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tv   Opioid Crisis Hearing at Johns Hopkins Hospital - Panel 1  CSPAN  November 28, 2017 9:00pm-12:13am EST

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preferred candidate for elected let me introduce you to group. the foster. in a meeting that took place at the old ymca building still stands around the corner from where the music i'm currently operates a intrepid latina leaders met in 1920 before the baseball league and they could then go up and operate from 1920 until 1960.
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the house oversight committee held a hearing at johns hopkins hospital in baltimore focused on opioid abuse. new jersey governor chris christie, chair of the presidential commission on drug addiction testified along with baltimore governor in maryland governor. this hearing is three hours and ten minutes. [inaudible conversations] good afternoon, everyone. welcome to hopkins. i have the distinct pleasure of welcoming you all to the institution. as the president i've often had the immense pleasure and privilege of working closely with congressman elijah cummings on a variety of issues and we are grateful for his steadfast
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leadership nationally and on behalf of his local constituents we are lucky to count ourselves among those he's represented from more than two decades. we are honored to be a part of the house government reform committee's efforts to find meaningful solutions to the opioid epidemic. thank you all for being here today. it is no secret that we are in the throes of a crisis that has reached epic proportions throughout the country, and baltimore is no exception. in 2016, we've averaged nearly two fatal opioid doses in the city per day. this is a problem in need of thoughtful answers as both an anchor institution and steward of health care for the local communities, hopkins takes the problem very seriously. we see first-hand the devastation fielded by substance abuse disorders. here and at th desist or hospito
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the east, the number of opioid overdose patients seen in the emergency department doubles last year doubled. this is a part of our reality. so, what are we doing about it? as an academic medical center, we are addressing the issue of research to clinical care and education. first, research. hopkins research runs from bench to bedside starting with the original identification by doctor solomons mitered in the 1970s to the multitude of clinical trials that are conducted in the behavioral pharmacology unit on the campus. we are working hard to make an impact. the clinical care we are working on two fronts, treating the disorder that already exists and preventing future addiction. an addiction to the treatment units.
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it's addressing mental health, social services and family needs and we have specialized programs targeting pregnant women, youth and adolescence. perhaps just as important as treating, we are working aggressively to prevent the pathways of substance abuse from opening. they've implemented guidelines of the opioids such as limiting the dosage o of the first prescription particularly after surgery and eliminating automatic refills. while patients are in the hospital we have team of specialists work with them to find alternate modalities of treatment and we provide access to the locks on fo luxor for pah disorders visit. though we haven't stopped there in the third part of the mission of education. as educators we are working to ensure the next generation of the physicians and providers is to practice his treatment and prevention by incorporating them
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into all aspects of training. we realize the work we're doing is one piece of a complicated puzzle. the opioid epidemic is after all a public health crisis that requires a systemwide approach. among the partners is john hopkins school of public health. the bloomberg america health initiative launched last fall with a generous gift from being innovative research projects partnering with community-based organizations and working with policymakers around the country to implement evidence-based comprehensive solutions and beyond the hopkins campuses, we rely on the expertise of so many other health-related institutions and businesses from the baltimore city health department to the local pharmacies and our elected leaders. so i look forward to today's testimony from a dedicated and edwarandinformed group of important group of witnesses. i am confident that your work
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will move us forward to achieving solutions. thank you. now i' i am honored to yield the floor to the mayor of baltimore city mary catherine. the plus [applause] to the esteemed committee, thank you it up to the congressman. everybody knows at this point that we are in a crisis. opioid addiction, we are suffering here in baltimore but the nation is suffering and it's important that we pay close attention to what we do as it relates to the individual
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suffering from this and the communities that are being destroyed by it. we know that in baltimore city we have a big problem and we know that we are part of a larger problem with the governor whwho convened a group to look t this particular issue and we are focused on not only making sure that people don't get involved with drugs but doing what we can to keep people from overdosing. i have one of the greatest healthcare sugars in the country who's really focused on this particular issue, so again i want to welcome you all here and i know that this panel will continue to deliberate over this issue and i look forward to hearing the results of the panel so we welcome you to baltimore but more importantly we understand the importance of your work. thank you. now i have the distinguished honor of bringing before you the governor of the great state of maryland, where governor.
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thank you so much. [applause] thank you mayor and governor christie as you know who chaired the resident's commission on the opioids and i want to thank the congressman cummings, ruppersberger and all of our members of the house for coming here today to baltimore. we thank you for holding this hearing in the city of baltimore and the state of maryland and also want to thank all of you in the audience for being here today and who have enough interest to be here this is a national crisis and something i've been very passionate about for about four years. when i first decided to run for governor i was traveling in maryland and every single town and community i was going to indict thinvite the task of locs what is the number one issue
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facing your community and it didn't matter whether i was in baltimore city or urban areas or wealthy suburbs of montgomery county and washington suburbs and it didn't matter if i was in a small group county the answer was always the same in every place i went they said the number one problem we are facing his heroine and opioids and it came as a shock during the campaigthat during thecampaign g folks involved in addiction and police officers and we got everything we could. soon as i was sworn in as governor whe one of the first ts i did in january of 2015 is put together a heroine and opioid emergency task force chaired by the governor and hundreds would testify. we came out of that with 38
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recommendations all of which we implemented and it continued to get worse no matter what we tried. we became the first state in america to declare a real state of emergency just like we went for a natural disaster and it is a national disaster. so far this year in our state 1180 people have died of overdoses in maryland. in almost every single day people are dying. this has now evolved, we have leveled and reduced the number of deaths from prescription opioids for the first time ever we flatlined heroine overdoses but we have a 70% spike in front
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of fentanyl. as we try to be aggressive on this issue, it's constantly involveit constantlyinvolved int it and i want to thank governor christie for his work because it isn't just a health crisis but it's impacting into tearing apart families and communities from one end of the country to another and it's going to take it all hands on deck approach. federal government working with the state and local governments along with people in the private sector in hospitals. i want to think hopkins for hosting us today that i want to thank you for your interest and say that i called on the federal government back when we did our state university and said federal government ought to do the same thing and that would be my recommendation to the committee to have federal funding, and i would say this is
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the most important problem facing the country so thank you and i'm going to turn the floor over to the chair man who is here. thank you so much for being there. [applause] >> thank you, governor and johns hopkins for pardoning the inconvenience and appreciate the seriousness of the issue that brings us here. the committee will come t to orr without objection the chair is able to call recess at any time. we are in the hometown and because he cares so passionately about this issue we are going to recognize you first for your opening statement. >> thank you mr. chairman. but i cannot come into this
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hospital without saying thank you to hopkins for saving my life. i spend 60 days here this summer and a lot of that was here in this building. i see a lot of white coats out there and others. thank you for what you have done. i want to begin by thanking the chair man for calling today's very important hearing bringing the oversight committee to baltimore i also thank my colleagues for coming to baltimore and certainly my colleagues who represent baltimore along with me and doctor ruppersberger. i've been in the congress now for 20 years and i've seen a lot but i've never seen as many
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members attend any since i've been in congress. today is a remarkable turn out and the fact that the opioid crisis is a national emergency that doesn't discriminate based on politics. it affects red states and blue states and every state between. so i'm extremely grateful for the request to bring the committee to the road to investigate the devastating effect of this very difficult problem. i also want to thank doctor miller for your hospitality. the work you do makes a huge difference in the committee and around the globe. we are honored to have you in our prisons and of course i think our witnesses, governor
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chris christie doctor alexander. thank you for testifying and for all that you are doing to help us save lives. a year and a half ago at the committee's first hearing on this issue either warned that so many people were dying and communities into that we could no longer ignore this emergency. today the centers for disease ce control and prevention estimates that more than 64,000 americans die from drug overdoses in 2016, an increase of more than 20% over the year before it last year alone was higher than all u.s. military combined.
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every 20 minutes someone dies from an opioid overdose. today's hearing lasts for two hours, half a dozen families who have lost a parent, a sibling or a child to opioids. we have the reports, years of talk and no it is tim now it isr action. the american people are looking for us to take action, looking to the president and the congress they are asking what are you going to do. governor christie and the other members of the commission on drug addiction have given us a group with dozens of recommendations and now it is up to us, republicans and democrats, local officials, researchers, drug companies, health providers on the ground
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and families of the communities. we need to work together to end this epidemic. something we can do right now to help prevent addiction and save those who already have this disease, for example, we can assure that every single person who need needs the lock so it hs its. the commission's report highlights the importance of equipping first responders including police officers, fire departments and public health officials. but here's the challenge. drug companies have continued to hike up the price of this 45-year-old drug and have been forced to ration it. in september the members of the house of representatives are sending a letter urging president donald trump to negotiate lower prices just as
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the commission recommended that unfortunately we never received a response. the president should act now to make sure it is available at a reasonable price whenever and wherever it is needed. we also need to ensure that every affected person has access to an effective treatment. according to the commission and i quote today only 10.6% of the youth and adults who need treatment for the substance disorder receivsubstance disord. only 10%. there is no way to end this crisis if those affected are not being treated and if we do not act now. to do this, we need funding. last month president trump declared this epidemic a public health emergency that didn't propose any additional funding to combat it. we cannot fight this epidemic
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without equal to the challenge we face. this is a sad truth, so finally we must recognize and acknowledge the many factors that people at risk. woefully inadequate support for our children and vulnerable residents, worsening the economic inequality, lack of opportunity and profound disparities of the criminal justice system. we cannot solve the crisis until these risk factors are addressed. with that, mr. chairman, thank you and i look forward to the testimony into taking action on it and i ask for unanimous consent.
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with that, i will yield back t the. back stronger than ever, so thank you all governor christie and past and present governors witnessed a drug epidemic in the history.
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it kills more americans than homicides in car crashes combined. it is a staggering reality, two out of every three overdoses in the united states involve opioids prescribed to believe and manage pain. over 33,000 americans die from an opioid related overdose in 2015 which is an increase from the year before. in south carolina where i come from, they've suffered more than 100 opioid related overdoses in 2015 and while the numbers are fewer when compared with those like baltimore behinwith baltimy member in the statistic is a lifwife with loved ones and friends, potential aspirations we have a tendency to use numbers and governance in our line of work that the victims are rough numbers.
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we can cure diseases the past generations lived on. we can put people on the moon but we are struggling on how to respond with this epidemic. i guess we need to start with how did we get here. there are illicit uses for these drugs. one is unlawful and the other is legal. physicians have a role to play for certain. these drugs are not available legally. what are the pharmaceutical alternatives, is there overprescribing, sufficient information shared to avoid the misuse and abuse, frequent
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exposure and access to painkillers lead to intolerance, substance use disorders to intensify the methods with or without the help of the physician. it is growing exponentially on the illicit side of the equation they have high potent pills to the market to be placed through an resulting in the drugs so lethal they've been called a grave death to describe the risk associated with every single injection. opioid related overdoses are deadlier than the hiv aids epidemic at its peak that predated it. there's there is a plethora of s to be asked in the use of substances. also prosecutor doctors.
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i want to make sure they are evicted going to the source of the issue outside the course of a professional medical practice. are they monitoring and sugars with less addictive outreach for patients or the states regulating the homes that can move patients in and out of treatment physically for profit and these are the questions people want answers to all across the nation. almost everything seems capable of being reduced to political exercise i genuinely hope that this epidemic is above that. i hope it's about protecting those especially among the premature, especially the premature death of a young wife with no political or ideological victims and the perpetrators,
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addiction is addiction, heartache is heartache. the issue to me comes down to those seeking a solution and those who profit off of other people's addiction and pain. it's not just those across the healthcare system is also the disease of addiction that is permeating and threatening in some places within the country the very fabric of the communities. at the same time, the pain is real for the homebuilder and mr. cummings district for mine with an immense vaccine. how do we solve this epidemic. there's a provision aspects of the treatment aspect of education aspect, punishment aspect and oversight aspect. the president signed an executive order for governors and attorney genera attorneys gd
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a professor to recommend policies for the federal response of the epidemic. the commission finalized recommendations for how the federal government can help the stakeholders and stave off the emerging threats. today we will have an opportunity to highlight and appropriately so. we've also examine the state and federal partners and how they can assist with and learn from the efforts that are occurring here. the devastating statistics may leave us feeling like we just left the starting line. but our country is resilient, we have resources, compassion, i think we have a commitment to win this battle with opioid and opioid addiction so i want to thank all of the witnesses. governor christie, you are the great governor of the state of nestate ofnew jersey as i mentiu
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you are also a former united states attorney, so you are uniquely unjust for your presence today that the ability to undertake this vitally important responsibility and with that, you are recognized. the president asked me to chair his commission on the opioid and drug addiction in the country and we worked together on to join that commission. that is an important place to start. there's much that divides the political dialogue in the country right now that makes it difficult to get things done. this can often be one of them.
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i read the obituaries and in none do they designate whether the person was republican or democrat, they are a son or daughter, husband or wife, mother or father so i hope what we do today will help get this problem the ability to rise above the partisanship we have in the country today. it is the publi public-health ec of our lifetime. everything fails in comparison. it is everywhere in america. people are dying each day. the most powerful and allergy this means we have a september 11 every two weeks
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come every two and a half week. i want to ask all of you that the committee is invading our country killing citizens every day. what would you be willing to pay to make it stop? we don't ask that question and the reason we don't in my view is because we still believe that it is -- we are making a judgment of the people who are suffering and dying and making judgments on their families. every time i go to a drug treatment center in my state and i ask someone who's been mistreated tell me your story, within the first two minutes they say to me i'm from a good family. and my response is why would you think that i would think otherwise?
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because the stigma attached every day makes people believe, but somehow we believe this is a choice. who in this audience has not made a bad decision in their life? we all have. many of us are fortunate that decision was to use opioids were we might be in a very different position than some people are today. addiction is a chronic disease if it needs to be treated as such. that's why i'm glad the president has declared that the public-health emergency.
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i last checked it was at $66,000. we need the funding to make sure that the administration has at their disposal the resources they need to implement the recommendations of the commission has made. let me be clear this is a epidemic that didn't start on the corners of baltimore committee started in doctors offices and hospitals across the nation and while some of it is done by folks boast of no intent
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and they are not educated on this issue. it's every state in the union we are not educating future doctors in versus on the dangers of these drugs. [inaudible] how is it they can have a license and not be required 64,000 people died last year.
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for people who are terminal beginning march 1 of this year they are down 15% from march and a number of pills is down 20%. those restrictions work and should be instituted. granting for the old-fashioned antiquated researching the institutes of mental disease it says that if there's any
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hospital healthcare provider more than 16 beds those folks cannot be reimbursed because they are a state psychiatric hospital. what this means is there are thousands that can provide the treatment that the ranking member recommended in his remarks to states have been asking for this ability for four years. they will be coming to receive their waiver within the next six months for people who need drug treatment and these are folks that are the neediest in our
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society. we need to increase and we need to decrease the influence of the pharmaceutical industry. right now they only get their education by those producing the pills they were prescribed. as the chairma chairman is thata former prosecutor and that makes me a little bit skeptical and because i'm from new jersey at makes me cynical. it'if the only education positis are getting is to prescribe these polls and then in 2015, 259 million prescriptions were written in this country enough to give their own bottles of 30
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pills, 259 million. 4% of the worlds population and we consumed. we don't think that's where the problem started said it began with prescription opioids. we need an alternative because it is the chai chairman said, is real but that is where they should be spending their money, not on paying doctors. that is why we brought together all of the executives in the country in new jersey and those that agree partnership they would work with the nih to come up with two different solutions to the problem.
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and more alternative treatment. we have three in the country and there should be more. they could address the positions if they are not moving forward. they need to be the ex- apartments for moving forward with to make sure we work in partnership to get these things to market as quickly as possible. the consumer that wants to avoid the addiction that would be more helpful.
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insurance companies play a large role in this house of. why don't you change the regulation and make sure. middle-class folks that have employer provided health insurance and right now most of them do not. 70% are regulated so we say why have they not stepped in? they don't have the authority to do it for mental health act they do not allow the department of labor to find an insurance company who isn't treating the addiction and they don't allow the department of labor to investigate the companies a it s
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the employer by employer. how ridiculous is that? we encourage them to give the authority and responsibility to find insurance companies that are not treating addiction with older diseases and to give the secretary of labor the authority and responsibility and not have to go employer by employer when we know they cover thousands of employers. one robust investigation is a lot easier to staff than 2,000 little ones.
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we have the largest criminal justice reform in the last few years and one of the things we've done what does this mean exactly when you come in not as a dealer or actor but the nonviolent you are now required by law to treatment, not to ja jail. the judge decides you are not utilizing the opportunity given to you they will send you to jail but you'll get the chance first to go to treatment for every federal district in the nation to be committed to dealing with the drug problem in
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this country and to give those families and those aspects that are suffering because he's helped and an opportunity to get better. i'm a former prosecutor and i'm in favor with your standing in the street corner in every town and city in the country were standing in a hospital or dr.'s office. if you run a pell-mell you should go to jail just like it should dealer on the street, but it will not solve this problem by incarcerating addicts and we must get them the treatment they need to have the tools to recover. in new jersey we are the first stagstate in the country to cont
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a state prison to give to a treatment facility. so, now in the final year of incarceration who have a problem they transfer to the state prison facilities we have other properties in new jersey run by a certified company working in conjunction with the department. all these things are recommended for states and we are proud of governor baker, governor cooper, attorney general bondi and professor beyond the commission and work and a completely nonpartisan manner to make these recommendations and i hope the members of congress work with
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the president and hold the administration and each other responsible for getting something done on this issue. thank you. i'm happy to take questions. >> we will now recognize the governor from maryland for his questions. >> thank you, governor christie. i want to as i said to you and foforthe hearing and now this excellent report, i want to talk about maloxone. they talked about dropping a man right in front of the hotel and i said what's going on and they said this happens all the time, we see people who may be at a party and they have an overdose and they don't know what to do.
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i use this as an introduction to maloxone because as you know it's been used to save lives and to get your report you said price increases of the various forms continue to create affordability issues as well as organizations from stopping maloxone at the levels necessary to rescue people from the overdose. is that correct, governor? >> we recommended in the report that the governance, starting with the federal government should ban together the purchasing power to make both at lower prices.
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there's no reason you shouldn't be able to do this and they also recommended a report you prescribe an opioid for accessing. two pills every four hours is good, poor pills might be better so it's not just a person suffering from addiction but also unintentionally misused in the home and the folks that live with them if they have an overdose it is easy, to push his of a button in the "boston globe."
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>> testifying in a few minutes the thing that i think bothered me so much about nays maloxone is that the price was jacked up at the very time when the first responders and others were trying to get it because they saw the effectiveness. did you have discussions? >> we did not in terms of the pricing issue. what we did talk about is the concept of the purchasing and their willingness to consider. so we did talk about that with the manufacturers and that's why we urged the report is something that can be done and they
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recognize that the commission emphasized the responsibility. >> i noticed it was in the interim report but i didn't see it in the final report. >> it shouldn't be read as exclusive, it should be written together. we've made 65 recommendations, so these recommendations should be added to the final report. >> i'm glad that you clarified that.
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my last question is can you discuss this report at length, can you discuss this maloxone recommendation and what response did you get? >> i haven't discussed this specific issue but how important it was for the ball enforcement officers and first responders but we could get into the price in my conversations that i have had that conversation with other members of the administration. >> the gentleman from maryland. >> this is a very publicized thing and it's still very
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publicized. have you looked at other countries who perhaps didn't have the opioid problems that we have where they had like no problem i think england has a big problem could you comment on the criminal justice systems and how they deal with possession or the sale of opioids in other countries? >> what we looked at was and availability perspective and the difference between this and the others is the extraordinary overprescribing of the drugs. part of it quite frankly this pain as a vital sign a fair everybody has a smiley face on their lack of pain so what is
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going on is to give you a whole bottle of percocet. at the very base of the problem is the availability of the medication. >> how they even get access in other countries who don't have this problem. >> the commission can be very helpful in that regard. [inaudible] i don't know the exact number if
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you have a pvs position to this within three days is why they said it is no more than three days on the initial prescripti prescription. when you talk to people d who ty say they are addicted? >> i will tell you that, there is a young woman and i have spoken to literally hundreds of people across my state in treatment centers about this i will tell you one young woman who was part of our public advertising campaign in new jersey suffered a knee injury and used her first bottle of
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pills t for this young woman who was a college graduate, had a first job and within the first week she went from being employed in her own place to live, 60 days having lost her job, kicked out of her apartment and living on the streets in new jersey. >> i will get one more question. in vietnam i understand heroine was somewhat widely used in something has been said about how it wasn't used when they got back into the united states which would be a little bit inconsistent in the idea, could you comment on that?
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>> there are people who can use it recreational league and not become addicted so we have to be careful about using the phrase always or never because you are dealing with human beings with different genetic makeup, different psychological kneeca kneecaps. they tell you it's this as well as a science. what i would tell you is four of every five start with prescription opioids and we are talking about the same compound. in terms of its ability to become addicted. >> if you wonder where the lighting system is, it's right there.
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although if you do have one more question. >> one of the things on treatment some people feel it is ineffective, can you give us your opinion of what constitutes an effective treatment what constitutes as an effective treatment is anything that isn't evidence they seemed so we shouldn't be operating theoretically here with sufficient information across the country on what works and what doesn't. it works for most people the fact is though it's the state regulatory bodies across the country who need to be very vigilant about regulating what happens in the treatment centers, and there are places in this country where there is a
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lot of fallacious treatment. i don't want to be the first to say it is flawed in all different areas where there is money to be made. it doesn't discount the value of the treatment. whawhat thiswhat it says is ince need of the regulatory bodies with prosecutors who are ripping off people by giving a false hope for treatment. >> the gentle lady from the district of columbia is recognized. >> thing you very much and i want to thank the ranking member for this hearing and seeing q., governor, for coming in your forthright report. the last congress and the last administration did come forward with a billion dollars, but we see no slowing you down in this epidemic and in my own district which isn't considered it
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tripled in just two years. this notion of a national emergency versus a public health emergency and i know, governor christie, the report indicated it wathere was a national emerg; is that not the case? >> it could be addressed one of two ways, a public health emergency in the safety act. who would administer the funds with the department of health and human services and the stafford act would be administered by fema, having had a little bit of experience with fema.
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[laughter] i would just tell you i don't believe based on my experience that is why we made that. it's the best alternative because i can tell you the recommendation in the public health and safety act in an emergency fund would have a greater sense of expertise on how to deal with this issue. >> i can see that they make a difference otherwise. >> this region that we are now just have a summit and at the te governor declared a national emergency or state emergency.
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i am trying to find whether it would encourage congress to come forward but you indicated what was necessary and your remarks were complete with versions of funding one way or another. you asked in the beginning of your testimony what would we pay a terrorist, for example, who invaded the country and making that analogy i is that this has done. what this has done. you called for public funding, but the sit here and congress frankly lost the focus. we are not sure whether the government is good t quick to bt open and therefore nobody is thinking about this if you
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forced us back to the front burner of the congress of the united states which hasn't funded anything since the last administration and additional fun thing. >> with all due respect i think that the congress needs different wording to focus its attention. if you can't tell from 64,000 die each day for the public health safety act, then i would say to both sides of the aisle you need to reassess what you're doing and i recognize the last congress put in what was needed. in new jersey this year year-$30 million of state money. $500 million. so quite frankly i am not impressed with the state of new
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jersey is dedicated a 34 billion-dollar budget you are dedicating half a billion dollars just to increase the available treatment of the training, maloxone, all of that is being supplied by the state localities. now we need help from the federal government and i want to be clear it is a national emergency sent to two different ways. ..
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[inaudible conversations] >> now we can hear you. did the clock start now? >> it just started. >> we are restarting. >> don't go there. >> is worth at least 15 seconds. >> i just want to go back to something that we brought up with my colleague from wisconsin about, heroin and if the initiator versus the prescription for painkillers and what we found is that opioid
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addiction is initiated by painkillers like oxycodone and hydrocodone has actually gone down from 42.4% for oxycodone, to 28-point -- 24.1 and 42.3% for hydrocodone to 28% but in the case of heroin is the initiator it's gone to 33 .3% in 2015. i think we are on two tracks here governor that i think the medical community has to address but also that law enforcement community has to address. >> now question. the report talks about that. there's no question we need to make sure and i think i said this in my opening statement that as a former prosecutor they
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are spreading throughout our community. it has to continue aggressively. i don't think, there's no reason we can't chew gum and walk at the same time. we also need to acknowledge the treatment as a part of what our overall national government and state government is a fraction of what we spend on enforcement and so i want a three-legged stool to operate that i wanted to be education law enforcement treatment but right now as long as that continues will continue to have this problem. you will not find me being opposed to stricter enforcement but we must draw a distinction in my view. those people in the criminal justice system need to be dealt
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with differently. >> i also think we need to look at this in a holistic manner. i don't know anyone who doesn't know someone either a friend who has a family member. across his every boundary that you can think of race, gender, income level, profession but one of the interesting things is that doesn't get talked about his family structure. when you take a look at that 68% of the population is either married or widowed yet that only represents 20% of the overdose death whereas the never married and divorced population is about 32% but they represent 71% of
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the opioid deaths. i would like to see us do a deeper dive into that and start looking at the ages in those categories. i think that it's got to be part of the discussion, the overall breakdown of the family and how that is contributed to this. >> i think has a father of four, married for 31 years i believe we are doing something right, at least we are trying to put they also want to be careful about this as well because there are plenty of folks who are in the situation i am to wind so wind up having children who wind up at the did. part of bowie said in the report is there is not one silver bullet to fix this problem whether it's the issue you raised her treatment so i think everything has to be considered and looked at as what is leading our country to consume -- it's
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something that happens across a country that is encouraging us. i don't want to mislead anybody that there's a silver bullet because there is not. >> for my own personal experience one of my children's classmates tremendously talented of african-american artists died from an overdose and one of my board members from a think tank iran i sat in her living room with them while local authorities moved the body of their son. my last point mr. chairman if i may is taking a look at the drugs prescribed through tri-care through the va. i have gotten information from people about their tremendous numbers of drugs that are sent out that these people don't need need. this is a huge issue in alabama. it gets back to where we started
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the overprescribing of medicine. if you would like to address that. >> a large part of the diversion so that's why we are advocating a good partnership with the private sector as well places like walgreens and other national pharmacy chains that are setting up kiosks in all of their stores for people to dispose of the unwanted or unused medicine. a lot of times what happens is a young man or young woman they don't use the entire prescription and they say heck i might as well try this or worse there is great guy you on the streets for this. in every way it impacts this crisis and that's people who overuse of themselves and also people who use it but don't know how to get rid of it safely and
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as a result they want the painting around and it's available for diversion to either other users directly in the home or spitting sold outside of the home. i do want to mention one other thing if i could at the va. we took a visit as a commission to the veterans hospital in cleveland and bera been some extraordinary things and lowering the opioid use by veterans with alternative therapies and other ways to deal with this issue for vets and the report secretary shall consider spam to that for the very reasons we talked about. they are offensive to want to take the stuff that they are in real pain from injuries from protecting our country. >> thank you mr. chairman. the gentleman from missouri is recognized. >> thank you governor christie's for your testimony today. while we have made critical
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games in coverage as a result of the aca we still have work to do. we need to make sure that the aca parents in requirements would require that insurance benefits for mental health care be comparable to those of physical health care. i guess that's why i recommend the dll must have the authority to investigate insurance companies. let me quote the report that says the commission found that there are commercial insurance barriers to medicaid and assisted treatment despite the fact the treatment is evidence-based and largely successful. would you agree that all the insurers both private and public should work to remove barriers? >> that's the law of the country.
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this is the frustrating thing. congress passed the mental health and addiction. the act but for reasons that are beyond me is the executive branch no ability to enforce it and so i don't want to be again cynical but where counting on the insurance industry to cover this treatment. that is required and there's no reason for not doing it for my view is as a this a former prosecutor the law should be followed. if congress will in the president's will is to treat a physical ailment than the law should be enforced. >> we need to put more teeth into it. >> he asked for this authority. he said if you give me this authority i will use it and chairman gowdy i think the secretaries of former u.s. attorney deserved with me during the bush 43.
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i am convinced that someone with his background and experience as a prosecutor in miami on this issue would be helpful and i urge congress to give him the tools. >> thank you for that response. represent the state of missouri and i'm proud of a lot of things but one issue that i'm not that proud of is that we have a patchwork for pdmp in missouri. it may go by county or city. it's not really statewide and is not effective. talking to law enforcement in missouri they tell me that it's really become a pill mill and it's an attraction for users as well as physicians who want to make profits off of it. tell me how is missouri, how do they compare to the rest of the nation as far as being a problem
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for law enforcement? >> it's the worst state in the nation. >> i appreciate. we need to be critical of our state. >> it's stunning that there are states in this nation that don't have a prescription drug program and they are not sharing that information with their neighbors. we know the people go from state to state to be able to feed his addiction. they can use the pdmp and if someone comes than presenting with symptoms if they go to pdmp aunt a dozen, two dozen, three dozen prescriptions from other doctors. missouri is a state that is the sole outlier on this issue and
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one that is damaging the health on the safety and welfare in my view of the people of missouri. >> i appreciate hearing that and i will make the effort. with our legislature and governor to reinforce and tell them how much we need to get our act together. final question hhs and cms now get down to the tough work of implementing some of your commissions report and i understand that they are calling for states to apply for waivers from from the imd exclusion. new jersey and utah just got a waiver of proof but as i understand that cms has insisted the waivers or budget neutral so cms is asking for states to fund fund, to find cuts elsewhere and underfunded behavioral health systems to pay for treatment and
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residential settings. to me that doesn't reflect the urgency of this epidemic. can you talk to us about how new jersey dealt with its? >> i think we are finding areas and this is part of the governments responsibility is to find where spending is not being given so i think it's a good start. they think once we become convinced at the state level that we have done what we need to do in terms of cost savings the administration will have to make the next decision which is made budget neutrality from it. that is our ultimate recommendation but i can tell you a new jersey that governing is about choosing and i do believe i can make the choice as governor that are necessary to make it available almost immediately.
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there will come a moment when you are cutting at the end not the fata when that happens and i think the broader imd exclusion that needs to be considered by the. >> thank you for your response to my time is up. >> the gentleman from kentucky is recognized. >> thank you chairman gowdy and governor christie thank you for being here today to discuss the growing crisis of substance abuse in our country. the opioid epidemic is a particular challenge for my state of kentucky where deaths rose by 12.4% last year alone. appreciate your work on the president's commission of combating drug addiction and look forward to working together to make progress on this issue for the american people. my first question is i would like to discuss the issue of fentanyl which attributes to nearly half of the overdose deaths in kentucky last year.
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>> fentanyl is what will take this crisis to its next geometric explosion because the strength of fentanyl is so beyond normal street heroin that the first use can lead to death and often does. it's a lethal that law enforcement officers come to crime scenes where they have to be careful in terms of how i deal with the crime scene. in the report we make it very clear that this is a chinese problem and we have urged the president and secretary of state to make this a priority with the chinese in negotiations that they are undergoing right now. china is where most of the of fentanyl and carfentanil is coming from. more times than not we have found we recognize an increase in border security not just the mexican border with the united states postal service. the united states postal service is the leader in stopping these
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drugs. these drugs are being mailed them to the united states and fedex and ups. we are not having the level of enforcement we need into your point before congressman this is one of those areas where i think we need to be able to step up our efforts. the postal service and bog -- doj to make sure we are stopping this stuff from coming into the country but we also need to make very clear to the chinese. you are sending this into our country to kill our people. there is no other purpose for this drug. this drug -- in any foreign country in my view that is willfully allowing this to be done is committing an act of extraordinary aggression on our country and if it's met with the right diplomatic response by the and secretary of state.
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>> i appreciate the work you have done along with the administration on seeing a recent crackdown on the chinese manufacturers and i'm looking forward to working with the committee to see what more we can do through the internet and postal system to try to prevent that. through legislation congress has worked to provide more support and flexibility for the states on the front lines of this battle. what advice do you have for congress on how best to support state and local efforts to combat the opioid epidemic both now and over the long-term and i know you mentioned the billion dollars that didn't go very far and was divided up among the states. what advice do you have for congress? >> first off i think if this battle is going to be one it will be one with the federal government and state government
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acting as partners and the state government taking the lead. the problem in kentucky is that different than the problem in new jersey and the problem in maryland is different than the problem in missouri. these are state circumstances depending upon all the different ways that you will go go about enforcement or state ranging from the treatment availability. our view is that there should be accountability block grants to block grants should be sent to the state dealing with the crisis and congress should be demanding accountability in return for the block grants. if i am given a block grant is a governor i say to you is the best way to spend this money is x and it shows a decrease in deaths if i show the decrease in depth i should continue to get my funding enough i and if i don't my funding should be reduced. as governor to be accountable for what i'm doing.
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with respect to congress is a difficult job to be able to individual programs that are necessary and effective in all 50 states. i believe we have to trust the governors. i don't believe they think it's a bipartisan issue. there's a democratic or republican way to combat this. i really do believe this congress is serious about dealing with this they need to sit down with the governors. they all come to washington in february. i won't be there but the rest of you will be and the fact is we have to sit down and say this is what they need and congress need to put demands on the governors. we will be partners with the avail help you fund this and what accountability measures are you willing to give up so we can be accountable in the financial situation we are in and that this money is being spent in a way that affect the destabilize. that is determining -- that her.
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when deaths go down we are succeeding. hymn thank you governor and i yield back. we want to be good stewards of the government and we want to be a good steward of the next panel's time so to the extent we get it done before the red light comes on that would be great for everyone and with that i would recognize my friend from michigan. >> thank you mr. chairman ranking member cummings and thank you governor for being here. you know there is a thing that in government if you want to know my priorities follow my budget. many of the organizations receiving funding through the community mental health block grant to the substance abuse and mental health services and these findings provide the wrap around services. we are talking about the axis to the drugs but those of us in this room and those who have
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been on the ground with the snow putting those services to transition and nurture a person out of addiction back to a healthy life training, rehabilitation, case management comes to the substance abuse and mental health services. unfortunately the house appropriations bill which we will vote on this month proposes cutting funding for the community mental health services block grant by $141 million. and our president's budget proposes cutting it by 116. i read your report. thank you for it but you strongly recommend and urge congress to do their constitutionally delegated duty and appropriate sufficient funds funds. being in congress and being a former mayor and to the local government king held accountable
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for my budgetary decisions iam perplexed that we can have this commission having you appointed and yet what we do in our budget would cut the legs out from under this program. they need you to know in your leadership and in your recommendation to this bipartisan body this agenda of this budget that cuts the thing that we are saying that we are so passionate about, we have statistics that i wanted to say in michigan we have enough drugs like you said in united states to give every person in the state of michigan 1.8 prescription, 1.1 prescription which is 84 opioid pills for every resident in my state. that's how many prescriptions we write. but if we really want to make a difference, if they live we want
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to get them off of this i need you to comment on that. >> i made very clear in the report. we believe there needs to be a greater financial commitment at all levels of uber. there are other things we can do as well it should be doing. increase medical education, increased requirements and continuing education. there are a lot of things we can do that we don't. we do not sufficiently fund these programs now and we also recommended a report that there needs to be in a dilution of all the different programs. there are literally dozens and dozens of programs we have looked at. how effective are they? i can tell you the gao two reports during the obama administration that were not being effective and we know that
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from the number of deaths. there are a number of things that need to be done. some of them are good and some of them maybe were not. then there's going to have to be additional funding. we have made that very clear and i made it clear to the presence of my direct conversations with him. whenever congress has asked me about this i say there is no avoiding having increased funding to deal with this problem. the question is how and you guys need to make that call. >> mr. governor and to the panel we often hear repeal and replace and the affordable care act and i equate that to you having a cadillac and you don't change the oil or you don't rotate the tires and then when the when the car doesn't operate you say that the car is inefficient and you just throw it away. the affordable health care act
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provides essential health benefit services that actually directly go to the mental health parity part but all we talk about is repeal and replace. a old you are comfortable talking about this but i'm very comfortable. it is time for us to have a real discussion on this. we have talked about the lives we are losing and we are so compassionate and our hearts break when we read these obituaries that we must do the work and i want to be that voice in the room while we are talking about this. the action in these to be taken needs to happen. it's not good enough to get a mission together and mission together and write an excellent report if you don't fund it and if you don't look at the affordable health care act that has those essential services that we are saying eliminates how we are going to do it. thank you very much. my red light is on. [applause] >> the other thing i would say
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to you is we need to remember that my position on the affordable health care act has been clear that i will just say this. the affordable health care act ensures a fraction of the number of people that private health insurance in this country ensure and yet congress is not allowing mental health and addiction. he could be enforced. the fact is that they have tens of millions of americans who work hard every day and are able to obtain health insurance through their employer and pay for a good part of that as well and then not getting the benefit of the lawn party either. it's not just the affordable health care act. we are not enforcing that to private insurers. if you want to talk about a feel-good these of legislation
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the mental health and addiction. he acted as a feel-good piece of legislation because all you do is ask would you please do this and if you don't there's great penalty, we know what happens in those circumstances. i would say we need a broader discussion about this is not just about people who are covered by a ca. it's also those people who have been covered through private insurance for very long time who are not getting the benefit. we should have enforce that law the day we passed it. it should include all of that. >> professor raskin. >> mr. chairman thank you and governor christie welcome to berlin to want to first of all thank you for the passionate intensity of your leadership in this commission and the way you have clearly absorb all of the
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lessons and a powerful way and i want to thank you for the comprehensive nature of the recommendations that are in the report which include messages for us in congress and i very much take your point about empowering the secretary of labor to akamai hope that's one of things that will come out completely from today's session but also they are a there are series of recommendations across the federal government the department education department just as the national highway traffic safety administration hhs and so on. i know you are a springsteen fan. who is the boss now? in other words who is in charge of implementing all of these recommendations across the federal government in being the leader in making sure that these things come to fruition? >> first and foremost the president has to be the leader. he's the person who empowers the commission and he's the leader of the executive branch of government as his responsibility and the constitution to make sure that the laws are executed
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so the buck stops at the president of united states and i'm confident that the president is serious about this effort and will pay for the research necessary to do it. >> and i just follow-up on that point pics i follow your work very closely. he came out with the commission report at november the first i think it was, earlier this month. did you have a discussion with the president and his advisers about everything that is in this report and talk about what the next steps are? what became of that meeting? is there an opioid crisis czar in the white house now? should there be one? >> as the governor the czar can sometimes get overplayed. the president needs to give direction to his hhs secretary but if you look at the representations you are right as all across government. that's why at the hearing of the deputy attorney general and they
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have the secretary of hhs and the acting secretary. we have the secretary of labor the secretary of veterans affairs. all those individual that officers need to be empowered to take a section of the report that is there is and report back to the president on what he's doing to implement it. sirak is a governor you know if everyone is responsible, no one is responsible. will we have tweets about people kneeling during the playing of the national anthem and we have tweets about who got the americans out of china. i haven't seen any tweets about the opioid crisis of an oc that kind of passionate intensity of leadership that we need to do with what you describe as the equivalent of a 9/11 every two weeks in the united states of america. >> let me respectfully say this. before this presidency didn't
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see a national commission on this problem. this problem didn't just start on january 252017 for this problem was happening for years before this and neither president obama nor president wash empowered a national commission or recommendation and there were no restrictions on the national commission or recommendations. this president declared a national emergency. this president is the one who got the grant waivers to this president is the one who has taken leadership on this. >> i'm talking about constructively moving forward. they have got to make sure that there are dozens of recommendations here. how do we make sure that they actually get into practice? >> there are few ways. the president of the united states should require men and women who serve in the cabinet offices who are covered in this. reporter: reporter: him on the progress they are making and implementing the report.
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i don't think your repression of the person sitting in the executive office building sending out a mouse with all due respect to the governor i higher cabinet people. they are cabinet people that were most departments but more importantly what they have seen from this president is he's the first president who has ever debated as to this to this level and he deserves praise for that. i know it's fashionable in love for corners to be critical and i've been critical myself but i also think it's right at this moment in time in this regard and he will be held to account for what he produces. i would also say that congress has to step up as well and it's not just the presence responsibility but every person sitting appeared every other member of the 35 if you know about this problem. you don't need my report.
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what you know was that people are dying every day. i would say what are members of congress doing as well to demand that this be done to exit that happens then there'll be a cacophony in that city which would force action from me executive and the dash. >> thank you mr. chair. >> the gentleman from vermont. >> i will try to be quick in light of your admonition. number one governor christie greetings from governor shumlin. he gave the state of the state in 2014 totally dedicated to the opioid crisis in many of my colleagues wonder why in the world could do that and then he started the analogy this was a huge problem in their state. second we need concrete actions. there is bipartisan concern about this issue. there is bipartisan conflict about spending on just about
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anything that you outline some concrete things we could do. for instance if we can appropriate money which i would be in favor of the many people here would be we can at least deal with it drug company ripoffs and you acknowledge that increase that is worth of becoming an enormous burden on our local communities that are on the frontlines of trying to address this. i want to ask you this question and then i will stop. the adl outcome is that congress would step up and find the areas where we can act that would make a difference like addressing the cost issue in the prescription issue. my question to you is what would be your advice to this committee knowing we are divided on many issues but we have a common concern about this horrible scourge in our community. what are the three things you would recommend for us to do? >> you are asking me to take 65 recommendations and boil them down to three. i'm pretty good but i'm not that
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good. i would just say this, that the first thing we need to make sure we do on the supply-side is to nip this fentanyl and carfentanil problem in the bud. 64,000 is going to look like the good old days aware and direction with the chinese on this needs to be unequivocal and our ability to invest in making sure we are stopping this as best we can from coming into our country. fentanyl and carfentanil is going to make heroin and prescription opioids look like child's play. secondly is the issue of education of our medical community. i include pharmaceutical companies in this, about the dangers of these drugs and having a real national conversation on the benefit of using these drugs has to happen.
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with this many deaths and i understand the pain is real and the chairman is right we need to deal with that and get to work every day for the people who suffer from chronic pain but i can tell you we are losing that fight. we need to try to have a conversation and get them to the fact that these are killing people in third i would say we have to fund treatment in this country. he does have to. i was safe until carfentanil and our on law enforcement has to be strength in american education with china who see it as an attack on our country but secondly we need to work on medical education because our medical community is not educated enough on this issue across the country. that's what i also recommend,
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treatment of folks in rural areas who can't get to a position. it's very important to do and lastly we have underfunded treatment in this country going to make sure it's more available available. when 10.6% of the people who need treatment are getting treatment you need to do better in a few -- [inaudible] >> thank you very much. i yield back. >> just one question. this is one of your finest moments and i really mean that. and i've got to ask this question because i think it's critical. how can you governor with your passion and your full understanding and embracing of this issue how can you help us bridge the gap between
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republicans and democrats so that we can get something done and i don't mean to put you on the spot but i mean it's a critical moment and when you'd said what you just said about fentanyl we have got to do something and you seem to have pulled it all together to come up with a very balanced report so that we can be effective and efficient. >> i appreciate the opportunity and i'm not burdened by your question. the fact that i will take any role that leadership and the administration wanted to play as a private citizen in 49 days to be able to continue this fight. mr. cummings this is something that began to be a passion for me in 1995 when is a local county official who was brought to a drug treatment center in my county for adolescents and i saw what was going on there and the
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priest who started this treatment facility said to me at the end of my visit chris' is something you'll want to be involved in for the rest of your life. in 1995 is 32 years old. my life seemed a lot longer than it does now. why will i be involved with this for the rest of my life? he said you just walk out of place where god makes miracles happen on earth. from out moment on mr. cummings i have been hooked on this problem and saving lives. i have worked as republican governor. everyone of my 2920 days in the democratic legislature get the package that we have on this is passed overwhelmingly bipartisan majorities and i gave my state of the state in 2016 on this and
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package of reforms to ensure pharmaceutical companies -- a pass within 30 days and it was fine. i'm happy at any time sir by the incursion of the chairman, a few to come and speak and meet with anyone and my relationship with the president which goes back 15 years to encourage people to say this is the new water's edge in our nation's conversation. we have to end the politics here. we have to compromise with each other and there are things that my side i will have to vote on that they have some concerns about and there is some flexibility and trust the folks on the side of the aisle may have to give the governor's which you are not normally accustomed to doing that i can speak to that directly and you have my word that i will not only speak up publicly but i will play another role. any role you gentlemen want me to play.
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when he needs to hear the truth he comes to new jersey not just did play golf. let's put it that way. >> the gentleman from maryland is recognized. >> thank you mr. chairman and thank you for the opportunity to sit down in the hearing today. governor thank you for your testimony and thank you for the report for the commission which i think is outstanding and has a myriad of great positive recommendations that we need to prioritize so we can make forward progress. i think a lot of the building blocks are there. we are very proud of the efforts here in baltimore that our health commissioner who we will hear from shortly has undertaken for institutions like johns hopkins and others are
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undertaking to change the trajectory on this. it's obviously a heavy lift but these recommendations will help. i want to echo congressman cummings concerned about making sure naloxone is available in the way that it should be and there is not price-gouging going on around that. think it needs a closer look. i was able on i want to thank you for the recommendation about co-prescribing naloxone. we are able to get included in one of the bills that was passed last year the -- comprehensive addiction recovery at a project on co-prescribing of naloxone to examine best practices around that. we thank you for that. my question is this. i would imagine that you don't think yet that the sense of urgency that needs to be in the country around this issue is
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there. but it's changing and as i move around in my district and i'm sure this is the experience of others, not only are you hearing about these tragedies that raise your awareness but you are also hearing people say things like you know i went to my doctor the other day i went to my dentist and they gave me a prescription for this oxycontin or something like that in all he really needed was tylenol. so patients are starting to step back from this. something is getting to them. there is beginning to be a level of public awareness around this. when will you look at the situation based on your experience and being involved in this commission and what will you see it? what will be the indications to you that the level of urgency is where it needs to be among
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policymakers that the level of education and awareness out in the public is where it needs to be? is a psa's coming across the airwaves in a way that matches you know at election time in a swing election somewhere? visit the president getting a briefing every monday morning on what the status is with all the steps are being taken with respect to addressing this crisis? what are the indicators that you are looking for to say to yourself we are starting to get it? >> congressman thank you. i've been asked this before. someone in our remarks i forget which member talked about this epidemic being a greater number of deaths than the that make aids crisis at the peak of the aids crisis in the united states. i was a young adult and here is what i think.
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where are the march is? i remember the aids epidemic and i remember marching in every major city in this country and in washington d.c.. if people marching say the government must do something to find a way to stop the death and in this crisis there are many many many more people impacted them the aids crisis yet we have no march is. i will tell you that i think we have begun to remove the stigma of this disease and the people that are impacted are willing to show their faces in march and demand from their government a response. i believe they will march today because they are ashamed to march because they don't want to be identified. i'm talking about mass numbers,
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they don't want to march. they don't want to be identified identified. but something happened to their family, to their loved one. that's why we have recommended a national advertising campaign beyond psa put out so you in new jersey and this year you will have spent $50 million on an advertising campaign to remove stigma and let people know how to get treatment. $50 million of state money and the reason we do these things, the want people to be stigmatized anymore for this and to avoid treatment and avoid asking for help and we need to demand that something be done about this. i will tell you one quick story. my mother was addicted to nicotine preaching against smoking when she was 16 years old and she smoked for 55 years and she tried everything she could to quit and she couldn't.
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she inevitably was diagnosed with lung cancer at the age of 71. nobody said to me well your mother was smoking for 55 years. she's getting what she deserves. no one said that. people said we are so sorry for your loss what can we do to help? did she go to this hospital or that hospital plex they came and visited her. they encouraged her and i felt no shame in telling people that my mother had lung cancer caused by smoking. if my mother was a heroin addict would i do the same thing? and what all those people who come to her innate in recommended treatment and help? with my dad had been willing to ask for that?
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i know word spring urgency to this one barriers go away and people demand that congress and the president of government along with their private sector find treatment to three people who are addicted and to find ways to not get addicted in the first place by alternative medicine. i will believe it when people are marching in showing their faces and when that happens we won't know we are on our way to a solution and that's why i firmly believe in my heart it's a stigma that's causing death every day almost as much as the drug itself. [applause] >> the gentleman for maryland is recognized. >> ranking member cummings thank you for having this hearing and to all of our members from both sides of the aisle welcome to baltimore. governor and i want to acknowledge dr. nguyen who has done a lot in the baltimore area. governor think you were in the right place at the right time.
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you were in local government. you were a prosecutor. you manage a major jurisdiction. i really appreciate the fact that you made this one of your highest priorities. when you leave office probably won't dominate your life for a while. there are a couple of suggestions that you have though to make sure we pull all of this together. the first thing we have a major crisis you got to identify the problem. i think these hearings we understand with the deaths brought the country as a national issue and not just an urban or rural areas cometh everywhere. the part that i'm interested in and one of the issues we have to deal with is clearly money. we have to have that. there has been a lot of money put into this. there other areas as far as treatment and doctors, nurses and treatment centers on all those types of things but i know in your report which said that report. i haven't read it that i have
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heard it not been briefed on it there are a lot of recommendations and when you have that many recommendations you have to pick priorities. i think for us to get to the level those of us who are appropriators we are going to have to find out what your recommendations are for money especially for the federal government. we have to have a number and i would hope that your committee or your staff or your committee can start putting together a port through the second king there is no question congress maintains the power of the purse but in the situation the president who has within his power as president to free up funding as well. i'm glad the president has made this a priority but we have to follow through. with your relationship and i didn't know you have known the president for 15 years and that's even better in with your tenacity in your experience in all the areas i have talked about it like to know what your plan would be to work with his advisers, his administration to
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make sure we find out where we are as far as the money. our governor and i praise him as governor hogan has dedicated $10 million for the next five years for this epidemic. this is not a partisan issue. this can't be the case so my question to you is first thing can you decide what their recommendations would be as far as funding is concerned and when we find that number we will work with you. to find a way to get congress fund this issue and also the president. governor lawrence made a comment about quds verity there. we are going to have to find a way to get him to make this a high priority to go forward and what we need to do. >> two things. i think when you say my staff i
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want to be clear by chief of staff in the governor's office is the main staffer. we were not given staff on this i will tell you the work you see in that report is the product of the commissioners. we did not get into amount of money quite frankly it's up to -- to do that. we set up the priorities that we believe are very important and we believe every one of those are important. i know from personal experience they governments choosing but the choosing needs to be done by the government and the congress. we filled out all the things that we think need to be done and near-term and long-term. now it's up to the leadership of the congress and the president along with appropriate cabinet members to sit down and to say how do we implement this plan? how do we want to do that?
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i have done this stuff is the governor. i believe you are the ones who have the authority and the responsibility to do it. i'm happy to identify the problem and identify solutions and bring a practical opinion to it but i don't believe it's in my well to talk about how much. >> i respect what you have done but you are the man in the snow snow -- if you can't do that nobody can. >> you have the expertise. you're an advocate and you have committed but if you don't have the money is not going to work. we need you to be not only the advocate we need you to be the lobbyists. we will work with you. democrat and republican staff i guarantee you the appropriations committee on the house side will come together but we need your expertise and your epic is the especially when it comes to this president. >> as i said to mr. cummings and
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chairman gowdy i am and will continue to be available to all the folks on this committee and other members of congress who care passionate of this issue to give you my advice my counsel in my opinion it to be an advocate. i'm going to continue to be an advocate no matter who is in the congress and no matter who is in the white house. i've been an advocate on this issue for 22 years and i will continue to be an advocate on this issue because my heart i believe the more important role of government is to protect the health safety and welfare of the citizens and this is right at the core of that. i don't know but like the phrase lobbyist but i would be a advocate for this. i will continue to be. >> my time is up but i will reach out to your staff to find a way we can start working on the numbers and the endgame. >> look forward to insert.
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>> the gentleman from maryland yields back. governor thank you on behalf of everybody for not just being here and sharing your perspective today but for the hard work the commission did. i'm last when it comes to questioning and i want while we appreciate the audience it is here no one is in the upper echelon in terms of engagement and i want think of a broader jury. our fellow citizens that have heard about the epidemic, perhaps someone close to their family who has been touched by it or live and breathe it every day. as i listened to your opening -- you can put physicians and one of three categories by the vast majority of physicians are incredibly well intentioned and well-trained and well-educated than they do it the right way for the right reasons and then you have a group that is equal in intentioned but they lack the education on it and you made reference to continuing legal education and continuing medical education.
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there is that group and i don't know how big it is. our perspective is swayed by the prosecutors. there is that group that is profiting from people's addiction and i don't see that the version cases being prosecuted like i did in the olden days. did you all find it? >> i don't think you are missing it. i do think there has been over the course of the last decade or so a deemphasis on that. and i think it's a mistake. i also think mr. chairman to emphasize one issue is to deemphasize another. in new jersey for instance we have criminal justice reform that has lowered our -- population more than any state in the country. get our crime rate is down significantly in our state.
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that doesn't mean that i don't want to see my attorney general continue to aggressively pursue the drug dealers in our state who are killing our people. i think that sometimes jumps the department for which we have both been members of. if you are in the criminal justice reform the can't be -- if you're in favor of prosecuting criminals you can't be for criminal justice reform. the federal government for the last decade has dropped the ball in these cases and they think it's contributing, not causing the contributing to the problem that we have today. that's why i'm not in aber of shortening enforcement interdiction. we need to continue to do that and i share that opinion with general sessions and i believe he understood but that message
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has got -- and that can only come from the attorney general the deputy attorney general. you and i both know the u.s. attorney is like king and the captain of a ship odyssey. sometimes the radio works and sometimes maybe it can't hear. you need to make sure the radio is working on this one and the attorneys are not given an option. from their boss the attorney general of the united states that these are important cases to do. it doesn't lessen our commitment condemn the chinese on what they are doing to user foreign-policy totals -- tools and it doesn't mean we don't think that education aren't important and we talked about that today but in conclusion might perspective if we don't start talking in the middle schools about this issue
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we will lose them. to think my 11 and 12-year-old daughter haven't been spoken to about this issue. .. >> predominant clarification so they step up to the plate and start educating our kids on
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things we need to do. so in these cases we need to do then to slow the supply. this is the bipartisan nature of it we've got to get rid of the barriers on this issue against the other. we can and must do both i want
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to mention one kind of issue there at the end and address what kind of barriers did you find in the alternatives that are not addictive, pharmaceutical alternatives butt are the barriers to having the research developed order to market? >> that is the single biggest barrier as a part of your to see which ones are most effective and allow them to go to the
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market. new jersey has more pharmaceutical companies so the role that they play in the country i am an advocate reminded they have a social responsibility to go along with the bad and purely on the basis about the profitability in my view to walk away as a corporate citizen in the country. so the right compounds ge rate e right money spent and all i heard from them the biggest concern was an issue is this the best way to spend that money for their shareholders and that is a concern that the need to have in the economic system but they
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also have that social responsibility as well. would you trust them to say they need to be developed but each one is a potential to be nonaddictive pain relief and medication assisted treatment and they agree to submit the compound but we need to do it now so that they have the funding to complete the best job and that's going to help significantly as a pain reliever that is nonaddictive but effective. you mentioned the phrase social responsibility.
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one of my favorite who was also a public defender would have been fortunate to have him. i saw sometimes in the state system others would opt for straight up probation because it was easie easier but that isn'te client's interest. it is easier on the grand strategy then sending them to encourage their clients to get help as opposed to the next three or four months of remaining an addict. >> unless we took a baby option. your option is due to treatment or go to jail. now it's kind of a chimp or encouragement.
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a lot of people opposed to. i've never met an addict who is ready. i have a great friend of mine that sat there and argued that he didn't need treatment, he was fine. i know that's happened in my state you can go to drug court treatment of in my mind it's not
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the older men and womenit's working out at the audience of t their lives are hopeful again for the restoration of a life which they've almost given up on. why i advocated for every district in the country is because i've watched it change lives and so have you. it's filled with people who would be better off treated as it comes down significantly.
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they would rather spend less than on other issues with time limited resources. it's because we are treating the folks that have this problem like they have the disease and not a moral failing. >> i know mr. cummings would want to thank you as we transition. [applause] thank you very much. the cost of doing nothing is
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never nothing to and now we've got to act. thank you. [inaudible conversations]
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[inaudible conversations] the committee will come to ord order. we are pleased to welcome a second panel of witnesses. we have the acting director of
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the drug control policy, the health commissioner from baltimore city and doctor caleb center for drug safety and effectiveness bloomberg school of public health. welcome to you all would take five minutes understanding we have your statement in the record and then we will recognize the members further questions. >> thank you mr. chairman for inviting me. i am honored and pleased to be here.
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you are all familiar with the problem that we face. the epidemic goes no socioeconomic or racial bounds. the loss of too many of the country's sons and daughters. we are committed to working with you to turn this crisis around. this is the worst epidemic in the history as it has been referenced we have over 60,000 drug overdose is mostly caused by prescription pain medicatio medications. speedy compared to heroin and cocaine and other drugs increase the lethality complete with fraudulent. we are not getting enough into the evidence-based treatment and the system with response to overdoses and other outreach efforts has to move faster to go out and play with the people that need help. once they go through detox the
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need ongoing recovery support as well as help the housing and employment to rebuild their lives and society and we also need to ensure that agencies reduce the drug supplier. the administration is working hard to address the crisis -- in destino president of his vocal booth during the campaign have since taking office. when he established th the physician took an additional actions the government can take to address the epidemic is i have the honor to serve as the executive director of the commission and th staff to contribute their expertise to assist the commission with its work totaling 5,000 staff hours. read the recommendations are not
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considering consideration the leap [inaudible] crisis of public health emergency as the commission recommended in the report and the entire year administration to address the crisis. the policies allow fo allow fors for the decades-old ban on medicaid reimbursement for patients receiving treatment at facilities in the exclusion. overseeing the approval of the policy with many more in the coming months. the availability of administration has taken a number of steps that we are looking to reduce this includes getting additional advanced electronic data on the packages into the u.s.. they will reduce trade over the
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internet and the response strategy is bringing law and force them together to respond to be overdose and increase law enforcement and the fda is working to make it safer. the administration proposed 28 including $10.8 billion for drug treatment. this year there've been 800 million out part of prescription programs and recovery services as requested 500 million to help the states
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early next year as the lawful tools in the toolbox to make headway which is affecting every state and constituents in some way, shape or form. i've seen how people are coming together to address this at a local level. as i said that this crisis is unlike any we've seen before and we are working hard to address it. i think the commission for the recommendations and i also want to thank the courier staff for supporting the commission's work and i think the committee and the puck forward to more discussion and dialogue thank you for calling this hearing
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where today, two resident residl die of an overdose. first we save lives by making it available to everyone. they forced us to ration and now can receive the antidote and at a time of a public health crisis it is unconscionable we are being limited in our ability. second, the science is clear that the treatment works but only one in ten people getting treatment. i see patients coming in all the time asking for help.
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my patients have over good -- overdosed and died waiting for them. this is the beginning of a 24/7 addiction to mental health. treating addiction as a crime is unscientific, inhumane and ineffective. that's why the public health and public safety collaborates closely to pilot law enforcement diversion where individuals with small amounts of drugs were offered treatment instead of prosecution.
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they do not go far enough in four areas. the commission didn't identify the substantial federal funding. we desperately need not repurposed from big that will divert from other parties. they should also be given directly we shouldn't have to jump through additional hoops competing having funding in many more lives. they advocate are on medicaid. if it were gutted many more with overdose and die. many find themselves without
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treatment that has required a part of their health plan. it's estimated that the repeal would result in 3 million losing access to treatment. it shouldn't replace the coverage because no disease can be treated. they don't guarantee access to treatment. this reduces the likelihood of death come incidences of their coldness and criminal behavior. at the very least the medication should be the standard of care for all treatment centers and we can go further to lead to addiction why should the hospital be required to treat this disease. first the commission ignored evidence-based practices. in baltimore the needle exchange resulted in the percentage of individuals with hiv from drug use, decrease from 63% to 7% in 2014. the programs are staffed by people who help patients end
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here in baltimore we need to urgently allocate additional funding to areas hardest hit by the epidemic and directly negotiate so that communities no longer have to ration number three, protect and expand the coverage to get to on demand treatment of addiction. i urge congress to commit the resources to save lives and save more futures. thank you for coming to the hearing. good afternoon ranking members of the committee. i appreciate the opportunity to speak today. i'm a practicing primary care physician and director of the johns hopkins center for drug safety and effectiveness of the
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johns hopkins bloomberg school of health. new research focuses on the policies to the opioid epidemic that has a practicing physician i also know the power to compel actions and i'd like to share with you a brief one now. in 2011, gps lost her son from an overdose. i worked on the policy reform and asked if i could share the story. she'she said i'm always happy to share a story if it helps the cause. the journey began like so many with a lower back injury that led to the use in subsequent addiction. years before his death he wrote that first they were a lifeline and then became a noose around my neck. he didn't want to die that he succumbed to be an overdose and now she keeps a picture of him along with a note.
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you would have lived forever. his story would ensure others don't have to experience what they have and it's a reminder of what the state here and so many have endured. we have reviewed other data points and released this report from evidence to impact provided in my written testimony to for e recommendations to address the epidemic. we were so honored that you participated in this report and the remainder of my time how the commission's report can best drive change. first the finding provided a framework for action. it's based on evidence with our own appraisal in most areas. for example, but both agreed
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they should be required to use prescription drug monitoring programs and should be standard practice nationwide in high-quality evidence-based addiction treatment should be available on demand. i made specific recommendations regarding the steps such as the passage of the prescription drug monitoring act of 2017 and i highlight areas deman areas thee increased the comprehensive impact of the review. second, as we already heard by some of this afternoon, to develop a strategy to support the implementation of the recommendations it is one thing to say we are going to send a man to the moon and totally different to have a plan in place to do so. in my opinion some o, the most important recommendations were we need to reduce overprescribing and provide high-quality evidence-based treatment for addiction upon the demand although i think reducing
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the supply in the country is a close third. but i must ask the questions some of you asked which is what specific steps is the federal government agreed to reduce the opioid prescribing, which agencies are responsible, with taiwan will be followed and how will we know when we have been successful? we need an implementation plan. the committee can exercise oversight so other federal agencies act on the committees recommendations o representativs would have more americans people like steve and so many others incredibly expected in 2017 more than ever before as we look to 2018 there are reasons for hope
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providers are increasingly using safer treatments and following the awareness and more americans are living fulfilling lives. communities are increasing demanding affordable access for addiction treatment, stronger regulations and coordinated federal action this is a fixable crisis but not without implementation plan to a company june 18 to 2017, they published an article on walks maloxone entitled the overdose remedy. it stated that the city has
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about 4,000 left to last until next may. you were quoted saying we are rationing deciding who is the highest residence giving it to them. how many doses does the city have left now is the number adequate to meet us at the speed? and who are the highest priority people? >> individuals that are the client of the program these are individuals we know are using drugs and i will say tha see tho not in any way condone drug use but we do believe in saving people's lives. if someone is tidying today there is no chance to get a treatment tomorrow, so for every unit that is given, one is used
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to save someone's life. i don't know how many advances are that have a number needed to save someone's life. i have about 8,000 units left between now and july of 2018. we are grateful for the work of the states. they have been gracious in providing additional funds once they saw the need in the multiple cities but if i got a thousan8,000 more units today, d distribute them by this weekend and shouldn't have to decide who gets a medication that could save their lives. >> ho >> how many doses do you need? to adequately distribute enough
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to be effective? >> i would like for everyone in their city to carry a first aid kit. we have the remedy we want to make sure every person has the antidote. why shouldn't it be available everywhere >> the price is up 500% and has increased nearly 63%.
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one can now cost about $4,500. [inaudible] is manufactured by a company that is one of the sdk approved versions of the medication and we would hope they would negotiate the price. we spent a lot of time negotiating a and it seems sad and this is my conclusion and a lot of peace price hikes it it's not about the cost of research, but greed and at the same time we know we have something here
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that works. are there other things coming down the pike that you know of that might be just as effective? have you heard of any of those? >> i have not. there are very few antidote available. it is on the world health organization list of essential medications and available by the pennies in other countries. >> thank you very much. >> last question for all of you. i had a relative who's been through treatment and improve times and i'd like you folks to comment on percentagewise how often in your experience were programs you deal with treatment
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works and what distinguishes the programs that are successful to those that aren't and what percentage of admissions to expect to be successful with regard to treat with? >> i could begin and say there's no question the opioid use disorders are really serious and individuals that have opioid addiction remained a lifelong vulnerability to the products and this is one of the reasons it's so important that we reduce the overprescribing of the prescription opioids in the first place. >> can you tell me percentagewise for treatments that you are familiar with, percentagewise how often are they successful? >> about 40 to 60% rate of recovery recognizing it is a
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complex disease and we need to be ready for people whenever they want to go to treatment. governor christie mentioned he hadn't meant people who were not ready for treatment. i need them all the time and the problem is we need to be ready for people at th at that momentd not have them wait weeks or months and recognize. >> is this what our expectation is? >> they may not be successful the first time that they will the second time and recognizing that there are forms of treatment are evidence-based and some that are not so we need to be promoting the evidence-based treatment that include -- >> so you get on the internet and it implies that these are wildly unsuccessful, that's why i'm asking. >> i just want to add to that is true it is a challenge but i
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think if you move away from thee sort of isolated treatment model to be an ongoing continuing care we could drive down the relapse rate. sometimes we have a detox program separate from the inpatient treatment from ongoing recovery support. we have to stop doing it that way. the system has two evils the ongoing recovery support so that it isn't driven down. in summary i would say you should accept the level if we could drive it over if we work harder and smarter. >> i asked the governor christie and i will ask you as well, something is made apparently common in vietnam, i don't know but people came home almost all the truths stopped using heroin, can you comment? >> it's an interesting point of history. in vietnam is when they had the first drug testing program and people were not cleared to go home until they tested negative for drugs, and so people were
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highly motivated to get home, they had to stop using drugs and tested negative and then they went home. i don't dispute the point that you change the environment and the behavior but it's also part of a program to test people and encourage them. part of it may be overprescribing that people are also treating others and we know the same communities facing overdose are also facing poverty and homelessness and unemployment and in order for us to break that we have to be addressing those underlining factors in helping those communities. >> you are touching on something the governor wanted to stay away from. i think this is evidence of all
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walks of life and backgrounds of every level. there is a little bit of variation that everyone is affected by the problem. the gentle lady is recognized. the i think you can hear me now.
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i think it is fair to say that both democrats and republicans underestimated the standing of the affordable healthcare act until the most recent election where we saw the governor elect and the polls say that delete indicator was the affordable healthcare act literally has to. people apparently are very afraid for their healthcare and they chose distraction as a kind of parallel to express themselves even though they knew they would have a hard time so my question is about what role the affordable healthcare act can play or is playing in this
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crisis. i know governor christie indicated the affordable healthcare act unlike by the way the plans many americans have does require that substance abuse be afforded in the same way as other healthcare. that is important for health care in the united states, those in the affordable healthcare act. one of the figures that interested me was the one on medicaid expansion and the fact that benefited from it. it appears three out of ten long elderly adults with substance abuse disorders nationwide get medicaid expansion so it's being used by the very people we are discussing here today.
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so i need to know from you what you believe would occur if in fact those states that had medicaid expansion. more people have died because of medicaid expansion who have substance abuse disorders they are now able to have treatment. prior, one third of the individual market plan didn't cover substance abuse disorders and for people there is no margin of error if you are to takwere totake away their treat, the only option may be to overdose and so studies have shown it will take $180 billion
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over a decade to provide healthcare to those who lose coverage, so back to the point that the ranking member made that the cost of doing nothing isn't nothing. we are spending that money anyways. we can choose to invest in the treatment. his affordable healthcare being used to prevent and not intervened once it occurs? >> we need to do a lot more when it comes to prevention including stopping the overprescribing of drugs but also things like investing in nutrition and all these things also helped to boost poverty which also reduces addiction. i would add that there are several provisions although it wasn't designed for the treatment with these disorders. there are several provisions that have been important for
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those seeking treatment and that's not just the parody provision but also the requirement that treatment for addiction be considered an essential health benefit so this is something the commission report speaks to in ways that there may be barriers to access the important medication treatment that doesn't directly address the role of insurance in the first place and as a colleague of mine i think has eloquently put it, until you make it easier for patients to access high-quality addiction treatment than it is to find their next bag of heroin in order next bottle of oxycontin, they are going to go towards treatment so it's vital that they be expanded. can you give some insights on why some jurisdictions are worse off on this crisis for example the district of columbia is a big city.
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you don't have to have a degree to see a other i the third is ah correlation between the volumes of those prescribed in any given area and injuries and deaths from these projects. we do know tha that there is a variety of different state policies and account policies that can make a difference that
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i think there's a lot more we have to learn probably why it is so bad in some counties but why we have seen some remarkable gain in terms of reducing the volume and also injuries and state policies prescription drug monitoring programs at either opioids that are prescribed in making addiction treatment services all of these play an important role. >> the gentleman from alabama is recognized. >> thank you mr. chairman. >> the november 2017 journal noted the shift of the first using according to the report 7%
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of individuals had been using opioids in 20005 began with heroine and then it changed to 33%. has your office been able to determine what causes this? i do not have a definitive answer but i would say it continues to evolve rapidly. i won't repeat what was the overprescribing of the painkillers as more people have been using there's been a spread of the hal having shared between boyfriends, girlfriends and others in so i have seen those reports and it is concerning. let me empathize with the ticket message out about the drug supply of someone consumes heroine it could contain fentanyl that might contain other substances as well, the same with these prescription pills people by the drug supply
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is is more lethal than ever and people are taking their lives and their families lives when they use these drugs. >> doctor alexander has reported that over 64,000 deaths in 2016. is that an accurate number? >> yes, >> from all overdose is? connect the information i have indicated my feet under reported as much as 20% and each of you touched on this a little bit because they had that cited as the cause of death. is that 20% under reported? >> i'm not sure the precise degree that there is underreporting that there is no doubt you raise a very good point and any underreporting would be in the epidemic is even worse than the 64,000 number
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would suggest. >> that's my point is tha at the point now that it's literally reduced the life expectancy for the first time i forget and how many years but at least a couple of decades, the life expectancy in the united states has declined into there are some studies that indicate that it's related to the number of people dying from drug overdoses. >> that's correct if we see manifestations in many different sectors of the economy, the labor force i think the commission's report to did a good job of outlining many of the ripple effects we heard about the strains on the foster care system and so there are effects manifested around. the other point to make is they are tragic and yet it is the tip
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of the iceberg. there are dozens or more that have opioid addictions. the number isn't effective for about 40% of the population and we talked a good bit about another drug out there that doesn't have the same impact as opioids. it once a month but it literally requires the patienc patient too withdrawal and takes a few days for someone to come clean to use that. would be more appropriate to address to you?
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>> we believe all three forms of the medications that are methadone [inaudible] or three should be available in all settings without there being a prior authorization from insurance or the last one being available at some places because it is just like other illnesses some may do well with one medication and some may not so we believe all three should be available and methadone has a bad reputation because they can be abused and misused but so can many medications and we have to follow the signs of the evidence to show it is the gold standard in that it reduces illness and death and even criminal behavi behavior. >> i think my time is expired. i appreciate your responses to this i just want to point out
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this is not a political issue. in my opinio opinion it is a puc emergency. we have seen a major increase in deaths from drug overdoses since 2010. i just want to encourage folks to not look at this as a political issue, it is a national crisis. >> if we are to be successful i am a firm believe or tha leadere must first remove the stigma traditionally associated with drug use for far too long as we've been drug users as criminals in need of incarceration rather than a patient in need of treatment as we saw so clearly during the 1980s and 90s.
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you've summarized that change back in january stating and i quote traditionally it's been seen if you have an addiction as a moral failing and as a personal choice now we are calling it the disease. how important is it that we as a society finally recognize addiction for what it is, the disease? >> i think we heard this question can you imagine if we told people with diabetes ten out of 100 will get treatment for people with kidney cancer we will take 100 of you had people offer ten of you the best treatment that we have that's when you look at setting you'vee that where one realizes the role the stigma has. another pervasive underappreciated point all too
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often we discussed i was heartened by the commissions report the word addiction i believe it is in the title and charts of the commission this is an epidemic of addiction, not abuse. there is nonmedical use that takes place but for far too long, we've suggested that there are two populations of individuals. we have the drug abusers we need to do everything we can to prevent them from accessing the medicine, and then when i was a resident i was taught we need not worry about the potential if a patient had true were legitimate pain and nothing could be further from the truth so i think that she would stigma is front and center and this will take resources of massive scale to continue to educate individuals who would choose the life of addiction it is on
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anybody that's understood and met somebody that knows this isn't a choice people are making any more than a few choice of a 10-year-old to have type one diabetes. >> you say to someone with diabetes that they should go to jail and once they returned they should be cured which is the type of stigma we continue to put on people with the disease of addiction. one of the questions is about the communities that are heavily affected. here in baltimore we've been effective for decades. this isn't a new issue and we've spoken eloquently about this and many talks in the past that we go in apology to generations that we have incarcerated and we owe an apology because we knew the science but didn't think about it. >> police chiefs and sheriffs are doing an incredible job of this country.
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they know the difference between someonsomeone that is a of his t needs treatment and someone has to drug trafficker. working closely over 300 precincts they do a quick intake
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as well as those physicians to turn their offices into a pell-mell. >> they've been incredibly reckless and deserve prosecution for those crimes as well. >> is that the decision of the department of justice? >> the department of justice wants to prosecute those that are killing our citizens. i will yield back. you mentioned overprescribing. what are the causes for her
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prescription? is a misdiagnosis? what are the root causes? >> thank you for the question. the commissions report discusses this in some detail and here again i think that they've looked at the high point of misinformation as i noted from my own when we were taught in the late 19 '90s we overestimated the addictive potential of prescription opioids. lately that is inconsistent with the totality of evidence regarding the safety and effectiveness of the products and of course the labeling as you know affects the way pharmaceutical companies can market products. widespread settlements of pain and that it needs to be fully debated and people should get to see her on a scale of one to ten rather than in many countries and cultures where pain is
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something to be manag managed rk many pain experts say it's something to be managed and lived with, if not expect you're going to be taking enough opioids that you get down to a zero. there are many thoughts that have contributed to the overprescribing. are there certain specialties or subspecialties that you've identified where the over prescribing is more prevalent? >> that is a terrific question and it would be a privilege to share some of our own feet and analysis in this regard, but the point i would make is to prescribing is highly skewed so if you look for the example in the primary care physicians it is a small subset of positions that account for the lion's share that are prescribed. with that being said, these are not primarily down on main street seeing 300 patients in a
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day and only accepting cash. there is a very important point and in fact governor christie spoke to it and he said most prescribers contributing to the epidemic are not doing so out of a willing full intent if not intent. it's important to recognize while it is highly skewed, but prescribers that are prescribing it are not necessarily just floating in the standardfloutint medical practice. >> when you see primary care physicians who think internists and gps. what am i missing? >> family doctors are the biggest, pediatricians are lower because fortunately not many kids are prescribed opioids. >> if you take pediatricians out, would you think internists and gp family doctors?
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>> two questions in this realm, hahave there been any analysis f physicians who write restrictions for opioids after a patient has been declined a prescription from another physician? in other words, doctor shopping? >> that is a terrific question and with the prescribers when we look at the dw beach and interesting conclusion that they are exceedingly rare and in importance with other high risk patients that's not to suggest that it's not vital we identified and intervened but there are other populations of chronic opioid users at a much higher risk than you look at a population level in public health level than opioid shoppers so i'm thinking of individuals on chronic opioid samples of individuals on a combination of prescription
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opioids. >> i have a couple more questions i will try to fit them in so i don't violate my own rules. in terms of alternatives, we can test the blood pressure and cholesterol, and you can check someone's temperature. how close are we to having a diagnostic test for pain? >> nowhere in our lifetime would be my best guess and one of the other factors that has contributed to the epidemic because it's really because it is so intersubjective and is very difficult, there is no objective test for it. this is one of the reasons i think it's so important we teach the next generation of professionals and those in practice there are lots of tools in the toolbox you just need to
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be for the fda to bring drugs down the pipeline. we already have dozens of different treatments both pharmacologic and nonpharmacologic and one of the things happening as we are signing such a bright light on opioids that we are neglecting to consider all the alternatives that in many cases are safer and more effective.
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>> this will help foster children, and the alarming rate they 75 times more from ptsd and trauma. we've talked about the priority groups based on social economics, is there any focus on foster children as far as education screening in support? >> we know from studies that children who experience trauma which with their families would be that trauma or also these children have higher rates of addiction himself. that's poverty, trauma and addiction. so from our standpoint we need to provide this for these children but we also need to
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provide for the parents and caregivers. unless were going to have an issue like tripling from the number of children -- 40% of children in icu days are because of the child being born with the opiate addiction it himself. we can stop it by providing treatment for the parents and caregiver. >> i am told by the department of human services the fastest growing and growing is from children being taken away from opiate addiction. i did enter a bill which requires all children to get a physical health assessment.
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we know they suffer in the family,. >> we move recognize a gentleman from vermont. >> thank you. i thank you for organizing this hearing we leave with some significant humility. when i look at what you've done in baltimore the people who are capable of administering life-saving and john hopkins is taken as well our role is to try
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to get resources back to the community. it appears to me to be fundamentally an initiative that can only be addressed at the local institutional level the 24 year patient says it all i think you for your work will have a tough time in congress when we don't provide it are put in a jam we can do something about the cost of these drugs there's been a number what has the cost of these life-saving drugs done to your budget and your health
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department of baltimore? >> given the scope of the epidemic we redirected funds in order to fund it. i have to choose to fund programs for children on these drugs have the changes been made to the extent allowed additional price increases have they made significant increase to these qualities? or is it just the higher price? >> it's hard to say. it's available in other countries for very little and i like to see us get this broad
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access. >> i have met with all of the manufacturers and they talk about how you have insurance, public or private they have a local payment. >> i hear that all the time. it is so corrupt. not directing this at you, what is the problem with being able to go on the internet and find out what it costs without the convoluted things that occurs? is that is frustrating to. >> you know drugs save lives we want everybody who has access to it can have access to. >> what happens when the drug companies hold hostage your desire to save lives in
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bankruptcy or operation? >> i think we need to continue and find resources. >> why the crisis has gone up so much? >> i don't want to speak for the manufacturers, but they had a list price but the retail level that's paid by consumers. >> if you went to buy a car and paid $15000 in the same car year later was $25000 you'd be able to figure out it's a $10000 difference. you can figure that out now. >> were contingen committed to s out at a fair price. >> president trump said these
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formal companies and prices are getting away with murder. pharma does fantastic things. but if the price kills us for not getting ahead. we need the president and all of us to get involved to contain price couching i you back. >> i want to thank our panel, we had votes in washington and that they expect us to be there for. want to thank all three of you not just for your time and expertise but for your help in other people. it's been very instructive for all the members. on the mayor and the governor
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that i want to thank you for being such a phenomenal host. thank you mr. chairman. made a commitment to me that you were going to do what you needed and i do appreciate that. i appreciate our witnesses and we thank you. i want to thank you remember. you literally had to come in earlier than you normally would've i want to thank all of our members for being here. one request is that when the
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association from health and wellness be entered into the record and the testimony of national healthcare for the homeless council be admitted on november 28, 2017. >> the gentleman from alabama six recognition. >> will have the opportunity to submit things in writing? >> the hearing record will remain open for two weeks for anyone to submit an opening statement. if there are no other questions will sink thank her second panel again and may have gone a little bit longer we appreciate your expertise. with that, we are adjourns.
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no one. [inaudible] [inaudible] [inaudible] [inaudible]
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[inaudible] [inaudible] >> the senate budget committee voted out the tax reform bill on a 12 - level partyline vote. the committee moved were merged two different versions into one bill. what has been added to this tax reform bill? >> they merge the tax plan with energy from natural resources committee which would open up oil drilling, this is a big priority for senator murkowski. it's been a long time goal for

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