Do in their states to address the Opioid Epidemics. This is just over an hour. Good afternoon, everybody. Those of you whore Still Standing who plan to set, set it and those of you who stand can stand. My name is charlie baker, governor of the commonwealth of massachusetts and im the chair of the nba health and Human Services committee and i want to welcome you all to this conversation about an issue the nga has been engaged in in a big way for the past several years and i think it is fair to say that every governor of every state has made dealing with this particular issue is significant and important priority in their work and thats certainly been true in the commonwealth of massachusetts. I did run for governor to work on this issue, but upon me because wherever i campaigned, i ran into people who talk to me about it in their stories frankly broke my heart. Over the course of the past several years, working on a bipartisan basis with our legislature and others, we have made some progress in dealing with this terrible epidemic. In massachusetts, after years and years and years of doubledigit increases in opioid prescriptions and dads, literally for the first time in a very long time in 2017, we have a 30 reduction in prescriptions, overdoses leveled off and deaths dropped by 8 . Now, the way that was referred to by most people was sort of positive, but muted. The reason it was muted as because we have so far to go in so much more to do. Literally after bad news every single year for year after year after year, people did take some comfort in the fact that trend like this for a long time finally started to go like that. Theres a lot that went into that in todays conversation is to talk about what is working and where should we go next. Some of the things that i believe have worked does speak to others add to that as we go on to be the following. In massachusetts, we now required everybody graduates from medical school, dental school, nursing school, Pharmacy School and social work school to take and pass as part of their core curriculum for kosovo. Therapy and pain management. If youre a subscriber, as part of your continuing education for getting the license renewed, you have to take and pass a course about. Therapy and pain management. We are one of the first states on prescriptions. Over seven days. So far the states have followed since then and we dramatically upgraded and simplified or prescription monitoring program. As a result of that, we finally got to the point where the vast majority of prescribers who are working on that system and using it as a Search Engine every time they were prescriptions and in addition to that, finally got to the point where they can start giving them some pretty decent information on their own prescribing patterns relative to their peers. We also created programming to assess network in our middle schools and high schools for students and i Hope Department and also created as part of our sort of annual program for all athletes and their parents and coaches, and inclusion of a discussion about the positive and the negative along with discussions about hydration and health in concussions and all the rest. That is kind of the prevention Education Sector treatment and recovery we added 1100 treatment beds come increase state spending by 60 in a variety of addiction based programs that need medication assisted treatment a much larger part of our repertoire and portfolio than had been previously. One of the other elements that we pursued our pilot bases that turned out to be reasonably effective. We have embedded recovery coaches and some of our hospital ers around the commonwealth to engage in discussions with people who overdose to see if they couldnt talk them into moving into treatment. Most of the folks who played the recovery coaching role our people and recovery themselves and it turned out that their ability to reach out and speak to people who are just overdosed on were in the throes of this addiction is pretty powerful. In some cases besides much as 80 of those contacted and touched by this program find their way into treatment. That doesnt mean 80 got out of treatment. The bottom line is for the first time without a mechanism that help most people, many for the first time with treatment as a possible option for them. With respect to what is next, we filed legislation before legislature, the care act chosen number of elements to build on some of the things we had done previously. One of which is to take this whole nation of recovery coaching and turn it into a bona fide local program. But the process for it to really make it sort of a fundamental part of the way we deal with addiction, especially opioid addiction where recovery coach can be a big part of what helps somebody lower their medication assisted treatment or some other form of treatment, staying on the Positive Side of their Treatment Program that they battled their way out of this terrible addiction. The legislation also includes elements to experience some of our schoolbased assessment and Service Programming and also for the first time, well have us engage with the folks in the firm a community to see if we can create something that will look like a blister pack, which we have in many other parts of health care to provide the very small number of opioids that you might want to make available to somebody who had their wisdom teeth out or had minor gum surgery or sprained her ankle or Something Like that. The reason for that was the conversations is we write 30 days. Thats the thing we did. 30 days for a lot of this stuff is what weve been writing opiate prescriptions were for the better part of the past decade makes no sense at all and if we Credit Delivery model that makes it possible to give someone the two or three pills they might need to deal with whatever the particular acute pain is coming out of a minor procedure, we might be able to take a lot of this stuff off the street to begin with. The final thing i will speak to the sentinel. In 2014, sentinel was present in about 30 of the overdosed deaths announced she says. In 2017, and it is over 80 of the deaths in massachusetts. If it wasnt for sentinel, the success we have had a reducing overdose Overdose Deaths wouldve dropped dramatically more. But the sense of truth is we can do a lot of things in prevention education and i believe we are. We can do a lot of things on treatment and i believe we are. But we have got to come together state, local, federal with a lot harder than we are now if we truly want to protect and preserve the opportunity for treatment to be successful as many people on our states. So we are going to hear shortly from the newly confirmed health and Human Services secretary, alex azar and have an opportunity to engage in a roundtable discussion led by the los Angeles Times. But before we get there, i did want to give the vice chair of the health and Human Services committee at nga the chance to offer some of her thoughts on what has worked. Governor brown. [applause] tonight, governor baker for that in your leadership on this issue. Also thank you to nga for its continued focus on is critically important issue. Im looking forward to hearing from secretary azar in a few moments and from all of you. I am eager to hear how other states have made progress toward implementing Creative Solutions and what struggles our state share in common. There are too Many Americans who feel the impact of the Opioid Crisis every single day. We cant ever look at opioid abuse in isolation. The effects of addiction were pulling to family members, friends, colleagues and our communities. Oregon, 60 of foster children have parents who struggle with addiction in general. 25 of abuse to opioids. And each year with this dozens upon dozens to death by overdose. This is tragedy demand inaction. Part of the reason the opioid addiction is so insidious is that it still carries too much stigma. To face this crisis, we need to let people know that its okay to come out of the shadows and that they have a Supportive Community on their side. We must focus on prevention, treatment and recovery to turn the tide on this epidemic. Right now, the federal government recognizes the problem, but from my perspective is overly focused on punishment. That leaves us, the state, to address the issues that drive this Health Crisis while prisons in foster care system are filled to capacity with this problem. We must do to what this by increasing access to treatment and doing away with failed first policy. We must be creative in bringing forward alternatives that work. We know that reduce the chance of relapse or overdose, we can make sure treatment support is immediately available. The governor baker, were pushing forward on legislation that includes a Pilot Program that would dispatch recovery mentors, highly trained people in recovery themselves to Emergency Rooms, to connect with the patient immediately and act as a peer, friend and navigator in the next steps on the road to recovery. Im pleased to say we have so many people testifying in legislation. We didnt have time to hear from all of them. A past that is committee unanimously. I look forward to our conversations today, the hearings from you on what innovative strides you have made in your own states. Thank you. [applause] is very much, governor. A coasttocoast overview. We are very pleased today to be joined by the newly confirmed secretary of health and Human Services, alex azar and i know many of us have had a chance to speak to him about this issue during the brief time he spent on the job. The best part is this is not somebody whos new to this issue. He comes to with a wealth of knowledge and information about what it means to all of us and what it means to the people we serve and represent in our communities and he is bringing what i would describe as not just enthusiasm, but a ton of knowledge and experience to this and as someone who is no stranger to the role of hhs and the federal government. Were certainly looking forward to working with him and serve on the administrations opioid task force. Looking for to have a chance to see the recommendations that we may pursue on a grand scale on a National Level. Thank you undersecretary for being with us today. We really appreciated. [applause] thank you, governor baker and Governor Brown. Id like to express my gratitude to both of you into all of the governors who have gathered here today on this vital issue. Todays turnout reflects the level of commitment to this crisis that weve seen from governors across the country and from both parties. Your involvement and input are deeply valued at the federal level. We applaud your work on the many different runs where you have thought this crisis from establishing and improving Prescription Drug monitoring programs and expanding Treatment Options teasing Community Resources like fire and police stations to connect people to treatment. State governments and local communities have taken late. Im grateful to be here today to share how we see our role in complementing and empowering this great work that youve already been doing. As many of you know, President Trump has made the Opioid Crisis a top priority. Hhs has occurred in historic nationwide Public Health emergency last year, bringing a level of experience across the federal government. President trump in this administration recognize that its not the federal government on the front lines of this battle. It is all of you and your Law Enforcement officers, teachers, school counselors, committee leaders, doctors, emts and nurses in your faithbased partners. We are dedicated to empowering you and your allies on this site. That is what undergirds the comprehensive strategy for fighting the Opioid Crisis that hhs introduced last year. He brings a unique powers and resources of the federal government to bare empowering those on the frontlines. Many of you may already be familiar with the strategy, but the five points but as briefly as possible our data, research, pain, overdose reversers and access. After running through the strategy, i want to highlight a couple pieces of news for the food and Drug Administration that underscore commitment to advancing particular access to effective Addiction Treatment. The first one is better data on the epidemic. We have to understand this crisis in order to stop it, which is why hhs is working with state and other stakeholders to support parttime a specific Public Health data and reporting. The center for Disease Control and prevention for instance works with your state Health Offices and local corners and monitoring overdose data. The second point of the strategy is Better Research on pain and addiction. We clearly need more tools to help us win this, which is why we support cuttingedge research on pain and addiction in part through the National Institutes of health. The potential advances we see at nih in the air like nonaddictive painkillers and new methods of Addiction Treatment are credible. As they get closer to reality, we look forward to partnering with states and private partners to understand how these can best be put into this. The third is pain management. We need to do a better job of addressing the real problem of pain in america, which is quite hhs wants to ensure everything we do. Payments, prescribing guidelines, best practices and more to promote healthy evidencebased methods of pain management. We look forward to continuing to work with you on disseminating best practices including the work of the federal Interagency Pain Management Task force that were standing up before this better targeting of overdose router seem drugs. People in communities across america and our own cities and towns are alive today because of the progress made in making drugs like malloc sound available when and where they are needed. We are committed to working with you to ensure communities have access to lifesaving drugs are hhs grants, research and Technical Assistance. At this point of the strategy is better prevention, treatment and recovery services. We know directly providing these services often falls on state and local governments and community groups. But we can help by issuing grants that support access, expanded coverage theyre hhs programs and providing guidance and Technical Assistance. The budget includes a range of different investments. 74 million to improve targeted distribution of naloxone, for instance, and 150 150 millior rural Substance Abuse treatment. It takes a state target response grants to 1 billion a year, twice what we had under 21st century cures act we look forward to building a base of experience from these grants, hearing from you about how you have used this money. One particular point want to emphasize to the 2018 grants is that states of a wide range of options for using them. This includes treatment vouchers which allow for the use of funds for evidencebased services from faithbased providers. Americans affect the taken a leading role in the compassion approach we need to take, we have to take to this crisis and were were eager to support their work, however we can. On top of the grants we have released guidelines to accelerate the approval of Substance Use disorder waivers within the medicaid program, three of which weve already granted this year for indiana, kentucky and louisiana. I would just what your note for our governors that if you have waiver requests with us and you have particular waivers of this kind we can also streamline holdings is out and working directly with cms for approval around those concrete waivers so it doesnt have to be caught up in broader waiver discussions that we have to have. So what works . Medicationassisted treatment. One particular piece of artwork on treatment is supporting access medicationassisted treatment. Part of the title of todays session is whats working. As i said hhs is always dedicated dancing our understanding of what does work when it comes to Public Health challenges like opioids. But we already know some important facts. One of them is this. Medicationassisted treatment works. The evidence on this is voluminous and evergrowing. One study from governor baker state massachusetts sound footing survivors of overdoses on medicationassisted treatment along with the appropriate therapy and social supports reduced further future chances of death by more than 50 . That is a remarkable number of lives saved, and speaks to the number of lives we can be sitting by expanding access to treatments that work. Eight sf on the dedicated to promoting access to an awareness of medicationassisted treatment, or matt. We still have a long way to go. According to samhsa date at just third of specialty Substance AbuseTreatment Programs across the country offer medicationassisted treatment. Many People Struggle