demonstrate that this is a presidential priority, that we need all hands on deck, that we are working on will all of government federal response to this. so with our health and human service, department of justice, but we also need and we've also recognized that we need strong partnerships that the federal, state and local level. that we need an offense on deck at the state and local level to make sure we're dealing with this issue. so we are really pleased that you i'm really pleased to be her today and want to thank you for all of your leadership, your continued focus on this issue, and making sure we have continuous dialogue with both states and the federal government to make sure that our policies and resources are attuned to the issues that you are facing at the state level. so i want to thank you all for the work that you do, and happy to answer questions or hear comments. thank you, everybody.

[applause] >> thank you so much for your insight, director. this is our favorite part, and it's where the floor is open and you folks to to pepper the director with questions. so first question. >> thank you, governor. into mr. director. i think we open up and talk about leadership as you mentioned our this -- medical school grouping and you inspired them to understand when a script is written you don't need to have a 30 day script for a lot of these. and for your outreach, you talk of leadership and inspiring those people come it's pretty impactful. so thank you for being here and encouraging us. as we were talking to you coming in, i'm, background in emergency medical pressure medicine as a nurse.

an individual who has a severe monkey on his back as a friend over the last year and a half continues to drive over his hand so that he can continue to get access. so he sat his hand driven over three times. one of the points that he brought up to meet him at lunch that we had in a small town where i met him, is that with all of these monkeys that people have end of these demons, that we don't have very good cross communication electronically, not only like what was let in terms of electronic prescribing there isn't one system for telehealth delivery in chemical dependency. we have so many credentialing issues. you can't even get into a ihs without busting down a wall. the same into v8 and the same in this community health centers. so one of those pieces is to be able to be able to integrate, and i hope that with document health centers and federally qualified centers and whatever,

but that could be leadership from you in the demonstration to streamline this process so that we can have regardless of the size of the city, the communities, telehealth, behavioral health support for treatment whether it's in a prison setting or community corrections or diversion. because this hodgepodge is what i actually think is a huge systems failure that we could fix, but other than that i don't have any opinions. >> thank you. one of the issues that i think this epidemic has really brought to light is that for a very long time we've had firewalls in many respects between medical care and substance abuse issues. so part of our kind of overall work is to look at how to integrate issues about mental health and substance abuse disorder in primary care, particularly in primary care setting? i know that we have a long way to go to do that. one of the issues we have heard

we are trying to do with is to look at confidentiality laws as it relates to sharing information particularly with an health systems and electronic health records. clearly we want to make sure we still have some level of protection, but we don't want to inadvertently create systems that can't communicate with one another or share information as they relate to that. hhs has proposed modification to the confidentiality law that would help facilitate better communication between and within health systems for people who are receiving both primary medical care and behavioral health care to do that. i know that doesn't solve the entirety of the problem but we are really going to look at ways in terms of better sharing of information and better integrated care within primary

care settings and within larger medical settings. >> great question on streamlining the process which brings follow-up to the next question. >> thanks governor. director comey thank you. actual presentation. i thought that was a really interesting point about veterinarians having more training and prescription training that actual physicians. i think it really goes to the point that we did not do enough training on addiction in general, medical students have no idea what they are looking at. i think there's a lot of different ways to approach him when we mandate of medical schools have larger blocks of training. that's one area. but they key is i think what you are talking about in this country we are all finally started to get over the stigma of addiction, which is one of the things that gives it so much power your we are trying to maneuver our way through this to save lives.

at the end of the day, treating addiction is one of the areas that gives weight in the back of the line, whether it's state level or federal level. what you were trying to do and what we are trying to do is push for because it's one of those cases where you can spend the money now on treatment, or we can continue this process of spending billions on corrections and law enforcement and all those things. so i really appreciate the point you are making and i would just look forward to working with you and other lieutenant governors on prioritizing treatment. another issue you're talking about that we are maneuvering our way through is just the whole confidentiality issue. all these things are really important, and for me that was an important point on the issue of pregnant moms trying to seek treatment. i think most people react to

that emotionally, and angrily instead of seeing it for what it is. it's a heartbreaking aspect of the need to get folks treatment. so typical lieutenant governor, no real question. just want to make a big speech. >> thank you. you are really doing i think outstanding work in terms of look at this issue and a couple things that i think are important that you talk about is one competitor will stigma plays in preventing people from getting care. so just substance abuse rob has the same prevalence as diabetes yet to trigger rate for diabetes is about 80-85%. but in the united states even with all the advances that we have only about 20% of people with addiction are getting the care and treatment that they need. and i think to your point, that is not a free pass, that we know that has resulted in an

inordinate effect on our medical system, certainly on our criminal justice system when you look at the percentage of people who are in our jails and prisons as a result of it. i always say that funding addiction could is one of the best returns on investment that you can make. and again i think of a really great opportunity and particularly looking at, i visited states have a tremendous amount of flexible in terms of what they're medicaid benefit package looks like and particularly we are pretty generous ssp for medicaid and looking at your medicaid package. i think becomes really instrumental in doing that because we know that ultimately when we invest in that we are really saving money. we see the biggest cost offset. white house on the criminal justice of settings and i know many of you are struggling and looking at ways to kind of how do we diminish the jail

population that we have. that's often kind of one of your greatest expenses at the state level. to be able to do not buy really moving people away from incarceration. we have seen just remarkable results in terms of when you implement good addiction treatment program him when you intimate things like drug courts. they have a tremendous savings opportunity as well as and much more compassionate and humane response. but the last thing i will say is when you look at data come stigma still plays a huge role. so anything you can do i think to call attention to this issue, as i've talked to a lot of people in this room, i have i t met with him that hasn't been impacted by addiction. i think the more that you as leaders can talk about that or feel comfortable with that or hold of people in recovery in your state, you know, we need to make sure that we're diminishing

the stigma associated with it. >> i'll tell you just one less thing. in pennsylvania where the secretary of drug and alcohol come and women who started out a number of legislators were sort of like this is more government, and extra cabinet position. but it's really worked out well and he's been a leader on the issue. i can get my own experience as a state senator. we spent a lot of time with constituents and constituents family members finding ways to connect to fight to get them into rehab. i mean either representing people most likely going to represent people in crisis who are trying to get help for the loved ones. a big part of it. thank you very much. >> next person with either a query or a thought. >> new york state. first of all i would want to commend you and the administration for your laser focus on this issue and also wish congress would step up and do right by the american people

and put the fun in that is so essential of us. this. i have history as a much younger staffer for senator moynihan, crack cocaine was a crisis of the day and i was called working on $1.4 billion bill back again. in today's dollars i'm delighted with it would be but i think he could do a lot more to provide money to states for targeted treatment and rehabilitation programs. also access to the prescription drugs come anyway. the way. way to prosecution up in our corner where i am from where one doctor while he was on vacation was found guilty of prescribing 19,000 scripts for prescription drug. so we need to do more to make sure there's less access and our governor cuomo just last week directed that all prescriptions occur electronically. we need to have some time to get that in place but i think that's the way we can stop people from literally selling scripts and creating access.

my question is, is there a central repository for the best practices of states? the are a lot of great ideas and i'm hearing from today i want to make sure we're doing pashtun we feel we are meeting with her other ideas out there as well. so is that something her office is providing already do we need access to it, or can we continue, you know, we all need to be in this together and this is state, federal and local issue but we are desperate. we are losing people. my county we are losing one person a day for two weeks straight. and i will also say the numbers are underrepresented because we had over -- in one county but 900. if we did not bark camp that would've been 1100 deaths. that's the crisis of we are at. >> onto a single going to try to do for this meeting but we were able to do. we would get to the letter we sent out that listed kind of basically 11 best practices that we have seen, particularly

coming out of the states to do that. i know many of you armory working on those kinds of issues so we be happy to share that with you. the other thing i will say i think new york state that was really important was to look at the enforcement of parity protection for people with mental health and substance abuse disorders. one of the things we've seen is particularly with private insurance a reluctance to treat mental health and substance abuse disorders the same way they do other medical, surgical disorders. with the affordable care act also was the passage of the mental health parity and addiction equity act that required private insurers to basically make sure that they were administering those benefits at the same level. i think we've all heard widespread reports that people feeling like they are not getting their full due as it relates to parity.

i think new york state working with her insurance commissioner i think it's a really great job at looking at things like parity enforcement issues or private insurance. we need private insurance at the table as well. >> wonderful. next query. >> thank you very much. thank you very much for being here. i guess something that you test -- touched on it was going to touch on, the fact that tenet governor from new york said, prescription. i guess the prescriptions most are written by doctors. and how do we change the medical field to try other things besides just writing that prescription, or at least monitoring the amount of the drug that they give somebody? >> i think with the release, dr. frank is your from health and human services, bipartisan wartime talking about this but

the cdc just released their guidelines last week that are really focused on chronic pain but also talk about treatment for acute pain. talking to a number of things to look at. and again some of this relates to for the back of how do reintegrate issues around addiction in medical school. because i think that becomes really important to do. but again i think where looking at some level of mandatory education prescriber training i think becomes really important to do that. checking prescription drug monitoring programs becomes really important. there are some states that require prescribers to check the prescription drug monitoring program outlays that the initial prescription, and then subsequently thereafter i think becomes really important to do that. i think to look at the cdc

guidelines and how you work with states, looking at how might reintegrate those the cdc guidelines into the medicaid program to being able to do that i think becomes really important. because i do think that the vast majority of physicians, and a dentist, dentists are pretty high prescribers of prescription pain medication as well. you know, i think the passenger people are well intended. i think we are misinformed by the addictive property of these drugs. we are lobbying very heavy by pharmaceutical companies to continue to prescribe. and again, we want to look at also non-opioid therapy for it. so t who be interesting to lookt particularly medicaid plan and to what extent do they support non-opioid prescribing pain

management strategies. so things like physical therapy, making sure that cognitive behavioral therapy is important. can we look at not only just not incentivizing opioid prescribing not incentivizing other pain management therapies i think becomes really important. >> good point. >> i want to follow up on that. if you can give another example -- a state that has done that with the cdc and the medicaid program, i think they'll be helpful. the other thing i would offer, if you can get the information to julie to then shall have a central repository. we will post the information on our website so we can all access that. i would not discourage you from sending information out to the individual governors but that would be a central repository. i wanted to speak about the impact of the foster care system.

i think it speaks to the collaboration and not operating in silos and how we have to deal with is not only federal but state but committee levels. the more we can break down the silos and look at from a holistic perspective, there's just no other way we can be able to address the crisis we are facing today. >> you're right. i can tell you that it might experience in massachusetts. we know that as significant an escalating particularly the opioid issue that we have seen increased referrals to the child welfare system as a result of the opioid addiction. these are two systems that in some respects need to work better together to ensure that quite on was a child welfare workers have some level of education in addiction, that they have established partnerships with treatment programs that can treat pregnant women and women with children. that you have substance abuse services that actually support women and children accessing

care. i can tell you that sometimes women have to go through this like sophie's choice about qe to treatment, and what happens with my children? and so supporting i think rehabilitation programs that do family-based treatment becomes really important. and again the federal government puts out grants to support pregnant and parenting women. i would encourage you, there is actually a technical assistance center funded through our substance abuse mental health services administration. we will get julia information as well. it's called the national center for substance abuse and child welfare. it provides technical assistance to states to look at kind of good communication, good protocols, good treatment with child welfare agencies and substance abuse agencies. it's a really good asset. >> wonderful. next week getting to ready to wrap it up so i will take the

last question. -- we are getting ready to wrap it up. >> thank you very much. gil scott from vermont. first economic are thinking about our experience -- may be afflicted with a number of communities -- [inaudible] governor reynolds has talked about rock together community leaders, state resources and local law enforcement and so forth they are having some success in doing so. my plea is if there is money that comes along, when it comes along, that it remains -- one size does not fit all. we found some success in this community that would be beneficial. the other question i have is maybe a hotter topic in vermont. right at this very moment we are considering legislation to legalize marijuana. and i wonder if you have an opinion as to whether that -- [laughter] >> leave that for the last

question. >> and with that in mind, as the drug czar, does this have any relationship at all with the opioid discussion? >> i actually point to the assessment that vermont department of public health at it as it relates to the potential impact of the legalization of marijuana, i think is a thoughtful report that they did at that point out to states. i do have a lot of strong feelings. so on, so i was asked -- separated from the opioid addiction. i'm a longtime public health person so this is not kind of come from ideological perspective. we made a lot of progress on reducing adolescent substance abuse in the united states but not around marijuana. so we have marijuana use rate at its highest level for youth that we've seen in history. one of the things we track is perception of risk because we know if you perceive something as riskier, less likely to we

have the lowest levels of perception of risk of marijuana use among youth in this country. we have more 12th graders were smoking marijuana than we do tobacco. quite on, part of what we've seen is the development of this billion dollar industry. so it's not just legalization of marijuana. it's the commercialization of marijuana. we have seen billions of dollars being poured into this marijuana industry that quite honestly looks remarkably similar to the tobacco industry. i understand that we don't want of people arrested and incarcerated, have long sentences as a result, particularly simple marijuana possession. but i don't think legalization is the way to do. i think it's bad public health policy and i think will pay the price for it. the other thing i will say, it's pretty clear, and all of you have probably had -- were to talk to people struggling with opioid addiction and you hear

from people time and time again and the data supports this, that they started at a very young age and often started with alcohol, tobacco and ordinary water. and that we no, it's the early use that sets the trajectory for addiction -- and/or marijuana. i do have some concern about everybody has been focus of a big on the opioid addiction side that we're moving in opposite ie opposite direction as it relates to legalization of marijuana. >> appreciate your honesty. last thing on the other side of this is what we are trying to do on the medical side is really enhance the scientific research on the potential therapeutic value of medical marijuana. i think that's really important because there appears that we want to make sure that we are investigating not just the harms of marijuana what might be the potential therapeutic value but i think there is continuing

evidence to support that there might be some therapeutic value for a whole host of conditions. i want to separate the two issues because we do want to encourage and we're trying to do everything we can to diminish some of the barriers that federal government had in place on supporting good research for medical marijuana. >> thank you for all of your thoughts, your questions. director, thank you so much for your thoughtful insight and your time today. i know we really enjoyed peppering you with questions. so i move on to our next speaker -- [applause] piece from the great state of maryland and is actually tackle this very issue in his own backyard i would like to welcome to the stage lieutenant governor of maryland rutherford. thank you very much. [applause]

>> thank you very much. well, thank you. it is good to be here, and it's good to go to a conference that's just a couple miles down the road. so that's always continue. although dealing with d.c. traffic is not always the best thing. but i want to thank director botticelli, a number of things he talked about, and in particular response to some of the questions, the queries that came in, are things that we address in maryland and continue to address. this is really a worthwhile substance but i want to ask though to come to the stage mark goes on and secretary frank, if they can make their way. the previous conversation and discussion is a good jumping off point as we get more specific in charge of tackling the opioid abuse issues in the states.

the department of health and human services is executing a multipronged fight for dinner with the opioid epidemic, and i'd like to have us welcome from hhs assistant secretary richard frank. [applause] >> i'm very pleased to be here, and usually michael botticelli and i do this as a pair. so i'm not just following him. what i would like to do is really focus in on what hhs is doing, and i'm going to sort of in a sense do this in three parts, which is first i'd like

to briefly review what the hhs strategy is to put in a little bit of context and then give you a brief progress report on where we have common. and then want to spend a couple minutes about where we're going and actually a focus on this year's presidential budget proposal. and been happy to take questions. last week as you all know, cdc released prescribing guidelines that hhs released its national pain strategy. and believe it or not that's not a coincidence. because, in fact, we view the two of them marching in lockstep together, that we have a pain problem, we haven't opioid problem, there interconnected and they can only be dealt with together. so the prescribing guidelines are really aimed at addressing one piece of the pain problem, which is when we do use opioids

to deal with pain, how do we do that in the safest possible way. and then the pain strategy outlines beyond that they program of research, provide education, patient education and continue sort of programmatic and development so that we do a better job on pain management in this country and do it safely. all of this is embedded in the secretary, and the president's approach to corralling the opioid epidemic. and so what i would like to do is for start quickly, remind you what the strategy is. there are three prongs. literally, the week that sylvia burwell arrived at hhs she convened a meeting where she directed us to develop an evidence-based focused plan to do with the opioid epidemic.

and then as you probably comment many of you who have seen this secretary in action, she wanted it quick. she's all about execution, and believe it or not we got it to her quick. so there are three parts to it. the first part focuses on dealing with opioid prescribing practices. and that involved a combination of doing things to improve clinical decision-making, such as the guidelines, provide education, also decision-support like using our health infrastructure technologies and prescription drug market program so that we support doctors in making the best possible decision. and then we also want to make the data flow more easily and more freely so that, in fact, he the doctor can see a patient's

entire treatment history and all the places that touching the medical system and what's happening so that, in fact, you don't miss a situation that was weaselly pointed out where 70% of people who recently overdosed from a prescription pain medication get a new prescription for pain medication. that's not happening because doctors are doing a bad job. it's happening because they don't see the whole picture. so this is very important. second part is about naloxone, and that is, we have a drug that reverses overdoses. and what we are really focused on these two things. on, hitting it in the right hands at the right times. and that involves -- getting it. sort of tweeting the site so we get more user-friendly versions on the street and into the right hands. in fact, overdoses don't

necessarily happened near an emergency room or necessarily near a well-trained first responder. very often it the police or family member or someone else on the playground was actually the first responder. and having a user-friendly way of administering the drug is very important. and so we've been sort of pushing this development as well as making it financially possible for communities in high need to sort of deal with it. the third piece of the puzzle is medication-assisted treatment. that is, we have a package of very strong support evidence-based treatments for dealing with opioid use of disorder. and those are medication-assisted treatment involve three drugs, no trucks on, long acting up talks on, even offering and what we are

really bent on doing is making sure that we spend access to those treatments and really fill the treatment get the right now there's about 2.2 million people in this country who haven't opioid use disorder. a little under a million get treatment. we believe that some people don't believe they need treatment so those are very hard to get but there are a lot of people who don't get it because it's not available. they can't afford it. they are not fully sure what to do about their addiction and it's those people be believe that we can get all of them into treatment by making the right investment. let me now turn to the progress we've made on each of these areas. as you know the cdc guidelines came out last week along with the pain strategies, and i think that's an important first step so we're coupling that as i will

tell you a little bit more about in a minute, with money to make sure that we educate the physician community, that we support the surgeon general in its efforts to educate doctors and other providers, and we get the word out and then make a part of our electronic decision support system. second is in september we released a variety of the funds to help the cdc expand the use of prescription drug monitoring programs across the country. the cdc just put out an announcement where we're going to go from 16 to about 20 states, and then hopefully by the end of the year, 50 states. the president put out a presidential memorandum in october where he insisted that

all federal departments taken measures to do several things. first, to drink all our physicians in appropriate prescribing. and literally every month we meet and we monitor. we have a dashboard and forego hhs is now up to 93%. dod is moving ahead very quickly. my va has been excelling over the last few months. so we are really pushing all of her own doctors because, in fact, we have to get our own house in order if we're going to ask everybody else do. the president also directed us to review all our programs to see where it is that we are -- impediments. work on clearing those away. third, the presidential ticket in west virginia, the administration announced that 40 provided groups have voluntarily agreed to up their gains in

terms of training their members in appropriate prescribing. we meet monthly with those groups, and we are getting great response of the everybody is committing to numbers, to metrics, and we are moving ahead with that. let me now turn to the budget. you've heard hhs portion of it is about $1.1 billion of new money, and the lion's share of that money, about 9.6, i mean $960 million is going to expanding treatment opportunities, to close the treatment gap i mentioned earlier. and as i said we believe that we know what to do. we have the treatments. we understand where the holes are in the system, over

geographically and sort of institutionally. in many respects getting the people who are interested in getting treatment can't get it or to our outreach work to persuade those who are persuadable, we think we know how to do it and it's really about the money. in addition to that we are putting $10 million of new funds into expanding the prescribing guidelines, disseminating them in developing decisions, support for space on those that can be used in the physician community. this is on top of the investments, the new investments we're making in the prescription drug monitoring program for a total of about $77 million. and then finally we are targeting high need, low resourced rural communities to purchase the locks down --

naloxone and to train first responders but even though we are seeing great progress at the fda we have approved a new version, a user-friendly version naloxone, it's a nasal that laypeople can administer it. knowing how to do it, having as many health professionals trained and how to administer naloxone in the safest possible way is key. so we are putting $10 million in targeting the communities in greatest day. we are tracking these trends carefully. we have an active monitoring and research program. we tracked our own progress. we track everybody else is progress. we meet monthly. it starts at the white house. michael and i see each other a lot.

and we are really sort of focus on those three targeted things. that doesn't mean that we are not doing a variety of other things, and michael touched on a few of those in his remarks, but we really think that the evidence points us to making the biggest difference and have a nice impact by focusing on the prescribing the extended use of naloxone able to making big investments in medications as a treatment. when it comes to the states, literally we touched you guys think of the ways every day. you will notice if you look into the details of the budget that the medications treatment, their grant programs, cooperative agreements and they are building and to be partnerships. we recognize that one size does not fit all. we recognize that circumstances

and values differ dramatically across this country, it's a big country, but most importantly we also recognize that we have learned things from the science and from our experience so that, in fact, there are things we know work and are some things we know don't work. and so we do our partnership as sort of offering some general guidance on what the evidence-based playing field looks like, and then we just view ourselves as wanting to partner with you all to make headway. ..

[applause] >> thank you, mr. secretary. we will hold the questions until the end of the panel. next, i would like to bring up a gentleman who talks about the pharmaceutical industries. a new formulation as well as more information. so please welcome pharmacist and attorney, art you heard. [applause] >> thank you. a tremendous honor for me to be here this morning. my name is mark bozeman.

i work for a company called alchemy has come the manufacture of a medication called as a trial, which is the extended release version of the tracks sound, not to be confused with the lockdown. similar entities but not quite the same. i wanted to disclose the bias i will break to the presentation. but i'm not here to talk exclusively but more specifically about medication treatment. my background as a pharmacist and attorney, mostly as a pharmacist. i began my career early on working for the main association of substance abuse programs. it was during a time when it was purely 90s when they only had one fda approved medication to treat opioid addiction and that was methadone. even morphine was on the horizon and used more widely in the year 2000. in the year 2006, the fda approved extended release of mel tracks on to treat alcoholism.

four years later the fda approved extended release to prevent a relapse from opioid addiction. then they sent with a challenge we are still fighting today as evidence-based substance abuse treatment is not very old. the criteria guideline in 2012 and i like the analogy they used in their forward to a talk about the abolition of substance abuse treatment in the united states is using the fact that reference. i thought i've got a work that man. they talk about this past century and for many decades of the modern time, it was a 12 step program. 12 step programs are very thick

different as an admin people. but it's referred to as a unicycle approach. some people can learn how to read a unicycle and some people can do it very well, but it's very difficult. a number of people never despite how much training they get the letter b. a cycle. we've got to have some e-mails for people who cannot quite get to recovery with 12 step programs alone. so they added recovery support programs, and recognizing that these treatments than just a 12 step program. it isn't just counseling, but also affects so much of your life benefit to recovery support program behind it. they talk about the three leg is still get their education, jobs, those things often contribute to someone recovery. they refer to that as a 12 step

program along with psychosocial support, along with lifestyle management support, education and job training, housing. that was the bicycle. many, many more people had a successful recovery approach because the bicycle is much easier to write than a unicycle. but we still have people suffering with this disease. it wasn't until we recognize that this is a brain disorder and it was a brain disorder we have no cure for. if the lifetime affliction. it describes the tricycle as the component that takes all of the intervention and we discovered have been successful. psychosocial support, recovery support services and medications treatment. we talk about director botticelli talked about people

being treated with diabetes. 80% of those at diabetic deserters are presumably receiving adequate treatment if a small percentage of people get adequate treatment, get treatment at all. include the name medicaid is the current state-of-the-art evidence-based approach giving people the best chance of recovery and recognizing that without evidence-based medicine we are not going to get verified not have much impact on this program. to that end, what can the state still wanted the state doing? there are two things the states can be doing. one is making sure that pinup models provide equal access to all evidence-based medicine.

director botticelli describes the return on your investment investing in substance abuse treatment, particularly medication and making sure that parents -- patients have access to all medication and particularly when it comes to lucky not some of the issues going on, there are two things i like the highway. one of them started in maryland. washington county maryland was the first county in the united states that decided to use extended release naltrexone to help but the prisoner reentry program. understanding the revolving door of incarceration often has its recent substance abuse disorder. by using a medication like x release naltrexone, an

injectable medication, patients have a blockade -- let me back up a little bit. i promise to talk about all three. buster was methadone. the oldest medication. methadone is an opiate medication in the same class as morphine, oxycodone, other of long-acting pain medications. it is very fact that because it is a long acting opioid medication at valve. when he is under appropriate supervision, people are very bold people are able to satiate their cravings because they are getting opiate replacement there be in a controlled environment and they tend to do, many patients tend to do very well i methadone replacement therapy. they take it every day. they often report to and have to report to a licensed methadone treatment center to get care.

one not available at regular primary care at the methadone treatment facility. the next area is another opiate medication called a partial agonist, works very similarly to the doctors allows people to function. one of its benefit that can be used in the primary care setting with credentialing of the prescriber. prescribers need to get special training for it. they need to obtain the waiver when you have the appropriate training. but the number of patients and their primary care doctor can see is limited to 100 per doctor. the trawl for extended release naltrexone is a full blocker. if it's on the opiate receptor, blogs the effective opiate for the person relapsing and it

lasts for 30 days when given in an injectable form. it doesn't require any special training. anyone within a prescribing potential whether it be a position on transposition or mid-level provider. but it's highly underutilized because it is fairly new. and it's an injectable. people given a choice of either have an oral medication and there's a lot of education that goes with it. there's also an education gap. as the number of doctors and specialists. i like to tell when i was hired by my wife finishes at what to do? it's a once it's a month-to-month injectable to treat alcoholism and prevent relapse and opiate addiction. she said what now? why aren't more people are not?

i know. we are working on it. what are they doing with these therapies, particularly with the newest one. the washington county, maryland program recognizing the revolving door of people arrested and incarcerated predominantly as a result of substance abuse and addiction disorders. we want a cigarette way to get these people into recovery in a way that perhaps didn't involve a controlled substance because frankly some of the criminal behavior has to do with usage possession version of controlled substances and providing them with a controlled substance wasn't the mechanism we wanted to go through. so utilizing -- utilizing an extended release naltrexone, not

the vertebral common nonnarcotic come in on the take it active for 30 days, combining that with psychosocial support and recovery support services, counties like washington county, maryland several years ago when a very successful prison reentry program. people would get a shot before their release and the community support providers provide wraparound services, provide more injection upon release and the study says at six months is a good period of time to reevaluate the medication. it's not a lifelong medication i was and one with the right supporting treatment and long-term recovery without the medication. if the hundred 30 programs in different states in both jails and prisons. the other application for extended release naltrexone is being utilized in the foster care program. i come from arizona.

the governor approached us and said 80% of the children that we removed from the home are not removed because of the abuse. they are removed because of neglect. 80% of those people can be attributed in some sort of substance use disorder. i would like to be more aggressive, implement the program where we are treating the parents of these kids that we can send them back home. that is a program in its early stages, one with the theoretical process and arizona studying implementation. i'll end my remarks because they have big yellow light. please to be here and pleased to answer questions you might have. [applause] >> thank you very much. now it's much appreciated. i want to spend a couple minutes on what we been doing in maryland over the last year which is occupied a group of my

time as the governor asked me to be on the hair went and opioid task force. they really started more than a year ago almost two years ago when we were campaigning in traveling around the state, talking to thousands of individuals, but mostly to local officials. all of you have done that process for new ) talk to local officials and say what are the biggest issues you are confronting? we were hearing over and over again that it was trans pics. didn't matter of large communities, large urban areas, suburban or a small rural town. we were hearing heroin. the governor decided that once we were elected we were going to do something about it and trying to address this particular issue. in fact, governor had lost just a few years ago, so he had a

personal interest as well. so we heard of the devastation to families and how it had overrun local and state after it and had created essentially a public health issue, a family crisis as well as law-enforcement issue. and so, we set out, once elected they set out to put together the task force. we brought together experts in medicine and substance abuse treatment and law enforcement. we held meetings which we called regional summits around the state and we produced the report in december this past year with 33 recommendations to the governor on actions that we could take to try to address this issue. prior to the final report, we put out an interim report back in the summer, which had 10

steps that we could take immediately because we felt that we didn't want to just wait until the end of the year with a report if there were some things to our state agencies. most of that has to do with treatment because we have access to funding and a year and we could expand the trial program that was just mentioned that we knew was going on at the local level as well as some additional education and prevention efforts. and so, the final recommendation dealt a lot with improving public awareness and prevention, access to treatment, quality of care, alternatives to incarceration for the nonviolent offenders who have substance abuse disorders and no coordination. as governor michelle taught

about, one of the things that we would also recommend with integrating our systems a lot better. our internet i'm going to say that one of the stars in our cabinet is our secretary of human resources, which had up all the conservative agencies. he doesn't come from a public service area. he comes from information technology. so one of the things he noted right away was the state touches a number of people in different places in the state. we don't know. were not coordinated care to comment on social services and child welfare, we don't know that they also have been touched by her criminal justice system or we don't know that they've been touched by her public housing. and so the health aspects as well. so we are trying to put together -- bring together a lot of that information with the understanding of privacy and concerns.

and it is also, you know as well as i do you can have john smith in one system, gene smith in a different system. jj smith junior in another system. so it is bringing it all together so we know where we are touching it. after the report, while the task force ended, we were in an implementation process and members of the task force were still involved and still in contact with us because they came from the community. we didn't feel that government people. individuals in this community, and treatment programs, somewhat former users that were involved to help us formulate these recommendations. one of the things we looked out, prior to coming in office, a lot of the actors had to to do with overdose prevention which was understandable because of the surge in actual deaths

associated with this disease. but we also said we needed to take a long-term multifaceted approach. as i would always say, we have to stop the pipeline of new users. so that is the prevention aspect or the prescription drug monitoring that we talked about because the new gateway drug arby's prescription as well as what director botticelli said. we have an issue in terms of some individuals may start with alcohol. so we have to look at that as well. a large portion of new users, 70%, 80% common nonprescription medication. we need to make sure we educate people who didn't think we had a problem as well as deal with the stigma. as more and more people talk

about it they rewrite their neighbor when the i permanently tied to a tied to neighboring up tied to a neighbor in their husband or wife also had this problem. so it was an eye-opening program, process that we went through. we've realized as far as the prevention and educational aspects that there had been a gap since the 1980s i say what there's a lot of emphasis on the dare program. nancy reagan's just say no program. after that, there had been somewhat of a gap in terms of public information. one of the things that i would say over and over again as virtually every third reader can tell you how that cigarettes are for you, but they can't tell you the danger associated with taking someone else's prescription medication. so we sat out in october as part

of our interim report of public information campaign and the local schools. we also encouraged our state of education to start implementing substance abuse disorder for drug education earlier in school and not waiting until high school health class to start talking about it. at an age-appropriate level as early as elementary school we talk about taking someone else's prescription medications. including the biology classes, possibly history classes. so it was to try to get more information now. we also started running public service announcements with some help from the local universities in terms of setting up a competition amongst the local

film schools to come up with developing these messages that can go out to people in their age group as well as a little older. we had an ulterior motive. one, we didn't have to pay for it. to accommodate younger people to talk to younger people versus an old guy like me trying to talk to them. so those were a number of items that we submitted to the governor. probably six or seven recommendations required legislation and so we're working through that process. the governor also included additional money in the budget to deal with overdose prevention as well as treatment money. and in a supplemental budget, we added additional money that was administered through the court system, which provides alternatives to incarceration for those who their main issue

is they have a substance use disorder. one of our policy people who worked with us to the campaign and continues to work with us now used to say and i always quote him. he said we need to make the distinction between those who are upset with and those who we are afraid of. we are upset with the person broke into our car group were really upset with the person broke into her car, but were not necessarily afraid of it. we are afraid of the person is trying to kill us or other harm to sr families. those are the people we want to have in the lockup in jail without person who really has a substance use disorder more than anything else. so we continue to work to try to address the crisis. like i said, it's the implementation process. an education process, not just for public, but legislatures as

well. as we talk about integrating our systems, a number of our legislatures say why aren't you putting the money into that verses into treatment? we are saying we need to. this is part of treatment, part of knowing who to give access to. it is only an patient sometimes a person does not need inpatient treatment. in patient is the most expensive. it is doing a good assessment, making sure they are placing the right environment that is where the issue they have. and so we continue to work at that. it's going to be an ongoing challenge and i thank you for this opportunity and i think we will open up to questions. [applause] >> s. yes, sir.

>> 30 powerful. dr. boyce and something i talk about a great deal of my personal life that this is nothing new to any of us. my father was an addict and due to chronic pain he threw his family away for it, eventually died of it. the piece that i find difficult and i'm going to paint it to your knowledge as they come up with so many other different types of medications in so many other world that you are talking about treatment. but the aspect is we don't prescribe any more. there are new drugs. my father was a percocet darvon fan and nothing has changed. i am curious what you see on the horizon for other non-opiate type of treatment out there because of what is advertised or

what is they are in addition to the non-soluble type of discussions at the prior panel. governor rutherford talked about those. both of you talk about an educate us because it is stunning to me that over my lifetime it is now positioned medication to >> i'm very sorry about your father. but the heartbreaking story, but not unusual unfortunately. regarding development of new drugs, the holy grail that i believe a number of manufacturers are chasing is the nonaddictive pain medication that works as well or better than opiate-based education. having a safer pain management program would benefit so many

heartbreaking stories related to people who frankly, whether they have a genetic predisposition to the disease of the drug causes the disease, we still don't know. tremendous research needs to be done on what the root cause of addiction is and what are the modalities they use to treat it. but that is the holy grail. i know there are manufacturers choosing not. i don't know how close we are though. my guess is we are not very close to. but certainly we know that is the next iteration. interestingly enough, you mentioned percocet and darvon. percocet is still around. it is a staple medication used for short term acute pain. darvon isn't though. the fda several years ago found that it wasn't their effect is and withdrew it from the market. and though, the regulators do

keep up with research and are constantly looking at nature of medications. and at times taking them away when the risks not outweigh the benefits of them. so some things do change to the benefit. we don't see it anymore because it's not on the market anymore and that is mostly because there was a black of risk-benefit information. but like i said, companies are chasing the pharmaceutical industry with as much as we get from time to time, we really do viewers saw as a to try to improve the health and well-being of people in a safer manner as possible. i hope that is the message i can relate on behalf of the entire

industry. >> there's also a lot of research that seems to be going on with medical marijuana and madison area with a number of entities looking into whether that can address some of the issues and some of the areas. >> and i talked about? >> yes, absolutely. first of all, i think there's three parts to the answer. one is not only is the industry chasing this in part of the reason they are chasing it is because the drug abuse is putting out a lot of money to help them chase and they are also partnering with universities and other research organizations. qaeda has an extraordinarily program to help the industry to help non-opioid pain medications. that is one. number two, one of the things pain strategy does is point out

how underutilized things like therapy is, acupuncture and the like. and really, there are things we know that work for certain people and kind of making sure those used appropriately as the second part of the answer the first part is abuse deterrent formulations. we have a first generation out there now that is really in its infancy, but there is sort of new science in the pipeline that will potentially make that deterrent formulations really a deterrent and that is something that can be defeated by, you know, fairly easy science. ..

>> you've made an interesting point about, you know, i think we've gone a long way to believing that 12-step programs are key. some folks are of the school of thought that that's really the only effective way to treat addiction. but there are things that happen in life where it's difficult for most people to continue on in that. so we've been at a point where we have actually, working

against a thinking ma against people -- stigma against people who aren't in 12-step programs. what are you doing for your recovery, and they say, well, you know, i just pray, or i'm working hard. usually that's not received well. but i think that goes back into the whole issue of stigma in addiction, and we're starting to learn more and more things. my own problem is i have, i still am learning to find acceptance for the idea of methadone because, basically, i feel like with methadone you're still, you know, you're carrying on this cycle of opioid addiction. and in some way -- and i've said this to addiction specialists, isn't this a remnant of the '70s, can't we do better than this? i know that there's still some places for it. but i think, you know, what

we're talking about here, it's a growing area where we're all still learning. and it's hard to believe, you know, that with this -- this is a health crisis, that we're still learning. i'm with the school of thought, too, that -- and we just legalized medical marijuana for, you know, children's diseases and traumatic injury in pennsylvania. but i'm one of those believers that marijuana is a gateway drug for a lot of folks. and so i guess what i've done, again, is made a speech -- [laughter] but i really appreciate matt's experience. i mean, if we have folks who put that out there, i think that makes it a lot easier for other people out there who have the issue of addiction in their lives and in their families. but look forward to working with you folks and, governor, as we

go forward. >> yeah, we, i would just real quick, when we were putting together our task force and we had people coming in who a lot of people in the treatment community, they come in with bias. 12-accept works, medically assisted works. -- 12-step. and me being kind of not having a bias there, not being involved and just learning the process said, look, we want to have all the solutions, because one size doesn't fit all, which was said earlier. and for some people that it may, they may need this process. but i agree, i have that -- the bias i have is the concern that you have with methadone treatment. you, you know, we would ask, and that's why we talk about quality of care. is there a stepdown, is there an exit ramp from that type of treatment? is it the vivid troll, is it something else and then

eventually be able to, you know, get your body off of these treatments? but i don't know that. so, sir. >> yeah. lieutenant governor potter from the virgin islands. just a basic question. the prescription drug monitoring program is going to be expanded to the 50 states, you specifically said that. to arethe virgin islands and the other territories excluded? i just need to know frofd. >> well -- for the record. >> well, my understanding is that it's state-specific. many of the states have a prescription monitoring program. some states like maryland right now is voluntary, but we have legislation to make it mandatory , mandatory registration and mandatory query. we're still in session, so i don't want to -- things look good now with my fingers crossed. [laughter] yeah. but i probably just jinxed the whole thing. there's resistance to it

particularly from the medical community. but there's so much on the other side that is putting pressure on them to come to understand that this is where we're going. and i think what the federal was talking about is making sure there's more integration with the other states. but the secretary -- >> couple of things. one, 49 of the states voluntarily have prescription drug monitoring program. there's just one that isn't that seems to be at least on a glide path to get there. but i, what we're trying to do is trying to support, one, using the best technology, integrating it with electronic health records so that it becomes easy for doctors to track things. if you don't make it easy for doctors given thousand busy they are, given how much they have flying at them, you'll never get there. so that's where we're making our

investments. we do work with the territories, we're delighted to work with the territories, and, you know, we're happy to work on that with you. the other thing that we're trying to do with the prescription drug monitoring program is make them so that you can go across states x. a number of states have made great progress. there's one state that can now connect with 28 other states. there, but, you know, we're moving in fits and starts there. but, again, we're working with states. we're about to have a series of regional outreaches where we actually help with best practices on that. >> [inaudible] as a pharmacist who practiced for 20 years before getting into the pharmaceutical industry and saw that the growth of the pdmps, one of the things i'd like to recommend to the states is as you consider the

usefulness of the pdmps, one of the challenges that i think one of the resistances from prescribers when it comes to mandatory usages is what do i do now? i found someone who's doctor shopping, who's clearly addicted, where are the resources in my community where i can get this person treatment? and it's stunning mostly because of the fairly new aspect of medicalized treatment that the people who are on the ground, in the primary care setting, in the grocery store pharmacy, in the independent pharmacies, in the chain pharmacies, i would suspect many, many of them don't know what to do next other than to say, gosh, i'm uncomfortable treating you. and if you just turn them away and turn them off, the disease didn't go away. they're going to need to find the drugs from somewhere else, and they're going to turn to the street. so we've got to have a plan and an education program to teach prescribers and pharmacists what

do you do now, now that you know? and i think that's the next iteration of pdmps. >> okay. governor from new york. >> kathy hokill from new york. in the state of maryland, we've been following it closely. i remember a conversation i had with the head of a major metropolitan emergency room, and i said to him when people come into the door and they're injured and you prescribe an opiate-based drug, why would you give them such high doses? why do you continue to do this? and he said our whole training, our whole dna is centered around keeping people out of pain. and i responded saying, but if you knew that this temporaryf pe this injury could lead to a lifetime of addiction and death, why would you keep doing it? he said something, i want you to pond to this, we are rated by how we keep people out of pain by the federal government. providers are rated and their reimbursements are tied to that. so in a sense, are we incentivizing this overprescription because of

federal standards which, if that's the case, i think something's got to change. can you comment on that? >> it's a great question, and there is a part of the answer that's simple and a part of it that's really complicated. the simple part is two important things. we're in the middle of studying this, so i'll give you a progress report on where we are. question one is how much money is on the line if you prescribe more, okay? so let's say there's a connection between more prescribing, more pain relief, higher ratings, how much would you benefit financially? the answer is we're talking pennies. not enough money to get anybody ever to change their behavior. so that's one thing. second part is when you prescribe more aggressively, do you get higher ratings? there have been three or four studies done of this, and the answer is, no, you don't get

higher ratings be and, in fact, sometimes you get lower ratings because, in fact, when you prescribe more, you tend to spend less time talking to your patients. and the thing that gets you good scores is talking to your patients and helping them solve the problem with you. third, having said all that, the perception is real. and what you pointed out we hear every day. and the problem is one of education and of understanding. so let me pose to you our problem which is it's very important to manage pain. and our major source of data on whether, in fact, we're doing it reasonably is those questions on the, you're referring to the thing called the hcabs which is our -- hcaps which is our quality tracking program. one thought was let's get rid of

those questions because there'll be no misunderstanding we're not bonussing anybody on it. on the other hand, that's our major source of data on how we deal with pain. so that'd be throwing the baby out with the bath water. really what we're going to do, we're taking a hard look at how the questions are asked, and then we're going to have to really go out there and educate and work with the physician community because, in fact, the if they pursue that path, a, they're not going to get higher scores, they're not going to get extra money, but we are going to continue to have our problem. >> governor? >> thank you, governor rutherford, for all of your insight today. this has been very helpful. i know that governor reynolds is collecting a few of the documents we've spoken of today. not that i want to copy your report, but i would certainly like to contrast and compare both the preliminary -- >> it's actually on our web site. it's still there, but i'll make sure i get it to julie, yeah. >> thank you so much. >> okay. i think that was, i think that

was it. well, thank you all. thank you, panel. [applause] [inaudible conversations] [laughter] >> absolutely. thank you, governor rutherford, and that was a great session. aide like to ask director blackburn and general agger to come on up to the stage. and i know that this is an issue that lieutenant governors are leading on nationally. and before i was elected

lieutenant governor, actually for a short time as lieutenant governor i continued to serve as an officer in the pennsylvania army national guard, and as a judge advocate, so i got a chance to serve with folks who have been in the war and also get a lot of exposure to our veterans. and as i lieutenant governor, one of the things i wanted to do was i wanted to find a way to connect more and more with folks from the military and veterans at all of our major military installations in pennsylvania and asked a lot of questions and listened. and one of things that we found out was that we have to get a little bit better at communicating with our veteran community and connecting with them to the programs that they are vitally in need of. and so it's a fundamental issue of communication. so our next panelists, and i have the privilege of

introducing them, are going to talk about that vital issue of these, our folks, our heroes that we're really interested in and finding ways to support them and serve them as they've done for us. so join me in welcoming director scott blackburn of the my v.a. task force in the u.s. department of veterans affairs. [applause] that's you, buddy. >> we made a change because we're going to play off of each other. [laughter] >> is that okay with everybody? it's not in my script. [laughter] [inaudible conversations] >> who the heck are you? >> he's in my state, i might be in trouble. [inaudible conversations] >> okay. with that -- [laughter] with all hell breaking loose now here -- [laughter] finish so we're going to have, beforehand we're going to have carol eckardt.

she is a retired general, she's from pennsylvania, and the panelists are going to play off of each other. [laughter] so with that, general, take over. [laughter] [applause] >> that's what you get when you put a panelist and a director -- i mean, a general and a director on the panel. so thank you, lieutenant governor. i appreciate that. thanks for having me here x i must say it's retired general, which really sounds good to me. although i really enjoyed my time serving with the pennsylvania national guard as well as the deputy commandant at the army war college, it's also great to switch over and serve the public sector. i consider it to be continued service. i was asked to speak today about some of the challenges of some of our transitioning veterans, because i've seen both sides of it both as ap individual who

did, in fact, transition and then one in the private sector who is assisting our veterans. it's important to understand that every year about a quarter of a million, 250,000 veterans return to our communities across america. a 2014 study revealed that the general population considers our veterans as broken heros who are more likely than non-veterans to be unemployed, undereducated, homeless, experiencing mental health issues, but the reality, however, is so much different and much more complex. and it's important that we all challenge these claims in order to change the public perceptions of our veterans. these are not broken heroes. i like to think of them as hidden "heroes." are there any veterans in the room? can you stand up if you are? [applause]

i know -- thank you. we have dave back here. i'm so excited, does he look like an air force pilot to you? [laughter] i mean, other than he always wears blue suits, i don't quite get that. [laughter] but he joined us, he's a c-130j pilot in the rhode island national guard. you would never know it. so i think of all of them as hidden heroes, but i would add that i think i can speak more most veterans that we certainly don't consider ourselves heroes. we're doing our jobs for the nation. granted, the public tends to call us that, but they're not broken heros. the majority of veterans return home seeking new challenges and new opportunities. they're looking for ways to continue to serve their community and their country. so just think about it. almost half of today's veterans were members of the all-volunteer force. so it makes sense these were individuals who volunteered to

serve in uniform, so it follows that when they return home, they volunteer to serve their communities. and they're uniquely qualified to do just that. they are experienced, their leadership abilities, their training, their very honed skill sets position them to continue to seek solutions to the challenges that face our communities. in recent years we have seen veterans leading across the nation very important movements. think of disaster relief and community preparedness. what do you think of? team rubicon. think of probe moting physical fitness -- promoting physical fitness. who ran across the nation with the flag? team red, white and blue. combating homelessness. the 100,000 homes campaign. increasing educational attainment, our student veterans of america. so these folks have come back, and these are just a few of the incredible organizations, and they've come back and continued to serve. but too often negative stereotypes about our veterans

dominate the public dialogue. the average american believes that, in general, veterans are significantly more likely than non-veterans, as i said, to experience unemployment, incarceration, homelessness and various other issues. and these notions are, in fact, misconceptions. they paint, as i said, a picture of veterans as broken. and as a result, many of us feel pity much more than we feel respect. and i think of them as hidden heroes. and so we need to make sure we understand who they are among us and highlight their contributions to our communities and our nation. a great report is out there that i recommend you all read. 215 veteran civic health index. it was a report prepared in partnership with american express, got your six, the william flora hewlett

foundation, and the purpose of this report was to foster understanding and, i quote, the civic strengths of the veteran population and provide a data-informed platform i through which to eliminate the misconceptions about veterans. so i'd like to cite some of their findings. employment. the veteran employment rate has been below the non-veteran rate every year for the last decade. from 2014-2015 the average uni a justed unemployment rate was 13 percent higher than the veteran rate. income from 2005-2013, veterans have consistently earned significantly more than non-veterans. homelessness, non-veterans comprise 91% of the homeless population while veterans comprise 8%. there are 578,000 homeless individuals across the u.s., and almost 50,000 of them are veterans, so that's a small

portion of the total homeless population. post-traumatic stress disorder, which many veterans like to think of it as post-traumatic stress and not call it ca mental disorder. there's a movement out there to eliminate the disorder distributer of that. the department of veterans affairs estimate even when considering at the highest end of that, 20%, this is a very broad spectrum. it's still true that the vast majority of veterans do not experience ptsd. but many americans think it's much higher. if somebody popped a microphone right now or spilled over a glass of water and it made a loud noise, dave, what would happen to me? he's observed it. i have a hyperstartle reflex. i can't stop it, i don't know why it's there, but do i have ptsd? does it impact my ability to contribute to my community?

that's the other issue. veterans might have some of these, but i was also bitten by a large german shepard, and every time i go past one, my leg hurts. [laughter] so let's be careful how we twine this. define this. ptsd is a human condition, not a veteran condition. 5.2 million adults experience it during a given can year, and about 7.8% of the population with ptsd will have ptsd at some point in their lives. four-year college completion rates are higher within veterans than than-veterans. however, veterans participating in the g.i. bill are completing degree programs on par with their non-veteran counterparts. think about the veteran population. there are 21.3 million veterans in the united states. that's 9% of the adult population.

the median age of all veterans is 62 years old. in general, veterans are more likely than non-veterans to be married, more likely to have completed high school and more likely to go on and progress through college. though veterans are far more likely than non-veterans to have some college experience, they are less likely than non-veterans to have completed and have a four-year degree. however, the trend -- that same trend does not exist for female, hispanic and african-american veterans, however. in fact, veterans in these groups display significantly better educational profiles than their non-veteran counterparts. additionally, veterans participating in the g.i. bill program, as i said, complete at the same rate as traditional students. so when i cite these statistics, i am not saying we should not continue to help our veterans. what i'm saying is we need to look at the rest of the veteran population.

the narrative focuses on those veterans with homelessness, unemployment, ptsd. but sometimes we forget to enrich the lives of those veterans who are returning so that they can continue to contribute to society. so please don't go out of here saying get rid of all those programs assisting our veterans. that is not what i'm saying. i'm saying let's widen the aperture and look at all those healthy, contributing, enhanced, resilient veterans that are helping our communities. and they are, in fact, civically more healthy than non-relate irans. they consistently show higher levels of community engagement. in fact, or over the last sently, veterans from all generations have outpaced the general population in their habits of civic responsibility. they show more mature civic engagement as indicated by their involvement in their communities. service to the community includes both formal and informal volunteering which is a very important indicator of civic health.

not only do they deliver critical services through volunteer, but they also are much more likely to participate in the political process than the non-veteran population. and our young veterans have the highest rate of volunteering among all americans. but despite the facts that we, that i just shared with you, a discussion which was sponsored by macdill national security initiativeindicated that veterans entering the job market or going to college suffer severe stigmatism that is likely -- that they are likely to have mental and emotional problems, and that very myth is holding them back to attaining full contribution and meeting the potential that they have. many voices are calling for this narrative to be changed. and it is improving. think about organizations like got your six.

they are dedicated to to responsible reflection of veterans in the media and entertainment industry. this very report is often cited. i think it was just cited by our undersecretary of the army, acting secretary of the army, patrick murphy. so we are changing that narrative. so i want to share with you the final recommendations from this report. we must all challenge these stereotypes, dispel the myths and recognize our veterans and their civic leadership. so when we talk about some of the challenges facing veterans, let's talk about the other side and those veterans who are helping their partners in facing some of those challenges. we can all take a moment and learn about military history and the veteran experience. read the books, watch the movie, watch the videos, there's a great one out recently. anybody see "the american experience"? i think it's on friday nights, pbs. they just did one about the evacuation of hanoi and saigon.

it's amazing to watch. but not everybody takes the time to watch these. so talk a moment -- take a moment to understand that and engage veterans in conversations. don't just say thanks for your service. say what are you doing now, what did you do? de-stigmatize mental illness. non-veterans and veterans in institutions, let's work together to change the cultural narrative about veterans. and there's something that we can do also as veterans. we need to tell our own stories. i often refer to this story when i go to the home depot, so as a general officer, we had the placards on our windshield in order to get on and off base. mine has a star saying that i can get in and out of carlyle army base, and i haven't gotten around to try to get the stuff that gets it off. so when i get out of my car if

i'm there alone to pick up whatever i need for a home project, someone will come up to me and say -- very often -- oh, where did your husband serve? [laughter] >> yeah. >> now, i get a little irritated. [laughter] and i usually say, oh, he served in world war i. [laughter] just to see if they can do the math. [laughter] and then i say, okay, let me help get the story out there, and i stop. and i explain that i've served in the military and that my husband supported me throughout those many 30-some years of service, and i tell the story. do i feel like doing it? no. but we must reduce the civil/military divide. and we have to stop telling our stories only to each other. if you go to a meeting like this, this is unusual, actually, but if you go to a panel about veterans, guess who's in the room? who are we talking to? we're talking to veterans.

people that like us, that like our story, that think we're wonderful, we could pat each other on the back. we are not moving the needle. so go to those organizations that don't particularly want you to be there. tell the story -- >> we will break away briefly here. the u.s. senate's gaveling in for a short pro forma session. back to live coverage in moments here on c-span2. esiding officere senate will come to order. the clerk will read a communication to the senate. the clerk: washington, d.c, march 24, 2016. to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable tom cotto, a senator from the state of arkansas, to perform the duties of the chair. signed: orrin g. hatch, president pro tempore. the presiding officer: under the previous order, the senate stands adjourned until 11:30 a.m. on monday, march 28, 11:30 a.m. on monday, march 28, >> the senate pack for a short pro forma session on monday as well.

we return back to the national lieutenant governors association, live coverage here on c-span2. >> profile them. they can put on a suit or they can put on their uniform. and they can speak to both groups. but let's bring 'em out, and let's show that they are interconnected. right now we have several national guard units activated. colorado just activated their guard for the blizzard, oklahoma national guard is out supporting wildlife suppression -- i mean, not wildlife suppression, wildfire suppression. [laughter] back that tape up. [laughter] i'm in trouble. wisconsin just activated the national guard today for storms. michigan national guard has been activated for the flint water crisis. louisiana, we have them activated for the floods. we have them activated for the drug interdiction missions. and that doesn't even touch on all those guard and air guard

units that are on standby for operational noble eagle. operation noble eagle. to protect the skies over america, over our homeland. they are ready to go up and scramble at a moment's notice. so let's -- i ask all of you to share their story. you've got the power to bring 'em out. they report to you and your governor. so please showcase them. so thank you for taking a few moments to share this, and i'm hoping you will help us get the word out, and slowly we will lessen that civil/military guide. thanks. [applause] >> thank you, general. excellent. now we're going to hear from dr. scott blackburn of my v.a. task portion in the u.s. department of veterans affairs. [applause] >> wow, thank you. thank you very much. and thank you, carol. that was fantastic -- and i think you've inspired me to tell a little bit of my story to start up. i'm a veteran.

i was a, i was a young army officer when 9/11 hit. i was, i'll never forget i was at fort gordon, georgia, that day in the signal officer transition course. and my unit didn't get called up, but i raised my hand, and i ended up getting, was able to get a detail and headed over. and very soon afterwards in, you know, early 2002 i was in the middle east and was also one of the first troops on the ground. if anybody's familiar with operation anaconda from that time. and it was a big time, you know, for our history and certainly for the army, you know with, fighting force. very few people in the army were, had any combat experience at all. matter of fact, i remember going back to fort wayne wright, alaska, i was the only guy on the entire post other than a few gulf war veterans who had a combat patch.

so i was the cool kid at the time. i had dreams of doing kind of other stuff in the military, but that was cut short by a noncombat injury, a back injury. i ended up getting medically discharged, and the v.a. was there for me. so i had, i applied for the vocational rehab program, was able to get it, was able to go to harvard business school. after harvard business school -- i wouldn't have been able to afford harvard business school any other way. was able to go there, and i went to mckenzie and became a partner there, turning around fortune 500 companies working with industrial-type companies. and then i kind of saw phoenix happening on the news and secretary shinseki, who was, you know, a bit of a hero of mine as originally an armor officer, he was the chief of staff at the time. and he became the chief of staff the same week that i came into, got commissioned and was the

chief of staff throughout, somebody i always looked up to and admired. it was really unfortunate to see him have to resign. and i remember talking out loud saying, wow, you know, i'm working with all these companies and trying to turn around and transform the culture, and the v.a. needs that. the v.a. needs that. and then shortly thereafter, i'm sitting with my family, and i see bob mcdonald was named the secretary. and bob was on the board of one of the companies that i was working on, and literally a few days later my phone rang, and how would you like to serve your country again? that's something that, you know, really stuck with me. my service wasn't done yet. it was cut short by a back injury that -- and once you take the oath, is the oath is for life. and you mentioned so many folks like team rubicon and team red

white and blue that are incredibly inspiring, the vfws of the world that are doing so much great work, and i wanted to continue to serve. so i jumped into it and continued to serve. so that's my story. that's how i ended up here, and i've been with the v.a. for about 15 months. i'm kind of the private sector guy in the v.a. working with bob mcand sloan gibson and a few -- mcdonald and sloan gibson and a few other folks. i'm going to give you a quick overview, i have just a couple of slides to share, pictures to share here. the first one is bob likes to start every presentation that he gives just grounding himself in the v.a.'s mission. why we are here. we are here to care for those who have borne the battles, just as abraham lincoln said in his second inaugural address. we've modernized the language here. and these are the values of the v.a. these were actually developed by secretary shinseki and his team.

when bob came onboard, he did a quick diagnostic, and he found that there is no better mission in government. there is no better mission in the world than caring for our veterans. and our values are fantastic. but they weren't being lived. not consistently. they were in pockets but not everywhere. they looked great, and he said, you know, my v.a. is all about fulfilling that mission. my v.a. is all about living our values. and we're going to turn around and fix it, and that's what we've been focused on doing. but we are also, have heroes that are doing amazing things every single day. so i'll just tell you one story. this was an e-mail that i got about two months ago, and it was from somebody at the, our white river junction hospital up in vermont. and it was a story about somebody going above and beyond.

and we have too much of a rules-based culture, too much of a fear-based culture. people are worried about stepping out of line. people worried about, you know, i've got to follow the rules or saying, no, i can't do this because of x, y and z. and we want to flip that. we want to be a values and a principles-based culture. and we're going to do the right thing no matter what. we are going to say the answer is yes, and we're going to find a way how. and this is an amazing example of three people who did that. so susan livingston was the nurse on duty that day, and a veteran didn't show up for an appointment. no big deal. in some places up to 20% of our scheduled appointments are no-shows. but this was a veteran that sharon knew, and this veteran always showed up for the appointments, and if they didn't, they would call, or if they were running late, they would call. something didn't fit right. the rules told her don't worry about it, move on to your next appointment. but she wasn't going to have that. she called john reich ardson, chief of -- richardson, chief of

police, and john said, you know what? the person hasn't been missing this long, the rules say we're not supposed to do this, that or whatever, but john said, you know what? let's look into it. he asked officer guy gardner to go and track this down and say, hey, could you investigate this a little bit. guy gardner drove by the veterans house, there was snow on the ground, saw there was no tracks, did everything he legally could do and said, you know what? i'm not comfortable with this. called local authorities, they did a health and welfare check, they found the veteran wedged between two pieces of furniture, had fallen, couldn't access the phone, water, couldn't access food and was about an hour away from dying. and if they had just followed the rules and just simply done their job, right? that veteran wouldn't be here today. but instead, they lived our values. they lived our principles of integrity, of commitment, of advocacy, of respect and of excellence. and they went above and beyond.

and today that veteran is alive in that white river junction hospital and recovering. and we're using this, you know, storytelling, because this happens every single day but not as consistently as we want it to be. and what myva is all about is being values-based, being principles-based, and that's the cultural transformation we have going on at the v.a. the one other thing i'll kind of talk about a little bit as well, this is a chart that bob mcdonald likes to use a lot and, by the way, it's bob, it's not secretary mcdonald. he will correct you if he says that. as he likes to say, he is the lowest ranking member of the organization. when he walked into his first meeting, everybody called him secretary mcdonald, they announced him as he walked into the room, everybody's stands up, the placards and all this stuff like that, and he said, you've got to be kidding me. this is not about me, this is about veterans. we're flipping the pyramid, we're putting veterans and their families up front.

those are the people that serve, those are our customers -- he came from procter & gamble -- and the employees, the front line employees are the ones that serve them. our job as leadership is to make those people successful and to serve veterans. and that is a major, major cultural shift going on at the v.a. right now. it's not about the v.a., it's about the veterans. sounds simple but, you know, if you think about it, your behaviors are very, very different if you're all about the v.a. versus all about your k -- all about your organization versus all about the end person that you're trying to serve. the other thing i'll say, so we've launched a transformation initiative called myva. and the origin of the term myva comes from we want veterans to be proud of the organization that fulfills that mission of caring for those who have borne the battle. and unfortunately, that's not the case today, at least not everywhere, right?

there isesome but not -- there is somewhere but not everywhere. we want them to say, hey, we've served our time, we want to continue to serve our country. we might not be whole, but we're very proud of what we've done. and the v.a. helps me out just like it helped me out when i needed to go to graduate school after i got injured. we want the veterans to be proud of it and say it's my v.a. we want employs to -- employees to show up and say i get to serve veterans every single day. there is no place else i would rather work. i don't mind that i'm not paid like the private sector. this is my v.a., and this is my life's work, and this is what i want to do. and unfortunately, right now we don't create that environment for a lot of employees, but we're going to change that, right? we want our employees to say this is my v.a. as well. and we want the american public to take a look and say, wow, this is a model of efficiency, this is a great roi.

any dollar that goes in is going to go right to veterans and be helpful. unfortunately, that's not how a lot of people view it these days. and we're going to fix that as well with. so we're going to get more efficient. the five, just real quick, five strategies that we're trying to work at the v.a. right now or that we are, one, improving the veteran experience overall. number two, we cannot have a great veteran's experience if our employees don't have a great experience. if you think of the best customer service organizations in the world -- starbucks, usaa, wegman's, comcast, organizations like that, they're also the best places to work. it's almost one for one as far as the list. and if you went to starbucks this morning, you wouldn't have had a great experience if that barista wasn't feeling empowered and didn't enjoy working there and going, taking the extra effort. we can't get that employee

experience if we don't solve for kind of our internal problems around h.r. and i.t. and acquisitions and all that stuff. we're trying to create the employee empowerment culture of performance improvement where people are stopping the line, identifying problems and fixing them right on the so spot. and last but not least which i think is extremely relevant here is strategic partnerships. we can't do it all on our own. we don't want to do it all on our own. the v.a. is not best positioned to seven veterans in every single -- to serve veterans in every single case. i work very closely with all of your state directors, and it's been an absolute joy. they were just down in alexandria a couple months ago. i'm looking forward to seeing them all again in san antonio this summer. it's been fantastic. the private sector, comcast, organizations like that, starbucks, as i mentioned, usaa, joe robliss is the chairman of

our advisory board, fantastic partners. the vfos. you mentioned team rubicon, team red white and blue. carol and i met at a travis man onfoundation event, the vfw, the american legion, tremendous organizations that go and serve veterans every single day, nonprofits. and we're looking to partner with them. and for the better veteran experience overall. the last thing that i'll touch on before, you know, sitting down is we also understand that this, we have a huge challenge, and we have a multiyear transformation to go on at the -- there is a lot of issues at the v.a., and there's a lot of issues as carol pointed out that we need to address with veterans and even much larger if we open the aperture out and very, very important things. but we want to, we've set our agenda for 2016, and we basically said we're not naive that there's an election coming up.

all bets are off as far as kind of, you know, who next president will be are, if secretary mcdonald, bob, will still be there. but you know what? it is absolute no regrets to buckle down and get stuff done and lay the foundation that needs to happen to transform the department, deliver the service that we need to deliver. on the left-hand side, you'll see kind of our priorities on, that are going to be veteran-facing in green on the right-hand side, some of the critical enablers in blue. for each one of these, bob mcdonald has taken six, sloan gibson has taken six. they said we're the executive sponsors, we're meeting every other week with each individual team on these for an hour, grilling them, figuring out where they need help, what are the bottlenecks, who do we need to do in the homelessness meeting we have, which i know is an issue, get heather french from kentucky on the phone

because we need to work with them and push, push the agenda there. who are the other partners that we should be partnering with? each one has kind of clear outcomes, clear metrics that we're really pushing, pushing hard on. it's quite a challenge, but you know what? we've got to do it, and we're looking forward to on continuino partner with you to go and help serve those hidden heroes that are out there and kind of unleash that, you know, that sense of service and that sense of pride and help people back on their feet after they've served. [applause] >> well, great job, both of you. now it's time for questions. >> or lunch. >> or lunch. [inaudible conversations]

[laughter] >> thank you. [inaudible conversations] [laughter] >> listen, first of all, both of you, thank you for your service to the country. i wear my 9/11 pin every day because it's changed my life and changed a lot of people's lives in this world. and, you know, i understand where you're coming from, but i never want us to forget that even though, i mean, i never served, but you -- i jump all over the place. i understand your feelings. it's not ptsd or anything else, but i never want to forget that we still have to help a lot. one of the things that i'm finding and i've been working with national guard for years, welcoming them home. the truth is that there's a

different, we're in a different world now. many of these men and women have been sent out overseas three or four times, and they come home, they haven't seen -- they've been away for a year each time. and i just really believe that we have to have more programs for them and their families because the family is separated, and as it is hard for them to come back sometimes, to come back to the regular life in their household, same thing for the spouse that is home that is, has been for a year taking care of that home. and so i guess what i'm asking both of you is -- and i know, listen, the veterans, they need help as much as we possibly can. and the fact that you talked about them getting back involved. tomorrow -- no, saturday i'm

supposed to be going to a campaign meeting for veterans to teach them how to get involved in politics, to get involved in the local communities, statewide and stuff like that. my question to everybody is, you know, you see it from different levels. the base level, i know it's finding out. we in our state have started programs in our community colleges that have resource areas that those veterans want to sit down and talk to each other at times. as you say, we're patting each other on the back sometimes, you need to be patted on the back -- >> right. >> and to people who understand more. so i guess that the homeless issue for our state, we've now cured the homelessness -- >> i know. >> -- for our veterans, and we're very proud of that. but i guess my question is to both of you. as a lieutenant governor, and we

are second in command, what would be the best thing for us to do in touching our veterans? is there a way that you've seen in other states that the leadership gets in there and really has an ability to thank them for their service, talk about what they're doing but at the same time helping them -- it's not a handout, it's a hand up. >> right, that's a good one. may i? well, first, i'd like to reiterate that i am in no way suggesting we don't serve these veterans. we have veterans who need, as you said -- that's a great way to put it -- a hand up. i like to say this is not a needy population, it's not an entitled population, it's a population that is deserving, deserving of exactly that, that hand up. so when you ask what's the best