And chairman gowdy, were honored to be a part of the House Oversight and government reform committees efforts find Meaningful Solutions to the Opioid Epidemic. Thank youall for being here today. It is no secret that were in the throws throws of a crisis thats reached Epic Proportions throughout our country. Baltimore is no exception. In 2016 we average nearly two fatal opioid overdoses in this city per day. This is a problem in desperate need of thoughtful answers. As both an anchor institution and steward of health care for our local communities, hopkins takes this problem very seriously. We see firsthand the devastation that substands care at our sister hospital to the east, the number of opioid Overdose Patients seen in our Emergency Departments doubled last year. Doubled. This crisis is very much a part of our reality. What are we doing about it . As an academic medical center, were addressing the issue through the lens of our mission of research, clinical care, and education. First research. Hopkins research runs the gamut from bench to bedside. Starting with the original identification of the opioid receptor in the brain by dr. Snyder in the 1970s, to the multitude of Clinical Trials currently conducted in our behavioral pharmacology unit, were working hard on making impact. Clinical care. Were working on two fronts. Treating the disorder that already exists, and preventing future addiction. In addition to our inpatient treatment units, our Broadway Center for addiction logs about 25,000 outpatient visits each year antiprogram is comprehensive. Addressing not only and the program is comprehensive. Addressing not only issues but Mental Health and family needs. And programs targeting pregnant women, youth, and adolescence. Perhaps as importantly as treating were working to prevent pathways to Substance Abuse from ever opening. We have implemented guidelines of mphasize why prescribing opioids such as limiting the doses on first prescriptions, particularly after surgery, and eliminating automatic rebills phills. While patients are with us in the hospital, we have pain specialists work with them to find alternate modality 80s of treatment for their pain. We provide access to naloxone r patients substance disorder. There. t stopped the third part of our mission, education. As educators were working to ensure the next generation of physicians and providers are taught these best practices and treatment there. The third part of our mission, education. And prevention by incorporating them into all aspects of their training. We realize that the work were doing is just one piece of a vast complicated puzzle. The Opioid Epidemic is after all a Public Health crisis that requires a system wide approach. Among our partners is the Johns Hopkins blueberg school of Public Health. The schools Bloomberg Health initiative launched last fall a generous gift from the philanthropies is Funding Research projects partnering with communitybased organizations and working with policymakers around the country to implement evidencebased comprehensive solutions. We reline expertise of so many other Health Related institutions and businesses from the Baltimore City health department, to our local pharmacies, our payers, and you our elected leaders. I look forward greatly to todays testimony from a dedicated and informed group of witnesses. Im confident that your work here will move us forward to achieving solutions to the crisis. Thank you. Now im honored to yield the floor to the esteemed mayor of Baltimore City and friend of Johns Hopkins, mayor katherine pugh. [applause] first let me say good afternoon to everybody. And to this esteemed committee, thank you for being here. Mr. Congressman, to both our congresspersons, i see congressman cummings, and congressman ruppersberger is also here with us, and mr. Chairman, gowdy, thank you for convening this meeting here in baltimore at one of our most esteemed institutions in the world. And so were really grateful because Everybody Knows at this a crisis. Were in opioid addiction, were suffering from here in baltimore, but the nation is suffering. And it is important that we pay close attention to what we do as relates to the individuals who are suffering from this and communities that communities t destroyed by it. So we know that in Baltimore City we have a big problem, but we know were part of a larger problem. I was thankful to our governor who has convened a group to look at this particular a crisi opioid addiction, were issue. Ng were focused on not only making sure that people dont get involved with drugs, but doing what we can to keep people from overdosing. I have one of the greatest, i believe, Health Commissioners in the country in dr. Wynn, who is really focused on this particular issue. I want to again welcome youall here. I know that this panel will continue to deliberate over this particular issue and i look forward to hearing the results of this panel. So we welcome you to baltimore. More importantly we understand the importance of your work and we look forward to results. Thank you. Now i have the distinguished honor of bringing before you the governor of the great state of maryland, our governor, mr. Governor come on up. Governor hogan, thank you so much. [applause] Governor Hogan thank you, mayor pugh. Thank you, governor christie, as you know governor christie chaired the president s commission on opioid. I want to thank chairman gowdy, congressman cummings, congressman ruppersberger, and ll of our members of the house for coming here today to baltimore. We thank you for holding this important hearing here in the city of baltimore and state of maryland. Also want to thank all of you in the audience for being here today. To e of you who are going before the committee that have enough interest to be here. This is a national crisis. Its something that i have been very passionate about for about four years. When i first decided to run for that have enough interest to be here. This is governor, i was traveling the state of maryland and every single town and community i would go into and ask the local leaders whats the number one issue facing your community . And it didnt matter whether i was in Baltimore City or urban areas or wealthy suburbs of Montgomery County and washington suburbs, didnt water if i was in a small rural town, the answer was always the same in every single place i went. They said the number one problem were faced with is heroin. And opioids. That came as a shock to me but during our campaign we started bringing in folks involved in treatment, education, interdiction, crime fighting. Police officers. And we got all the input we could. As soon as i was sworn in as governor one of the very first thingsdy in january of 2015, was i put together things i did in january of 2015, was i put together an Emergency Task force. They travel the state and held hearings in every part of our state where hundreds of people would show up to testify and tell their stories of addiction and the problems. We came out of that with 38 recommendations, all of which we implemented. Focused on every aspect of the problem. And we it continued to get worse no matter what we tried. We have now we became the first state in america to declare a real estate of emergency. Just like we would for a natural disaster. And it is a national disaster. We just so far this year in our state, 1,180 people have died of overdoses in maryland. And almost every single day dying in parts of our state from one end to the other. For the First Time Ever this is has now evolved from we have actually leveled d. We reduced the number of deaths from opioids. On we for the First Time Ever have flat lined heroin overdoses. T we have a 70 spike in fetinal. We have 850 of our 1,1le 0 deaths are from the new synthetics. As we all try to wrestle with this issue, it constantly evolves and so must our effort to fight it. I just want to thank the governor christie for his work, committee for their work, and interest and focus on this. It is not just a Health Crisis but its impacting and tearing apart families and communities from one end of the country to the other. An all hands take on deck approach. Federal government working with the state and local governments along with people in the private sector and hospitals. I want to thank hopkins for hosting us today, too. I want to thank all of you an a your interest and say that this i called on the federal Government Back when we did our state of emergency and said, the federal government ought to do the same thing. That would be my recommendation to the committee. Weve got to have federal funding. I would say this is the most important problem facing our country. Thank you all for foesing on it. Im going to turn over the floor to chairman gowdy. Thank you so much for being here. [applause] congressman gowdy thank you governor, mayor pugh, pardon the i convenience of having a committee of Congress Come and appreciating the seriousness of the issue that brings us here. The committee will come to order. Without objection, the chair has authorized to declare recesses at any time. Im going to brange from poet kohl a little bit because were in mr. Cummings hometown and because he cares so passionately about this issue, were going to recognize you first for your Opening Statement. Mr. Cummings thank you very much, mr. Chairman. Want to first of all take mention one thing thats so important to me, mr. Chairman, to the members of this panel. I cannot come into this hospital without saying thank you to hopkins for saving my life. Spent 60 days here this summer. A lot in this building. So i want to thank i see a lot of white coats out there and others. Pass the word. I thank you for what you have done for me and my family. I want to begin by thanking chairman gowdy for calling todays very important hearing. For bringing the Oversight Committee to baltimore. I thank my colleagues for coming to baltimore and certainly my colleagues who represent baltimore acongress with me, Dutch Ruppersberger and john sarbanes, i thank you for being here. I have been in congress now for 20 years, and i have been to and seen a lot of field hearings. I have never seen as many members attend any field hearing since i have been in congress. I believe todays remarkable turnout reflects the fact in a the Opioid Crisis that the Opioid Crisis is truly a National Emergency. It does not discriminate based on politics. Feakts red states and blue states. It affects red states and blue states and every state in between. Im extremely grateful the chairman agreed to my request to bring the committee to on the road to investigate the devastating effects of this very difficult problem. I also want to thank dr. Miller and Johns Hopkins for your warm welcome and hospitality. The work you do makes a huge difference in our community and around the globe. I also thank our esteemed guest, Governor Hogan and pugh for joining us. Were honored to have you in our presence. Of course i thank our witnesses, governor chris christie, commissioner wynn, dr. Comperned, and mr. Baum. Thank you for testifying and for all you are doing to help us combat opioids and save lives. A year and a half ago at our committees first hearing on this issue, i warned that so many people were dying in communities across america and that we can no longer ignore this emergency. Today the centers for Disease Control and prevention estimates that more than 64,000 drug ns died from overdoses in 2016, an increase of more than 20 over the year before. To put this in perspective, the death toll from drug overdoses last year alone was higher than ll u. S. Military casualties in vietnam and iraq wars combined. Every 20 minutes, every 20 minutes someone die from an opioid overdose. If todays hearing lasses for two hours, half a dozen lasts for two hours, half a dozen families will have lost a parent, a sibling, or a child to opioids. We have the reports. We have had years of talk. Now its time for action. The American People are looking if todays hearing for us to take action. They are looking to the president and congress and they are asking what are you going to do . Governor christie and the other members of the president s addiction n drug have addiction have given us an excellent blueprint for action with dozens of recommendations. Now its up to us. Republicans and democrats, federal, state, and local officials, researchers, policymakers, doctors, Drug Companies, Health Providers on the ground, and families of the faith communities. We need to Work Together to end this epidemic. There are some things that we can do right now to help prevent addiction and save those who are already who already have this disease. For example, we can ensure that every Single Person who needs naloxone has it. The missions report highlights the importance of eequipping First Responders with naloxone, including police officers, fire departments, and Public Health officials. But heres the challenge. Drug companies have continued the price of this 45 yearold drug and communities have been forced to ration it. In september, i led 50 members of the house of representatives in sending a letter urging President Donald Trump to lower prices for naloxone just as the commission recommended. Unfortunately, we never received a response. The president should act now to ensure that naloxone is available at a reasonable price whenever and wherever it is needed. Lower prices we also need to ensure that every affected person has access to effective treatment. According to the commission, and i quote, today only 10. 6 of youth and adults who need treatment for substance, youth according to the commission, disorder, receive that treatment. Only 10 . There is simply no way, no way 90 l end this crisis of affected are not being treated if we do not act now. A treated if we do not act now. To do this we need funding. Last month President Trump epidemic a Public Health emergency. But he did not propose any additional funding to combat it. We cannot fight this epidemic without funds equal to the challenge we face. Truth. A sad but stark finally, we must recognize and acknowledge the many factors that put people at risk. Woefully inadequate support for our children and our vulnerable residents. Worsening economic inequality. Lack of opportunity. And profound disparities in the criminal Justice System. We cannot solve this crisis until these risk factors are addressed. With that, mr. Chairman, again i thank you for convening this critical hearing and i look forward to the testimony and taking action on it. Mr. Chairman, with unanimous consent, that representative ruppersberger from the state of maryland and representative sarbanes from the state of maryland be permitted to sit in with the committee and participate in this hearing today. With that i yield back. Mr. Cha unanimous consent, [applause] chairman gowdy without objection. Welcome to our colleagues. Also want to thank the Johns Hopkins community for taking such great care of our friend and colleague over the summer. You send him back stronger than ever. Thank youall for whoever had a role in that. Didnt send him back quite that strong but sent him back stronger than ever. Governor chris t. Governor hogan, recent, past and present governors, have witnessed the most devastating drug epidemic in our nations history. Since 1999 more than half a million americans have died from drug overdose. And the epidemic is escalating. Over the span of nearly 20 years, the death toll has quadrupled with the emergence of even more poetent drugs and ever expanding Online Market for illicit distribution. Today drug overdoses kill more americans than gun homicides and car crashes combined. As staggering reality, two out of every three daily death from drug overdoses in the United States involve an opioid, class of drugs commonly prescribed to relieve and manage pain. Actually over 33,000 americans died from an opioid related overdose in 2015, which is an 11 increase from the year before. In South Carolina where i come from, greenville and spartanburg counties in particular suffered more than 100 opioid related overdoses in 2015, and while the numbers in the upstate of South Carolina are fewer when compared with cities like baltimore, behind every number and every statistic is a life with loved ones and friends and potential and aspirations. We have a tendency to use numbers in government and our line of work, but the victims arent numbers. The victims are fellow human being