Transcripts For CSPAN Senate Panel Looks At Stopping Flow Of

That occurred last year, is occurring again this year and will continue to occur next year. Each year is getting worse than the previous. In my home, we will see approximately 800 drugrelated deaths in 2017, which is an increase from our most devastating year, last year, 2016, when we saw approximately 660 people die from drugrelated deaths, up from 370 the year before. Nearly 9 to of these deaths will be due to opioids of some kind. Prescribed pills from which the crisis originated and grew from, heroin, fentanyl, and now the newer analogs of fentanyl. Its nationwide Public Health emergency which is simply out of control. Ohio is one of the hardesthit states. Appalachia, the New England States are also particularly hardhit. In the fall of 2011, my office alerted our county executive to an alarming trend and the rise of heroinassociated deaths. In the subsequent months and years weve partnered with our county sheriff, Cleveland Police department, u. S. Attorneys office, county prosecutor and our board of health to launch a Community Initiative which im proud to say has attempted to combat this Public Health crisis. Partners were quickly added from the Major Medical institutionses, including the Cleveland Clinic, Case Western Reserve University hospitals and our county hospital metro Health Medical center, as well as the free clinic, a Free Health Service provider. And set in motion some important pieces of response. We have drug dropoff boxes now to take back overprescribed prescription Health Service pai over 50 Police Departments. Our no lox own Distribution Program is run out of the county hospital as well as the free clinic and the board of health. Wish you warn issue warning letters to released inmates who are at greater risk to overdose, as well as patients leaving treatment centers. These folks are wish you warn of decreased tolerance. The creation also of our heroin Death Review Committee allowed us to look at data from the overdose fatalities in an attempt to plan intervention strategies. We also hosted a heroin summit at the Cleveland Clinic. The Cleveland Clinic hosted the summit in november, 2013. Law enforcement is also creating Specialized Task forces that work with our medical investigators, to begin investigations earlier, provides highly accredited, too manyly and efficient scientific testing. Are now leveing much stiffer charges against targeting dealers. Aum of this work continues to imple amount communitywide, communitybased strategy that was the result of the Cleveland Clinic summit. When a heroin overdose occurs, individuals typically fall asleep and breathe more slowly and shallowly until at last they stop altogether. During this progression the relieved nce can be by the heroin antidote no lox own which was made more readily available in ohio and is an immediate first step in saving lives and should be applauded. The metro Health Medical center partnered to distribute it by prescription, and we have currently documented over 1,000 reversals with it. Police departments and a Pilot Program starteded in 2014, but ramped up in earnest last year, ave documented another 300 reversals. These 1,00 individuals did not have to make a final trip to my office. The introduction of fentanyl and even more poe nent analogs like car fentanyl, which is initially seen in our jurisdiction, is a large animal tranquilizer, has diminished the efficacy of noloxone. Several doses may be required and the time window is greatly shortened. This is the fundamental reason for the catastrophic mortality rise in 2016. Research conducted at the medical Examiners Office in my county, a collaboration with medical Law Enforcement, 600 people died of heroin overdoses between 2012 and 2014. Some promising intervention points should be considered. At least 72 of all of these overdoses had been prescribed a controlled substance within two years of their death and over 50 for opioids. Several of these people were doctor shopping and with the mandatory implementation of a Prescription Drug monitoring program, or as in our state, we positive e nag a direction moving in a positive direction. The final example of how the valuable information can be gleaned from death certificate and death positive direction review data is the fax that fact that many of the individuals who came to my office is been in contact with the legal system and or drug and alcohol treatment programs. Theres a tremendous need for education and these opportunitieses are needed to maximize us for messaging but its naive to think that education and messaging would be effect fve we dont adequately address the need for Treatment Options once the message has people can recover from drug addiction with adequate result support. All data and information are it has been particular inspiring to see a sense of community in Cuyahoga County that has brought treatment prevention Law Enforcement, prosecution, and medical examiners like myself together for a single purpose, to save lives. Time, our local resources are stretched to exhaustion. System and the forensic laboratories are facing doubledigit caseload increases annually, personal shortages, equipment problems, and increasingly complex processes with the fentanyl increasing. Have interacted successfully, the sublime delivery of our drugs the drugs to the community is unabated. Our community has added millions of dollars to the effort in the past several years. Our estimates are that there in a people in my county to fill a football stadium. Every year, approximately sufficient number of people to fill our basketball arena transition over to the use of prescription opioids to helen and fentanyl. They usually was a largely caucasian popularity and this is changing now. Cocaine is being mixed into the fentanyl distribution in an effort to introduce these drugs into the africanamerican community. Cocaine had been the only drug that victims in our community were predominately africanamerican. That has changed since the cocaine intoof that distribution. It is also of note that we have a rising percentage of africanamerican deaths and our drug overdoses crisis. The strategies to combat to this are not a matter of innovative creation, but of sure will, cooperation, and adequate resources. The cooperation we see already that the resources at a local level are depleted and overwhelmed. Treatment beds need to be opened and adequately funded. Has createdxecutive an additional treatment exclusion that limits the number of treatment beds to 16 for Substance Abuse Treatment Facilities. Bill offered by you as was your senator brown that your colleague senator your colleague senator brown. Theres a National Crisis in my field. I field, especially, is in dire need. There are less than 500 boardcertified frantic pathologists in the United States. On my organizations website, 28 offices are seeking to hire pathologists. I have the privilege of having the oil is training program, training pathologists in the country. Such programs 35 in existence and theyre not funded my medicare. Unlike any other medical training specialty. Our Program Graduates one or two doctors a year and a system that can only produce a few dozen pathologists annually. , toely on accurate data define this crisis and i think it will Service Serve as gnificant actionsse axes are beyond the local county. We need your continued and renewed assistance, resources, and commitment to all stages of the fight. Im psyched to go over time, it is a very important topic for me. I think you are timing consideration. I would be happy to answer any questions and we provide a packet of information which. Ummarizes even more i could have talked longer. They give very much. Thank you doctor. Mr. Chair. Just because i have to lead, i would second say for all of you, but i would also like to thank dr. Gilson who was deputy chief for somexaminer time. Thank you for your work and continued work and thank you for all of the panelists. Thank you so much. Remember your full statements wont be part of the record. Will be part of the record. As you leave, thank you for your leadership in this epidemic. The Opioid Epidemic is oppressing Public Health issue of our time, and a Public Safety issue of our time. The 2016 National Survey on drug use estimates approximately 2. 1 Million People in the united usees have an opioid disorder. In 2015, we had complete national statistics. From opioidday died overdoses. That resulted in 33,000 deaths in 2013 alone. In massachusetts, 1900 people died of an overdose in 2016. That is up from 742 just from 2012 in addition to addiction and death, we know this toociated has been linked Viral Hepatitis along with local outbreaks of hiv. A recent analysis done by the cdc show that there are at least 220 counties that are a significant risk of another outbreak similar to the one in scott county, indiana. Past two years, we have seen the emergence of synthetic open with like fentanyl. The cdc estimates that Overdose Deaths estimated to these increased by over 72 from 2014 to 2015. Reports from the dea as was state local Law Enforcement indicate that the deaths have been associated with Law Enforcement seizures testing positive for fentanyl. This increase is not a result of internal prescribing indicating this is a largely a salicylate largely illicitly prescribed. Limited to those dates, like ohio, that have had excellent or good reporting. That means Overdose Deaths are reported with a specific drug involved. Significantported from 2014 to 2015. A recent analysis of Overdose Deaths in massachusetts show deaths involving fentanyl rose 2013 22014. The 272 in the first app of 2016. Fentanyl has mixed with heroin or cocaine and with or without the users knowledge. Usually without. As weve seen a highprofile deaths, it can be prescribed the skies as Prescription Medication and taken without the users knowing it contain fentanyl. This appears to be largely manufactured in china. Either directly from the United States or shipped to mexico where it gets mixed in with the u. S. Before transporting it to the United States. I wont go into detail for lack of time, that i know you all know the administrations response to the efforts and ensuring people that need treatment have highquality care including medication assisted treatment. The Affordable Care act contributed to the greatest that itt by answering was one of the 10 essential benefits that Medicaid Expansion plans and marketplace plans had to cover. It also ensured that those benefits be offered on par with the federal Mental Health parity and addiction equities. Again, black of time, i wont go into detail, but im proud of the accomplished we are able to make with congress in terms of the passage of become brands of Addiction Recovery act that ca work rescinding the band. Which come us a lot in our time here in washington. We saw a long way to go. Remainder of my remarks, and what i think the recommendations as i look on how we deal with fentanyl. Continuing to enhance our intelligence on the manufacturing and information of fentanyl is critical. I was very appreciative of the Intelligence Community, and it calls for better information and there are still unanswered questions. I was happy to hear that the d and i looked at synthetic opioids is a major threat. Quite frankly, i was frustrated during my time that i didnt know we had fentanyl and things like car fentanyl until we saw local outbreaks in the United States. Our Intelligence Community is too good to because unaware in terms of what is coming at us. Fentanyl is much harder to detect and present a hazard to Law Enforcement, we need to developbetter ways to detection capabilities. Need to continue to find factbased information to others who may come in contact with it. Need to continue our engagement with china and press them for additional actions to schedule fentanyl analogues logs and to take down illicit manufacturers and shippers. There is also significant variability of standard testing of fentanyl of Law Enforcement treatment programs. They need to incorporate fentanyl into their panels. Weh Public Health experts, need to distribute informational material on how users can minimize their overuse overdose risk were fentanyl might be present. We need to expand the use of naloxone for anyone able to witness an overdose. Because of the potency of fentanyl and the parent of time isreverse an overdose shortened. We need the federal government to deploy Rapid Response teams like other diseases so that the communities have the investigatory tools to examine the outbreaks and the causes behind them. We need to expand Syringe Service programs that engage active drug users to promote safer injecting and minimize overdose risks. More importantly, most , we twolegged Medicaid Expansion and other federal grant programs. Even with these provisions, timely access to quality care remains an issue for many. Particularly in rural communities. I look for to your questions, thank you for your time. Thank you. Thank you chairman. Issued like to say this of addressing fentanyl is important. It certainly exacerbates any issue i have to attend to the hospital in trying to help individuals get into care and create a rapid spiraling of addiction that we would say otherwise. In delaware, every 25 of our fentanyl dying had only 25 of our individuals had fentanyl in their blood. Where you look in the potential for damage in our state when we iach goals of massachusetts, think there will be a real catastrophic increase in the coming year. Having said that, i want to share gleefully briefly, as someone in Emergency Rooms and clinics for 20 by years, some of the lessons learned. This is a horrid thick epidemic. Strength across the board, i take care now of not only, and Young Mothers who have given birth in High School Kids who are champions and wrestling champions, but also grandparents, couples, all races ges and they share a core epic addiction. Their brains of changed, their motivational circuits have been distorted, and as well, they have this onset of withdrawal. Withdrawal that is primal misery. It is withdrawal that prevents them from moving through that wall to go into care. It will stay outside of that care and avoided at all costs because they cant attend to withdraw. But is not reachable moment. That is what we can leverage. We have done that in hospitals and jails. Put in thee is hospital and they can no longer be on the outside, and they are desperate to avoid withdraw, we can address the withdrawal, treated aggressively with medications like suboxone. Two thirds of the people i see in hospitals are very agreeable to go into the care and dont come to the hospital about an affected leg0 or0 hearts, they use the opportunity to get into drug treatment. It is remarkable. Two thirds of individuals are actively looking to go into drug treatment when i offer it or address their withdrawal. Remarkably, nearly 80 show up to the Community Care provider. Ints when i inducted them the hospital. The hospital is a reachable moment. 70 are there month later. Individuals who are addicted to opiates come into our hospital withdrawal andss we can use that to leverage them into treatment and they stay there. If your treatment, medicines like suboxone which like opiates, if you use opiates, youre not going to opiate overdose period. Take your suboxone today, and tomorrow, and those days we wont have to worry about you overdosing. Pretty safe message. Its really critical to what im trying to do on helping individuals get into care and stay into it so they dont overdose and died. Its really having access to the care and we are fortunate. In delaware, we were able to expand outpatient thoughts for Substance Abuse care by one thousands by thousands. For me, i have no difficulty, when i identify in the digital when i headed by an individual in the hospital, i am no problem getting them into here. It is remarkable that im able to do that, but im able to because the care is available. The care is dependent on medicaid. Without medicaid, that care wo