Good afternoon. Good afternoon. Can i ask everyone to take a seat . Thats quite a rumble. Thank you very much. Good afternoon. I want to welcome you all here today to talk about one of the most important issues that affects every state in the country, every community in the country, every neighborhood in the country. Thats the Opioid Epidemic that runs across this wonderful country of ours. Im charlie baker, the governor of massachusetts and im vice chair of the nga health and Human Services committee and im especially pleased today to be joined by governor roy cooper from North Carolina who i serve with on the president s commission on opioid addiction. Where is our host, Governor Gina Raimondo . Issue here . Shes late to her own party. Gina will be joining us later along with roy. As well as our distinguished speakers to talk about his Opioid Epidemic which obviously is a pertinent relevant issue for all of us. The Opioid Epidemic is now claiming the lives of an estimated 90 million, 90 americans a day. And massachusetts read about 2000 deaths in 2016, more than five deaths per day which is more than all the deaths associate with automobile accidents and gunshots combined. There was a 22 increase in opioid related ems transport between 20152016. In the First Quarter of 2017 the number of opioid prescriptions dispensed in massachusetts declined by 23 compared with the same time in 2015, and by 13 compared with the first three months of 2016. Thats for a number of reasons but among them in massachusetts, you cant graduate from nursing school, dental school, medical school of Pharmacy School unless you take and pass the course in opioid therapy and pain management. You also cant continue to be a prescriber and get relicense up taking a course and passing it in opioid therapy and pain management. We dramatically upgraded and simplified our Prescription Monitoring Program and at this point prescribers have made more than 2 million searches of that new program and its had a tremendous impact on prescriber behavior. We have doubled state spending on treatment and recovery for those dealing with this issue here in the commonwealth of mass. More than 800 medical, dental, nursing a physician physician assistant students have undergone the training which is now as a mentioned a core competency requirement, thousands of narcan kits have been distributed to First Responders and family members. Many other states are pursuing albright of other initiatives with respect to this and Governor Cooper and i had a chance to talk to many of the governors have been involved in this issue to get a sense about what practices are working and what practices are not and how we can take those and incorporate them either into her own strategies are at the state level or into some of these National Reforms and recommendations. We will continue to lean on the nga as an avenue for discussion and problem solving as we deal with this issue Going Forward. In february 2016 the governors expressed their frustration that despite many of our efforts to innovate and change the trajectory of this crisis, change wasnt coming quickly enough. We specifically identified a series of prescribing practice issues and opportunity to deal with that and other issues associated with what i will call the front door of all this. As a result of that we passed a resolution that directed the nga to unite governors around strategies, change a prescriber behavior, to prevent opioid abuse and overdose. Since then we parted with a number of leading organizations that are doing research and providing guidance in this field including the National Academy of medicine to better understand the clinicians role in reversing this epidemic. With that im very to be joined today by dr. Michael mcinnis who is the chief executive officer of the National Academy of medicine who will discuss the forthcoming release of a paper that is focused specifically on opioid prescribing practices. Doctor . [applause] thank you, governor, baker and thanks to each of the governors here and throughout the nation who have provided such important leadership in drawing attention to the terrible epidemic that we see throughout the country. The importance of this epidemic really cannot be overstated. There are the numbers. This is the fact or 3 Million People in this country today who are suffering from a opioid use disorder. That is, they are addicted. The fact that their unprecedented increases in the rate of addiction to opioids that weve seen in the last several years that are contributing to unacceptable and tragic deaths throughout the nation. Last are an estimated 59,000 deaths due to a Drug Overdose come about twothirds which related to opioids. Thats an unprecedented high for drug use, overdose deaths. Its also higher than the peak levels for hiv infection deaths, and for automobile for talented deaths. Its higher than either of those at their peak level. But in addition to the numbers, the realities that each one of those numbers imprisons several souls. Not just the souls of those are affected directly by the addiction, but their families, other loved ones, communities, healthcare workers throughout the nation. This is an epidemic that when you think about its dimensions in terms of the combination of numbers, lethality, rate, reach, the Opioid Epidemic is the fastestgrowing serious and farreaching epidemic threat to americans across the board. So it requires the kind of leadership that you folks are providing at the National Academy of medicine is honored to be a part of the work that you are under way. We are doing everything we can in support of your efforts. Our special publication targeting every one of the some 5 million collisions has been developed and direct support of the nga resolution on opioid prescribing. You have a Short Description of that publication marshaling clinician leadership to counter the Opioid Epidemic at your tables. There are in effect three key messages in this publication. First is prioritize not opioid strategies for chronic pain management. Second, follow the five basic axioms of responsible opioid prescribing. And third, promote policies that facilitate action on the evidence. On the first, prioritize not opioid strategies for chronic pain management, its very clear that many patients who have cancers or are at the end of their lives require opioids for treatment. But when it comes to treating the chronic pain conditions that also suffered by millions of americans, there are alternatives which are generally effective in engaging those problems. So its very important that we prioritize those alternatives, those effective alternatives, in engaging chronic pain conditio conditions. Second the five basic axioms. First, understand and to the treatment to your patient. Understanding what individual circumstances are for every patient is the watchword in healthcare in general but it is especially the watchword in managing people with chronic pain and who are struggling with issues that might compound their susceptibility to opioid addiction. So know your patience very well. Second, employee or a cautionary protocols. The highlights here are, start if youre prescribing opioids, start with the lowest possible dose and duration. And check the state Prescription Drug monitoring database. Fairly basic, but underutilized by a substantial measure in this nation today. Third, actively manage and monitor treatment. Treatment merely begins with a prescription, and its very important that when an opioid is used that there is an exit strategy in mind and in place, and agreed upon exit strategy with the patient from the very first moment. Fourth, know your team and your Community Resources. Prepare for the likely probability that you will at some point in counter patients with opioid use disorders. And nowhere the Community Resources are. And no where prepare the team for the probability will have to manage an opioid use disorder, and if those resources are not readily available, work hard with your community to try to develop alternative strategies. Dont wait until the last minute. Fifth, ensure access to Substance Abuse treatment. Thats a logical corollary of the previous note. It is vital that a spatial in these days with our treatment resources are being overwhelmed that we work at every level to expand the availability of the treatment and followup. And then the third point is the direct offshoot of this issue, promote policies that facilitate action on the evidence. As a couple of quick notes on that. Because we in the National Academy of medicine are committed to steadfast support for the related evidencebased policy initiatives that the state and national level, the sort of policies that we heard from your colleagues in the Governors Council of the Bipartisan Policy Center called for in an announcement yesterday, on the regulatory front we actually at noon today released a series of recommendations to the food and Drug Administration on strengthening the Regulatory Approval and monitoring policies of the food and Drug Administration in order to ensure that once the fda reviews and opioid for approval, they are not just looking at the individual costs and benefits but they are taking into account the societal costs and benefits. This is vitally important to provide air cover, if you will, for those policies at the clinician prescribing level. In addition we are committed to working with you to ensure that every clinician is supporting the monitoring efforts that are embedded in the Prescription Drug monitoring programs that you have the route your states. The treatment policy arena, weve mentioned briefly, its especially important that programs for medicaid, medicationassisted treatment under medicaid are supported so that the treatment thats needed is available when necessary. The policies related to Recovery Support are also especially important. Let me underscore this in my final comments. And that is, opioid abuse, or opioid use disorder, is a chronic disease. Its a chronic disease with different manifestations but in fact, its not that much different in terms of its neat and its management requirements than diabetes or hypertension or heart disease. You dont treat those conditions with a one time interaction. There needs to be the ongoing Recovery Support that will help every patient to move into a productive come back into the Productive Lives that they had before. Thank you for your leadership. Thank you for our partnership if we are honored to with you on behalf of our patients, our communities, our states and our nation. Thank you very much. [applause] thank you, doctor thats a nice set up for the panel were going to have. At this time i like to invite richard baum who ive had a chance to meet and is going the acting director of the White House Office of National Drug control policy and has been one of the focus that we and that i am Governor Cooper and governor christie and others have been working with on the National Commission on opioid addiction. He spent part of the ondcp for nearly 20 years and his tenure has spanned four administration di. Id also like to ask gina rae mondor to come up and join this discussion as well as my seat mate on the National Commission, Governor Cooper from North Carolina. Come on up. Richard, come on up. [applause] thank youthank you, governor, for that introduction, and today in a couple of minutes the three governors that are taking Decisive Action against this problem will stand and have a good conversation. Let me just share a few words about my perspective on the issue from office of National Drug control policy. As already been said this is the worst drug epidemic in american history. With laura talked about the numbers, 91 people per day. This crisis asserting emitters and families just about everywhere. Reducing the supply of hair wet and fentanyl from abroad is critical. Better agencies are working to tighten Border Security and dismantle the trafficking organizations that are moving his deadly drugs into our country. In addition to reducing the supply we have a great view of work to do on a demandside. They need access to evidencebased treatment which means medicationassisted treatment in most cases. Theres also a need for the treatment system to change where it operates to make accessing care much easier. Naloxone should be available everywhere they can keep people alive. We also to focus on Recovery Support which sustains investment of treatment and reduces relapse rates. Critical for successful recovery is making sure people have jobs. Employers should give people in recovery a chance. They make great employees. We also have to do a much better job on prevention. Our youth are not getting a clear and consistent message about it credible risks posed to the health from illegal drugs. We intend to change this. They administration has already taken a number of critical steps on the oprah problem. In march the president established the Opioid Commission. Two of our panels serve on the commission. In april they released the first of 20 teachers act round of funding sending five hundred million out to states. Another 500 million is coming your way next year. At ondcp we run high intensity Drug Trafficking areas and the drugfree Communities Program to these programs are fully funded and wonderful to operate in most states. At ondcp want to partner close with governors offices. On staff at ondcp with some of the countries top experts in both demand reduction and supply reduction. We have readily available for this research and data on the drug problem. Please think of us as a resource for you. This problem is too big and too complex for any one love of government to solve on their own. The only way we can turn this around is to working together. This all good issue is not a new one for nga. As you probably know in july 2016, 46 governors signed onto a compact to fight opioid addiction picked the first time in more than a decade governors politely came together through a compact calling for action in three areas. Reducing inappropriate opioid prescribing, change the nation understand of opioids and addiction, and ensure a pathway to recovery for individuals with addiction. Since that compact signed, we have double our efforts to address the crisis. There is an overview of some of these actions on your chair and details about what states data is Available Online [inaudible] have been a part of the process and that they can active roles in addressing the Opioid Epidemic. They are all invalid statebased solutions to end the crisis to legislation, executive action, new partnerships and by talking publicly about the issue of addiction. Governor cooper and baker on the Opioid Commission governor raimondo has established an Overdose Task force in rhode island and the permitted innovative [inaudible] yesterday i joined as she signed a new executive order on this problem. Today to honor to moderate this discussion of governors were on the front lines on this critical work. We will hear a bit about [inaudible] im going to move over to the chair and i will ask Governor Cooper to start us off. We love to hear about what youre seeing, doing a North Carolina. I talked to too many Law Enforcement officers who are frustrated, to meet Emergency Responders and medical providers who are overwhelmed, employers who cant get employees who can pass a drug test. And i talked to way too many moms and dads who of loss kids to overdose. Weve heard the figure, 91 people a day in the United States dying as result of this epidemic. For people a day in my state of North Carolina. Has to stop. What we have done in North Carolina is i put forth just last month a comprehensive opioid action plan. We had over 200 people from all fields who came together to help us with this plan. When we attack this problem, its got to be comprehensive and its got to be databased. I am sitting on the president s commission to fight opioid addiction with governor baker, governor christie. What were doing is listening to you and your states. We know that many of you are facing the same from all of you really are facing this problem and you know that weve got to step forward as states. We move faster with laboratories of democracy. We can do things quicker. What we want to try to do with his federal commission is title of this together and help states. But the first thing i have called for his treatment. The first thing where to realize is we cannot have millions of americans lose their Health Coverage and still effectively attack this crisis. We cant significantly reduce medicaid funding and still be successful in fighting opioid addiction. About 25 of opioid Addiction Treatment and Substance Abuse treatment comes from medicaid coverage. So we are kidding ourselves we dont think whats happening with health care in congress now isnt affecting this issue. But at the same time there are other things that we can do to attack the problem. We heard about the issue of overprescribing and making sure that Prescription Drugs are less available to people. We do have a comprehensive strategy on that in North Carolina. Already we are seeing reductions in prescriptions to people, but its almost like squeezing a balloon. We are seeing now an increase in heroin use. Sometimes thats even cheaper. Whats really deadly is when it is laced with synthetic fentanyl and other drugs that can cause death immediately. So what we need help from the federal government is helping us fight the drug kingpin and the traffickers and in china were a lot of the synthetic fentanyl is being made, we need help with that. But one thing we know at the addiction level, and Law Enforcement will tell you this, we cannot arrest our way out of this problem. This ever ending, never ending cycle of people going to Emergency Rooms and being arrested and then put in jail and getting back out and overdosing, thats not going to work. And what we have to do as part of our plan is widespread use of naloxone. We have to make sure that we have emergency intervention with these people who overdose. Thats the time as they are neardeath and recovery in the next 2448 hours we had to get to them and convince them that they need treatment. Weve got to have that treatment available. Law enforcement stands ready to divert these people who are addicted to substances and opioids through treatment. Already we have comprehensive programs throughout North Carolina where Law Enforcement is making sure that theyre getting into treatment. We are a set of medicationassisted treatment. Each individual is different and jeff have Healthcare Providers deciding what is right for them. We even has some Law Enforcement agencies who are inviting people with problems to come in and theyre promising not to arrest them and to assist them into getting help. So these strategies are positive that we are implementing. They are comprehensive. Theyre probably 36 or 37 of them. We need to make sure that we share our data particularly when you have our studies to tell us whats working. We know this Law Enforcement diversion is working and there is significantly less of a chance that people get rearrested once they are diverted into treatment. So i look forward to hearing your ideas both at this conference, make sure that you let us know whats happening in your state. I know governor baker and and governor christie have had a number of calls with you to let us know whats happening. Its important that you attack it in a comprehensive way, and we have to make sure that we fight this problem on every level from Law Enforcement to treatment to prevention the education. Ive had enough of it and i know you have, too. Thank you so much. Governor baker, you lead the hhs committee here at nga. Can you talk about that experience and would want to go from there . I would just say the following. Im looking at this row of governors in front of us and i know that almost everybody here has persisted in those phone calls that Governor Cooper was talking about and is doing one way or another with this issue in their own right and in their own state. I cant emphasize enough how important it is that we handle the front end of this, which is the overprescribing of painkiller medication in the United States. We have 5 of the worlds population. We consume 80 of the world opioids. There are places all over the globe where people would never get someone and opioid prescription to deal with their particular problem requires they did they would give them one or two instead of 50 or 60. Part of the reason why we made training in this mandatory for anybody graduating from nursing, medical, dental and Pharmacy Schools is you cant come if youre a carpus, you cant get relicense and let you take and pass the course and this was because so many of the people who have been writing this prescriptions for so many years, when you confront them about it basically say this is a something comes at a part of the curriculum. When youre writing as a u. S. Did in 2014, 240 million opioid prescriptions, then you have the Substance Abuse and Mental Health administration sink for at a five people who become addicted to heroin started on prescription pain meds, its pretty clear where the problem came from. If you look at the data associate with the last 15 years and the growth of the Opioid Epidemic, prescribing as a top line, overdose is a second line and death to opioid in heroin is of the third line. Over that period of time its pretty clear where this came from. One of the things i sort of help we get out of this National Commission that were participating in is a much more aggressive stance as a country to the way we handle and it with prescription pain meds. I agree completely with all of the words that were in the commentary about how important it is to focus on the exit strategy right from the start and separate first prescriptions for smalltime stuff from larger prescriptions for people who are dealing with chronic illnesses and terminal disease. We have not treated the study and research on addiction with quite the same focus or quite the same rigor that we treat the study of cardiovascular disease or certain kinds of cancers or other mechanisms and illnesses an cures and therapies come out of a lot of nih work. One of the things i think will be critically important to the whole medicalassisted treatment is much better data on what works and why. One of the things that always bothered me about this when you talk to the folks in the treatment business on this they refer to themselves as providers or methadone providers or vivitrol providers or actuallystep folks. Now in most or the forms of medicine the way it works is somebody has a tool box and based on best practice standards, historical experience, and tons of bodies of evidence this person is probably best suited with this approach to dealing with their addiction. That is not the way we currently do this in many cases in this country. One of the things, another place where i think federal government states and a lot of folks in Research Community can play a big role trying to help us all get a lot smarter which treatments are most likely be successful with certain kinds of folks dealing with certain kinds of circumstances, situations and stocks. And the final thing i will say is one of the things i appreciated about the nga conversation on this was that everybody was open to chasing this. There wasnt anybody that felt this was something they could sit back and do nothing about. When i look at our own data in massachusetts i see modest progress on both prescriptions overdoses and deaths, okay . But it is modest. I have never seen anything with the kind of negative trajectory this issue has and, and it is really going to take persistence and determination over a long period of time of working the front end, associated with how people become addicted in the first place. The whole area associated with enter venges and, treatment and recovery. And what tools and capabilities approaches to treatment will work best for certain people and collected, incorporated into Ongoing Development of best practices for people Going Forward an investment on both part of state governments and federal governments to eour way through. We have to recognize we didnt get hear overnight this is 15 years because of bunch of bad behavior in the clinical community. It will be pretty important that everybody stay wit for a long period of time and not make it an issue we all focus and for a few years an move on to Something Else because this one is going to require continued vigilance, continued inquiry, continued investment, and a real big change in the way we handle this stuff. 80 of the worlds opioid prescriptions, 5 of the worlds population. If you walk away with nothing else today, i hope you walk away with that. That has to change. Great. Thanks, governor baker. Governor mondale youre leading efforts in your state. What would you share with your fellow governors what is working and what you recommend based on your own experience here . Yes, thank you. Thank you, welcome to rhode island for those here. Were happy to have you excited for a great weekend. I think i probably speak for all of my fellow governors in saying this issue is something that we work the hardest on for unfortunately very marginal improvement as charlie just said. I have done two executive orders on this. We are, i have a task force with some of the best minds in the country. Were seeing some progress. Im very happy to say that our, opioid prescriptions in rhode island are down by about 25 in the past five years. Some of the biggest dips in america. And still 1200 people have died in rhode island in the past five years. State of a Million People. And so i agree completely that we have to do more and we have to stay at it and we have to commit ourselves to the long run. The other day i was doing a business tour at, in a town nearby. The event had nothing to do with opioids. It was a commerce event focused on business development. I was talking to the owner of a thriving and successful business. He is a welloff guy in a well off off suburb. In the end he pulled me aside, governor, keep plugging on the opioid issue. I said as i always say, do you have someone in your family that has been affected by it . He said my son, 29 years old. I was in high school, straight as. A baseball star. He got a scholarship to go to college. He started with shoulder pain. He said if i only knew then when i know now. He started with four motrin at a time. Six motrin at a time. Then the vicodin. Fast forward he has been in and out of prison four years. In and out of rehab dozens of times. About a month ago, he and his dad were in gas station. He was in the a gastation and in a bathroom for a long time. He broke the door down. His son was unconscious on the floor. That is what were dealing with here this is successful businessman, this in his life happens to me all the time. I know it happens to you guys all the time. This issue is like almost no other were dealing with because it is so pervasive, yet still relatively not wellunderstood by the average person, i can say the average rhode islander, it requires unprecedented level of collaboration in order to fix it. I have put together a task force as director bonn has said. I think that is vital. One of the things that is a little frustrating, an im sure the governors can relate to this, this issue requires Law Enforcement on a state, federal and local level to be on the same page. Teachers, principals, coaches and superintendents, same page. Doctors, did not activities, orthodontists, nurses, hospitals, same page. It is an unbelievable level of coordination and no one really feels like it is their problem to solve. Which means it is our problem to solve. It is exactly where a governor needs to step in and convene and you know push this forward. We have done similar to what has been said and success. We have a Prevention Campaign which were about to kick off. We have done medicalassisted treatment using our medicaid money for that, particularly in our prison system. A little bit controversial. Very effective. Previously folks that had been incarcerated abstinence was the cold turkey, was what happened, makes people much more likely to die of overdose when they get out. Were having luck with medical assisted treatments in prison as well as other settings. We have Great Success with the pier recovery coach model. If youre not familiar with that, i recommend learning about it. Again using medicaid. With a peer recovery coach almost a former user themselves, can have a great relevant experience to share with the patient. That is something that worked well. And then the other thing that is working well is we set up several, what we call centers of the excellence. So these are health care centers, either at hospital or Community Health clinic which are designated opioid centers of excellence. Its a place, our gentleman interest is all roads lead to treatment. As has been said this, is a chronic disease. We cant force our way out of it. Get everybody into treatment. So centers of excellence are places where they have expertise in all kinds of medical assisted treatments and the point is, anyone with an addiction disorder can walk into one of these clinics and see professionals who are expert at the whole range of medical assisted treatment. And i want to take a second to give a big shoutout and thank you to cvs. Cvs is he had quartered here in rhode island. Just today announced a quarter of a Million Dollar investment in a clinic a poor town in northern rhode island, struggling with the overdose issue. Again i come back to where i began. This is an everybody issue. Corporations, government, Law Enforcement, everybody. It is a crisis. Were losing people every day. Were seeing some progress and eager to share that and learn from but we have to stay at it because too many of our friends, families and neighbors are dying every day. Thank you, governor raimondo. You i will ask governor baker another question and open up conversation to governors in the front row. Dont be shy. Let us know if you have something to add. Governor baker i was going to ask but the shifting role of police, there is the Angel Program where Police Diversion has become a major initiative. Do you think of role of police and Law Enforcement in the midst of this Opioid Epidemic has to change, should be changing . I actually think, getting back to a comment Governor Cooper made, i think Law Enforcement knew about this first. They were the ones who discovered more and more people overdosing and being called to try to revive and deal with. I would bet in many states, including mine, firstresponders probably administer more narcan than, even maybe the folks in the e. R. Es. I think, i think their interest and support for alternatives that lead to treatment or treatment as part of the criminal Justice System or drug courts or whole bunch of another initiatives come about as a result of this epidemic, much of that was led by and advocated by folks in Law Enforcement because more than almost everybody else they saw this, they saw the terrible carnage that was going going on out in their communities before anybody else because they were the ones who got the call more often than not when somebody overdosed. I dont think it is so much that they need to change. I think, i think they have actually been ahead of a lot of the rest of us on this one. And will probably continue to play a leading role. They are in fact huge players and huge advocates of diversion. Theyre huge avocats for diversion because they dont think we can arrest our way out of this either. Yeah. Governor cooper, as you look forward, youve been grapple ifing with this problem since youve been in office. What is coming over the horizon . What do you want to accomplish over the next year or two as we try to turn around this crisis . I think education and awareness are going to be big. When you think about this problem of Prescription Drug overprescription, one of the byproducts, particularly a lot of kids, most where they get medicines are from their own parents, from their grandparents, from their neighbors house. That is epidemic in and of itself and awareness of parents, particularly people just in their household that these drugs are very powerful. I think where you have the mistake is that people think because of a pill in and of itself is legal, that it is safe. When in fact, a Prescription Drug can be more deadly than a street drug. And the awareness of that, the getting people to lock these drugs up, you know, our, prescription cutbacks are going to help this problem. I think overall education and awareness and making sure the public is behind you as you make this change, theyre beginning to see it just because there are not many people who dont know someone who has been affected by this, whether through a death. Whether employment. So theyre realizing that there is a problem. Our education and prevention to help them help us prevent it, i think will be important, vitally important. Thank you, Governor Cooper. Governor raimondo, one of the things i learned being here in rhode island, how in the state youre using recovery coaches, trying to go out and reach people that may not be coming forward themselves for treatment but are out there and need treatment. Can you talk a little bit how youre trying to reach more people . Yes. So as i said, we have had some success with the peer recovery coach model. As we all know there is still a stigma associated with this disease. And we have a lot more work to do to extinguish the stigma. And, there are, it is extremely helpful to have a recovered user who is experienced as a peer recovery coach to be able to be available as part of somebodys recovery and so we have had success with that. Often these organizations are based in the community and its a comfortable place to approach and a peer recovery coach has a shared experience with someone who is suffering from an addiction. I will say one challenge that we have encountered that were trying to deal with is, especially for folks that might be in a hospital or in a hospital or leaving an emergency room, theyre still reluctant to accept a recovery coach, for, part of it is stigma, all kinds of reasons and what we have found is that when they commence to see the recovery coach and it is a person who is just like them, the uptake in using a recovery coach is much higher. Which tells me we do have an awful lot more work to do to reduce the stigma and get back to the fundamental issue which is, this is a disease. Recovery is possible and treatment is necessary. Can i just leverage off the educational awareness and the stigma think that governor raimondo and Governor Cooper talked about. I cant tell you how many people, ive been talking about this issue ever since i started running for governor in 2013 so there are very few people in massachusetts dont know that i think this is important and i believe this is a place and space where we have a lot of work to do and help. Even with that, there is still a lot of people who when i have a Town Hall Forum or town meeting or just out talking to people in a diner or something will only speak to the issue oneonone. They wont raise tear hand when everybody is talking about tax policy, local aid or he had edun or whatever. They only one talk with me afterwards. Despite people are trying to help people develop a sense of comfort it is okay to talk about it a lot of people still cant and wont. I went to visit, there is group called learn to cope in massachusetts which is Peer Support Group for parents dealing with this he had be with this issue. She had no place to go and talk to so she created a group. We have them all over massachusetts. I went to one of their, i have been to a unbp of their gatherings. Theyre really raw and really informative, i really am glad i go to them. I was out there one night and this guy said, i live in this town but the first time i went to one of these meetings i went to one, you know, 30 miles away because i was afraid i might run into somebody that i knew here from our town. He said i went to the 1 30 miles away, and i ran into two people from our town who went into that one too. The other guy in the room said that is really fun my. Same thing happened to me. He was going to a different one. This is going to a meeting you knew everybody who was there was somebody who was dealing with this. You know, there is a great, sad, moment, in an hbo documentary they did on this issue on cape cod in massachusetts where they have a mom, tacking about her own childs addiction. You know, if my kid had cancer every day one of my neighbors would be over here with a cast role looking to casserole looking to help. But because my kid is dealing with opioid addiction with mortality rate a lot higher than forms of canner, i cant talk to my neighbors and my neighbors cant talk to me. The more we do collectively to make it okay to make people realize theyre not alone on this stuff, help them into it treatment and help them acknowledge they have a problem and access resources better off well all be and we can play a big role in that. Governor, i wonder if i could ask you to share with the group what you shared with me, how in your state youre trying to get more employers to hire people in recovery and trying to support people in recovery to sort of get their full lives back by getting a job . Sure. Again, i think this is a great Panel Discussion and unfortunately New Hampshire is right on the ground zero of it like a lot of states are. What were finding is there are so many folks out there gone through recovery and treatment that want to enter the workforce, as someone, in my former life last year i had 700 employees. So we dealt with this all the time. Were up in the North Country of new england, of New Hampshire, where we didnt have all the resources southern New Hampshire did. So we had to design our own systems where we were training our hr staff so employees would feel comfortable. As governor baker was talking about feeling comfortable and talk to us that we had issue. We werent going to fire them. We would keep them employed with our own peertopeer systems. Something occurred to me when i became governor was create a recoveryfriendly workforce, employers where were going out and looking to train hr staff. Were making sure all the employers know what the tools and resources are available because so many folks, you go to a guy that owns a diner, he says well i knew soandso had issue, eventually came to me was addicted to fentanyl, i had to let him go. That was bad for him and bad for the employer. We have a workforce shortage. By making, more recoveryfriendly workforce where the employers get, for lack of a better term certified, it is really encouraging folks to come out of the woodwork, i will reenter the workforce but i know i will enter in a way with an employer that understands the issue, that will supportive. That is hardest thing coming out of treatment and recovery knowing we have support system there, not just because with a family, as governor bake are hit it on the spot because there is so much isolation. But you go to a place to work where people understand it, support you and free to talk about and know tools and resources to help broaden that support experience which as we discussed doesnt take six months or a year but takes year, years, sometimes a lifetime of challenge. So really encouraging that getting folks out of the workforce we think is a winwin because it is dealing with some of our workforce shortages as well as helping the lifelong process, the whole Community Process of recovery. Great. Panel, anyone want to jump in on that issue . You know i feel like because i live in virginia i ought to call on my home state, governor mccullough do you have any statements on the challenges of in virginia of the opioid problem . We had a dramatic increase in the last yearandahalf. My secretary of public safety, brian moran who testified at congress yesterday. In virginia, cut the state right in half. Go to the western part of the state it is 100 opiates. It is all Prescription Drug. You go to the east part of the state it is all heroin and fentanyl. Right undo the state, i assume North Carolina is very similar, western part, coal country, a lot of people get pain addiction. We have two very distinct problems. Governor hogan and i had a conference on it. There are no borders, maryland, d. C. , virginia, were all dealing with this issue. We put a compact together of prescription monitoring immediately within 24 hours were parting to one another what Prescription Drugs are being done by doctors. No doctor in virginia can no longer prescribe an opiate for longer than ten days. Then you have to send in with the state Certified Health risk assessment. Cant go another 30 days without a special permission. We cracking down on the doctors in the state. Way too much opiates are being described. Weve gotten very tough. Put more money in our budget for more drug courts. As we all talked about you can not arrest your way out of this. Putting somebody in some type after incarceration does nothing but cost the state a lot more money in the long run. Weve gone out with very creative legislation, holding doctors responsible with a prescription monitoring plan, with real sanctions you will lose your medical license in virginia if youre prescribing these drugs incorrectly. Weve seen dramatic increase. We have to report those into the state. Limits how long you can prescribe them. What you can prescribe and what combinations of drugs you can prescribe. We limited that. Were working out front regionally with the jurisdictions on prescription monitoring with all the doctors in our reason. It helped a lot. Governor hogan, you want to get with that, share what youre doing in your state or what we in the federal government are doing to support your efforts . Thank you. I would love to. Thank you, governor mccullough were working well on the prescription monitoring and prescription limitation form of the problem but we havent heard a lot of talk about heroin and fentanyl and has been mostly about prescription opioids. That is big part of the problem. 80 of overdoses in maryland started asoff prescribed Prescription Drug problem but it evolved. This is, the problem is constantly evolving. We went from heroin to fentanyl, to now carfentanyl. One is 100 times more powerful than the other and killing people first time they use it. Governor baker, since i first started running for governor, i traveled around our state i was shocked to hear from one end of the state to the other people talking about what is the number one problem in your region. They would say heroin. It was in small towns and rural communities. Wasnt just a urban problem. None of the government leaders at that time were talking about it. It was something we were sort of being quiet about. When i first became governor and sworn in 2015, the first thing i did was create an emergency opioid and heroin tack force. I had our Lieutenant Governor chair it. They held hearings around our state in various regions to got input and hundreds of people would show up. And out of those hearings and that task force we came up with 33 recommendations from education and prevention to treatment, to intervention. We enacted all 33 of them. It did nothing to slow down the problem. So we went further. We passed tougher laws on Law Enforcement. We doubled number of treatment beds. Did nothing. Crisis kept evolving. Heroin in the last 12 month killed 2,000 people in our small state of maryland, which is far more than gun shootings and traffic accidents and number of other diseases all added together. So we, all these governors at this table have done incredible work. Weve done almost everything they have done in every other state and it hasnt slowed this problem down. It continues to grow out of control. We became the first state in the nation actually to declare a state of emergency. Some people may remember the riots in baltimore. We declared a state of emergency, sent in the national guard, 1000 extra Police Officers and this emergency is far bigger. We didnt have a single death in the riots in baltimore. We have 2000 past 12 months with heroin and opioid and carfentanyl. This is tearing apart families and communities from one end to the other. I will say in spite of all of our efforts were not making much progress. We have to find a way to get the federal, state, local with faithbased organizations an families to hit it from every direction. Not just from a drug crisis. It will become a number one killer if we dont slow it down. Thank everyone for the great work theyre doing, and thank the nga for putting this on. I want to ratchet up the panic level a little higher say this is not just an important issue were talking about but a real crisis and a real danger to our country. Car fentanyl. Governor . I have to leave for a call but i have to comment on a discussion. I look for action. I dont need another study to tell me how bad it is. Everything has been said. We can all say it. It is very, very bad. I came here a year ago, listened to governor baker talk about the legislation he passed in massachusetts. I went back to alaska. Find out what he did, make it a little better. And we did. We made it a little better. We passed it. I issued a declaration of disaster. Its a disaster. We have meeting every week with our cabinet one hour on what is being done. We passed legislation. We, you know, narcon kids gone out. We saved lives. Drug dogs, im all about drug dogs. I am all about prevention. We are putting up signs and messages in port of entry into alaska out of seattle saying with a drug dog on there saying, come to alaska. Can hardly wait to meet you. If youre carrying drugs i will get in your luggage, i will get in your face. My attorney general tells me all things i cant do. I had to stop inviting her to the meetings. We are aggressive on it. We have to be aggressive. Its a disaster. Every bit of disaster as fire, flood, earthquake, oil spill it is a disaster. Meet it head on. Be aggressive. Talk about it. It is widespread. Every spectrum of income. Sports injuries are heartbreaking. So many in our community of juneau young people, same graduation, sports injuries died as a result of escalation of that. Treat it like the disaster it is. It is a disaster. Looking for somebody else to come and help to do it . Do it yourself. I, i reduced my salary by 1 3 because of fiscal situation in alaska. Did that state of the state. Im doing that to buy drug dogs. Step up and do something. I went as far to say, we dont have the red sox in alaska. We have dog teams. Give me those dogs in the offseason. Put aprons on them. Theyre not drug dogs. Who knows that. You know, have a bunch of at apart. Friendlier, better. Jump up lick their land, scare the hell out of these people but keep them coming into the state. We have forfeiture clause, one of the ships on the deadliest catch we have one of those. They had drugs. Now we have their boat. Pull every lever that is there. Its a disaster. Only way to get ahead of it be aggressive. Dont study it. Act on it. Thank you, governor. Were about to wrap up, but can i ask governor raimondo as our host. This of course is very, very serious crisis. We need a sense of urgency as you gather leaders in the state are there things you are hopeful about end on positive note how we will tackle this problem . Certainly awareness is much greater today than it was a year ago. That is a key piece of the puzzle. As i said earlier, more than any other issue that i tackle, this requires collaboration from so many different groups. Everybody has to, think it is their problem to solve. And i think that awareness is leading to it greater level of collaboration. As i say, we have seen pretty substantial drop in our prescription rate over the past handful of years. And last year we also passed legislation similar to what it sounds like virginia did to limit the dosage on a first prescription of painkillers. Were just starting to see the effect of that. So, the hopeful sign is that were here, talking about it like the crisis and emergency that it is and you know, i say to my people too, lets throw the kitchen sink at it. We cant do enough. We are starting to see results. And the most important thing is that, we not let up. We are starting to see a leveling off of deaths. Still hundred as year. It is a huge problem. It is not where i need it to be. Under no circumstance can we ever let our foot off the pedal. Fentanyl problem is out of control. Enforcement is enormous. The fact that you can put enough fentanyl to kill a person is enormous. The hopeful sign everybody is focused on it. It does seem some of the interventions were trying are starting to have positive impact. Thanks, governor. Thank you, everybody, for a great discussion. I will turn it back over to governor baker to introduce our final speaker. Thank you. By the way on the fentanyl piece and carfentanil piece, one of the things we ought to do with our colleagues at the federal level, maybe it about what is going on at wholesale level and not just chasing retailers. A lot of what we do in local and state Law Enforcement, chase folks the last stop on the distribution chain. I would love to work with our colleagues in washington to see if we cant start chasing people higher up the food chain to begin with on the illegal side of things. I think that would make a difference. I much appreciate all of the work all of you are doing. I completely share the frustration and sense of urgency. But i also agree with governor raimondo. I think there are things that people can do will work here, boy, oh, boy, you have to stay with it, stick with it a long time because it didnt happen overnight. With that i want to give dr. William bell, head of the casey foundation, before that had one of the toughest jobs in government, serving as head of Child Welfare in city of new york for 10 years. I thought it would be helpful for him to give thoughts what this Opioid Epidemic meant with Child Welfare. Im sure we all know has hit our Child Welfare agencies hard. Dr. Bell . [applause] thank you, governor and thank you all for your leadership. I really wan to say thank you for nga as you have continued to push leadership role of governors in this nation. I dont think there is any greater call for today than to tackle this issue of addiction. I am so thrilled sitting here listening to your leadership, listening to the direction that you have already chosen to go and the ownership that you have taken for this challenge that is facing our nation because at casey family programs, which is the Sister Foundation of annie casey, we believe that one of the greatest challenges facing this nation today is the erosion of hope in the lives of our citizens, and that many of the challenges that were facing are directly connected to the lack of hope that some of our families are facing. But i heard something here today that i think we all need to hold on to. These are people. These are our people. And they need to know that we care about them. I was in new york city during the 80s when the crack epidemic hit. Unfortunately we tried to punish people out of drug use and we didnt see what someone said here today which is, this is a disease. Recovery is possible but treatment is necessary. And the underlying point i heard here today, were not just talking about individuals who are addicted to a substance. Were actually talking about sons, and daughters, and uncles and aunts and mothers and fathers and brothers, and sisters. For every addicted person we will encounter, there is a family standing behind that addiction. There is a father who is afraid that his son is going to die. There is a brother who, as i had to do in 2010, who has to go bury his deceased brother. There is a community that watched this young man or this young woman grow up expecting great things from them, that one day they were going to be the leaders that would replace you, who have to come facetoface with the fact that might not be possible. So i stand here today to applaud you for your leadership but i want you to encourage keep reaching up, because the federal government has to support you in what youre doing but i also want to encourage you to reach down because from our seat you need to engage the mayors and the local city leaders who are responsible for these same citizens in those communities and get them also on board with what youre trying to get done because as was said from this panel, we can not do this alone. And we can not do this from a singgel department or from a, the business sector cant do it by themselves. The elected governors cant do it by themselves. Notforprofit sector, i include faithbased and philanthropy who cant do it by themselves. We cant grant our way out of this. The groups that to include the fifth sector and the fifth sector has to do with the community who surrounds these people, who touched them every day, who changed their diapers. We need to engage in a way that says we can not rest until this is over. We can not give up on a single soul no matter how many times they relapse. We need to understand we can beat this. We have a history of winning and this is no different but we can not give up. We can not declare it done. We can not say well, we fixed this neighborhood. Therefore we can use this money to go someplace else. We have to rebuild from the ground up. And i will give you two numbers. One is, 25 minutes. Every 25 minutes a baby is born in the u. S. Who is sufficienting from withdrawal from opioid addiction. That means during the time of this conversation, this very inspiring, very encouraging discussion, three babies have been born suffering from withdrawal from opioids. That means by the time we finish this threeday convening, 173 babies would have been born suffering from opioid withdrawal, dramatizing how serious this is and how we can not rest until we get all of the Solutions Working for us, and that we can keep moving forward together, saving as many as we can, butted thatting the longer we wait the more casualties were going to experience. And the second number that i will give you is 1 3. That number is significant. In 1999 there were 567,000 children in foster care in this country. Casey foundation and programs along with others Building Communities of hope, effort to change what is going on in communities so children dont have to come to foster care when families face challenges but we serve them at home. From 1999 until 2012, there was a 30 reduction of number of kids in foster care. It had gone from 567,000 children in foster care to 390,000 children in foster care. From 2012 to today, that number gone back up to almost 430,000 children in foster care. It is heading in the wrong direction. And children who spend their lives in foster care have some of the worst life outcomes than any of our children in this nation, including those who chronically poor. We must see the faces of these babies. I encourage you to reach out to your other colleagues. Every governor should be in this room on this issue. And we need to make sure that the federal government is in it. I will tell you philanthropy is on this issue. Casey family programs will be a resource. Doesnt cost any of your states anything. We bring resources we gotten from the late jim casey, founder of ups, we give them to your states. We work with everyone of your Child Welfare agencies to make sure were not leaving any of our children on the playing field. We cant leave them behind. They need to be leading this charge as we go forward. And the challenge is for us to continue to remember that these are people. And that 1 3 number, 1 3 of all of the placements that are made, that were made in this last year, over 200,000 children coming into foster care, 1 3 of the reasons of all the cases had parental Substance Abuse as a reason for he removal. This epidemic is not just dealing with adults. It is also dealing with our babies. I believe that working together, one of the quotes of the late jim casey, committed people, working together can do anything. And so i was honored to be invited to say a few words to you today but the one word i want to say with you, we will work with you. This is a fight we have to win. Failure is not an option. Thank you for inviting me. Thank you for your leadership and thank you for what youre doing for our children. [applause] thank you for all of you being with us today, to our colleagues in state government. I take great pride in the fact that some of are working this issue so hard. My big message to all of you, stay without. I do believe were making progress. But it will be a long hard slog. Thank you all again for being here. Anything you want to say governor . This is your town. I want to thank everyone. This is big attendance by governors. This is a big crowd. That gives me hope we will solve the crisis in this country. Thank you all for your leadership. Also. [inaudible conversations]. We are live in providence, rhode island, this afternoon for day two of the National Association Governors Association meeting. Governors are in a break. But when they return Vice President governor mike pence address the group. Along with canadian Prime Minister justin drew he dough and governors across the country to talk about the global economy. That is live 1 15 p. M. Eastern on cspan2. Talks by leaders of girls who code and spacex ceo elon musk. That is 9 30 a. M. Eastern on cspan. Coming up tonight, our profile interview with linda mcmahon, head of the Small Business administration. Before becoming sba administrator, she was cofounder and former ceo of World Wrestling entertainment. She ran in connecticut as republican nominee for u. S. Senate in 2010 and 2012. Doesnt us 8 00 eastern on cspan, on live, with cspan. Org and with the free cspan radio app. Coming up next, a look at u. S. Uk relations with british secretary Michael Fallon from the center for International Strategic studies here in washington
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