worse. teen of quick questions. i would love to get more -- two quick questions. i at what level of service you get for medicaid. covering certain aspects of medicine. we are fairly liberal in that aspect. some legislators want to increase that. i be curious if you have any consistent benchmark. the second thing is, you have been high enough to have governor herbert and i visit with the president in the oval office and we had a very frank discussion and good discussion on many things about waivers. one issue, we are attempting to look to see if there are waivers we can get for able-bodied people to require work or

training to have medicaid expansion. we did this in public housing when i was mayor of charlotte which was effective and we want to know if there is any more flexibility or is that the line drawn in that area. i want to congratulate you on you reaching out for us and the honest dialogue. sylvia: in terms of the benchmarks, that is something we will get back to you and your team directly on. with regard to the question of work and how we think about that particular issue with regard to health, in terms of -- one of the things that is an important thing that both sides agree on that was an important changes that pre-existing condition shouldn't keep you from an ability to get health insurance. maybe how one gets to that

maybe, the idea that health care is not a conditional thing. health care differ by a number of things. different from tan of -- tanf. having said that, we think that there are incredibly strong ways . we're with you on work. that is a place where we would like to see -- it would be great to have people working and earning a wage. we would just as soon have people in the market. the concept, we have a number of place where we have worked with a number of you all to get to a place that derives this in a way that will get more people through your work training program than you have ever seen. we look forward to be able to have that conversation.

we think we can get to a portion of what you want, work and cordage -- work encouraged. there are ways to do that. >> governor fallin, governor walker? >> thank you. it is a pleasure to have a dialogue with you which is important. you have one of the toughest jobs in america. you have a tough job the past year. thank you for visiting with our governors. a couple of things i want to commend you on. paying for outcome versus volume of time someone sees a doctor. we are all about approving the health of our citizens versus just what we hope might work. we deliver services. thank you for that. and the comment about trying to

fast-track the waivers themselves, one of our requests from our governors was that if we had a waiver that you had approved in the past, if you would consider being able to continue that improvement of that waiver because you have done it several times before. we have a great program where we have a three-way match of medicaid money and the person paying a small portion of their insurance. the employer paying a portion of that. back to the question of working and paying, and you have approved that, which i am grateful for. at one point in time, if we have something that is already working, can't we just make that permanent versus every single year trying to reapply for that? i continue to ask your consideration of that particular issue.

on the prescription drug abuse we have had a great legislation one of the things we have done is passed prescription monitoring bill to stop doctor shopping. it was hard to do. it took me three years to get that through because doctors did not want to have to spend the time away from seeing patients to check this and check that. could we not do that for medicaid recipients and other -- under federal guidelines, if someone is on medicaid that you require a doctor to check it every time, or they get a medicare recipient, opioid that may be there to consider on that track. the last thing i want to mention, we talk about rising costs of medicaid and expenses to our state which has always been a challenge.

we are one of those states that we have seen unemployment dropped really low. when our per capita income went up, our funds went down. we had a huge drop to the cost of $100 million. then we grow our population. more people coming into the system am a from the federal government. now we are going through another economic downturn with the energy sector but we are short of that money. it is just something to consider. >> i won't touch on all of figuring out how we work in terms of making the program encouraged movement to economic health and people being able to be in the private system where possible. that is part of how the reductions in funding about trying to get people to move and encourage economic growth.

on the opioids i would mention the prescription drug monitoring plans. almost every state has one. in the conversations i've had around the country with a number of you it is a very important enforcement tool and the ease of the tool, the ease of being able to use it, how quickly it is updated, and some of your states do it and some of them down, the relationship with other states. people border shop. that is another issue we need to work on. bringing folks together, one of the things we talked to physicians about how easy it is to use or not to use in terms of the system, if a doctor says how many cliques -- you don't want to spin the time checking. that is one idea of how we can influence people with regard to our payment system. that is what we will look into

in terms of what we can do. we will need to get to the space where vision assumes -- physicians are trained. how much training did you actually receive in terms of treating pain? that is one of the issues. we are working very hard. we have a representative from the cdc as part of your panel. we need to make sure people are trained in them. it is about starting at the point of the physician and the tracking you are talking about. a tragic story of a young woman who had gotten her wisdom teeth taken out, took too much of the prescription drug after her wisdom teeth, became addicted, after months it became cheaper easier, and better to use heroin, and the trajectory. four years clean but if we can stop that journey because there

are many stops along the way in terms of what happens in that picture. we are seeing it everywhere. it is not geographic anymore. it is not socioeconomic. the number of people that you probably know whose children have some of these issues, i'm sure everybody in this room does. it is one we want to work on. >> governor walker. >> more of a comment than a question. thank you for being here for a second time. i appreciate her presentation. then began a process with me. i begin the process for alaska to be the 30th state to accept medicaid expansion. i share the concern about the -- we're pretty rural. our methods of getting to our

those that need care don't always involve a road. we have 100 and 10 airports. i want to thank you for your passion in this area and for your staff and your access. i know you are the person that gets it done. they are the ones that answer the calls. we worm -- we are removed from mainstream america. we have russia and canada. there is not a lot of options. we do feel when we have a need washington has been helpful to us. it is a process i have begun. we had 45 days to get through before i can sign it. we appreciate your helping us this far and look forward to helping you. sylvia: thank you for this leadership on this issue.

>> governor nixon:----. governor nixon: i want to thank you. on behalf of all of us we feel we appreciate it deeply. this feels a lot different than a congressional hearing i would imagine. sylvia: that is on tuesday. i have talked to a number of folks from your states and prepared. governor nixon: we have not succeeded in the task of expanding care to working missourians. we're working on that again. there is no term -- on the with side of this, as you look at cost-containment looking

forward, you have some triggers that are difficult for states and hospitals that are built into the affordable care act. whether it is on reimbursements for medicare, equaling out payments, or the share. give assistance of what you are under budgetary wise -- i think some of the the folks don't think that is going to happen. it can cause the delay of those instead of having it smooth then, could cause a cataclysmic effect in states that don't move forward in a timely fashion. if that becomes a cliff instead of a slide, it has a very cataclysmic effect in rural areas and underserved areas.

sylvia: my ability to predict on this one, it involves two things that i don't have a lot of say in. one year, five months, 1015 days is all that i would be here. i will no longer be here pretty other thing i will just say is the congress is engaged on these issues. part of the way to -- that ability to predict is limited. i think you all know i will tell you. the one thing is we think of it as a nation, -- governor nixon: it is an executive branch decision. it is a congressional decision. sylvia: to turn it off. today it has been turned off. when the congress has taken action to extend, right. the question whether they will

do that again is something i'm not going to guess. governor nixon: the question is, whether the administration is going to ask them to continue to extend the budget document presented to the congress this year or not? sylvia: i will be revealing proposals in the coming months. the broader issue of how we think about the issues of cost-containment, why those provisions were put in is because it was thought that it would be more cost-effective to pay for uncompensated care and indigent care through a systemic approach in the states. instead of the way that we were doing it. there are a number of tools that exist, some of them, you have mentioned a number of them. they have low income tools --

pools. so that i think is, why it was put in place is about how can we most cost-effectively help low income people have access? those were the decisions about that. how it plays out is something that we have to evaluate as we go through it. >> governor beshear. >> governor beshear: the experience in kentucky could be enlightening on a couple of these issues. competition. before we implemented the affordable care act and expanded medicaid we had two companies in the state that would sell health insurance. we now have five. that was -- that obviously is encouraging to us because we have been working for 20-30 years trying to get other companies to come in and we just

had no six says added. now we have that kind of competition. the second thing regards rural health care. a lot of folks live in rural areas. we particularly have always had issues with rural health care and rural hospitals, how late they can stay open. as the demographics change. we have gone, and there are hospitals as a whole have gone from 25% uncompensated care to 5%. our rural hospitals have in a fitted from this because for the first time in their memories and in mine they are in the black. their bottom-line is in the black because they are getting

paid for the care that they are delivering. there is still a lot of problems with rural health care. we are going to continue that. from a revenue standpoint, having expanded medicaid is a boon to our providers. in terms of getting more money into their pockets. it has been a boon to our economy and that before we did it we got price waterhouse cooper to project what was going to happen and whether we could afford it down the road. they projected that over eight years we would create 17,000 new jobs and have $15 billion infused into our economy. we implemented based on that and after the first year i said let's take another look. now we have actual numbers.

one year of hard numbers. consulting went back in to take a look at our first year. we are sorry to tell you that price waterhouse coopers was wrong. they thought you were going to create 17,000 jobs in eight years. you have already created 12,000 jobs in the first year in the health care area. it looks like you're going to infuse $40 billion into your economy over the next eight years instead of 15. for my friends who are concerned that the federal government may back up at some point and not do their part or that these numbers at some point may change and we can't afford it, my message would be this, you can stop. the court case says anytime you want to we can stop. either one of those things happen, you can say we can't do

it anymore because we can't afford it. in between now and that, if that ever happens, a lot of people 400,000 people in kentucky are having health care coverage most for the first him in their lives. if you can get past -- i know a lot of legislatures have trouble just because of the name of the act. if you can get past that politics this is a win-win for both your people and your economy. you're going to create a lot of jobs and put a lot of money into your economy in addition to improving the lives of these people. our screenings for cervical cancer, breast cancer, diabetes they have gone like this. these people can get these. what that is going to do is it is going to cut down on the big costs down the road because when

they were getting screenings the first and we would see them is when they ended up in inpatient days in the hospital. now we are able to work with these people to teach them how to take care of themselves and take responsibility for themselves. that is part of this deal. your citizens need to learn how to do this and they want to know how to do this. that is what we are finding. if there are ways you can massage things around and get to this point it is going to be a big benefit to folks in your state. sylvia: thank you. >>, to virginia for a couple of days. i could use that. >> we have almost worn out the secretary. on behalf of the organization i want to express our gratitude for all of your engagement with all of us. we really appreciate it. sylvia: thank you. thank you. i look forward to working with

you this year. on a range of issues that i hope all not -- i'm looking around the table. i don't have to call any of you about ebola. i hope that we will have a good year moving the ball forward on the many places that we overlapped and the many places we fund. we want to hear from you. they want to know when we are getting it right and when we are getting it wrong. we have much bigger spaces and common ground than pieces of this agreement. there will be some of those but i think we can work on a lot of areas where we can move the ball forward. thank you for having me again. [applause] >> now, the bottom line is governor tomlin has set a high standard. now it needs to be beaten.

we are and ask governor brad sit to tell us what we're going to look forward to in iowa. >> i want to thank you for your leadership, delivering results gives us a great toolkit on how we can do a better job in each of our states. i want to thank governor tomlin. this is my 50th state. i have never been to west virginia. we have the whole family here and having a great time. if you saw my grandchildren out there dancing last night, we are looking forward to hosting the summer meeting of the national governors association in our capital city, which is a surprising place, a lot of things going on there. july 14 through the 17, i have been to summer meeting is, this

will be the first time for me to host it. we are looking forward to having you there. my whole family is involved in the planning. we want you to bring your children and grandchildren. my children and grandchildren have gone to the last three. milwaukee, nashville and here in west virginia. it is been a great experience. we want to make it a family-friendly thing, and we are going to have events, we have a special governors only spouses dinner at our historic governor's residence. we're going to have an event at the world food prize hall of laureates, a beautiful building restored library in des moines. we have a beautiful historic fairgrounds. there is going to be a lot of fun things to do.

mark your calendars for the 2016 nga meeting. we have a sweet tooth in iowa. we have this chocolate covered bacon -- [laughter] and the candy company in sioux city. there will be a lot of sweet things in iowa to enjoy when you come next year. thank you all very much. [applause] >> thank you. we look forward to it. little known fact for most of you who are too young, my great uncle was the lieutenant governor and the senator from iowa for 24 years. >> absolutely. >> i started a group hug in des moines. i can guarantee we are going to have a good time.

i want to thank again governor and mrs. tomlin, what a great host you have both then. what a place, between this afternoon's session, there were 30 minutes where i snuck down and bold a game in the basement. there are eight lanes, i doubled again with my son. it didn't go so well for me. this place, there are new things to find, i can envision coming back here at some point in bringing friends and family. a cabinet retreat. i want to thank all of your staff and volunteers. i know how hard they worked. we should give governor tomlin staff a hand. [applause]

>> first of all i want to say to governor brand stand -- brans tand, we are so pleased you came to west virginia, for many of you it was your first time, we hope you enjoy and hope you found the hospitality to be to your expectations and we would love to have you stay a few more days and come back to see us again. thank you for coming. [applause] >> this is my last meeting as share. that is a relief for some of you. trying to drive those schedules. it has been a great honor to chair this organization. we have accomplished a lot this year. i have been happy to be a part of that. probably the best part of the whole process from me is getting to deepen my relationships with so many of you. governor markell and governor

fallin act as my mentors on this. governor herbert has been an active partner. i wasn't sure if i was the chair or he was. just because of his natural talent, cream rises to the surface. getting also to know our sponsors and corporate partners and holding those relationships and recognizing that for so many of these companies is not a republican or democrat, they are trying to solve problems to make businesses grow and to make the lives of our citizens better. the nga does a great job of threading the needle to make sure we are working in concert and not at odds with each other. respecting the importance of competition, the productive side of capitalism. the nga is remarkable organization. it has a dedicated staff. i want to take a brief second to

thank dan crip it -- crippen. is going to stay with us through the rest of the year. some have started talking about what kind of appropriate gift we can give him. he came in with us when the organization was not in great shape and he has given his heart and soul. a lot of people don't realize he is a south dakota born and bred, born educated. he worked as a domestic policy advisor to president reagan, director of the congressional budget office under bush. throughout his career before he came to the national governors association he was known as someone that listened. and really was moderate in his approach, and able to create compromise and find solutions in some of the challenging situations.

he also was well known. we have seen this again and again, for his judgment and his wisdom. i got to make use of that over the past year. as early as 1998, 1999, he was calling for more technology and more service as a way of controlling costs, studying medicaid to find those places we could find the greatest savings. he was a relentless champion of investing in research and science. a great advocate or of the space programs. when he took over nga in 2011 he took a lot of that experience and brought it to the table. i'm not sure where dan is. stand up and let us -- [applause]

it is an unruly group. trying to make sure that the questions get asked, it is like being an option near. certain of view, you get a flick in your eye or something like that, and you have a question and i have to restrain myself to make sure you have confirmation of the wiggling of the eyebrow. i want to thank the staff for all they have done, not just for this conference but for throughout the year, the bipartisan expert advice, the technical assistance for our state governance, for putting

together all these meetings. there are dozens and dozens. getting to know them has been almost as good to know all of you. when i talk to most governors it is the relationships that we have with our constituents, our staff, the groups we work with that make these jobs so enriching. we nudge the universe from time to time from having these relationships makes it easier and better. now for our to closing administrative acts, we have two policy items before is that would wire a vote. -- would require a vote. american samoa only, the u.s. virgin islands, got together at our february meeting to discuss

issues unique to them. as a result they made it last that nj's permanent policy may clear the association speaks for all the states, commonwealths, territories. we have an immigration policy that has been reviewed. we have discussed it a couple of times. disgusted and gone back and forth with staff. it is ready for consideration. since we are taking the stuff in our summer session we have a two-step process, we are going to suspend the rules and then the second will do the passage. i need a mosys to suspend the rules and consider these policies pre->> so moved. >> can i have a second? all in favor say aye. the motion is approved. can i have a motion on the permanent policy at the association all states,, waltz and territories.

>> i'm sorry, first before the motion, a question on the language. i'm not sure, and maybe you have tracked this, the languages balance relationships between the states and u.s. possessions referred to as states, a question for you mr. chairman is our states then possessions, is that a legal term? it looks like it says for here and after possessions are referred to as states and states are possessions synonymous. if the intent of the preamble to change the preamble is to have the governors of the territories represented on the same level as the states, i see the words and that. if it means to call states possessions i wonder if there is legal or modifications or

symbolic ramifications of that, or if they move to formally add the commonwealths, and the territories as new stars on the flag, i need to know that. probably everybody is ahead on me on this language for the better language but between the states, the territories, and the commonwealth of pollen puerto rico to avoid this possessions question. that would be my only thing. i think there is a way to say it. have the same balance relationship. they are a part of this. if it is intended to be beyond that this title of possessions, i'm just not sure about it. >> how many lawyers to we have around here?

i am not a lawyer. i'm the wrong person to ask. i agree what we want to say. >> it is hard to disagree. i have no problem with that. >> david's. if we can amend to that. >> what i would ask that it be written so that the last sentence -- works to promote a balance relationship between the states, the territories, and the commonwealth of puerto rico, and the federal government. >> perfect. >> second. >> all in favor say aye. can i have a motion on the immigration proposal.

think of you are here. now because we have the amendment is approved, we now have a vote -- a motion to approve. [laughter] we have a motion to approve the preamble as amended? all favor, say aye. the motion is approved. can we have a motion to approve the policy on immigration. all in favor say aye. >> nay. the border states. >> i appreciate the discussion with the governor. i just think that the importance of border security is understated on the document therefore i vote no.

>> that passes. now it is time to call on the chair of the nominating committee to report on the decisions of the committee and to nominate next year's leaders of the national governors association. >> thank you mr. chairman. i would like to thank governor tomlin for hosting us. thank you to you and your staff to make these wonderful accommodations. thank you for your chairmanship. thank you for another great initiative on delivering results . we appreciate your time. we know it is a lot of work to be chairman of this organization. thank you for your service. it is my privilege to announce the nominees for the 2015, 2016 nga executive committee and move for their consideration. i would like to announce those nominees. from connecticut, governor

dannel malloy. from minnesota, governor mark dayton. from nevada, governor brian sandoval. governor patrick worry. from colorado and our former chairman, governor john hickenlooper. our new vice chair, governor terry mcauliffe. our 2015 new chair nominee governor of utah gary herbert. i make that motion. >> the motion, do we have a second? all in favor say aye. the ayes have it. when i was running restaurants they didn't give us a lot, we got to tell people what to do. now it is my honor to, with a

light heart, and a skip in my step, to be able to turn over the gavel for this organization to the governor of the great state of utah, gary herbert. [applause] governor herbert: thank you. thanks to the wisdom of the nominating committee. we have a great slate here. let me say thanks to governor hickenlooper. we appreciated his leadership and sense of humor. sometimes questionable. his attempt at humor is always appreciated by me. [laughter] he has a great demeanor, a leader to bring us together on many issues. some issues that we were reluctant to tackle, immigration

today for example. we had a good discussion on this . i can tell you i have worked with john for a long time and i like the guy. no accounting for taste sometimes. john has done a great job. let me just present to you the symbol of your leadership. that is a careful which we will present to hear here. we hope you will put that in your office and show it with some pride of your leadership of this great organization and congratulations. [applause] now you will have a little more time to work on your bowling.

let me just say i'm a big believer in this organization. i believe in you, in the states, in what you represent. i'm excited about the opportunity we have before us in challenging times. i'm excited to have governor mcauliffe as my vice-chairman as we commit to you we will do the best we can to take wherever the injury is today and raise the bar. we have opportunities to do some wonderful things. great minds think alike. governor hickenlooper's initiative on delivering results , and teaching assault that there are better ways to do things, we can find efficiencies in our state governments, and represent our taxpayers better and solve issues and problems better than we have in the past. i would recommend to the staff that the documents have been prepared and ought to be

required reading for the new governors that come in. it is a great place to start and say what can we do to find more efficiencies in our state government? that same regard, i am taking a page out of governor hickenlooper's book and saying to us all that we need to raise the bar and move forward. challenging times. we have had discussions about the challenges we face as states. i enjoy coming together and listening to how you are addressing your unique problems and challenging's -- challenges and finding solutions. i was reminded of james madison's comments from the federalist 45, which is on your nightstand and you review every night before you say your prayers. it reads this way. the powers delegated by the proposed constitution of the federal government are few and defined.

those which are to remain in the state governments are numerous and indefinite. the argument at the time of ratification was don't worry about the growth of the federal government it or it will re--- overrun your responsibilities. the concert of photorealism is born in the shared responsibilities that we have. we will show by example of the fact that states are in fact succeeding. governor hickenlooper has sounded the message and all of our states leaving the message forward. i want to echo that clarion call to the states to step forward. sometimes we see partisanship and we have always had partisanship in the inception of our country. it is a role for partisanship to play. we campaign as partisans.

but what is good about this organization share best practices, to network, to learn from each other, to become better governors and represent the people that we -- that elected us to office. that is a bipartisan learning experience that has made me a better governor in utah thanks to you. and your willingness to share your experiences. we had a pollster that spoke to us and said in describing governors and states, you governors are the problem solvers of the nation. i think that is true. we have as many examples of challenges that you are solving, the problems you are solving. it may come as no suppressed to you as a choose my own initiative here, as what we

should rally around. i believe the real action is happening on the state level. i hear great examples of leadership and you have implemented some of the most innovative solutions to challenges we face around the state that we are trying to learn about and coffee in power perspective states. i have chosen to focus my 2015 2000 16 national government association chairs initiative on the states and my title is states, finding solutions and proving lives -- and improving lives. it is a desire to highlight what you are doing. to that end, pick a topic. it could be education transportation, health care. we talked about the affordable care act and how it impacts our respective states in different ways because of different coulters and different health care need that we have in

respective states. public safety, how we work with our national guards. all those issues that are being highlighted by solutions that you were leading -- leaning forward on. if someone to pass those out? we have it on the screen. you will be given a card like this with a handsome guy on the front. my colleague's picture there. [laughter] anyway, what i did when i came in as governor, i created the goals and mission statement for the state of utah and the herbert administration. i required my staff people to carry this with them around all the time so we are focusing on what we think the goals and aspirations of the state should be. to that extent i'm going to give you this to hold me accountable.

to find real solutions, look to the real innovators. states are laboratories of democracy. my initiative will showcase those breakthroughs. to that extent, we have this, we are going to work with you and take the opportunity to have you and your respective states tell us what are the issues that you are proud of? what are the solutions you are -- you have solved? we are to push it out to the public. the public face to have an increased awareness of the successes of the state and the successes brought about by the leadership of the respective governors throughout the great land. 50 states and five territories a commonwealth, the success of the happening there.

and bring back and understand the shared responsibilities we have working as partners with the federal government, and making sure that they don't overshadow us, and we show them the innovative ways we are solving problems. to highlight these state solutions as good as we are doing here. over the next year we will examine solutions that you found in your states, and we're going to look for ways to apply those lessons as we share best practice so we can infect fact learn from each other and go back and be better governors. i expect in this process we will meet with many experts around the country, some from your states that will help us learn how you found innovative ways to solve problems, and showcase those successes. we would like to put those at the end of the year as we have highlighted two or three of the

best that you have in your states in the publication which will have the 50 states and the five territories to highlight what you have been able to accomplish. we will highlight the successes, and i think we will increase the awareness of the american public on where the real work is being done and accomplished in a significant way. we have the opportunity to be more nimble, to dress closer to the people in our backyards to solve these problems. and it fits in a moniker that was told today about being problem solvers. my message with all of your help is from the nga, the national governors association, this effective organization, to the people of america, look to the states. look to the states for the solutions. we have put to much demand on the folks in washington, which is hard for them to deliver. but the states are the ones that are solving problems.

look to the governors for solutions to issues of the day. i think you won't be disappointed. they are the leaders not only of today but up tomorrow. -- but up tomorrow. thank you. [applause] with that, i understand our bylaws require a gavel. i know john, do you know if we gavel in, it is my job to gobble -- gavel us out. thank you very much. we stand adjourned. [applause]

[indiscernible talking] >> you have been watching live coverage of the national governors association's annual

summer meeting. programming note we will be rearing today's sessions tonight , kicking it off with this closing session with remarks by sylvia burwell. you can watch all of our nga coverage online as well as c-span.org. we will give you another chance to see today's nga session on open your drug abuse -- opioid drug abuse. >> if i could have your attention, let's take our seats so we can get our joint session started.

first of all good morning, welcome. i'm governor steve this year from kentucky. i chaired the nga health and services committee. we will call this meeting to order and welcome the governors who are here. this they joint session of the health and human services committee and the homeland security and public safety committee. joining me as five share of our committee is vice chair governor bill haslam of tennessee. i am pleased we have been able to come together with the homeland security and public safety committee for today's discussion regarding the nations avoid -- opioid crisis. i want to thank the leadership of the other committee, governor rick snyder of michigan, terry

mcauliffe of virginia for partnering on this important topic. there is a few administrative tasks to perform. the briefing votes for this meeting were sent to governors in advance and include the agenda, the speaker bios, and the updates. the proceedings of this meeting are open to the press and all meeting attendees, please silence your cell phones. seated at the table our community -- leadership directors. you can see them after the session if you need further details about the issues we discussed today. before we go into our formal presentations i want to turn to heather hogg said+. heather and her colleagues will provide updates on key federal and state issues. heather.

heather: since the winter meeting we have made progress on a number of priorities of health and human services. from the health and human services perspective we advocated for an extension of the children's health insurance program which congress did extend in april for two years until fiscal year 2017 as part of a larger deal to overhaul medical payments to physicians. that maintains existing programs flexibility, and that was a key priority we were able to accomplish for you. one of the other things the committee has been engaged on is discussions reform the child welfare system provided flex ability to services that keep children safely out of foster care. at the same time the homeland security of public safety committee has been working with congress to maintain army national guard personnel and prevent the transfer of helicopters to the active army until after congress has time to

consider the recommendations of the army commission that is currently doing its work. the house and senate are conferencing their respective bills. they plan to have a final bill sometime in the fall. ng has been advocating that the senate bill provision which would retain additional personnel for the guard and present the further transfer of apaches until 2017 be included in that final bill. in addition to national guard members the committee has been working to promote the state's role in cyber security. and foster greater collaboration with the federal government and the private sector. that as the two main priorities of what to cover from the federal relations perspective read i will pause and see if there are any questions before we proceed. happy to answer anything afterward. i would like to turn to my colleagues for best practices. the director for health division. >> go to -- good morning.

i want to give you an update on how the division is going. we have had well over 20 very intensive products going on around the country. we have hundreds of your leadership staff. there are two projects i wanted to highlight for you this morning. the first is our medicaid transportation academy. this is very intensive we are working hard to negotiate billions of dollars in upfront investments from the federal government. it is very powerful work. we plan on providing you with a very victorious report in

february during the winter meeting -- january. we will be releasing a roadmap for all states that we are hoping to reach agreements with hhs that will allow you all to use a new process to get to medicaid waivers more quickly. we also are launching our next round of super utilizer work in two days. it's aimed at the highest cost, highest spend medicaid patients. they are spending millions of dollars and have terrible outcomes. that will be for the next year and a half. we are ready did two years and had some pretty impressive result your it -- results. prescription drug abuse, opioid agrees, heroin addiction have come to light as very strong

components to the reason these folks end up using a lot of these services. today's discussion is i think very relevant from a cost perspective and equality perspective. we will be able to solve one of the most important issues facing state medicaid budgets. >> now we will turn to jeff mcleod. >> my division has worked in close collaboration with frederick's division. we posted to -- two policy academies in several states. states have passed legislation launched public awareness campaign, trained providers on safe and effective prescribing practices.

we have put out a few different products. we put out six strategies states can adopt to address prescription drug abuse. we followed up with some new recommendations. through evaluations, states can better assess the ask -- the success. certainly, the problem of prescription drug abuse has been grabbing headlines. substance abuse in general is a real problem as it relates to the safety and well-being of children, especially children in the welfare system. we launched a new policy academy on approving child safety and preventing child fatalities.

my division will be working again with frederick and his team to build on the success of the policy academies and the momentum that i think there is nationally on this issue on helping states deal with the rising use of heroin. according to the centers for disease control and prevention three out of four users started on prescription -- four new heroin users started on prescription drugs. if frederick or i can be helpful, don't hesitate to reach out. back to you, heather. >> we will stick around after words to -- after words -- afterwards to answer any

questions. >> let's turn to the topic of today's joint committee meeting which is opioid abuse. it's a major public health and safety crisis that affects all of our communities in every one of our state. because of the rise in prescription drug abuse and in heroin abuse, overdose deaths now surpassed motor vehicle accidents as the leading cause of death in the united states. heroin deaths have increased especially quickly, nearly tripling between 2010 and 2013. kentucky has its problems in this area. we have long been plagued with high rates of drug addiction both to prescription painkillers and illegal drugs like heroin. over the last few years, two

things have happened that are giving us more hope and confidence in the future. one, we passed and implemented a couple of wide ranging and multipronged programs that attack the problem from every angle including treatment education, law enforcement, and health care. secondly, what we are finding is that our stakeholders are working together like never before, both inside and outside of our state. in 2012, we passed what we calleed house bill one, which targeted prescription rug of -- drug abuse and misuse. we ran a bunch of pill mills out of the state. we required our medical professionals to use our statewide electronic prescription monitoring them -- system. and we allowed for better

sharing of records among agencies in kentucky and other state. earlier this year, this addiction situation is akin to the game of walkable -- -- you attack it in one direction and it pops up somewhere else. we have seen tremendous progress. but now, heroin is raising its ugly head and is killing even more people than prescription drug abuse did. earlier this year, we took a similar approach in our legislature on heroin. we passed senate bill 192. this bill increased prison sentences for heroin traffickers, but it also helps us identify addicts that can benefit from more treatment than from lengthy prison stays.

i think we have all figured out that we cannot incarcerate ourselves out of this problem. we have expanded addiction treatment. we have allowed local option legal exchange -- needle exchange programs. we established a good samaritan provision to encourage friends of overdose fictions -- victims to call 911 and get help. last month, i announced the allocation of $10 million for a programs aimed at fighting and treating drug abuse, including programs to help inmates pregnant mothers, improve prosecutions of drug dealers help public advocates drop alternative sentencing plans and expand substance abuse treatment at the local level. governors all across the country are leading similar efforts to address the opioid crisis, bringing together law enforcement, criminal justice professionals, health agencies providers, and other key

stakeholders to develop and implement comprehensive strategies. the health and human services committee held a session on state efforts to combat prescription drug abuse during the 2014 winter nga meeting. the committee has since maintained a focus on prescription drug abuse bringing lessons learned from states to inform policymaking at the federal level. at the most recent nga and winter meeting, governors approved a new policy that calls on the federal government to work with the states in developing a comprehensive national response to prescription drug abuse. today's discussion reflects the reality that we are no longer confronting an epidemic of prescription drug abuse by itself. but an alarming resurgence of the use of heroin. recent federal data confirms that the link between rising rates of prescription drug abuse and heroin abuse go together.

indeed, almost half of those who use heroin also abused or had independence on prescription opioid painkillers, making them the number one risk factor for heroin use. next week in kentucky, we expect to hear positive news from an evaluation of our efforts to change the land of prescription drug abuse. but we still have a long way to go to fully address the opioid problem and the recent spike in heroin. i look forward to today's discussion and hearing from our panelists about additional strategies that we might be able to implement in kentucky. i'm going to turn out to governor snyder and ask if you would like to make some opening remarks and introduce our guest. >> i want to start by thanking you and your other committee members for the great work you have been doing on this or the health and human service committee. it's important.

i also want to recognize my partner in the leadership of the homeland security and public safety committee. we work well together on a number of issues, including cyber security. this is also an issue that's critically important to all of us as governors and citizens. this is a great venue to have a discussion. i want to thank everyone coming today in terms of the other governors, members of the audience, and distinguished panelists. i look forward to learning today and being stronger and better thanks to the knowledge you will show us. this is a major crisis and that is the attitude we need to take towards opioid abuse whether it be prescription drugs or heroine abuse. in michigan, we found it to be a tremendously growing problem. to give you some perspective, as i travel michigan, i often ask you what the biggest issue -- ask people what the biggest issue they face it. two sheriffs pointed out their greatest problem was prescription drug abuse.

that's the starting point of all of this. we need to do more. last year, we passed a bill dealing with opioid antagonists where we actually have our emf people carrying that with them to address the problem. you have to use that -- if you have to use that, it's much later than it should be. we need to do more in terms of education, prevention, treatment, and the public safety side of this together. that's why doing a joint meeting is particularly important and i am proud to be here. with that though, let's get to our distinguished panelists and learn from them. i look forward to this because in michigan, i have created a task force this spring that will lead into a legislative and other packages of actions to be taken. this couldn't be more timely in terms of hearing from people who are experts. i am proud to say we have a very distinguished panel. i am pleased to introduce congresswoman mary bono.

among the many a competence during her 15 year congressional career, she founded the congressional prescription drug abuse caucus and cochaired the congressional addiction, treatment, and recovery caucus or it now a principal at a consulting firm and cofounder of the collaborative for effective prescription opioid policies, she maintains a strong commitment combating prescription drug abuse and promoting recovery. thank you for being with us. also with us today is dr. debra houry. in that role, she leads the cdc's efforts to advance public health approaches to preventing overdose deaths, working closely with states.

prior to joining cdc in 2014, she served as vice chair and associate professor in the department of emergency medicine at emory university school of medicine, as well as associate professor at emory's school of public health. inc. you for joining us here at -- thank you for joining us. lieutenant detective patrick glenn who is a founding member of the norfolk county prescription drug monitoring program and director of the quincy program. in 2013, he received the white house advocacy for action award for bringing law enforcement and public health together to disrupt the cycle of drug use crime, and recidivism. congratulations for your fine service. welcome to all our panelists and i'm looking forward to the discussion.

>> let's start off with congresswoman bono. >> good morning. it's wonderful to be here with all of you and to see my former colleagues. thank you for testifying before my committee a couple years ago, governor beshear. my gavel was very like that day and i'm without one now. i want to thank all of you for taking an interest in this topic. i'm honored to be here to share with you my thoughts on the opioid crisis. i applaud you for focusing on this academic and i encourage you to throw everything you can add it. countless lives hang in the balance. the hush-hush nature of opioid overdose death has for far too long been preventing the serious public health issue from receiving the urgent attention it needs. i am here with you today as both

a former elected official who spent almost a decade focused on prescription drug abuse come a but i am also a passionate parent and family advocate who has personally will wrestled -- wrestled with this issue. my introduction to this problem started in my own home. as a full-time working mom, i knew my son was grappling with some issues but i didn't understand what they were. one day, i received a call from my son who said mom, i need your help. i have become addicted to pills. you can imagine how that felt. i still think god for that call and i consider myself to be one of the lucky ones. i grieve with the many parents who weren't as lucky as i was. that phone call was just the beginning of a very tough road for our family and it was a journey that we made public by doing national television

interviews. after that, my office and i became somewhat of a beacon for other parents going through either the grief of losing a child or pleading for help. to this day, i credit my son for his courage and compassion for speaking out himself and for allowing me to do the same. i have developed a very passion for our youth and their susceptibility to addiction when they face the powerful drugs we have all seen happening too often. we joined forces to create the prescription drug abuse caucus. a continues to grow in numbers. many solid strategies are emerging to deal with this crisis, and there is not one i have read about that i disagree with. they are widely agreed-upon strategies such as the real-time prescription drug monitoring program, research into personalized medicine, and good

samaritan laws. i support them all. but i focus my thoughts on a few other things. first, in addition to communing -- promoting community-based education, it cannot be overstated that there is a need for strong messaging for need -- from leaders like yourself about the dangers of prescription drug abuse. we hear so much about avoiding gluten and cigarettes and artificial sweeteners and more but we are simply not hearing enough about thinking twice before we pop a pill or it -- pill. the medical community needs far greater education about the diversion of these powerful drugs as well as the disease of addiction. i know the new terminology, but i can't break away from saying addiction and addict. for quite some time, there have been some who have denied any role in the epidemic but that thankfully seems to be changing.

physicians and other providers are on the front lines of this issue. providers, particularly those who treat a high percentage of patients suffering from any form of pain, must have the latest treatment died lines, including the use of monitoring tools for high risk patients are it -- latest treatment guidelines, including the use of monitoring tools for high risk patients. secondly, we need to finally and fully overcome the stigma associated with recovery. those in recovery needful support from their family, friends, society. recovery needs to be easily accessible with affordable options for anyone seeking help. court 12 stands for -- core 12 stands for comprehensive opioid recovery using the 12 steps.

the notion we can get somebody into recap and they will emerge 30 days later fixed or cured is not the reality. it takes seriously hard work and dedication for both the individual and family. if a relapse should occur, it should be seen in the same way we look at the recurring cancer. it's sad but true. it should not be stigmatized and we should reach out to anyone who needs support. that recovery should include doing all we can to promote and establish recovery schools and sober housing for college students. once a young person can leave rehab there should be safe and supportive options for them to enter. that support should last a lifetime. i would like to invite each one of you to participate in the unite to face addiction rally. you can find out more information about it at facinga ddiction.org.

recovery deserves celebration, not stigma. the last point devil make concerns -- the last point i will make concerns cpop, the collaborative for effective -- cfop the collaborative for effective opioid programs. law enforcement, treatment centers, medicine manufacturers who are striving to make treatment a for and tamper resistant. the collaborative seeks to stem abuse. we need an important meeting of the minds in order to advance solutions. i invite each one of you to join us, we could really use your

help and support. each one of you should ask how the many many federal agencies who are charged with controlling drugs could allow this to happen on their watch. the caucus could really use their sip -- your support with that. i really want -- i once saw a really good video about the pill problem in florida. imagine that 100 dead dolphins washed up on our beach every day. people would be outraged and demand action. now imagine that continuing day after day, year after year, but this isn't about dolphins. it's about our kids and families. imagine them washing up on our beaches. we must throw everything we can at this epidemic. thank you for listening and i stand ready to answer your questions.

>> thank you for your work congresswoman. it's important. next, let's hear from dr. houry. >> thank you l for inviting me here today. -- y'all for inviting me here today. i would like to mention that for our agency, this is one of our top priority areas. as somebody who has been on the front lines over a decade in an emergency department, i have witnessed this epidemic growing and changing. i have seen the patients' faces. the work we are doing at the cdc in partnership with you, i know we can make a difference.

in the year 2012, there were 259 million prescriptions for opioids. that is enough for every single u.s. adult to have their own bottle of pills. as we have seen that increase in death, we have seen it quadrupling during that time so with the increase in prescriptions, we have seen an increase in death. sometimes, pictures tell the story better than words. the picture i'm about to put up, i want you to watch. for your state and watch the changes. -- look for your state and watch the changes. red is not good. you can see the rates spreading across the country. dark red is the highest.

you can really see how this epidemic has spread across the nation. it does impact other areas more than others such as the southwest and appalachian regions. every state has experienced a significant increase. earlier this month, cdc released a report on heroin. it's important to realize why we are seeing this increase. it's because of opioid painkillers. people who are abusing opioid painkillers are 40 times more likely to be addicted to heroin. if you think about it, it makes a lot of sense. it has the same effect on the brain, so people that can no longer access opioid prescriptions will look for something that is easier to obtain or even cheaper. by focusing on opioid prescribing, we can impact the hair when epidemic. -- the heroine epidemic.

there are often consequences. as seen earlier this year in indiana and -- in stock county, the hiv epidemic, 170 individuals newly diagnosed with hiv because they were injecting opioid prescriptions. although this is an extreme example, it can happen in any community in the united dates. states are poised to respond to this and must be ready to respond. i wouldn't be here if i didn't think we can make a difference. i am very optimistic that we have the tools we need to have an impact to really curb this epidemic. we did this for car crashes. overdoses have now exceeded car crash death. that's because overdoses are going up but we have also seen car crash deaths go down.

this was a concerted effort, working with different agencies. the cdc will use the same approach we use on for that for opioids. by monitoring the problem, looking for where those high risk communities are, what are the risks and protective factors we need to identify those most at risk and identify a set of interventions and take them to the state level and share best practices across state. i am very excited that next month, we will be announcing our prescription drug overdose prevention for state program. it builds off a pilot program we had this past year. 16 states will be receiving $750,000 or more for the next four years. we will be working closely with these states to improve their prescription drug monitoring program so they are easier to use, more real-time and will

work with health care systems in those states whether it be the medicaid program or around guidelines to make sure things are implemented for safe prescribing. what we learned from the pilot year is to have flexibility for state. we have built in a rapid response project so states can target specific communities, do a communication campaign, or enact surveillance. our hope is to be able to make this a national program. we are excited to have the opportunity this upcoming year to work with these 16 states directly. we know this is the right approach. if you look at state-based interventions, we have seen that new york requires prescribers to

use a monitoring program, there have been a 70's -- there has been a 75% decrease. in florida, when they began to regulate pell-mell, they saw a 50% decrease in -- pill mills, they saw a 50% decrease in opioid deaths. we will also develop chronic pain opioid prescribing guidelines which will be targeted for primary care physicians. this will give talkers -- doctors tools to know when it is appropriate to prescribe these medications and when it's not and how to do it in a safe and effective way. what can we all do with this? i think there is a lot. we are already seeing a lot of these great practices. one is to promote best practices in opioid prescribing states.

i know some states such >> i know such states like oregon which has already been implementing this through medicaid providers, and arkansas . it would be fantastic if states use these in their programs and regional health care programs. in addition, encourage authorities to stop the work for prescribers, whether it be the state medical board or law enforcement. finally, really improve well informed opiate prescribing by making prescription drug monitoring programs easier to use. again, as someone who has had to use one, there is a long way that we can do to make them more user-friendly and more effective. you can work in your states to do that. i look forward to having further discussion with you at the end of this panel.

below is my contact information so we can talk about how to reach out to your states directly. thank you. governor beshear: thank you, dr. now, lieutenant glenn. lieutenant glenn: thank you, and it is an honor to be here. i bring greetings because back in 2009 i believe we took the bull by the horns and came out to say that we had an epidemic in the city of quincy. i can describe exactly what we did with that and how it blends into what is happening today. what we ended up doing is we refocused and took a humanistic approach. we did change some of the terminology, and it was difficult to do. in the past we would call a person "junkie," "abuser," etc. and we arrested them. we changed it from "junkie" to

"family member," we personalized it. we go back and forth with the terminology, i know. with over does, it is a poisoning, it has an adverse affect on the body. hopefully we can get the person to recovery. we do not think everyone is going into treatment, but as a -- as i said from the beginning in order to go into treatment, they have to be alive. that is what we try to do in the law enforcement field, get the person to be emergency department for treatment. we came up with this prevention treatment, much as the governor spoke of. yes, we are out there arresting, we are not soft on crime.

we are arresting the people who are dealers and traffickers. we do have a good samaritan law that was admitted to the 12 which prevents the arrest of the individual or someone aiding them in assisting our calling 911 for help. we know in the past that we would show up to the scene and have a dead person sitting in a chair or lying in bed with their identification in hand and there was no one else there. that life could have been saved. we want to try to do that and reduce the fatal overdoses. we collaborate with the parish. i still that phrase from bill brad and -- braden. we have to collaborate in this issue. we have seen the deaths in the streets now. we collaborate with the department of public health in massachusetts outreach programs, police officers such as myself other law enforcement agencies and administration. we went to the table and spoke.

the beauty of that is we went back to the table again and continue to speak and we came up with this program. the department of public health allowed us to enter into the pilot program, which was the first that allowed law enforcement to administer doses. we will show you the results in a few minutes. this is how we work well together. it is the quincy police department, the department of public health. these people who are overdosing belonged to someone, they are brothers and sisters, mothers and fathers. some of the statistics you have already seen, so i will go past that. the doctor that showed up there

i'm glad that massachusetts was representated. in 2013, three people die every day in massachusetts as a result of an overdose. i think we will be up to four or five in 2015. that is every day. some of the results here -- this is a little crowded, but what i wanted to bring out was the statistics. we started in 2010. we had 47 deaths in the city of quincy. the following year, when we introduced more noxon on the street we reduced the deaths. the myth that was there that if you are a substance abuser you will come to quincy because we have naloxone we have not seen that. in fact, at the time of the flight, we were about 7% repeat clients, meeting that someone reversed more than once.

that is a very low percentage. we are very high in the percentage of the reversal, a high 90% on reversals. it was administered to 433 individuals and we have reversed 416. those are individuals who we gave an option to go into some other treatment. or at least, we turn them into their family alive. that in itself is amazing. we have gotten a number of telephone calls thinking -- thinking -- thanking us for saving a father or mother. a quick story. we have a vigil every year. a woman came up after the vigil and said, you did not read my name off. i said, that means you are alive, that's good. she said, i know. 17 months ago i overdosed and a quincy police officer reversed me. i overdosed again about a month after that, and i was reversed. at that point, it was her tipping point.

she went into treatment and has been recovering now for 14 months. that is a success, when someone can come up and say that we were able to turn around. i know this is in your material, as far as prescribed by doctors and providers, over 71% came from a family or friend, meaning that there are too many drugs out there in the medicine cabinet, we want to get them out of there. the common risk is obviously the age group. we have a huge influx between 17-26, and then mid 40's on up. there are many drugs involved, it is not just heroin. naloxone will work only with the opiate family. these next two slides are probably our flagship slides.

they demonstrate what the opiate does. the simplistic description is it attacks the receptors in the brain until the respiratory system is nonexistent and you die. you are in an overdose stage you are not breathing. officers are fully trained in delivering naloxone, the brain starts breathing again, we have the reversal. documentation will be provided for counseling, and so forth. again, we are not naive to think that everyone goes into counseling, we know that. we have to give them a chance. and every police car, on the side of the police cruiser it says "protect and serve." we protect and serve all.

we hope to get them to the hospital for further treatment. there are two formulas, one is a nasal spray, another is an autoinjector. they are very similar, the same medication, different loads. there are some samples being passed around. the autoinjector is a very simple, much like the epi-pen. i've always ask, why do you do it? i go against the grain and say "why not?" we are all first responders and if someone was in a diabetic emergency, we would provide some kind of sugar product to them. if someone is in an opiate overdose, -- i never saw the results of this. i never saw the big deal. we are supposed to help

citizens. this is our job. i'm just a cop. i have seen people overdose and i within families, generation after generation. a lot of good people. this is not just for the addict, the substance abuser, there are people who are accidentally self-medicating and over who -- and over medicating who this will work for also. that is how we protect our community with one more tool in the box. i want to thank you and leave you with a few thoughts, multidisciplinary approach. this is a disease and not a crime. we do have to work together. there's no doubt about that. i always like to leave on more of an uplifting note. we did have a reversal two years ago, the boston red sox when they won the world series. we were in boston helping them -- why are you laughing? [laughter] we were helping with some traffic issues, an individual ran across and said, i know you have naloxone, my girlfriend is overdosing.

she was around the corner. they went, administered, and took her to the hospital. that is the perception that the public has now of the police that can help, not just enforce laws. we will enforce laws also. we are looking at this as a disease and have done that since 2009. i think that is great. i do not think we have to worry too much about the world series parade this year in the quincy-boston area, but you never know. we are always prepared. thank you for your time. governor beshear: thank you, lieutenant. let's open things up now for discussion. first, let me call on the vice chairs for any comments or questions that they might have. chairman? governor mcauliffe: thank you all for being here today.

i want to thank you mary for your time in congress. you chose where to spend the rest of your life and you chose the commonwealth of virginia, i appreciate that. a good low tax state. i do want to thank you for being here today. in virginia, we have done obviously very similar to what the other states have talked about. a couple of things that we added to our legislation -- all of our first responders have access to naloxone, but we also had to protect them civilly so that they could not be sued. it was a hesitancy for many first responders. other thing we have called for is a dramatic increase in our drug courts. obviously we no longer look at this as a law-enforcement issue, we have had to take a holistic approach to it. it is about health care,

communities, saving money to keep people out of prison. i want to thank my secretary of public safety who is here with us today. he headed up a 32 member task force to address these issues. my question to you, dr., if you just read the cdc report, it says the increase in heroin is coming from the least likely people that you expect to be heroin attics. my question is are there different things that we need to be doing in intervention earlier and how do we help our law enforcement deal with this epidemic? dr. houry: thank you for the question. i actually read your task force report. for people dealing with heroin as well as opiates, there are three things to focus on. what is stopping them from ever -- one is stopping them from ever being addicted, that is keeping

the substance is off the streets. the slide that the chief showed, a lot of people are getting these medications from family members, that is one way they can access them. safer prescribing. the second thing, for people already addicted, increase treatment so that we can help them really treat their addiction and get off the drugs. the third thing is naloxone. making sure that the first responders have access and the good samaritan laws will outlive that. -- will really help with that. i think it is important to look at what we can do to stop people from getting that. a lot of them will reverse in overdose, but if we can prevent them from getting to overdose, that is why i think is an -- that is what i think is the ultimate goal around prevention. thank you. governor haslam: i was struck at what you just referred to and the comments of 71% coming from family or friends. break that down a little more for us. how much is the original

prescriber an accomplice? how much is it being taken without them knowing? tell us more about that, and any other insight as far as things you have done to collect unused descriptions. lieutenant glynn: the prescriptions were legally written. the issue that comes into play sometimes is that people don't always follow the directions on the prescriptions. usually they stop when they feel better. they put them in the medicine cabinet. friends come over, they take them out, sometimes pill parties, you have no idea. people will start taking pills out of them. other than that, there are prescriptions stolen out of medicine cabinets in open homes when real estate agents have open home. it is one of the fastest growing areas of stored prescriptions during those times. -- stolen prescriptions during

those times. no longer is someone walking out with a flatscreen tv, they go to the medicine cabinet and leave with pills. it is not all of the pharmaceutical companies or the prescriber, it also is self-awareness and taking care of those prescription. the second part of your question on what have we done with access prescriptions -- excess prescriptions. we have a box where people can anonymously bring in unused prescriptions and we destroy them. if you don't come during the year -- we have ongoing programs to assist. the public has been very receptive. we also have senior pickup days where we go round to the senior citizen buildings and pick up on

-- unused prescription drugs also. governor malloy: thank you. i just wanted to share a couple of things that we have done in connecticut. we did pass a comprehensive opioid sills thatputs a lot of us but billy onthe doctor to check on thecomputer system before they write a prescription, it is mandatory. also education requirements on the subject, making sure that opioids that are tamper-resistant or consistent with systems to make it less likely that they be abused by that person or subsequent acquirers. we had done our narcan bill in response to ems, local police department's and troopers.

i can report that as of five days ago in the current year, 36 calls were service, 37 persons receiving medical -- who were in medical distress. this is just from our state police. in the bill i previously referenced, we are also making a possible for anyone to go to a pharmacist, explain the situation at home with respect to abuse, and receive narcan to have it available to administer themselves in the home setting. we think that will increase the usage. let me just say something. 36-37 states have more people dying of drug overdoses than they do in car accidents. think how much money we spend in making our roads safe, whether the snow removal, writing tickets, or having troopers on the streets or local police.

we do everything we can to prevent those. we are now seeing increases in death as a result of primarily opioid and heroin abuse, and we just have to step up our game. that is what we are tried to do -- that is what we have tried to do in the state of connecticut. i think this opioid deterrence proposition, where we might have to spend a little more to make sure this is available is an important thing to do. one other thing -- two other things i would say. we have worked in new england three years in a row, new england governors have worked together to break down some of the problems. what we found is people who dr. shop do it in multiple states. if you're not talking to your

neighboring state, you're missing the point. we saw that in particular with respect to hartford and springfield, hartford being one of the largest cities in connecticut and springfield in massachusetts. the number of folks who were doctor shopping in both jurisdictions was remarkable. the information was not being shared. having a better sharing system -- i will give you a for instance. connecticut had an opioid sharing platform with 16 states, but none of the new england states participated. we had to break down that wall. we also reached out to the eastern premieres of canada. we understood that number one, they were incentivizing the prescription by medical policy of opioids that were not tamper-resistant. just the opposite of what you want to be doing. and, there were people in maine and new hampshire and vermont, and i presume elsewhere, who were also coming across the

borders with that tamper-resistant, going there and coming back with tamper-resistant. these are some of the things that you might want to be aware of. let's do everything we can. the final thing, just because of our age, and i missed that both comments, i had to leave for a moment, sophie said this already -- heroin is purer than it has ever been. you do not have to shoot up. it is cheaper than it has ever been. both of those points may have been made. this is the third point of that. people are dying on their first usage. we are having it happen on a regular basis. young people think they are going to live forever, think they can tolerate anything. they experiment with heroin and if there is not someone to administer narcan, they are dead.

we're seeing 18, 19, 20 21-year-old. we see people other toy for his -- we see people at their 21st birthday parties die on first usage. we see them in graduation parties from college die from first usage. this is a big problem because of the expense and because young people think they will live forever. when we were going up, we all -- when we were growing up we all thought you would be a junkie in a week. it is very different now. it is cheap. but people are age are the fastest-growing abusers, for many reasons. how much is prescribed is important. you have a tooth removed, there is no reason for a doctor to write a 30 day perception for an

opioid. no reason for it. come back. if you still have pain after you have a mole removed after three days, come back for a renewal. stop writing long-term prescriptions. >> other questions or comments? governor: i agree. that is on point. we do all the things that were just mentioned. we also have dropp boxes. we all worry about national security isis, terrorism, cyber security, but the enemy within the nation is the addiction issues of our population and how it is running lives.

whether it is children ending up in custody because mom and dad cannot take care of them anymore, a school child having trouble learning and they are falling behind, because parents are not available or someone may be in prison, maybe grandpa and grandma taking care of the kids. it could be those living in poverty, those who are not in the workforce. 62% of the people who can work do work. but many do not. those who work and pay taxes have to help fund those programs and help those people. this is a national debate about how we can create a stronger america. but we are weak right now and we have threats outside and within

with our substance abuse and drug addiction problems. we need to have a national debate, besides the points that were made, is working with the judicial systems judges, and those who are involved in law enforcement, that if someone has a substance abuse issues and is not someone we are scared of, that might harm us in our homes, a friend, relative, an acquaintance who has an addiction issue, do we put them in prison for 20 years? with hardened criminals so that they come out worse, or do we help them address the core issue , which may be an addiction issue, hopefully not heroin, but it is a reality. how to week -- how do we do

things better, smart with crime yet tough on crime? how can we get people treatment? in oklahoma, i have encouraged people to look at how to get this substance abuse treatment if they are just not criminals but people with a problem. i am trying to remember the new word -- substance challenged? not substance abuse, what do you call that? >> substance abuser? i think sometimes we get caught on terms to much, we go back and forth. some parts of the country do not want to say addict. governor fallin: substance

disorder. but working with the criminal justice system, it costs money we know the outcomes for long-term. we want to keep those who are dangerous to the community locked up, absolutely. but how can we help family members, colleagues, as you were identifying addict versus a mother, daughter colleague friend, who has an addiction issue -- how can we change that dialogue in america to help people who have these issues? it is one of our biggest challenges. it is weakening us as a nation. we have acre issues like tourism and things we are really worried about. but we have a weekend -- weakened society and we are weaker as a nation.

governor: mary, you talk about public awareness. how can we do a better job of that? this is the key issue, get people to understand the issues and get them involved. mary: thank you. i look to you for some of the answers. i have some personal thoughts they may not be politically correct, but i will say them. and then i will speak to governor fallin and her questions. in this time of the legalization of marijuana, i think that kids are hearing some mixed messages. they hear that pot is ok, it is safe. but i think that the overall message right now on drugs altogether for the youth is

warped and more people should say, this stuff is stupid. we are not hearing this message. it is just stupid to do it. the just say no campaign that the first lady reagan, many people said it was not successful but we need something my back. it is stupid to do that. we are not hearing that. so even though we are looking at marijuana, in my opinion it is stupid. i will be one of the people to say it. i'm not popular with some of my kids friends, but i say it everywhere i go. and we have arguments at the dinner table. it is important. i congratulate your state to be one of the less transitioning. but to governor fallin, there seems in at the recovery community that they are enthusiastic about the

comprehensive recovery addiction act. portland -- i'm fine with that. it is gathering a lot of steam. tremendous bipartisan support. within that bill, there are guideline reforms. brenner is the cosponsor in the house, so guidelines are in there. we need some more support to get to the market level. the priorities of the country right now, it is hard to get senators to focus on this, but we are doing our best. with this i partisan nature i think that we have a good chance at it. again, the notion is people with substance abuse disorder shou