to. No one was required to take a course on addiction or Substance Use problems we have in this country. Yet it affects every single child one way or another. They know someone or a Family Member. Getting into the community and educating and being there often, having standard courses, i think physicians and pharmacists are great assets in this community. They could be out there teaching. It is a comprehensive community response. When we started the coalition, the vision came true about a month ago. We knew it was not going to be the four pillars, it had to be every part of the community. It is a complex issue that needs a complex answer. Last month, i sat in this room and for the first time in 2. 5 years we had almost every aspect of our community represented. Grassroots, religious groups, universities, doctors, hospitals, elected officials, police officers, health departments. I was getting emotional. Wow, this is our vision, and it came true 2. 5 years later. When we talk about the right people and organizations, it is everybody. I get this a lot. Everyone says you need to tear down the silos. I disagree. We should stay in the silos because those people are the experts. We should have a door to each silo that lets everyone in and everyone out and connects everyone. Those silos are extremely important. I am not the expert on health or treatment. I am not a doctor. I need them to share the information. If we have a comprehensive community response, then we can make a dent in this. Yeah, i go back to what i understand my charge as a minister to be. That is in Holding Space and making space. As such, it is incumbent on i speak specifically about faith communities to breach the silence around this. Make a statement prophetically. This is not an individual issue. This is a community issue. It is being felt across all divides. It does not occur in isolation. I think back to a dinner i had with some good friends who are here today and we had the opportunity i attempted to take a couple of days off for a soul care for myself. I found myself describing some of the struggles with work. By virtue of hearing into our conversation, one half of the couple sitting at the table next to us interjected herself into our conversation and came to find out that they had lost their son about five years prior. Had never spoken about it. Did not know they were people who were working to ensure nobody elses child was going to die from an overdose. They were people that cared about their child, who cared about them. By virtue of having these conversations, being able to challenge for us there are some well entrenched theologies that are horribly problematic. I dont know. We only have a few minutes left. I want to end by asking each of you, and president clintons charge about thinking going forward. You have all done an incredible amount of work. What are the one or two or three things we need to do next that we think is really going to continue to leverage change as a it relates to not just this epidemic but addiction issues in general . I would singularly put stigma at the top of the list. These folks are smart. We do know what needs to be done. There is a little bit of inside baseball risk of smart people talking to themselves that dont think we can underestimate we should not underestimate the debilitating power of stigma. Half the people do not think this is an illness, even though we have known it for 75 years. If you do not think it is an illness and it is your problem and why should i care . That is a huge issue. How do we get to them . We have all been having this conversation. A massive education campaign. I hope it is something we will get to, facing addiction with the Clinton Foundation. We call it a rebranding campaign, which is not to be confused with making this attractive. 90 of the people who suffer from addictions never get any form of treatment. Imagine if that were any other illness. There would be riots in the streets. You read obituaries of people under 25. It is a sudden cause of death. Shocking. We know what that is. We know what that is. If people are not willing to finish this thing and call it an illness, which is treatable. It is not inherently fatal. We can get there, but the first step is to get over the stigma and shame and discrimination that attaches to it. If we can do that, it will be a different ballgame. I would like to focus on prevention. At this point, from my perspective, i think that is where we have a lot of opportunity. Raising awareness in the Community Means education, education, education. Again, my background is in adolescent medicine. When we were all about antibiotic resistance, we went out and educated and got the community involved. Patients realized it was not a good thing. They went from demanding antibiotics for a cold to asking, do you think i need an antibiotic . Yes, this one you do. I saw it was mentioned in the report. That was my analogy i was going to talk about today, but oh well. We dont have that with opioid use. We have the stigma. People are still expecting to get the opioids and be painfree. That expectation has to be changed through education. Stigma. It is one of the biggest things blocking us. I hope within my career we shift the addiction out of criminal justice into the mental medical health system. It will allow us to get the right people the care they need. I will say stigma as well. I think it is the core of this crisis. As long as people who are created in the image of the most divine are redacted to behaviors, it will not matter what strategy we employ. Speaking of the church, we have attached stigma to the drug issue in people. We created a population of lepers. It is incumbent on us to liberate them. We must be a space and a place that offers compassion and stands in awe of the many burdens that people carry rather judging them for how they carry them. [applause] i am actually sitting here feeling a little disingenuous that i have not talked about that i am a person in longterm recovery. [applause] i am one of 22 Million People. I have often said to the extent we can, we have a personal responsibility to be open and public about who we are. That does change Public Opinion and does change peoples minds. I want to thank our incredible panel today for the work they are doing and for the work i know they will continue to do. Thank you, everybody. [applause] thank you. This just about wraps it up. I am caleb alexander. I am codirector of the Johns Hopkins center for drug safety and effectiveness. As i expected, those were two exceptional panels. Mr. President , on behalf of the Johns Hopkins Bloomberg School of Public Health, i would like to extend our deepest gratitude to you and the Clinton Foundation for your leadership and commitment to addressing the important issues we have discussed today. Five years ago, you mobilized the foundation to act. Since that time you have been on the leading edge working for change. Such as through the foundations tireless efforts to raise Public Awareness of the crisis and help people understand that addiction is a brain disease, not a behavior. I would like to thank congressman cummings, our other esteemed dignitaries, dean alan mckinsey, and all of you that have joined us here in the room and from around the country. Thank you for your participation. This event, as well as our newly released report on the Opioid Epidemic, from evidence to impact, took a lot of planning. It would not have been possible without the dedicated efforts of so many individuals from the Clinton Foundation and the Bloomberg School of Public Health, including those working to help communities fight the epidemic through the Bloomberg American Health initiative. As we have heard today, i want to underscore the importance of the efforts of all of you in the room and all of you who have joined us today from afar. We have all been touched by this epidemic one way or another and we should not doubt the power of our collective action. In 2011, judy lost her son to a heroin overdose. I told her about this event. I asked if i could share his story. She said, i am always happy to have steves story shared if it helps the cause. Judy talks about a note she keeps next to his picture. It says, if love could have saved you, you would have lived forever. Families should not have to endure the suffering. There is no conflict between reducing our overrelliance of opioids. It will take effort and mobilization. The good news is we know a lot about what works. Thank you again for all you do. [applause] hello, i am delighted to wrap up todays event. I direct the center for Injury Research and policy. On behalf of our centers, i would like to add our thank yous to the distinguished panel of speakers that have challenged and inspired us today. To president clinton, we sincerely thank you for all you have done to address todays Opioid Epidemic and for being here with us today. Your leadership and the work of the Clinton Foundation, with its power to bring a diverse range of partners to the table is responsible for putting lifesaving tools in the hands of First Responders, school officials, and Health Professionals from across the country. Today is the culmination of a long journey, that as you heard began with the first town hall in this very room three years ago. We are very proud to have been working in concert with the Clinton Foundation, then and now, as we continue in our determination to win this fight. Like many Public Health and injury problems, opioid overdoses reflect what happens when a product that delivers both benefits and harm exists in an environment that allows the harms to flourish. Addiction without access to treatment and too many medications from overprescribing, and medication supplied without the lifesaving antidotes are a few examples. Joined by the Clinton Foundation and a group of distinguished experts from around the country, we focus on finding the evidence to solve these problems. Our report was released today to provide the evidence, along with specific recommendations for actions. The challenge we are addressing is how can we act collectively to turn around the Alarming Trends in opioid deaths, so the public is protected and the benefits of proper pain control are delivered safely. We hope today is the beginning of a new journey, one that moves us surely and steadfast in ending this epidemic. With the help of everyone here and everyone joining us online, we are confident this goal will be realized and we thank you all very much for being here today and for joining us in the future. Thank you very much. [applause] for those of you in the room, i would like to invite you to the reception that will be on the first floor in the atrium. Thank you. [applause] [crowd noise] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2017] rnow and his new book on Ulysses S Grant on sunday nights q a. He was a perfect leading man for a musical. Moves differently. He was laconic. The charisma of grant he has no charisma. He was not dramatic. He is not as fascinating. He is a very subtle character. George washington had a similar kind of reserve, an enigmatic quality. Sunday night on cspans q a. The house ways and Means Committee gives its work on the republican tax plan monday before sending it to the house for vote. Watch live coverage monday at noon eastern on cspan2 and. Org. N listen live using the free cspan radio app. En route to japan and the start of his five nation tour of asia, President Trump visited the u. S. S. Arizona at pearl