app. c-span, where history unfolds daily. in 1979 c-span was created as a public service by america's cable television companies. and is brought to you today by your cable or satellite provider. former president bill clinton spoke yesterday at a summit in baltimore on the opioid epidemic. elijah cummings was also present. a white house drug czar from the obama administration and police chief from ohio. bloomberg school of public health at johns hopkins university. this is two and a half hours. ladies and gentlemen and

online viewers around the world. good morning and welcome. i ellen mckenzie, dean of the johns hopkins school of public health. i would like to start by extending a special welcome to president bill clinton. and also joining us today, several policymakers leading the way in health reform including congressman elijah couplings and dr. lianna wynn who will join us here in the program. also in the audience. congressman john sarbanes, antonio hayes and representation from senator ben carsons office. i would like to extend an especially warm welcome to senator barbara mikulski whom we are now proud to call -- [ applause ] who we are proud to call one of our own. thank you so much for being here. we are indeed honored to be

working with the clinton foundation to bring you today's summit on one of our most important public health problems, america's opioid epidemic. this is a national crisis that demands involvement from all levels of government, public and private organizations as well as from individual citizens. nearly 100 -- every day nearly 100 die from opioid overdose. over the past 15 years the death rate from opioid overdose has tripled. the causes are complex. millions with chronic non-cancer pain are prescribed opioids instead of safer, less addictive alternatives. heroin is more available and increasingly contaminated with fentanyl. and far too often -- far too few people have access to evidence-based addiction treatment. the bloomberg school's leadership in preventing and treating substance use disorders stretches back nearly 50 years when we founded the nation's

first graduate training program for drug and alcohol counseling and advocated for the adoption of methadone in federally funded treatment programs. the leadership has been settlemented in the two programs. our collaboration with the clinton foundation to address the opioid crisis began in may of 2014 when president bill clinton lead a town hall in this very room focused on the rising rates of injuries and death from prescription opioids. the resulting synergy, united national leaders from academia, government and the private sector and paved the way for yearly-long effort to synthesize efforts and identify best practices. based on this initial engagement in 2015, the bloomberg school and the clinton foundation produced a document that identified a path forward and framed the problem as a severe public health issue.

this document called for scaling up existing evidence-based interventions to prevent future loss of life. despite such efforts, however, we still have a long ways to go. opioid deaths reach an all-time high in 2016 and the numbers keep rising. despite recent announcements by the white house, our country has not yet embraced -- addressed the real need for urgent action and a true commitment of resources. a new report just released by the bloomberg school and the clinton foundation entitled the opioid epidemic from evidence to impact describes ten pillars to address that complex epidemic now, including implementing prescribing guidelines, optimizing prescription drug monitoring programs, advancing engineering solutions as well as combatting stigma. these strategies work. they have been shown to work. and today you'll hear from experts and advocates working

together to change the course of the epidemic by further developing and implementing these strategies and generating new evidence. but we need your help. please, let's work together to stop this deadly epidemic. i am honored now to introduce congressman elijah cummings. born and raised in baltimore. he has represented maryland's seventh district since 1996. he is the ranking member. as co-founder and chair on drug caucus on health policy he has helped shape national policy ton drug addictions, drug trafficking and access to affordable medications. join me in giving a warm welcome to congressman elijah cummings.

[ applause ] >> good morning, everyone. >> good morning. >> we can do better than that. good morning, everyone. >> good morning! >> it is my honor and privilege to be here. i want to thank you, dean mckenzie, for your kind words. more importantly, i thank you for your work. i must take this moment -- i have to do this -- on behalf of my family and certainly on behalf of generations of cummings yet unborn, i want to thank johns hopkins for taking good care of me. [ applause ] having spent almost two months in the hospital just a few blocks from here, after a heart

procedure, i must say that i have grown to love johns hopkins even more. so to dr. richard, sisson and the staff, the cleaning people, the cafeteria folks, everybody, everybody associated with this campus, i thank you for changing the trajectory of my destiny. i truly, truly appreciate it. thank you. [ applause ] i am honored to join former president clinton and dean mckenzie in welcoming our distinguished panel to this third summit on our nation's opioid crisis. certainly always good to see my good friend, my mentor, and i

will always call her my senator, senator mccullsky. i understand mr. sarbanes is in the room. i am glad you are here too. the danger that we now face and must overcome is more viralant now than ever. prescription opioids, heroin, fentanyl and other synthetic drugs were involved in more than 60% of overdoses last year that resulted in 64,000 deaths. let that sink in. 64,000 deaths. here in maryland at least 2,089 people fatally overdosed in 2016, up 66% from 2015. this is stark evidence of how

these dangers in human devastation are expanding exponentially. there is a bipartisan announcement that a national health emergency crisis does exist. resistance remains. in both the white house and congress to taking bold action. earlier this year the president's own opioid commission led by governor chris christie recommended that the process declare a national emergency. as all of you know, last week the president declared a public health emergency, which is a good first step but does not unlock any additional federal funding to confront this crisis head-on. the christie commission also recommended something else.

that the president authorize the secretary of hhs to negotiate lower prices for naloxone, the life-saving drug that reverses the effects of opioid overdoses. and i am sure you will hear a lot more about that from dr. nguyen, who has been a staunch advocate of expanding its usage. right now our people on the front lines of this epidemic cannot afford to stock up on naloxone. that's why last month i led 50 house members in sending a letter to president trump asking him to adopt this recommendation. we didn't ask him, we begged him. unfortunately, the president didn't even mention the word a "naloxone" in his announcement last week.

finally, the president and congressional republicans have spent years, years, trying to repeal the affordable care act and reverse the medicaid expansion, even though medicaid provides treatment services to 3 in 10 people who struggle with opioid addiction. if we are going to respond to this epidemic, we need your evidence-based research and your continued active engagement in the public debate. we must encourage the president to follow his own commission's recommendation to expand the availability of naloxone and reduce the cost. we must press insurance companies -- listen to this -- we must press insurance companies to eliminate their bias in favor of opioid-based painkillers and we must challenge our friends in congress to expand public health

funding, preserve medicare and safeguard medicaid. finally let me say this. you already know that our response to this public health crisis is a test for our community. it is also a test for our entire society. my good friend from maryland, congressman john delaney, has an expression that applies directly to the current crisis. it's one of those you hear and think, i wish i invented that. i think all the time about these words because they're so true. he said the cost of doing nothing is not nothing. tweet that. the cost of doing -- think about it, though. the cost of doing nothing is not nothing. so let me repeat it.

the cost of doing nothing is not nothing. and we've seen it over and over and over again. and so, ladies and gentlemen, i thank all of you for being here today. we are an army, and we are going to fight and we will overcome. thank you very much. [ applause ] >> thank you very much, congressman cummings for your leadership on this issue and those inspiring words for us today. i am now thrilled and introduce and welcome back to our school president bill clinton, founder and board chair of the clinton foundation and 42nd president of the united states. after leaving the white house in 2001 president clinton established the clinton foundation to build more

resilient communities by improving global health, strengthening local communities and protecting the environment. in 2002 he launched the initiative to negotiate prices for hiv/aids medications and extend access to 11.a million people in over 70 countries, an achievement that many thought was impossible. using a similar strategy, president clinton negotiated national partnerships with two pharmaceutical companies to provide predictable, affordable supply of naloxone to community groups, public safety organizations and schools and universities. his goal, to cut prescription drug abuse deaths in half over the next five years. saving approximately 10,000 lives. this would be done through strategic partnerships that raise consumer and public awareness, advance business practice change, and very importantly, mobilize communities. please join me in giving a warm welcome to president bill

clinton. [ applause ] thank you very much. thank you. thank you. first of all, dean mckenzie, thanks for having me back at the bloomberg school of public health, and for the ongoing partnership we have had in confronting the opioid epidemic. i want to thank congressman cummings for his remarks and his leadership on this and many other issues. he said that senator mccullsky was his role model, and he certainly proved it in the last couple of years.

when barbara was a senator from maryland, she was on a very short list we kept at the white house. it was called the justice say yes list. [ laughter ] >> of years when barbara was at the white house, she was on a very short list. it was the just say yes list. when she asked you something, you knew sooner or later you were going to cave in, because she was like a dog biting your leg. let's save a lot of time, figure out what she wants and say yes and we'll be able to go back to work. i'm glad to see her here. i'm glad she's teaching here. i want to say thanks to two other people for inspiration in hub health. one is mike bloomberg for funding this effort. he's got a lot of money, i know, but he could have done other things with it.

he was a great public health mayor of new york and this is a great school. the other person i want to thank with our foundation who is not here is my daughter, chelsea, who teaches public health at columbia and is sort of my family in-house free expert on anything that lights the public health policy and who urged me for years to get involved in this when most people weren't paying any attention to it. i want to thank mostly all of you for being here and agreeing to take action. the cdc's latest provisional data says that in 2016 more than 64,000 people in this country died of drug overdoses. well over half of them opioid related. if this data is confirmed, and

we have no reason to believe it won't be, that means last year more people died of opioid-related drug overdoses than the numbers of death from the aids crisis at the peak before it was treated. then from gun related homicides or from automobile accidents. opioid-related deaths are now the leading cause of death for americans under the age of 50. virtually all of us know someone in the family that has lost a loved one. hillary and i have five friends who have lost their children. i've learned a great deal from

these families. one of them had a son who was working for hillary when he died and had worked for me. it was in the law and mba program at george washington university. avenues very smart man, but nobody ever told him you couldn't pop a pill to get above drinking five beers before you go to sleep or you might never wake up. everybody has got stories like that. and now, as we know, the epidemic has grown like wildfire in small towns and rural areas with no public health infrastructure where people don't know what to do or can't do it if they know.

it's not only a human tragedy, the cdc estimates it costs us more than $78 billion a year to continue to do so little ensuch a fractured way on this problem. health care costs, criminal justice-related cost, addiction treatment, lost productivity. yet for all the noise that's been made about it and the genuine legitimate concern and extraordinary efforts being made by people with nothing. and i mean nothing. i was in chillicothe, ohio, about a year and a half ago. a little town in southwest ohio. and i was very proud of looking at it, because it was totally rebuilt, an early 19th century town, all the beautiful

buildings were renovated because of investments secured partly under new markets tax credit, which was the last completely bipartisan initiative i signed to get people to invest in small towns and rural areas with high unemployment and low per capita income. that was the bad news. the good news, the most beautiful building given over by the city to doctors who voluntarily came there so they could practice in appalachia. it was beautiful. there was a doctor born in poland, got her medical degree in new york, who was living in one of those lovely apartments. but i walked out and across the street this woman is waving frantically at me, please come over here. so i do over, and she said, i only owned one asset of any value, a used car. i sold it and rented that

office. what you're seeing is the only drug treatment facility we've got in this town. she then introduced me to the husband of a woman who died of drug overdose, opioid addiction and three women who were recovering heroin addicts. she said, look, i'm happy to do this. i know nothing about it. i get whatever help i can, and it's all we got. i'm glad that one of our panelists is head of public health in baltimore, which had the first public health program of any city in the united states going back to the late 18th century. but in many places, community health networks have been allowed to atrophy, ever

expanded to embrace this mission. this is like a good news, bad news story to me. the good news is, this is the first drug epidemic when we act like a grown-up country and treating it like a public health problem, instead of primarily criminal justice problem. [ applause ] some cynics have said that's because it started in a small town rural white people epidemic phases before it spread to the cities and may be something to that. i think the more likely expansion is this is the first epidemic we've had killing this many people that had a nonviolent delivery chain. now, the problem is, as we all

know, the more we get into heroin grown in mexico, harvested by preteens and fentanyl, the more likely we are to see more violent delivery systems as people fight over turf for guaranteed money. so it's coming to -- this movie is coming to a theater near you, whoever you are, whatever your color is, whatever your politics are. and so that brings me to the bad news. it's a public health problem. we've recognized it. good for us, we're growing up as a country. we're seeing all these people as people. the bad news is there's a woefully inadequate public response not properly coordinated with law enforcement, with the treatment

community, with the insurance, with you name it. so what we're here to do today is to figure out what to do next. the next panel after ours -- what we're going to try to do is identify what many of you already know, but the general public may not, which is where are we right now, what's being done that's good, what are the gaps. then we go to the second panel, and our panelists are here. they are going to discuss the report we're releasing today, clinton health matters initiative along with the bloomberg school called from evidence to impact, which is a sort of professional way of saying we know what the heck is wrong, we know what we need to do, how about we do something?

there are proven recommendations in this report for combating the epidemic, from allowing physicians to effectively treat those suffering from addiction much better than some of them are allowed to now because of all the barriers you know, to expanding coverage and accessibility of proven helps, changing the way health care professionals, employers and advocates actually talk about addiction so that we can reduce stigma and get people out of the closet quicker. because it's a terrible, terrible problem we've been working on this since 2012 as she told you.

i want to thank them for offering free packages of nil oxen, as they can with limited producti production, they have been great partners. i know there are debates about that. all i know is we've got a lot of people dying of drug overdoses and most are opioid related. if you can save a life, you ought to do it. i want to briefly say three things we're going to do from here forward and then bring the panel up. first of all we have known for some time sigma plays a major role preventing individuals and families from seeking treatment

or accessing sources. so in partnership with facing addiction chmi will launch a communications strategy designed to tell them people to get over it now the proper public health word toys empower them. what you know with a couple of people who lost their kids, i think we should dispense with the niceties, this is nothing to be ashamed of. it's a problem, a health problem. we have to hammer that. employers need to hammer it. no, you won't lose your job unless you're too bullheaded to get help to save your life, save your family, save your kids' future. we need the same message

everywhere. second, chief, law enforcement, thank you for being here. cripple justice and dependency experts share similar goals but they don't coordinate as much as they should, they don't cooperate. we don't one simple comprehensive strategy, even in p cases where you can take the money being spent and spend it more effectively. so we're going to work with the institute of justice to reduce opioid overdoses by people who come in contact with the criminal justice system, by having simultaneous contact with everybody else who can play a role in this. finally, our community health initiative works in several counties in america today and communities. we have learned that what we thought we were doing when i

started this, i thought we were going to go to all these people and say the biggest health problem we've got before the opioid issue blew up on us is childhood obesity, please come in and help us. but we said that first we would ask the people. it turns out like jacksonville, where i'm going when i leave you, has the third highest rate of deaths of pedestrians by drivers in america. did you know that? it's a city/county government. you're in the city proper, like you're in baltimore. all of a sudden you're still in the city limits, and you're in the country, and you literally drive and don't notice it unless you're just used to living there. so if you walk across a certain line, you may confront a car driving 60 miles an hour. so the point is we had to adjust this strategy in all these

communities. but everywhere they say we need help with this. so we're going to do more than we have done to build up coalitions of stakeholders. every other issue, we're getting everybody involved to fight together. we can't let this one alone. i'll just give you one example, and i'll introduce her more effectively in a moment. randi weingarten is on this panel and american federation of teach e teachers also represents 40,000, a lot of nurses anyway. kids are in school. this summer -- i'll never -- this summer hillary and i go -- we go out normally to long island as far out on the island we can get, find someplace our grandkids will come play with us in our dotage.

our daughter and son-in-law called and we have a good time. i try once a summer to go out to this wonderful old public golf course called montauk downs. it used to be a raceway in the '20s. still a great course. there's all kinds of people there. ordinary folk not rolling in dough come. afterwards i get off the course and about 40 or 50 people just appear. and they start talking to me about various things, some of which you would guess, but it didn't take long to get to this. and we're talking. it took me 40 minutes to get away from them. what were we doing, what were other people doing, what can be done in the community. most of them people were from long island but a lot from

there, too. they were desperate. there was one good looking one guy with big eyes. his eyes kept getting bigger during the discussion. i'd say 19 years old maybe. everybody walked away by him. i said, i've got to go, i've got to go. he said, i want to thank you for doing this. he said, i just got out of rehab. and i didn't think anybody cared about it. so i asked him how old he was. he told me. and he said -- i said, well, how do you feel about it now? he said, i think i'll be fine. he said, my family is supportive and i got a lot out of rehab, and i don't want to die. i want to live. but he said i think it's a shame that you've got to come from a

family like mine to be able to afford the rehab i had. why should i live knowing other people are going to die just because they don't have a family like mine that can afford it. this is a kid. he says, i'm happy. i know i should just be happy. but he said i can't get over the fact -- let me ask you something. did anybody ever tell you in college or in high school that if you opioid and alcohol and went to sleep, you could die. just that one simple thing. he said, no, not once. not in any class. why shouldn't we push for that? just for example. so the good news is, everybody from the white house to the smallest farms in america know this is a very big problem.

the good news is there are lots of good people everywhere who are working on it. the bad news is it's still not very well organized. for a lot of people it's not properly funded. and if you save people's life with the drug, you have to get them to the hospital fast. this is a multifaceted problem. we have to do this together. i may be wrong but i believe if we don't do what congressman cummings said, we'll regret it for the rest of our lives. this may be one of those if we build it, they will come.

if we can prove significant numbers of people whose lives have been saved, we can get the money we need. we'll be able to overcome the resistance. i'd far prefer someone take the tax cut i'm being pledged and spend it to save the lives of the young man like that i saw. or the five i knew who dependent survi survive. so you should feel in a funny way privileged to be here because you're being asked to turn the tide on a great problem that will preserve the lives of people you don't even know, to do things you can't even imagine. thank you very much.

[ applause ] >> thank you. i want to ask the panel to come up here. first tom geddes, ceo of plank industries and ceo of a local hospital and very interested in all this. and associated with one of the great american success stories under armour headquartered in baltimore. i recommend you go there. it's very humbling. when you walk in all day every day there's a man or a woman or both running on treadmills, because they test to see how long the running shoes will last. last time i was there, i was there for two hours. there was a young woman there

running on the treadmill at about a five-minute mile. she was flying. and when i left, she was still flying. i thought about applying for a job to test the durability of shoes on old people. maybe it would finally get me to do what i need to do. randi weingarten, as i said, ceo of american federation of teachers. i want to say just a couple of words about her. she is, first of all, a former teacher whose students repeatedly won state and national prizes for their expertise in the u.s. constituti constitution. and she's a partner, has been in planet global initiative for

america. she and construction unions organize the largest private infrastructure program in the united states. they raised $16 billion. they have committed $14 1/2 billion. they have spent $12 1/2 billion. they have created 100,000 jobs and trained 900,000 people to do infrastructure work and it database cost you one red cent. [ applause ] >> dr. leanna wen, runs oldest health department in the united states of america. she, i believe, was the first person in america to issue a planningette prescription for naloxone. [ applause ] which she said 30,000 people have already claimed.

so it's very important not to overlook things we could do while we're belly aching about what's not being done. congressman elijah cummings, as i said, in my opinion is a guy you ought to just say yes to because he is thoughtful, smart, tough as nails, and he always shows up for work in a very good way. [ applause ] so we will begin. >> okay. i'm going to ask you questions. then if i don't cover you want to say, say it anyway. imagine you're barbara mikulski asking for more money for a science and technology project. first of all, what do you think

the most important thing we could do now is to get more people to act on this research? i'm interested in practical things that could help millions of people. we've got all this research we know. if someone comes in surviving an overdose, the whole plan of action can be undertaken, if there was somebody to do it and some way to fund it. but what in your opinion, each of you, what's the most important thing we could do now to take what we know and make it work and local communities, with what we've got. it's okay if you say we need more money. if you could just take the system we've got, want to maximize the impact, what's the most important thing we could

do. >> i was going to say money, so you stole this one from me, president clinton. >> one of clinton's laws of politics is whenever somebody tells you it's not a money problem, they are always talking about somebody else's problem. [ laughter ] >> well, for us in baltimore, and we're very glad to have the partnership of so many in this room, including bloomberg school, we've been able to do a lot with very limited resources by issuing, changing policy, so that we can get the blanket prescription for narcan out there. we've gotten 30,000 people trained. but it's not just about people getting trained, it's about people actually delivering the services, too. so i'm happy to report that our latest numbers are in the last two years every day residents have saved the lives of nearly 1,500 of their fellow community members just by dplifrg neliver narcan to family members, community members. that's something tangible we've been able to do.

as congressman cummings mentioned, we're being priced out of the ability to do that. we're actually having to ration naloxone every day. i have about 10,000 units of naloxone to use between now and july of 2018. if i got 10,000 units today, i could give them out by the weekend. that's how much our community is asking for it. so if it's a question of what more we should do, we should scale up interventions we know already work. we know the science is there in terms of treatment. >> so what happens to those people -- what happened to the 1500 people, the ones you brought back? >> many of them are referred to further services. our hospitals now have an overdose survivors program where peers, who often are in recovery themselves, speak to those who have overdosed and helps connect them into treatment. our problem is we don't have nearly enough treatment capacity. nationwide one in ten people

will have the disease of addiction can get treatment, so we also need to expand treatment, because it's important, an important first step. they also have to get into treatment to help them longer term. we do need more resources, there's no doubt about it. i'm convinced people, mr. president, do things for two reaso reasons, or combination of both. one of two reasons. either to avoid train or gain pleasu pleasure. i think we have to convince our policymakers that they should not be trying to reduce medicaid. a lot of people who need this treatment would be able to get

it. at the same time we see members of congress crying at the funerals and on the 6:00 news. but when it comes time for making sure that the programs are there to help their very constituents who live right up the street for them, suddenly they get amnesia. that's very unfortunate. last night i called my fella who has been off drugs for 30 years. i said, ricky, what can we do? this is the very question you just asked. he said something to me i didn't think about. he said, elijah, in baltimore, we've got a whole army of people who used to use drugs. some kind of way we need to find a way -- those are the people who are most adamant, you notice, trying to help people

get off of drugs. some kind of way you need to use them because they have already been through the pain. so through their pain came their passion to do their purpose. come on, now. pain, passion, purpose. we need also to encourage people to be part of that. these are people that are out there and they have already been through it. and so just some thoughts off the top of my head. >> mr. president, to answer your question of what happens to the people revised under dr. wen's plan, we had a patient at the hospital who was revised. what happened by law enforcement, what happened was next survived by the fire department. the third time he was revised by a fellow user to went by a dumpster to use drugs, he found him, used narcan and where is he

now? he's soesh andber and alive and working. that's the work we're doing now in baltimore. >> so to that point as well, education is absolutely imperative, but it has to be coupled with a quick intervention like narcan. what we saw, for example, is our nurses in cleveland. we're now the second largest nursing union in the united states. the school nurse in cleveland demanded that the cleveland public schools actually have a supply of narcan in every single school. when they didn't get it, they got a grant to do it. and now they are getting it because this nurse actually revised a parent of a child. and i tell that story because the stories are important to destigmatize and educate. i think that there's -- i think

your point, mr. president, about they will build if we have enough pressure on the system, but the pressure comes with education. and so, for example, dr. wen was at our conference this summer with actually i call her dr. mona from flint talking about the issues in terms of border and issues in terms of opioid addiction and the epidemic. but i also couple it with a stick, which is there are a lot of worker pension funds that are invested in big pharma. so we are actually starting to do, frankly, what "the new yorker" magazine did this week as well in terms of creating some public pressure to reduce the prices and use the public pension funds as a way of trying to figure out how to reduce the

prices of narcan and other absolutely effective intervention drugs. >> are there any public school systems in the country you know of that actually have some policy of educating kids about the dangers of this and telling them basic things like what happens when you mix opioids and alcohol of any kind? it looks to me like what have we got to lose by having the appropriate experts approve a paragraph or two that could be read to every school kid in america at the opening of every school year. what have we got to lose? a lot of people, i'm convinced, are still dying in ignorance. you know, our -- i think our preconceived notion here is

often right. you've got people who use these opioids over and over and over again and then finally die. they overdose as addicts, or trade down heroin or fentanyl and they finally die. but there are lots of people who are being killed by the combination. that's just one example. is there any school district or any state that says as a matter of policy, we have run this by all the professionals, we want every kid in our coverage to hear this particular message. >> we actually just got legislation passed in maryland so that we are in baltimore city, for example, working with our schools to implement standardized curriculum on this topic. it's complicated. if i go to one of our schools and ask if the students think that using heroin is good or

bad, they will all say, unless they are trying to be snarky, they will all say heroin is bad. but if i ask them about prescription drugs, they might give a different answer. because they see their parents or their caregivers every time they have knee pain, they are taking percocet. or they have back pain, they get vicodin. there is a culture that we have, as you have spoken about this pill for every pain culture, that that pill is being used to treat physical pain as well as potentially emotional pain and deeper, other types of pain as well. so i think that culture has to change from the medical profession. it also has to change from each and every one of us with regard to prescription opioids. >> shouldn't these kids know you can abuse these things and they could kill you? are their parents? >> i don't know about school systems, but let me tell you one thing. when i was growing up, the first overdose i ever heard of, i was

seven years old. that was 60 years ago. i was seven years old. i didn't even know what drugs were. i didn't know what overdose was. all i know was bay bay, one of our neighborhood guys, had died from an overdose. i think education is important, because for me, my entire life i've never touched an illegal drug, none of that. you know why? i was scared. i was scared that my destiny would be ruined. i really was, and still am. i don't play. this life is precious. but i also understand the argument, mr. president, that is made when people say that what we want to make sure that people get the relief they need under certain medical circumstances, because when i was here at

hopkins, i'm going to tell you, i didn't know you could be in that kind of pain. i really did not. every morning, i'd get up and i was in so much pain, you almost want to die. so i can see where people can get to that point. there's something else we can do. that's one of the things we're looking at in our committee is why is it that the insurance companies favor paying for the cheaper addictive-type drugs -- come on now -- as opposed to those drugs that are nonaddictive, or least addictive, that are more expensive. we are doing a lot of research on this right now, in my commit, to address that issue. there's a lot to this. but again i am convinced, yeah, if you tell somebody -- some people you're going to die, or you're going to be harmed, it seems to me that some of them

will say, no, i'm not going to do this. >> when i was a kid in seventh and eighth grade, we actually had health classes. it was a different period of time, and there were a lot of jokes about the nancy reagan, just say no on drugs that ultimately people corrected and understood, stop stigmatizing at that moment in time. but there is someplace for having a real focus in schools on well-being. i frankly have flipped my own advocacy on schooling to start first and foremost with focus on children's well-being and then on powerful learning. because i think we have to actually meet kids where they

are. i think we should think about in light of having the new federal policy that deemphasizes tests to really think about how we do some of these things in schooling. childhood obesity is an issue as well, but it is about how we try to focus on well-being and have some kind of health-related work for kids in elementary school, junior high school and high school. it will be different developmentally for each of those years, but it's really important. i think it's more important, unfortunately, than at the beginning of the year going through the list of all the things we want to tell kids. that paragraph could be lost while elijah and i are talking to each other and not listening to that paragraph. so that's why i think we have to try to figure out pedagoguically

in a way that really goes to kids human being. >> i skipped the middleman and brought my daughter today. i thought this would be the best possible class for her. laura geddes is here. it's not too young to hear about it. mr. president, your question where do they hear it, my wife had a hip replacement at the grand old age of 41. she took time to educate our children as she was taking herself off narcotics she needed. she explained to them that she needed them and made sure they understood getting off the drugs is a priority. that's not happening in a lot of households. she's a wonderful mother and our doctor is leanna wen, under her supervision, too. an organization i'm involved with here, i noticed on the white board for her nursing staff, the pain protocol where it had last dose, pain level out of ten, the tag line is your comfort is our priority.

your comfort is our priority. this will be something i will be bringing up at the next board meeting to say you're recovery, health -- comfort is not necessarily the priority when you've had a full hip replacement. it's uncomfortable. as congressman said it will be very uncomfortable. her doctor said your managing pain to a seven, not 0. that's not the message we're getting and not the question kids are getting unless they are lucky enough to come to a session like this. >> let me ask you this. how much of a problem do you believe is a part of this continued overprescription? either a prescription of an opioid when a nonopioid painkiller would be effective in certain circumstances or prescriptions in amounts too great to be safe to leave in one place? how much of a problem is that

still? and if it's a problem, what else can we do about it? if there's something that private or public entities ensure lots-of-people can do to pressure the system and clean it up. >> my confession as a physician is that i have overprescribed opioids to many patients and not realized it. in medical school and medical training, i didn't learn about the addictive potential of opioids. i just learned as mr. go aheades was saying, that it's important to take away patients' pain. we doctors want to do the right thing. if they say i need opioids -- if they say i'm in pain, we give it to them. that tide is turning. we are beginning to change our mind-set. i'm hearing our medical schools in the city and also our hospitals now changing their practices. we've convened all of our doctors, our emergency department doctors, our primary

care doctors, dentist to teach about addictive potential and talk about why we need to decrease overprescribing. i think there's another issue, too. this the supply side. there's also the demand side, too. as long as we have people who have the disease of addiction, they will continue to seek out prescription drugs or heroin or fentanyl unless we can get them into treatment. so it's our recognition that addiction is a disease, that treatment exists, recovery is possible, and that we have to get treatment to people whenever it is that they are ready while also working on reducing the supply of drugs while reducing overprescribing. we have a big enough health care insurance pool. for example, the city of new

york when i was the union president and at uft, we had the entire city of new york's families. and we were a very, very big foot in the negotiation with drug companies, when you could negotiate with drug companies, and the negotiation with pbms. i think there is a lot to be said towards that. i think the dilemma is, as the doctor just said, look what's happening with fentanyl. if we don't actually deal with the issues of treatment and the issues of education, there's always something somewhere that is going to be there for either pain or joy. and that, i think, as congressman cummings said, we have to change enough of policy and enough of education and destigmatize, as you said, mr.

president, to try to deal with it. >> this morning i just mentioned a word that i think we all need to kind of center on, and that's stigma. you know, mr. president, when people find out they see somebody on drugs in their mi t midst, a lot of times they look at it as a moral failing. in other words this person just can't make decisions right, or they are weak, or they are looking for the easy way out. and then a lot of times people, by the way, are therefore afraid

to come forth. they are not like what you mentioned mr. geddes, where they are able to get somebody back on their feet and moving. an employer will say, wait a minute, i've got ten people who need jobs, and all with no drug problem. i've got this one person who's got a drug problem, maybe a good employee, but why do i want to risk that. that's a tough one, and getting past that. but in talking to the people that the former drug addicts i talked to, they tell me that basically a person does have to hit rock bottom. but they have to be able to get that treatment and get it quickly. i think that's what we've got to work more and more towards trying to get that treatment and get it quickly. there's another thing we've got to make sure that we do. that is make sure the treatment that is given is effective and efficient.

you've got a lot of people putting up little store front. i'm telling you, i don't want to mention any names. but there's certain parts of the city you can ride in. you'll see big signs, basically come get your methadone. so people are, i think, going there getting a coping drug. i'm not knocking methadone. there's nothing else going with that. the experts here, dr. wen can tell us even better, usually if a person has a drug problem, there's something, a mental illness situation they are connected in some way. you can't just deal with just the drug problem, you've got to deal with the other. am i right? >> absolutely. we need to follow the science. the science is that treatment for opioids exists. there are millions of people in long-term recovery, and it's a combination of medications

including methadone and others with counseling and other services, because housing, for example, is health care, too. >> first of all, i'm glad the last two or three comments have been very helpful. the thing i was most impressed about about that woman i met in a little town in ohio, is that she said i don't know what i'm doing. i want you to put me out of business. i'm not getting paid for this. i've got no business doing this. but nobody else is here. i trusted her, because she said, please, put me out of business. i'll be glad to be a counselor in somebody else's efforts. so what is the answer? let me ask two specific questions. how adequate is the coverage

today under medicaid? [ laughter ] >> how adequate -- how much do private insurance companies that theoretically cover this require waiting periods and what are the possible down sides to that? and if you were starting from scratch, if you could wave a wand, would you locate at least initial assessment and treatment in local public health units properly funded and staffed and accessible to law enforcement, to emergency personnel, to others, or would you -- or is that totally impractical and should people just be going to doctor's offices or specific programs? my feeling, is the capacity there to treat all these people if the money was there?

and if it's not, where should it be built out? so number one, how adequate is the coverage? number two, are waiting periods still a problem with private insurance? and number three, how would you deliver it even if everybody was covered tomorrow. we'll go. >> i'll answer the last part first because one of the major issues that we see here is that even if we have enough treatment, which we don't, but even if we did have enough treatment, and even if we had enough payment, which we don't, but even if we did, a major problem is we cannot connect people to those treatments. so there may be somebody who is ready -- >> because why? >> because they are not reaching the individuals in time or they are not getting services where they are. what we need, for example, in our health department i oversee our needle exchange programs.

we have needle exchanges at 20 sites across the city. somebody may come to the needle exchange and say i'm ready for treatment right now. we need for more people able to connect them into treatment and say, here are five different options for you. you don't have health insurance now but i could help you get there. i could physically take you to this treatment center. if you're ready right now, i will help you do that. it's those types of connections we don't currently reimburse for that we need to figure out. we started a program to the city called lle.a.d., law enforcemen assistance division where caught with small amounts of drugs will get treatment instead of incarceration. it's time intensive and resource intensive and funded by grants, not reimbursed through medical insurance. so it's those types of peers, speaking of peers who have been there themselves and walked through the shoe of the people we serve that we need to figure out how to pay for and connect

with treatment. >> if you had the money to pay for the connection stuff, everything you just said, where would you lodge it? i mean the ultimate -- look, if you got your standard i'm addicted to painkillers, this the third time i've shown up, naloxone saved my life. you got me in the hospital, you need to put me in detox. i do through detox. detox is over. now i've got to go into real treatment. where would you put that? who is going to provide that? >> i would put it everywhere i could put it. let me tell you something, mr. president, the problem is nobody wants certain things in their neighborhoods. come on now, don't act like y'all don't know what i'm talking about. they don't want it in their neighborhood. so as elected officials, am i right, senator mikulski, it's really a hell of a battle. i think in those roles i

remember seeing on cnn where they were talking about these west virginia town that basically was getting all these millions of opioids and the population was 300 people. so people were just flocking there. of course a lot of the 300 were -- had problems, too. so i would want those facilities wherever -- all over the place if i had the money. and then i would try to, again, get people who had been through it, to invite other people to participate. dr. wen and senator mikulski, big advocates of healthy start. healthy start is based on women who have had babies. am i right? they have been through it, so therefore they are able to teach others and encourage them. so if i've got a drug problem,

and i come to you and you say, man, just like the fella i talked to last night, my friend ricky faison, former drug addict 30 years off. you go to ricky and say i've got a problem. he says, look, i'm a barber, doing well, making money. i'm doing for my neighborhood. i've been where you are. i've been where you are. let me take your hand and take you to this place. that will make a difference. that will make a difference. i'm telling you, it will make a difference. >> so it's kind of dealing with -- let me start this way. when people have cancer, they make the connections, because there's a sense that cancer could affect all. it's not stigmatized. people try to get well.

that's why the stigma becomes really important to address. this is a national crisis. born out of a lot of -- you and i have talked about this before, mcdowell county where we work is one of the highest opioid epidemics for users. we saw that five years ago. we said, what's going on in ohio, west virginia. the anxiety of loss of jobs, loss of hope. so we have to flip the switch on the stigma, and then try to figure out how to do this, i think, through employer, through medicine, through doctors, and do it in a way that gets more and more treatment centers built, and more and more information out there in a way which is positive and proactive.

>> as the congressman said, the cost of doing nothing is not nothing. we can't afford not to find the money. from an economic perspective, this is what i call an unnatural disaster. mr. president, you mentioned the figure of $78 billion of annual economic impact, hurricane sandy five years ago was $65 billion. so we're talking about a major hurricane hitting the northeast of the united states level of economic impact we're suffering from this crisis. not to machines loss of life which is like hurricane katrina every three or four weeks. we can't afford not to make this a priority. we're worried about travel bans and walls. this epidemic is killing more people than international terrorism has since before i was born. i don't think we have the awareness people have, i don't think there's national awareness, i don't think employers have that awareness. employers need in terms of making those connections, where do we spend our time, we spend most of our time at work. sad reality of americans, we do.

hr and managers and employers are not recognizing and helping and treating it as if they would treat an employee with cancer. >> what's your sense about how large employers are handling this? is there any kind of general consensus? do they make their employees feel like they won't be fired and they will be helped if they show up and say i need help? do they, in effect, confirm what you might call the stigma bias by making them think they are toast if they have to fess up? >> sing my sense is that on this issue, as with the broader issue of hiring returning citizens, i think there are a handful of companies that are demonstrating real leadership. we saw that under obama administration with fair chance business pledge. i was in the room with 12 or 15

very large, coke, fedex, a bunch of big employers, very up front on these issues. a lot of people don't work for these companies or work for large employers. a lot of people struggling with these issues work with small employers or not at all. that's where the public health interventions are going to have to take place. i think the conversation is beginning. but given the numbers i was talking about, given the economic exact i was talking about, giving the impact on lives, the conversation in the private sector is way behind where it needs to be. >> do you think there's a difference, and maybe elijah can talk to this, too, do you think there is a difference in the degree which stigma remains a problem in small town and rural areas as opposed to urban areas or do you think it's pretty well uniform? >> i think stigma is everywhere. it's everywhere. you know, people have a lot of pride. first of all, to even

acknowledge that you have a problem, people don't want to admit that. they just don't. and then they do throughout their lives, deny, deny, deny. yet still their -- again, the people that i've talked to tell me by the time the person is going into the medicine cabinet to use mama's pills, they already have a problem. they already have a problem. people just assume it's almost like your 16-year-old just drifted off into your medicine cabinet and saw something and thought they were m&ms. no. they knew exactly what they were doing. so we've got to -- so we've got to concentrate on education and trying to make people realize how significant problems can arise. when i was chairman of the

committee on drugs, the oversight committee many years ago, we had some students, mr. president, come in from baltimore. we had maybe 50 baltimore, to a commercials. just to see how they felt about the commercials. you know, the one commercial that had the most impact? and all of you will remember it. they said this is when you use drugs, this is how you brain looks. it was an egg frying. i mean, by far, it was the number one commercial. and a lot of it, we have to make people realize that this is not the way. and i know we're going to be closing up soon, but i have to say this, mr. president. when i look at this audience, and it is -- i mean, just the idea that we're sitting here, and i want to thank you, by the way, for doing this and hopkins.

but you all are the ones who must help drive these -- the policy. because you are the experts. you know. you have firsthand knowledge. you're the ones. you have been trained for this. and so, you know, we look forward -- when i sit at the podium that we're all an army, we are an army. but you are the super experts on this. and you know the impacts. and you know that what you do or don't do can affect generations yet unborn. >> thank you. that was great. let me say why i asked the question i just asked about the stigma. maybe this is just my experience as being a slightly guilt-ridden member of a family that's had addiction in it, but i believe the stigma extends to family

members and coworkers. and i believe sometimes they are the most important, depending on how bad an addiction is, a heck of a lot more people know it than the person believes know it. or they suspect it. and that's why the culture in a community, in a workplace, in a religious setting, all these things matter because i believe that the stigma sometimes hangs around the neck of family members and coworkers and others, maybe even more than the person with the addiction who wants to scream for help but is scared. all of us are walking around like we're wanting to pretend it ain't so. i'm saying this, this is a confession, not a criticism. i'm telling you, and i think, so i believe when this whole stigma

thing is discussed, yeah, you want the person with the addiction to come out, but i think really the whole -- look, all these little towns, i was born in one of these little places that's supposed to be the epicenter of this epidemic. everybody knows everything. just about. somebody knows. in these little places. and maybe somebody knows in the microscope, manhattan people think such a big place. it's really 1,000 little neighborhoods. but so i think that it's only reason i mention this is my view is the stigma message, we have to be careful because it sounds like it only applies to the person with the problem. but if you know the chief of police in your hometown does not want to put your brother in jail, and you know that you don't have a clue how to get

your brother in a treatment program or your sister or whatever, you go to the chief of police. this is the message, in my opinion, at least, having been a family member and onlooker of all this on and off for, i don't know, 40 years. we talk about stigma as if we're all being broad minded by reaching out and trying to make the addict feel good enough about himself or herself to come out of the closet. this is a bigger problem than the person who needs the medicine or the treatment or the psychological counseling. and i think that it's one of the reasons i wanted to do this today, just so we could alarm people like you on the front line this that could use a little help from your friends here if we all just, you know, get over it. this is a big deal.

we would like to stop every single solitary person we can from dying. and one of the ways is we would like to give them their lives back, which they have to claim. and so anyway, i'll get off my high horse here, but i think we don't need to be patronizing when we talk about stigma. as though it's a delicate thing. stigma is something that a lot more people participate in than the employer or somebody in some oversight position and the addict. we're about to wrap up, i think. anybody else want to talk? you got anything you haven't said? >> i just -- just to your point, i think it's also we have a lot of different cross currents. so, for example, we know that after school or community health care plans would actually be

helpful. and then when they get cut, it makes it harder. we know that in terms of employers, we're all looking, i'll put my employer hat on, wee all looking for how we can squeeze the last dollar out of the health care plans. and so if we're not going to actually pay for any a.p. program, if we're not going to pay for those kinds of things, that's a cross current that hurts this. and so the alignment, the medicaid that you need a waiver to get, to go to a treatment facility that's more than 16 beds, why have a waiver? why not just change that law? i think that part of it is also there's a whole bunch of things that we need to do to be consistent as opposed to having this kind of cross current that basically says, oh, yeah, yeah. this is important, but i'm not acting like this is important. >> i just wanted to say thank you to you, sir, for shining a light on this. the last time you and i were together was at a summit for

america's promise. today, we're talking about what is really america's crisis that i don't think people understand is america's crisis. to have somebody of your stature in partnership with johns hopkins, not only a former president, bualso from a town called hope. so thank you.t also from a town called hope. so thank you. >> i want to close with somebody who actually knows what she's talking about. keep in mind, baltimore is not only the oldest public health unit in the country. it's on this score, one of the finest. and you said even if you got a treatment center somewhere, you don't necessarily have the transaction costs aren't covered. this, i think, is important. i want to mention this. when i was the governor of arkansas in my former life, and

we were the second poorest state in the country, we early on had one of the highest vaccination rates for basic vaccinations for kids 2 and under of any state in the country. and i would like to say it was because of my sterling leadership. but it wasn't. it's because we were so poor in the great depression, and a lot of southern states were, that the government helped us build out the public health network. and then, century later when people started suing people over vaccines, we literally provided 85% of the vaccinations for little kids in my state through public health networks. in other words, we were the connection. and so that's why i ask about the public health

infrastructure. somehow, we need to come out of this, all of us, with a clear idea of what kind of infrastructure we need that's not there. not just what elijah said, which i totally agree with. i'm all there on medicaid should cover and we need more money for all this, but the public health infrastructure is peanuts compared to the $78.5 million we're blowing, never mind the value of all these people's lives we're losing. so talk a little about that. do you think for a relatively modest amount of money you could do a heck of a lot of good if you did that? >> absolutely. you remind us of the saying that public health saved your life today, you just don't know it. >> oh, i do. >> we just don't know it.

>> no, i agree with you. >> and i'm fortunate in the city to work with so many who have helped us with doing things that are very difficult with starting needle exchange for example, more than two decades ago, where a lot of people said, well, isn't that going to make people use more drugs? what we have seen is the percentage of people with hiv from i.v. drug use has decreased from 63% in 1994, it's now at 7% from 63% to 7%. that's what public health can do. and so i would say as a call to action for all of us, in building the public infrastructure, but in general, in what we can do because sometimes the opioid epidemic seems so big. but i think there are three things we can do today. first is learn to use narcan, because we can all save someone's life. you have been a great champion of it, mr. president. the second is change our

language. change the way we speak about the issue, and director michael botticelli, who you'll hear from, taught me a lot about how we can reframe our own language about speaking about the disease of addiction, for example, rather than talking about addicts or just simple things that we can do that make a big difference. and the third thing we can all do is think about what is in our wheelhouse. if we're a hospital, instead of leaving it to another hospital to take the lead, what is it that we can do as a hospital or as an employer. what is it we can do as an employer or union or policymaker? i thank you for supporting us in building our public health infrastructure and raising the awareness of the issue, mr. president. >> thank you. let's give a big hand. [ applause ] thank you. they were wonderful. now, i just want to say one thing while we get off. the next panel is about to report that the bloomberg school

and our community health matterers initiative did. the report had some very specific recommendations. the purpose of that, in my ongoing obsession with this issue, which is that too many smart people in america spend too much time meeting and nothing happens, is that we all pick something out of this that we can and will do. that's why i began by mentioning three things we're going to do. coming out of this. so i urge you, this next panel is really good. really impressive. really active. so figure out what you can do and commit to do it as a result of what they say about these recommendations and their experiences. thank you, and bless you all. [ applause ]

>> hello everybody. we're about to get started with our second panel. trying to be very respectful to not upstage the president. that would not be a good thing. good morning, my name is michael botticelli. i'm here at the johns hopkins school of public health. the dean gave me a very fancy title which i'm not going to say, but i also have the

privilege of being the director of the white house office of national drug control policy under president obama. it really excited to be here today. actually, our work in washington, we work with many of these people on the panel, but very closely with the clinton foundation in terms of our response to the opioid epidemic. as the president indicated, i think we really understand this as a multifaceted problem. that manifests itself on the national, state, and local level. and we need a multifaceted response. we have a tremendous group of panelists here today who in their own way have been continuing to focus on this issue at various levels and they're going to talk a little bit about the work they're doing today. so let me introduce them. to may left and your right is erica paulette, who is the senior community minister in shaping sanctuary project director at judson memorial church in new york city. we also have chief signen from

n newtown, ohio. next to him is dr. carol forrester, physician director for pharmacy and therapeutic safety, and finally, jim hood, who is the ceo for facing addiction, which i think is an organization that many of you know. so let me start off, i'm going to ask jim to start here. so jim, like many parents who have been impacted by this, we heard very personal stories today. so you're one of many parents who has been personally impacted by this, and out of your grief, you changed that into advocacy and action by leadership of a national group called facing addiction. so why don't you tell us a little bit about the group, but also to this theme of evidence impact. where you see where we are now in terms of where we have made progress, but really, where do we need to continue to ramp up our efforts here to really implement what the president said in that we know what works

here. so give us your assessment in terms of where we are now and the kinds of efforts we need to continue to move forward. >> sure. thanks, michael. and thanks to the clinton foundation and the bloomberg school and some very nice words from president clinton. we're facing addiction, very excited to be working with the clinton foundation and trying to make greater progress in slaying this dragon. yes, i did -- i lost my oldest boy, austin, to this horrific thing five years ago last thursday. and so, you know, we soldier on because this work is so important. and i want to -- i think stories are so important, as you heard from the first panel, but i wanted to paint a quick picture and then also paint the landscape. i understand the focus here today is the opioid crisis as it should be.

it is horrific. but it's also the tip of the spear within a larger problem, which is all addiction to alcohol and other drugs. and this is not to divert. we must focus on the opioid thing, but we ultimately have to tackle this whole problem. it's just getting worse, and it's getting younger. and you know, there's a staggering figure about how many people die from opioids, from opioids. but someone dies every four minutes, that figure, by the way, is probably understated, but that's for another day. somebody dies every four minutes from addiction in this country. addiction to alcohol and other drugs. that's 350-ish people a day, and we sometimes talk and it's jarring. but that is a huge jet. that's a huge airplane, and it's often young adults. you think of young adults. bright-eyed college kids. maybe they're going to europe to do their international studies. that's a freaking jet falling from the sky every day, and

somehow, and we're trying to work on it. this country, i think at this point, everybody is concerned about the addiction crisis. i don't know if they care enough. i don't know if they're broken hearted enough, and maybe we have to get from statistics to absolute grief because you put that figure in perspective, and you know, none of these are value judgments, but the first panel mentioned the devastation of hurricanes. what that animal did in las vegas is unspeakable, yet we have six las vegass in terms of deaths from addiction every day. in this country. and somehow we don't rise to the occasion. and we simply have to rise to the occasion or, as president clinton said in an earlier speech, this thing is going to eat us alive. so our work, michael, to try to

keep it conceptual, is president clinton also mentioned in the aggregate, the country has gotten so little done, and also in such a disconnected way, we hope to get a lot more done, and part of that is to connect all these different parts. and i could paint a picture for you, i'll be very brief, but i could paint a picture for you that is both frustrating but hopeful because if you think of the journey of a young person in this country from prevention to early intervention to their interaction with regular health care, there are clear identified problems. they're in this report. they're in the surgeon general's report. there are problems with prevention. it's the wrong programs, we don't go to where the kids are. there are problems with early interventions. pediatricians are insufficiently trained. we talk about doctors who overprescribe because they only get a few hours of training in medschool. some training works. a lot of it doesn't. it's not scalable, not affordable, not integrated with the health care system. there's still too much of a criminal justice response that

has to be shifted. long-term after care is not what it should be. we know what to do in each one of those boxes but we don't do it. we have to stop talking about it and do it. in the larger sense, facing addiction is a national group, think of it as the american cancer society to try to integrate the private sector's response to this crisis. >> thank you. we can follow up on some of that. erica, let me ask you a question. so should i call you reverend or is it okay to call you erica? okay, thank you. so our faith institutions have long been engineers of social justice change in the united states. and i think particularly for highly stigmatized people and highly stigmatized diseases. i can't -- you know, when you think about the faith community response to the hiv epidemic and a lot of us have talked about the parallels to that. so talk about what you're doing,

and i think i want to go back to what dr. wen said in terms of how we think about harm reduction as an approach to this. we know many people are not ready to seek treatment, but we know we have to keep them alive and keep them healthy. so why don't you talk about your work, kind of the harm reduction approaches you're taking, but also kind of the call to action to other faith communities in this epidemic. >> great. thank you so much. yes, it's wonderful to be invited into this conversation, communities of faith have played a really significant role in, you know, we have in essence created a community of lepers by, you know, stigmatizing and shaming folks. and what the church does is as important as what the church doesn't say. i gave a sermon earlier this year on the gospel of harm reduction.

and within hours, i was receiving hundreds of e-mails, phone calls, encounters with folks in the church, in the community, in the halls of harm reduction coalition where i also work. people said they had never heard the drugs issue talked about in a sacred space. they had never heard the drugs issue talked about and imagined with a compassionate response. they had never heard their story reflected in those -- in those rooms. they had never heard their child, they loved ones, and their self called beloved. that's really significant. the church is really charged with making a space and a place and in order to do that, not only do we need to extend it,

but we need to make sure we're, you know, examining and tearing down those barriers that limit folks from accessing help. i work as judson memorial church and by virtue of the double belonging have had the opportunity to listen in to both spaces and to really, you know, identify a deep need that communities of faith, especially in communities that are particularly vulnerable to drug-related harm, they are often the points of access. they are often the ones with the most well developed social networks. and so it's really critical. so what we have taken on is the shaping sanctuary project, which we are working on mobilizing faith leaders across the country to be able to speak prophetically to the humanity of

people who use drugs, to be able to be a resource in their communities and for their congregations. as well as being able to advocate for compassionate drug policy. [ applause ] >> i want to follow up on that, because this is a really good example where kind of the evidence of what we know to be effective is a far cry from what's been implemented. you know, we have known for example, that access to syringes and naloxone are proven strategies. what do you see as the significant disconnect between kind of the evidence of what we know and why we in some respects and in some places in the country are still debating this? >> there is a multi-fold answer in there. i think quite honestly, there's an incredible, an immense amount of wisdom, expertise,

experience. people are doing this work. people who use drugs and their loved ones have been saving each other for a really long time now. and it really is, i mean, it's connection, collaboration, i think is really the key to addressing this issue. and in doing so, it's going to be connection with folks with lived experience of overdose, drug use with families, with the first responders. that's who are on the site at these overdose encounters. and that we really need to be, you know, this includes harm reduction programs which are constituted largely of folks from these same communities. and you know, the community, people with -- people who are the experts are the ones we really need to be following. we need to take our charge from them. >> michael, can i follow up on that in. >> sure. >> you said something very

important. here's one of the things i think would shift it. in our county, we have all the right people, all the right organizations. one of the big things we need is funding. one of the things that would shift this dramatically is stop treating addiction as a crime. take it out of the criminal justice system. [ applause ] take it out of the criminal justice system. put it into the mental medical health system. it should be. we can't get past any of this until we get past the part where everyone thinks that every user is a criminal. they're not. allow us in law enforcement to do the job of cutting down the supply. allow us to be the link to all these other organizations. and i think we would see a dramatic shift. but until the public stops seeing this as a crime, we'll have difficulty. that's the first thing we need to do. >> chief, let me follow up on this. many of us have remarked on the tremendous shift in law enforcement. right? so you're not the first chief where we have heard we can't arrest and incarcerate our way out of the brb.

we have to partner with the public health and community folks. how has that changed your work at the local level? who are your new best friends? >> i didn't know what a health commissioner was, sorry dr. wen, i had no clue, but one of my b friends in the city is the health commissioner. we worked with the health commissioners to push out narcan to every single police officer in the county in cincinnati. over 1100 doses. there's been 7,500 uses of narcan in our area in a year and half. we had a great conversation because you're dealing with cops, hey, should we do needles and don't give a needle to a cop? can we do something simpler? we have a spray. you can do spray. so we push that out there. he's one of my closest cohorts along with treatment. and i think law enforcement, and to say the bad part of this, we stand over the bodies. we inform the families.

so for us, it's real. so we need -- we know that we can't solve this ourselves. it's beyond us. so we need the people that can get people into not just treatment but care. long-term care so they can reintegrate back into society, so they can get jobs and have their life back. we talk about investment. we're spending so much money on the front end. why don't we put it in the back end and get our investment back? >> let me talk about, what are you seeing at the local level in terms of the major deficits? you talked about how do we get people into treatment, get them the long-term care they need, give them housing, employment. what's the biggest need your community faces? >> i'm going to say straight out, it is funding. there's no two ways about this. we call this an emergency, but we don't treat it like an emergency. we have 50 to 70 people overdosing every week in our area on average. four to five people dying every week. and yet the money's not there. we have all the right people, all the right organizations. it's not like treatment doesn't want to help. there's not harm reduction, it's

not like the community doesn't want to help. we don't have the resources to do it. we don't have the doctors, the peer mentors to go into the community. we don't have the links, we don't have that. and it needs to come down to money. we have an opportunity to have that. and i hope that we don't let that go. this is the time and the moment that we can shift addiction, and we and the congressman was 100% right. i have been saying this for a couple years now. it takes you. all of you need to get ahold of your policymakers and tell them to give us the money, that this is an emergency so we can fix it. it is not a waste of money. it is an investment of money. >> thank you, chief. so kelly, i want to shift a little bit because dr. wen, i think, in a very confessional moment, talked about the fact that as a physician, got little to no training on opioid prescribing, on substance use issues. we know even with well intended efforts, that was a significant driver. part of our efforts now is this

balanced approach, which i really want you to talk about. is, you know, we clearly want to make sure that we're diminishing unsafe prescribing practices, but not have the pendulum swing so far in the other direction that we're undertreating pain again. why don't you talk a little bit about your efforts and your balanced approach here to reduce opioid prescribing but still insuring people get adequate access to pain management strategies. >> thank you, michael. first, i want to say thank you for the invitation to be here among all these distinguished colleagues. and to president clinton and the clinton foundation and the bloomberg school. we are a national health plan, and although we're not the entire country, we have a tiny section of the country that we try to help. and for those 12 million patients that are part of our health plan, we really do want to make sure they are receiving the safest and the best care that we can possibly afford. and what we are -- what my role is as a director of pharmacy and therapeutics, is i try to use my

expertise and my background in educating our physicians as well as our patients regarding safe opioid prescribing, and also more importantly, the appropriate management of chronic pain. and that's really where our focus has been. about six or seven years ago, all across our health plan, which is in the district of columbia, we have implemented guidelines around chronic pain management. as well as safe opioid prescribing. so yes, i have heard the comment that, well, you're taking away opioids from people, they're going to be in pain. no, we're actually augmenting our chronic pain treatment. and we're augmenting the ability to prescribe nonnarcotic or non-opioid treatments and in fact, first line nonmedical, nonmedication treatments, really. it's not always medicine that will help you with your pain

syndrome. we make use of significant alternative medicine treatments. exercise, weight reduction, simple things can actually help people with back pain, for example. we have pain psychologists who, by the way, i think are way underrated. i love the pain psychologists we have. my daughter is a clinical psychologist in training right now. i think they're wonderful. but we have to understand that pain is not just going to be fixed by a pill. it's going to be a combination of factors. so a lot of our education has been really around chronic pain treatment as well as prescribing. we have standard guidelines for treatment for opioids. certainly, we have given our physicians many, many tools to try to do the right thing. decision support in our electronic records doesn't only include how to prescribe appropriate doses for shortest duration, but also has all the other specialists, referral

options, other treatments that can be used for a particular pain syndrome. so even at the point of care, you're reminded exactly of all the other things you could do for that patient if you didn't already do it already. we have also augmented the specialists and the services that we want to have to help patients with chronic pain. and over the last six or seven years, that's been significant. the resources that we have internalized so all of those services are under one roof in our medical center, so people don't have to have that barrier to access. it's difficult to get outside to go somewhere if you don't have a car, for example. but if you're at the medical center and it's all in one place, you can get there. so we have had a lot of internalization as well. >> let me ask you a question. the reavious panel talked about the role of insurance companies. and i have often heard from physicians and prescribers saying i want to do the right thing and not prescribe an opioid, and look at giving folks

physical therapy, acupuncture, and often have an insurance road block. that insurance doesn't cover those kind of nonfarm acollagic pain management. >> i'm lucky to practice in a setting where we have those internal resources. but i totally understand. i have friends, family that are physicians who do not practice in a setting like i do, and they have to be very cognizant of what that patient has as far as their benefits. they may want to give them certain services but they know that patient is not going to do it because they have to pay out of pocket for it. and that's one of those flaws in our health care system. we really need to expand services for everyone in all lines of business, for all of our health care plans. >> thank you. you know, one of the things that many of you have mentioned and the previous panel did, too, and i think with kind of many diseases and people, the role of

personal stories and personal narrative has dramatically changed the way we see people. it's not a disease about us and them, but it's all of us. so maybe for anybody, jim, chief, erica, you know, what do you see as the role of people with lived experience in this? either people who are still using, people in recovery, kind of parents who have been affected by this. how do we use those stories to kind of change public opinion and public policy? >> i'm happy to take a brief shot, michael. we talked about this within facing addiction, and i'm being a little euphemistic, but we talk about this as an illness that no one is ever going to get, no one ever has it, and then no one ever had it. except for about 40% of all households in america. and clearly, the statistics don't put us over the edge, stories will. stories will. it's stunning. i got here late last night. i went to a restaurant near the hotel. it was empty, and the server asked me why i was here.

i told him. within minutes, he told me, 30 year old guy, lost ten years of his life, nearly died six times, but he's on a great course. i needed somebody at the hotel to print stuff out, and a sweet little woman who looked exhausted, saw it and said are you going to go to this thing? i said, yeah. she said i haven't seen my boy in ten years. he's addicted to heroin and i don't know if i'll see him. the thing is all around us. everybody knows somebody. if they're honest, they're probably related to somebody. we still don't talk about it enough. we don't admit it enough, but we're going to get to a point where it's more than half the country, so it would be better if, as president clinton said, if we kind of got over it and got to work. >> so let me talk about this, though. congressman cummings talked about the kind of untapped potential for people in recovery and people who have been affected by this. and maybe jim and others could talk about the role of people in recovery can play in terms of

either changing people's opinions or as it relates to advocacy. i'll open that up. >> one of the things we're trying to do in cincinnati is use peer mentors. we're trying to, many in the treatment world are training people who have been there, who have done it. it's one thing for me as a cop to say i care. it's one thing for me to say i'll get you help, but another thing for someone who has been there and experienced it. i would think that one of the long-term goals would be great is we have crisis intervention teams that go out for the mentally ill. it would be great to have peer mentors who would be like a crisis intervention team that could go out to the street. they could walk them through the process. it's one thing for me to say i can get you help. its another thing for someone to say i have been there, i have done it. look where i'm at, let's go. that would be great if we could go that way. we're looking at it in our area. keep your fingers crossed it's something we can work out. >> i use stories often when i teach physicians. specifically post-op care, with

surgeons. there's, you know, a few of us have stories where we may have seen a patient who's an adolescent or a young adult who had an athletic injury in a sport in college or high school. as a result of that, they were put on opioids for a while. maybe longer than they should have. and maybe they held on to those after they were done and kept them in their drawer. and then when there was a party, a few weeks later, a month later, and their friend said, hey, you have oxys. let's go. i see that in your drawer. then you know, that leads to someone having an overdose. and that's how it starts. so, you know, prescribing too much, more than a patient needs, especially young adults, college age. it's 61%, i think, the report said is wasted. kept in a drawer, basically. that leads to trouble. so i use those kind of stories a

lot. >> erica. >> i was really pleased to see in the report the kind of inclusion of first responders in necessary groups to engage around this crisis. i guess i would also, you know, say as we're talking about stories and talking about inclusion and we're talking about kind of where we draw wisdom and ways in to communities most impacted by this, is that it is necessarily led by folks who have had this experience. i mean, the evidence, the evidence that we're talking about is being born out in their experience, in their work with one another. and it's really incumbent on us to listen in to those spaces and to figure out how we can work in synergy with what they're doing. i mean, it's -- yeah, that seems necessary to me.

>> one of the things we have been talking about is the role of advocacy. one of the things that i think really changed the trajectory of the hiv epidemic was quite honestly a bunch of really angry gay men and lesbians who said we're not going to take it anymore. and really created, i think, the urgency around this. i think many of us who have been doing this work have felt like this has not had the urgency that other, whether national crisis or other epics have had. maybe if you can talk about the role of advocacy and how we think about harnessing that kind of potential for really accelerating change. >> there's one thing i was going to say. look at mothers against drunk drivers. it was a group of, excuse my language, pissed off moms who affected change. i sit across from parents who have lost their child, and there's many people who want to help, but there's not a big

organization like mothers against drunk drivers. it would be great if there was a grassroots organization that could advocate that, not just so the public changes their image of the user, but also advocacy for policy change. >> well, i couldn't agree more. when we looked at the addiction landscape, there are lot of organizations with good people in them, doing good work. in fact, but for complicated reasons, no one ever built a movement, creating a critical mass. and frankly, all of these things we're talking about as we look to government, and by the way, we shouldn't really rely on government to solve this problem because government doesn't solve any of these problems. it can help. it can help, but in any case, nobody has ever built a movement in the space. without advocacy and anger and people putting pressure on their elected politicians, none of this stuff is going to happen. and gregg williams and others on our team who are vastly smarter than me saw that, and so far in

two short years, we have stitched together something like 700 organizations. some are kind of mom and pop, some are relatively big. they in turn represent about 35 million americans. we're learning and they're helping us understand how we can turn that switch, how we can get them to write letters, to get them to get angry with a short fuse, and it's going to take a much bigger group, and we're going to have to become even more cohesive, but that's going to be the answer. we've got to get a large group of people saying it's time for this stuff. >> erica. >> yeah, there is a movement. and i look at the work that my colleagues in harm reduction are doing and have been doing. they have been doing the work that many of us have resisted doing until it's got closer for us. i mean, and i think in that way

the frame that really lends itself to this issue is that this is, yes, of course, it's a pub lg health issue. it's also a social justice issue. very particular -- i mean, there are circumstances that make particular people more vulnerable to drug-related harm. and you know, in this way, it's an incredibly intersectional issue. i think we're going to gain an immense amount of strength by being able to find our ways into alliance with other movements. i mean, this is very much a racial justice issue. this is very much an issue for folks who have, you know, experienced trauma and gender based violence. this is very, very much an issue about poverty. and you know, we cannot divide the public health response from the social justice response. and so addressing all of

these -- all of these intersecting impressions is going to be really critical to insuring that we can -- that we're ready for the next time another crisis happens. until these core circumstances and such are addressed, we're not going to make a move on this. >> i want to say i think physicians were called to this movement, even though they're living in a kask, they figured it out about six or seven years ago when the data for increasing opioid dispensers in the country was directly correlated with increasing deaths from opioids, and then statistics such as 99% of the world's hydrocodone is in our country where we have 5% of the population of the world. so things like that made physicians engage and listen. but honestly, the government has helped us, has assisted us by passing mandatory continuing education credits that is necessary in some states.

many states. also, mandating -- we mandated before they did, but mandating prescription monitoring processes. a few things like even prior authorization. believe me, i hate having to fill out forms, and so does everyone. pretty much everyone does. that's a universal thing, i think. but when some states mandated prior authorization for certain doses and certain quantities ofopeioids, that did a lot to engage physicians that may or may not have been aware that they were doing something wrong before. so i think there's over the last several years, there's been a definite call to action and physicians are definitely engaged at this point. >> i wanted to ask because we were talking before about anger. i told them a story, i gave a talk last week and said 50 to 70 overdoses, four to five people dying every week, and there was not a single gasp. but the other thing i need to say also is we need to figure out who we need to be angry at. because right now, we are angry at the wrong person. we're angry at the user because

they overdose multiple times. but we're not angry at the dealer that i have arrested seven, eight, nine times, that gets out and puts fentanyl back on the street. we're not angry at a pharmaceutical company that lies to doctors, that lies to society -- >> good. we have two angry people. we need you to be angry at them. our anger is displaced in the wrong place. and if we put it where it should be, we could start fixing this. but we're angry at the wrong person. it's not the user. they have a disease. their brain is infected by the substan substance. we should be angry for the people who did it for greed. >> i love it when our law enforcement officers talk about public health physicians. >> i'm hanging around you too much. >> let me ask this, because while we have seen great change among law enforcement, all of us are worried that at the federal level, quite honestly, that

despite kind of pairing drug policy reform with criminal justice reform, that we might be backsliding. how do we keep the momentum going at the local level to really insure this is a health response and not a punitive response? >> i'm telling you, law enforcement is at a crossroads right now because what i'm saying is not necessarily what the majority are saying. and there is a group that is pushing back and saying, wait a minute, this is a climb. i'm going to treat it like a crime. for us, it's unique because we're arguing within our own realm, am i a law enforcement officer or a first responder inthis issue has blurred those lines, and even for us, we're confused. me, it's no confusion. my job is to save lives, period. i don't care who you are or what you did. i'm not the judge to anybody's sin because trust me, i have my own. if my job is to save lives, but we in law enforcement are arguing about what is our role. and this is where the public, and i keep saying this over and over, and i have been screaming it for two to three years now. it is you.

you shift all policy that we, the federal, local, county, state officials do, and when you stand up and say, we're going to treat this differently, then we in law enforcement will have no choice but to treat it differently. >> jim. >> building on that, facing addiction has an interesting program that we initiated recently. we started hearing from a lot of communities that they're lost. and it's not a criticism. they simply don't know what to do about this issue. so we created this pilot community where we go in, we don't have a silver bullet. we have some knowledge, some best practices we can peddle around and we bring together local leaders in health care, law enforcement, faith, parents, educators, and you get together and start talking about what's working in your community, what isn't working, what are the grapes. there are some similarities, but obviously, depending on the makeup of the community, they're different, and we're working with them to forge a plan that we can leave behind so that within a year or so, they'll

have some cohesive way to tackle this problem in their community and to either raise additional funding or redirect funding that exists but maybe isn't going to the best and highest use. there's nothing terribly glamorous about it or no magic, but it's rolling up your sleeves and getting to work. >> i want to kind of follow up on the role of community. so many of you probably have read the book "dream land," really great book. i have gotten to known sam over the years. one of the lines he uses that i steal from him at least with attribution, is that the fundamental response to our opioid epidemic is community. i think all of you who work in various sectors of community, and maybe just reflect on your own thinking about kind of community and community coalition. who needs to be at the table, what's really important for them to think about as they respond to this issue? i think all of us at the federal level or used to be at the federal level know we have a

role, but ultimately, it's what happens at the community level that's important. i wonder if you could just reflect on the role of community in this. >> i think when you say that, i think right away, i mean, my training is pediatrics and adolescent medicine, after i went to pharmacy school. so i think of school and education, and in the community in middle schools and high schools and colleges, how can my medical colleagues go out there and educate? and i don't mean just, you know, do a lecture once on third period and some kids don't even bother to show up. i mean having consistent eblgication in the schools that is required. i know all my kids are out of high school now, but i know they were required to take a course in economics in high school. that was a requirement. they couldn't get out of that. they had to do it. some of those thought it was easy, some struggled, but they had to. nobody was required to take a course on addiction or the substance use problem that we

have in this country. and yet, it affects every single child one way or another. they know someone or a family member. so getting to the community and educating and being there often, having standard courses, i think physicians are -- and pharmacists as well, are great assets in this community, and they could be out there teaching. >> it's a comprehensive community response. when we started the coalition, i just -- my vision of the coalition came true about a month ago. you knee it wasn't just going to be the four pillars of harm reduction, prevention, treatment, and first responders. it had to be every part of the community. a complex issue that needs a complex answer. so last month, i sat in this room and for the first time in two and a half years, we had almost every aspect of our community represented from gr s grassroots to religious groups. universities, doctors, hospitals, elected officials, police officers, health departments. i looked in this room, i was getting emotional. i was like, wow, this is our vision. and it came true two and a half

years later. when we talk about having the right people, the right organizations, it is everybody. and i will caution on this because i get this a lot. because everyone says you need to tear down the silos. i disagree. we should stay in those silos because those people are the experts in those silos. what we should be doing is we should have a door to each one of those silos that lets everybody in and everybody out that connects everybody. those silos are extremely important. i'm not the expert on health. i'm not the expert on treatment, i'm not the doctor. i need them to sit there and share the information and share back. if we have that comprehensive community response, then we can make a dent in this. >> erica. >> yeah. i go back to kind of what i understand my charge as a minister to be, and that is in holding space and making space for folks. and as such, it's, again, i say it's really incumbent on -- i speak specifically about faith

communities, to be able to breach the silence around this. and you know, make a statement prophetically that these are not -- this is not an individual issue. this is a community issue. it's being felt, you know, across all divides. and you know, it does not occur in isolation. you know, i think back to a dinner i had with some good friends who are here today, and we had the opportunity to -- i think i had attempted to take a couple days off for a little soul care for myself, and found myself describing some of the struggles with work. and by virtue of hearing into our conversation, one half of the couple sitting at the table next to us interjected herself into our conversation.

and came to find out that they had lost their son about five years prior, had never spoken about it. did not know that there were people who were, a, working to insure that nobody else's child was going to die from an overdose, but there were people who cared about their child, who cared about them. and so by virtue of having these conversations, having these public conversations, being able to challenge for us, you know, there's some really well entrenched theologies that are horribly problematic. and you know, so it's -- i don't know. >> we only have a few minutes left. i want to end by asking each of you in the spirit of this conversation, and president clinton's charge to let's think about actions going forward. and from your perspective, you

have all done an incredible amount of work, but what are the one, two, or three things we really need to do next that we think is really going to continue to leverage change as it relates to not just this epidemic but addiction issues in general? and jim, i'll start with you. >> michael, i would singularly put stigma at the top of the list. these folks are all so smart, and you, not so much me, but we do know what needs to be done. but there's a little bit of inside baseball risk of smart people talking to themselves. i don't think we can underestimate, we shouldn't underestimate the debilitating power of stigma. still half the people out there, give or take, do not think this is an illness, even though we have known it for 75 years. if you don't think it's an illness, you do think it's a matter of moral failing and it's your problem, and why should i care? that's a huge issue. >> how do we get there, jim? we have all been having this

conversation. how do we get to that? >> a massive education campaign. i hope something that we will get to, facing addiction, with the clinton foundation, but a massive, we call it a rebranding campaign, which is not call it rebranding campaign, which is not to be confused with making this thing attractive. it's to reframe how people think about it as an illness. 90% of the people who suffer from addiction never get treatment. imagine if that were another illness. there would be a riot in the streets. in my town, you read obituaries of people under 25, it is a sudden cause of death a shocking -- we know what that is. we know what that is. if people are not willing to face this thing and call it an illness, which is streetible. it's not inherently fatal, we can get there. but the first step is to get over the stigma and the shame and the discrimination that attaches to it. if we can do that, it's going to be a whole different ball game.

>> thank you. carol. >> i would like to focus on prevention i think at this point. i think at least from my perspective, i think that's where we have a lot of tune. raising awareness in the fuptd means as i mentioned before education, education education. begun, my background is in adolescent medicine, peds. when we were all about antibiotic resistance we went out there, educated, got the community involved. patients realized this was not a good thing and they went from demanding antibiotics for a cold to saying wait do you think i need that antibiotic? because that might hurt my -- a kidded with pneumonia, do you think i need that boitd? yeah, this one you really do. we ended up -- just the pendulum swung the opposite way with antibiotic resistance because we really did a great job with educating. that was mentioned in the romplt that was my analogy i was going to talk about today. but oh, well. not a big thing but anyway we

don't have that with opioid use. we have, as you mentioned the stigma. and people are still expecting to get their opioids and be pain-free. and that expectation has to be changed through education. >> stigma. it is one of the biggest things blocking us receipt now. i'll make this shormt i hope within my career we shift addiction out of the criminal justice system into the mental medical health system. it should allow us to go after the right people and allow us to give the people the right care they need. >> i am going the say stigma as well. i think it is really the core this crisis. as long as people who are created in the image of the most define are redacted and deducted to pathologistologies, it -- we have an essence, as i said of about, created a population of lepers. it is incumbent on us to

liberate them. we must be a space and a place that offers compassion and stands in awe at the many burdens that people carry rather than judges them for how they carry it. >> thank you. that's great. [ applause ] . in that spirit of stigma i'm actually signature here feeling a little bit disingenuous in that i haven't talked about the fact that i am a person in long term recovery. and i'm one of 22 million people. and you know, i think those of us in recovery have often said to the egg tent that we can that i do think we have a personal responsibility to be very open in public about who we are. because that does change public opinion and change people's minds. i want to thank our incredible panel today for the work that they are doing and for the work that i know they will continue to do. so thank you, everybody. >> thank you. [ applause ]

thank you. well, this just about wraps it up. my name is caleb alexander the codirector of the johns hopkins center for drug safety and effectiveness. as i said, those were two exception exceptional panels. mr. president on behalf of the johns hopkins bloomberg school of public health i'd like to extend or deepest gratitude to you and to the clinton foundation for your leadership and commitment for addressing the important matters we have discussed today. five years ago you mobilized the foundation to act. and since that time you have been on the leading edge working for change such as through the foundation's tireless efforts to raise public awareness of the crisis as well as help people understand that addiction, as we've discussed s a brain disease, not a behavior. i'd also like to thank congressman cummings, our other dig aniers to, dean mckenzie and

all of you who have joined us both here in the room and from around the country. thank you for your participation. this event as well as our newly released report the opioid epidemic from evidence to impact, too a lot of planning of it would not have been possible without the dedicated efforts of so many individuals from the clinton foundation and the bloomberg school of public health, including those working to help communities fight the epidemic through the bloomberg american health initiative. but as we've heard today i too want to underscore the importance of the efforts of all of you in the room and all of you who have joined us today from afar. we've all been touched by this epidemic one way or another and we should not doubt the power of our collective action. in 2011, judy rumler lost her son steve to a heroin overdose. and i told her about this event, and i asked her if i could share his story? and she said i'm always happy to

have steve's story shared fit helps the cause. -- if it helps the cause. jooud etalks about a note that she keeps next to his picture. it says, if love could have saved you you would have lived forever. it is going to take effort, and resources. and as you have heard today, mobilization. the good news is that we know a lot about what works. so thank you again for all that you do. [ applause ] hello, i'm delighted to wrap up today's event. my name is andrea gillin, i direct the center for injury research and poll see. on behalf of both of our centers i'd like to add our thank yous to the distinguished pans of speakers who both challenged and

inspired us today. and to president clinton we want to thank you for all you have done to address today's opioid epidemic and of course for being here with us today. your leadership and the work of the clinton foundation, with its power to bring a diverse raping of partners to the table, is responsible for putting life saving tools in the hands of first responders, school officials, and health professionals from across the country. today is is the culmination of a long journey that as you heard began with the first town hall in this very room three years ago. and we're very proud to have been working in concert with the clinton foundation then and now as we continue in our determination to win this fight. like many public health and injury problems, opioid overdoses reflect what happens when a product that delivers both benefits and harms exists in an environment that allows the harms to flourish. addiction without access to treatment, too many medications

from overprescribing, and medications supplied without its life-saving anti-dote are a few examples. joined by the clinton foundation, and a group of distinguished experts from around the country, we focused on finding the evidence to solve these problems. in our report, the opioid epidemic, from evidence to impact, was released today to provide that evidence along with specific recommendations for actions. the challenge we're addressing is how can we act collectively to turn around the alarming trends in opioid deaths so that the public is protected on the one hand and the benefits of proper pain control are delivered safely? we hope that today is the beginning of a new journey, one that moves us surely and steadfast, ending this epidemic. with the help of everyone here, and everyone joining us on line, we're confident that this goal

will be realized. and we thank you all very much for being here today and for joining us in the future. thank you very much. [ applause ] for those of you in the room, i'd like to invite you to the reception, which will be on the first floor in the atrium. thank you. come up in about anou