slightly and said, i want to find the awesomeness. he told me to go paid hunting in texas. so i went. everything from the philosophical to meeting people in diners and out their homes. host: we are getting the experience from ken stern, the author of "republican like me." if you want to know what he learned, republicans on (202) 748-8001. democrats, (202) 748-8000. independent callers, (202) 748-8002. how did your friends respond to what you are about to engage in? guest: it was interesting. i learned not to talk too much about it inside my house. my family, like a lot of democrats, have a concept of what i would find. and as i came back and shared stories. they were interested but they wondered whether i was -- i

don't want to say learning too much but thinking too much about the other side. >> i would like to start by stating a special welcome to president bill clinton. several policymakers are leading the way in health reform, including car was meant elijah cummings and -- both will be joining us in the program. also any audience, our condiment, john, and representation from the senator ben cardin's's office. finally, i would like to extend an especially warm welcome to senator -- whom we are now protocol -- [applause] -- 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 us today'summit on america's opioid debt -- epidemic. it is a national crisis that needs involvement from public and private organizations and individual citizens. 100 die fromarly opioid overdose. the the past 15 years, death rate from opioid overdose has tripled. the causes are complex. chronic pain are prescribed opioids instead of safer and less addict if. -- addictive. often, far too few people have access to evidence-based addiction treatment. the bloomberg school leadership stretching back

nearly 50 years, a training -- and advocated for federally funded treatment programs. two centers. one for drug safety and effectiveness. our collaboration with the clinton foundation began in may when president bill clinton led a town hall focused on the rising rate of injury and death. the resulting synergy, national leaders in the private sector, paved the way for a year-long effort to identify best practices. based on the initial engagement school, the bloomberg and the clinton foundation produced a document that identified a path forward and framed the problem as a severe

public health issue. the document called for scaling up, resisting evidence-based prevention to prevent future loss of life. despite such efforts, we have a long way to go opioid deaths reach a long term high in 2016 and the numbers keep rising. despite recent announcements by the white house, our country has not yet addressed the real need for urgent action and a true commitment for resources. released by just the bloomberg school in the clinton foundation entitled, "the opioid epidemic", describes 10 pillars, including implementing prescribing -- guidelines, advanced engineering solutions, as well as combating stigma. been shownegies have to work in today, you will hear from experts and advocates to

work together by further developing and implementing the strategies and generating new evidence. .ut we need your help please let's work together to stop this epidemic. i am honored to introduce congressman elijah cummings. born and raised in baltimore, congressman cummings has represented maryland's seventh congressional district since 1996. a member on the house committee for oversight and government reform and serves on government care reform. a chair on -- he has helped shape national policy on drug addition -- addiction, and access to affordable medication. please join me in giving a warm welcome to congressman elijah cummings. [applause]

congressman cummings: good morning, everyone. it is my honor and my privilege to be here. for your thank you very kind words. more importantly, i thank you for your work. this. to do family andf my certainly on behalf of generations of cummings yet unborn, want to thank johns hopkins for taking good care of me. [applause] rep. cummings: having spent almost two months in a hospital a few blocks from here, after a

heart procedure, i must say i have grown to love johns hopkins even more. doctors and staff , to the cleaning people, to the cafeteria folks, everybody , iociated with this campus thank you for changing the trajectory of my destiny. i truly appreciate it. thank you. i want to welcome our thisnguished panel to summit on our nation's opioid crisis. always good to see my good friend, my mentor, and my

.enator i understand john is in the room . congressman, i'm glad you are here. and mustr we now face is more -- now than ever. and other periods drugs, were involved in more , 64,000 last year deaths. in maryland, at least 2008 9 people fairly overdosed in 2016, up from 2015. this is stark evidence of how

human devastation are expanding exponentially. bipartisan that knowledge meant that the national public health emergency crisis does exist. but resistance remains in both the white house and congress, to taking old action. presidentis year, the has his own opioid commission, led by governor chris christie, recommended that the president declare a national emergency. as all of you know, last week, the president declared a public health emergency, a good first unlock anyoes not additional federal funding to confront the crisis head-on.

the commission also recommended something any additional federal funding elsee president authorized the negotiateof hhs to lower prices with blocks on, life-saving drugs that reverse the effects of opioid overdoses that i'm sure we will hear a lot advocate --a stark right now, our people the front lines of the epidemic cannot .fford to stock up that is why last month, i let 50 house members send a letter to president trump asking him to adopt this recommendation. day tim.t ask him, we unfortunately, the president did not even mention the word in his announcement last week. finally, as you all know, the

president and congressional republicans have spent years trying to repeal the affordable care act. -- expansion,nt though medicaid provides peoples to three and 10 who struggle with opioid addiction. if we are going to respond to the epidemic, we need your evidence-based research and your continued active engagement in the public debate here we must encourage the president to follow his own recommendation to --and the ability availability and reduce the cost. we must press insurance to eliminate the buyers in favor of opioid-based painkillers and we must challenge our friends in

expand public health funding, preserve medicare, and safeguard medicaid. know ouryou already response to the public health a test for our community. it is also a test for the entire society. my good friend from maryland, delaney, saidhn what flies direct to the current crisis. it is one of those come when you hear something, i wish i had come up with that. it is so true. i think about this all the time because it is so true. he said the cost of doing nothing is not nothing. tweet that. [laughter] rep. cummings: think about it. the cost of doing nothing is not nothing.

me repeat it. the cost of doing nothing is not nothing. we have seen it over and over again. i think all of you for being here today. we will fight and overcome. thank you very much. [applause] >> thank you very much for your leadership on this issue. and those inspiring words for us today. i am thrilled to introduce and welcome back to our school president bill clinton, founder and for chair of the clinton foundation and former 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 local health, strengthening local communities, and protecting the environment. in 2002, he launched the initiative to negotiate prices for hiv and aids medication to extend access to 11.5 million people in over 70 countries. an achievement many thought was impossible. a similar strategy, president clinton negotiated national partnerships with two pharmaceutical companies to --vide an affordable community groups, public safety organizations, and schools and universities. his goal is to cut prescription drug abuse deaths in half over the next five years, saving approximately 10,000 lives. done through strategic partnerships that raise consumer and public awareness, advanced business chains, and importantly, mobilize communities.

please join me and giving a warm welcome to president bill clinton. [applause] pres. clinton: thank you very much. thank you. thank you very much. all, dean mckenzie, thank you for having us back at the bloomberg school for public ongoingnd for the partnership we have had confronting the opioid epidemic. i want to thank congressman cummings for his remarks and his leadership on this and many .ther issues he said senator mikulski was his role model and he certainly proved it the last couple of

years. barbara was on a short list we kept at the white house. it was called the just say yes list. she asked for something, you knew sooner or later, she would cave-in because she was like a dog biting your leg and so i said, save a lot of time. figure out what she wants and say yes and we will be able to go back to work. glad to see you are here and i'm glad you are teaching here. i want to say thanks to two other people for their inspiration. one is mike bloomberg for funding this effort. 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 is my daughter, chelsea, who teaches public health in family in thes my an expert on anything relating to the public health policy. and who urged me for years to get involved when most people were not paying any attention to it. i want to think mostly all of you for being here and agreeing to take action. latest data says that in 2016, more than 64,000 people in this country died of drug overdose. opioid related. if the data is confirmed, and we have no reason to believe it won't he, that means last year,

more people died of opioid than therug overdoses numbers of deaths 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 deaths 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. frome learned a great deal these families.

one of them had a son working for hillary when he died and it worked for me. program at george washington university. he was a very smart man but nobody ever told him you could not pop a pill to get a buzz after drinking five beers and go to sleep, or you might never wake up. everybody has got stories like that. epidemic hasow the grown like wildfire in small towns and rural areas with no ,ublic health infrastructure where people don't know what to if they know. it human tragedy.a the cdc estimates more than $70

to don a year to continue so little in such a fractured way on this problem. treatment. yet, for all the noise made about it, the externa efforts being made by people with nothing. i mean nothing. a halfn ohio a year and ago, a little town in southwest ohio. itas proud of looking at because it was totally rebuilt, and an early 19th-century town. all the beautiful buildings were because of investments secured partially under the tax

credit, the last completely bipartisan initiative designed to give people who invest in small towns and rural areas with high unemployment income. that was the good news. wasgood news further was it the most beautiful building in town and had been given over by the city to doctors who voluntarily came there so they could practice and appellation. the doctor got her medical degree in new york i walked out and across the street, a woman waving frantically at me, please come over here, so i go over and i only own one asset of any value, a used car. i sold it and renovated that office. what you're seeing is the only

-- facility in this town. a woman had just died of a heroin overdose, the poor man's version of opioid addiction as we travel down, and three women who are recovering heroin addicts. she said, i'm happy to do this. i know nothing about it. i get whatever help i can and it is all we got. i am glad one of our panelists is the head of public health in baltimore, which had the first public health: m 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. extended 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 where we act like a grown-up country and treated like a public health care problem instead of a criminal justice problem. [applause] pres. clinton: it is a good thing. some cynics have said that is because it started in a small town of rural white people before it spread to the cities. there might be something to that, but i think the more likely explanation is that this is the first epidemic we have had killing this many people that had a delivery chain. the problem is, as we all know,

the more we get into cheap -- the more likely we are to see more violent delivery systems as people fight over guaranteed money. coming to as theater near you, whatever your color is, whatever your politics are. that brings me to the bad news. it is a public health problem and we recognize it. good for us. we are growing up as a country and seeing all of these people as people. the bad news is there is a woefully inadequate public health response not properly corrugated with law enforcement, with the treatment community, with you name it.

what we are here to do today is to figure out what to do next. the next panel after hours, what we will 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 is being done that is good, what are the gaps. then we go to the second panel. the analysts will discuss the report we are releasing today, the clinton health matters initiative along with the bloomberg school called from evidence to impact. saying weonal way of know what the heck is wrong and we know what we need to do. somethingwe do

allowing physicians to effectively treat those suffering from addiction much better than some of them are allowed to now because all of to barriers, you know, expanding coverage and proven helps,of to changing the way health care professionals and employers an advocate actually talk about , so we can reduce stigma and get people out of the is at quicker because it .errible problem we have been working on this since 2012 as dean mckenzie told you. good progress. i specially want to thank -- for offering to give free packages to every college campus, put

them online, to every high school in america, as they can with limited production. they have been great partners. i think improving access is still important. there are debates about that. all i know is we have got a lot of people dying from drug overdoses and most of them are still opioid related. if you can save a life, you ought to do it. say threebriefly things we will do from here forward and then bring the panel up. we have known for a long time that stigma plays a major role in preventing individuals and families from seeking treatment or accessing provision sources. in partnership with facing

addiction, see hmi will launch a communication strategy designed to tell his people to get over it. property -- the proper public health word is to empower them but what you have known, a couple of people who have lost their kids, i think we should dispense with the niceties. it is nothing to be ashamed of. it is a health problem. we have to hammer that. employers need to hammer it and , get helpto say no, to save your life, your family, and your kids future. we need the same message to go out everywhere in a very straightforward way. second, we have known that law enforcement -- chief, thank you for being here and for what you

have done. shareal justice experts similar goals but do not coordinate as you should and do not cooperate. a simple,have congress has of strategy even in places we take the money being spent and spend more effectively. we will work with the institute to reduce opioid overdoses by people who have come in contact with the criminal justice system, by having -- we can play a role in this. finally, the committee health in severalworks counties and communities today. we learned that what we thought we were doing when i started this, i thought we would go into all of these places and say, biggest public health crisis we

his childhood obesity, please come help. but we sit first, we would ask the people there and it turns out, like jacksonville, where i asgoing when i leave you, the third highest rate of deaths of pedestrian drivers in america. did you know that? because it is a city county government, so you're in the city proper like in baltimore and all of a sudden, you are in city limits and in the country and your drive and you do not notice it unless you are used to living there. if you walk across a certain driving 60 miles an hour. the point is we had to adjust this strategy and everywhere, with this. need help

than we have more done to build up coalitions and stakeholders. every other issue, we are getting everybody involved to fight to gather and we cannot let this one alone. i will give you one example and i will introduce her more effectively a moment, but randi weingarten is on the panel and the american federation of people -- people -- teachers represent 40,000 nurses, a lot of nurses, anyway. summer, i will never get this as long as i live, this summer, hillary and i, we normally go out to long island, as far out on the island as we can get and find a place so our grandkids can come play with us, and our daughter and son-in-law, and we have a good time and i to go out tommer

this wonderful old public golf course. it used to be a raceway in the 1920's. , and there areat all kinds of people there. ordinary people that aren't .olling in the dough i get off the course afterwards and 40 or 50 people disappear and they start talking to me about various things, some of which you would guess. [laughter] pres. clinton: but it did not take long to get to this. we are talking and it took me 40 minutes to get away from it and i want to know what are we doing, what are those people doing, and most of these people and they long island were desperate. there was a really good looking

young guy with big eyes and they kept getting bigger during the discussion. and everybody walked away but him. i said i have got to go and he for i want to thank you doing this. he said i just got out of rehab think anybody cared. i asked him how old he was and he told me. and i said well, how do feel about it now and he said, i think i'll be fine. 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 is a come that you have got to from a family like mine to be able to afford the rehab i have. why should i live knowing other

people will die just because they do not have a family like mine that can afford it? and he says, i am happy and i know i should just be happy, but he said i cannot get over the fact and i said, let me ask you something. did anyone ever tell you in college and in high school, if you mix opioids and alcohol when you sleep, you could die. just that one simple thing? and he said no, not once, not in any class. why shouldn't we push for that? just for example. the good news is everybody, from their -- house

there are a lot of people still working on it. if they are serious, you have got about an hour to get to the hospital and start a serious detox. then, if serious, you have got to put them in rehab and figure out how to do that if they interacted with in some way or another the criminal justice system. it is a multifaceted problem and we have to do this together. i may be wrong but i believe if we don't do what congressman cummings said, we will regret it for the rest of our lives. i think this may be one of those if we build it, they will come. if we can prove that significant numbers of people, lives have been saved, we can get the money

we need. will be able to overwhelm the resistance. i would far prefer someone take the tax cuts i am being pledged and spend it to save the lives of people like the young man i just saw, or the five i knew who did not survive. so you should feel, in a funny way, privileged to be here, because you are 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 cannot even imagine. thank you very much. [applause]

pres. clinton: thank you. i want to ask the panel to come up. of plankm, the ceo industries, who is also the chairman of the board of a local hospital and is very interested in all of this. associated with one of the great american success stories, under armour, headquartered in .altimore i recommend you go there. it is humbling. when you walk in all day every day, there is a man or a woman or both, running on treadmills because they test to see how long the running shoes will last . the last time i was there, i was there for two hours and there was a young woman running on the treadmill at about a five minute mile.

she was flying. when i left, she was still flying. i thought about applying for a job to test the durability of .hoes on old people it may finally get me to do what i need to do. randy is the ceo of the american federation of teachers. i want to say a couple of words about her. she is a former teacher whose students repeatedly one state-- won state and national prizes for their expertise in the u.s. constitution. [laughter] [applause] and she is a: partner and has been in the clinton global initiative for and she and the organizedon unions

the largest private infrastructure program in the united states. they made $16 billion and committed $14.5 billion. they spent 12.5 billion dollars and created jobs for 900,000 people to do infrastructure work and did not cost you one cent. i think that is important. the commissioner of health in the city of baltimore, run the oldest public health department in the united states of america. i believe she was the first person in america to issue a blanket description for -- [applause] which, she said, 30,000 people have already claimed. it is very important we not overlook things that we could do

while we are bellyaching about what has not been done. congressman elijah cummings, as is ae said, in my opinion, 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. so we will begin. i will ask you questions and if i don't cover something you want to say, say it anyway. money for a science and technology project. all, what do you think

the most important thing we could do now is to get more people on this research? i'm interested in practical things that could actually help millions of people. we have got all of this research. we know. if someone comes in surviving an the whole plan of action can be under -- undertaken if there is someone to do it in some way to fund it. but what in your opinion, what is the most important thing we can do now to take what we know and make it work in local communities? with what we have got. it is ok if you say we need more money, but if you could just take the system we have got, and you want to mac and -- maximize the impact, what is the most important thing we can do? >> i was going to say money. pres. clinton: one of

clinton's's law of politics is whenever santos to it is not a money problem, they are always talking about someone else's problem. [laughter] dr. wen: for us in baltimore, we have been able to do a lot with limited resources by changing policy so we can get the blanket prescription for narcan out there. we have 40,000 people trained but it is not just about that. it is about people actually delivering the services. i'm happy to report that the latest numbers, in the last two years, everyday residents have saved the lives of 1500 of the fellow community members just by delivering narcan to the family members and friends and members. that is something tangible we have been able to do. as condos and cummings mentioned, we are being priced

out of the ability to do that. 10,000 units to use between now and july of 2018. if i got 10,000 units today, i could give them out by the weekend. that is how much our community is asking for it. if it is a question of what more we can do, we should scale up existing interventions we already know work. we know the science is there in terms of treatment. pres. clinton: what happens to those people, the 1500 people that you brought back? many of them are referred to further services and in our hospitals, there is an overdose survivors program where tears who are often in recovery overdosed,'s 82 those and help connect to treatment. our problem is we don't have nearly enough treatment capacity. nationwide, only one in 10 people will have -- who have the addiction will get treatment we

need to expand treatment because assuming -- saving someone now is important but they also need treatment to help them longer-term. >> we need more resources and there is no doubt about that. i am convinced that people, mr. president, do things for two reasons. of one of twoon reasons. either to avoid pain or gain pleasure. avoid pain or gain pleasure. think we have to convince our policymakers that they should reduce medicaid. a lot of people who need this treatment would be able to get it. at the same time, we see members funeralsss crying at

and on the 6:00 news, but when it comes time for making sure that the programs are there to help the constituents who live right up the street from them, suddenly, they get amnesia. it is very unfortunate. last night, i called someone who has been off of drugs for 30 years. i said ricky, what can we do. it is the very question just asked. he said -- he sets on the two me i had not thought about. he said in baltimore, we have got a whole army of people who used to use drugs. in some kind of way, we need to find a way -- those people are the most adamant, if you noticed, trying to help other people get off of drugs. in some way, we need to use them because they have already been through the pain.

the pain came their passion to do their purpose. pain, passion, purpose. we need to encourage people to be even more a part of that. these are the people out there and they have already been through it. just some thoughts off the top of my head. >> to answer your question, we had a patient at the hospital where i am board chair and what was -- the third time, he was revived by a fellow user drugs,t kind to use found him unresponsive, and revived him. work wend that is the are doing in baltimore. [applause]

well,that point as education is imperative but it has to be coupled with a quick intervention like narcan. our nurses in cleveland, we are the second largest nurse union in the united states. the school nurses in cleveland, demanded that the cleveland public schools actually have a supply of narcan in every school. when they didn't get it they got a grant to do it. now they are getting it because this nurse revived a parent of a child. i tell that story because the stories are important to destigmatize and educate. your point, mr. president about, they will build if we have

enough pressure on the system -- that pressure comes with education. dr. went example, would at our conference this monar, i call her doctor from flint talking about the issues in terms of water and opioid addiction and the epidemic. i also couple it with a stick. which is, there are a lot of worker pension funds that are invested in big pharma. , frankly,rting to do 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 to try to figure out how to reduce and other of narcan absolutely effective intervention drugs.

any. clinton: are there public school systems in the country you know of that ofually have some policy educating kids about the dangers of this and telling them basic things like what happens when you mix opioids and out of all of any kind? it looks to me like, what do we the to lose by having 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 do we have to lose? a lot of people, i am convinced are still dying in ignorance. i think our preconceived notion here is often right. you have people who use these opioids over and over again and

then finally died. they overdose as attics. addicts. they finally died. addthere are lots of people whe being killed by the combination. this is just one example but is there any school district in any state that says, as a matter of kid in ourwant every coverage to hear this particular message? we actually just got legislation passed in maryland, in baltimore city, we are working with schools to implement standardized curriculum on this topic. it is 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, heroin is bad.

but if i ask them about prescription drugs they might give a different answer because they see their parents or caregivers, every time they have knee pain, they are taking percocet. or vicodin for back pain. there is a culture we have, as you have spoken of mr. president, this pill for every pain culture. that pill is being used to treat physical pain as well as emotional pain and other types of pain. that culture has to change from the medical profession, also from each and everyone of us with regard to prescription opioids. pres. clinton: shouldn't these kids know that you can abuse these things and they can kill you? or their parents? i do not know about school systems but let me tell you. when i was growing up the first overdose i 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 an overdose was. all i know is that one of our neighborhood guys had died from an overdose. importantucation is because for me, my entire life i have never touched an illegal drug, none of that. do 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. understand the argument, mr. president, that is made when suree say, we want to make people get the relief they need under certain medical circumstances because when i was here at hopkins, i did not know you could be and that type of pain.

andy morning i would get up i was in so much pain, you almost want to die. where people can get to that point. there is something else we can do. that is one of the things we looking at in our committee, why is it that insurance companies cheaper,ing for the come one type drugs, now, as opposed to those drugs that are nonaddictive that are more responsive -- that are more expensive? we are doing a lot of research on this in my committee right now to address that issue. againis a lot to this but i am convinced, yeah, if you tell someone, they are going to die or you will be harmed, it seems to me that some of them would say, no i will not do this.

when i was a kid in seventh and eighth grade, we had health classes. ofwas a different period 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. place 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. i think we have to meet kids where they are. , think we should think about in light of having the new federal policy that deemphasizes

dots, to think about how we some of these things and schooling. childhood obesity was an issue as well but it is about how we try to focus on well-being. and have some kindschooling. of health-related work for kids in elementary school, junior high, and high school. it will be different developmentally for each of those years but it is really important. i think it is more important, unfortunately, they just 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. i think we have to figure out pedagogically how to do it in a way that really goes to children's well-being. >> i just skipped the middlemen and brought my fifth grade daughter today.

i thought this would be the best class for her. it is not too young for her to hear about. where do they hear it? my wife had a full hip replacement last wednesday at the grand old age of 41, she took the time to educate our children as she was taking her self rapidly off the narcotic medications she needed. she talked to them, that she needed them, and nature they understood that getting off those drugs was a priority. she is an exceptional mother. while she was in the hospital, i am doing a disservice to the organization i'm involved with. i noticed on the whiteboard for her nursing staff, the protocol where it had pain level at 10, the tagline was, your comfort is our priority. this will be something i will bring up at the next board meeting, your recovery, your

health, -- comfort is not necessarily the priority. it will be uncomfortable. her doctor was excellent in saying, you should be managing your pain to a seven. you had your replaced. your hipot -- you had replaced. that is not the message kids are getting. pres. clinton: let me ask you problem douch of a you believe is a part of this continued over prescription, either a prescription of an opioid when a non-opioid painkiller would be effective in certain circumstances or prescriptions in amounts too great to be safe to be left in one place. how much of a problem is that still and if it is a problem, what else can we do about it and

is there something that private or public entities that in sure lots of people can do to pressure the system to clean it up? overprescribed opioids too many patients and not realized it. in medical school, i did not learn about the addictive potential of opioids. it is important to take away pain. we doctors want to do the right thing, we want to help our patients. if they say, i am in pain, we give it to them. that tide is turning. we are beginning to change our mindset. i'm hearing our medical schools in the city and also our hospitals changing their practices. we have convened our doctors, primary care doctors, to teach about the addictive potential

and talk about why we need to decrease overprescribing. i think there is another issue. the supply side. there is also the demand side. whoong as we have people have the disease of addiction, they will continue to seek out prescription drugs or heroin or fentanyl unless we get them treatment. it is our recognition that addiction is a disease. treatment exists, recovery is possible, we have to get treatment to people when ever it is that they are ready. we are also working to reduce the supply of drugs by reducing oversupply. so, i think the answer is yes when you have a big enough, you have, a big enough health care insurance pool. like for example the city of new york. when i was the union president at the uft, we had the entire city of new york's families and

we werethere he big -- very big in negotiation with drug companies when you could negotiate with them, and with pbm's. i think there is a lot to be said toward that. the dilemma is, as the doctor just said, look at what is happening with fentanyl. if we don't actually deal with the issues of treatment and education, there is always something somewhere that is going to be there for either pain or joy. that, i think is congressman cummings said, we have to change enough of policy and enough of d stigmatize, as you said mr. president, to try to deal with recourse.

you just mentioned a word i think we all need to center on. stigma. president, when that there ist someone on drugs in their midst, a lot of times they look at it as a moral failing. justher words, this person can't make decisions right or they are weak or they are looking for the easy way out. a lot of times people, by the way, are therefore afraid to even come forth.

the employer will say, wait a minute, i have 10 people who need jobs and all with no drug problems and i have this one ,erson who has a drug problem may be a good employee but why do i want to risk that? that is a tough one. getting past that, but in talking to, the people, former drug addicts i have talked to, personll me, basically -- a person has to hit rock bottom. they have to get that treatment and get it quickly. i think that is what we have to work more and more towards, trying to get that treatment quickly. there is another thing we have to make sure we do. make sure the treatment that is given is efficient. you have a lot of people -- [applause] i am telling you, i don't want

to mention names but there are certain parts of the city you can ride in and you will see big signs, basically, come get your methadone. i think people are going there, but therecoping drug, is nothing else going with that. , the doctorup here can tell us better, usually if a there has a drug problem, is something, a mental illness situation connected somewhere. with the just deal drug problem, you have to deal with the other thing. am i right? >> absolutely. we need to follow the science. ,reatment for opioids exists there are millions of people in recovery and it is a combination of medications including , with counseling and other services. housing for example, is health

care too. [applause] first of all, i'm glad, the last three comments have been helpful. the thing i was most impressed about that woman on that in ohio, she said, i don't know what i'm doing. she said i have no business doing this but no one else is here. said,ted her because she please, put me out of business. i will be glad to be a counselor. what is the answer? let me ask two questions. how adequate is the coverage today under medicaid? [laughter]

, how much do private insurance companies theoretically cover this, require waiting periods, and what is a possible downside to that? and if you are starting from scratch, if you could wave a leastwould you locate at initial assessment in treatment in local public health units, preferably funded and staffed in accessible -- and accessible to law enforcement and others or totallyu, or is that impractical and should people just be going to doctors offices or specific programs? my feeling, is the capacity there to treat all these people if the money was there? not, where should it be built out?

number one, how adequate is coverage? are waiting periods still a problem with private insurance? number three, how would you deliver it even if everyone was covered tomorrow? >> i will answer the last part, first. one of the major issues we see here is even if we have enough treatment, which we don't, but if we did, and even if we had enough payments, which we don't, but even if we did, a major problem is that we cannot connect people to those treatments. --re may be someone who is 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 the needle exchange program. there are needle and at over 20 sites in the city. someone may say, i'm ready for

treatment now. beneed for more people to able to connect to them and say, here are five options for you, you don't have insurance right now but i can help you get there. i can physically take you to the treatment center, if you are ready right now i will help you do that. it is those types of connections that we don't currently reimburse for and we need to figure out. we started a program in baltimore city focused on diversion. individuals with small amounts of drugs are going to face treatment and not incarceration. it is a pilot program that has been successful but it is time and resource intensive. it is currently funded by grants, not reimbursed through insurance. peers whose types of have been there themselves, walked in the shoes of the people we serve, we have to figure out how to pay for. pres. clinton: if you had the money to pay for the connection stuff, everything you said,

where would you lodge it? the ultimate, look, if you have i am addicted to painkillers, this is the third time i have shown up, naloxone saved my life, you got me in the hospital so you need to put me in detox. i go through detox. detox is over. now i have to go to real treatment. where would you put that? everywhere i could put it. let me to you something, mr. president, the problem is, no one wants certain things in their neighborhood. come on now, don't act like you don't know what i'm talking about. [applause] they don't want it in their neighborhood. as the elected officials, am i right? battle.ally a hell of a i remember seeing on cnn where they were talking about this west virginia town that

basically, was basically getting these millions of opioids and the population was 300 people. so people were flocking there. a lot of the 300 had problems too. facilitiest those all over the place if i had the money. get peopleld try to who have been through it to invite other people to participate. the doctor and senator, big .dvocates this is based on women who have babies. they have been through it so they have been able to teach others and encourage them. and iave a drug problem come to you and you say, just like the fellow i talked to last

night, my friend, ricky. a former drug addict, 30 years off. ricky, i have a problem. man, i am a barber, i making money, i'm doing well. i'm doing it for my neighborhood. i have been where you are. i have been where you are. let me take your hand and take you to this place, that will make a difference. i'm telling you -- [applause] it will make a difference. so, let me start this way. cancer, theyave make the connections. sense thatre is a it is could affect all, not stigmatized, people try to get well. that is why the stigma becomes really important to address. this is a national crisis.

and born out of, you and i have talked of this before, mcdowell county, west virginia where we work is one of the highest opioid epidemic users and we saw that five years ago and we said, what is going on in ohio? in west virginia? the anxiety of loss of jobs, loss of hope. we have to flip the switch on the stigma and then try to figure out how to do this, i think, through employers, medicines, 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, nothing if not nothing.

we can't afford not to find the money. from an economic perspective this is an unnatural disaster. mr. president you mentioned the figure of $78 billion of annual economic impact. hurricane sandy was $65 billion. we are talking about a major hurricane hitting the united states level of economic impact we are suffering from this crisis. not to mention the loss of life which is like a hurricane katrina every three weeks. we cannot afford not to make this a national priority. we are worried about travel bans and walls, this is killing more people then international terrorism is. i don't think we have the awareness that the people in this room have. i don't think there is national awareness, or employers awareness. in terms of making connections, where do we spend our time? at work. the sad reality as americans, we do. our managers and employees are not recognizing these issues. they are treating it --

pres. clinton: what is your how large employers are handling this? of generaly kind 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? confirm,y in effect, what you might call the stigma bias by making them think they are toast if they have to fess up? >> my senses, there are a handful of companies including large companies that are demonstrating real leadership. we saw that under the obama administration with the fair business pledge. largein a room with 15 employers, coke, pepsi, a bunch.

they're upfront on these issues. a lot of people don't work for those companies or work for large employers. a lot of people who are struggling with this work for small employers or not at all. that is where these public health interventions will have to take place. i think the conversation is beginning but given the numbers, the economic impact, on lives, it is way behind where it needs to be. thinkclinton: do you there is a difference in the degree to which stigma remains a problem in small town and rural areas as opposed to urban areas or is it uniform? >> i think stigma is everywhere. i think it is everywhere. people, have a lot of pride. first of all, to even acknowledge you have a problem, people don't want to admit that.

they just don't. then they go throughout their lives, deny, deny, deny. but yet still, as again, the people i have talked to tell me, by the time a person is going into the medicine cabinet to use moms pills, they already have a problem. assume, your 16-year-old just went into the medicine cabinet and saw something and thought they were m&ms. no. they knew exactly what they were doing. concentrate on education and trying to make people realize, how significant problems can arise. when i was chairman of the , thettee on drugs oversight committee many years

students, mr.me president, come in from baltimore. we had maybe 50 of them from baltimore. to test the commercials. just to see how they felt about the commercials. , all of youercial will remember, they said, this is when you use drugs, this is how your brain looks. it was an egg frying. by far it was the number one commercial. a lot of it, we have to make people realize, this is not the way. i know we will be closing soon. i have to say this, when i look at this audience, and, just the idea that we are sitting here and i want to thank you, by the way for doing this and hopkins. you all are the ones who

must help drive the policy. you are the experts. you know. you have firsthand knowledge. you are the ones. you have been trained for this. we look forward, when i sit at the podium, we are an army. experts on super this. you know the impact. you know that what you do or don't do can affect generations yet unborn. pres. clinton: thank you. great. why i asked the question i asked about the stigma. experienceis just my as being a slightly guilt ridden member of a family that has had addiction and it. i believe -- that has had addiction in it. i believe the stigma extends to

family members and coworkers. depending on how bad an addiction is, a heck of a lot more people know it then the person believes know it. or they suspect it. in ais why the culture community, workplace, in a religious setting, all these things matter because i believe that the stigma sometimes hangs necks ofe next -- the family members and others maybe even more than the person with the addiction that wants to scream for help but they see the rest of everyone walking around wanting to pretend it ain't so. this is a confession, not a criticism. i am telling you. i believe when this whole stigma you wantiscussed --

the person with the addiction to come out but really the whole, look, all these little towns. i was born in one of these little places that is supposed to be the epicenter of this epidemic. everybody knows everything. just about. somebody knows. in these little places, and maybe somebody knows in manhattan. , the only reason i mention this is my view is, this 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 do not have a clue how to get your brother in a treatment program or your sister or whatever, you

ought to go to the chief of police. least, havingat been a family member and onlooker of all this on and off years, we't know, 40 talk about stigma as if we are all being broad-minded by reaching out and making the addict feel good about himself or herself. this is a bigger problem than the person who needs the medicine or the psychological counseling. it is one of the reasons i wanted to do this today just so we could, you know, a lot of people like you who are on the front line of this and could use a little help from your friends here, if we all just get over it, this is a big deal. we would like to stop every single, solitary person we can

from dying. -- we would like to give them their lives back which they have to claim. anyway, i will get off my high horse. be patronizingo when we talk about stigma. as though it is a delicate thing. stigma is something that a lot of more people participate in them the employer or somebody in some oversight position and the addict. we're about to wrap up. anyone else want to talk? anything you have to say, say it. >> just to your point, i think it is also, we have a lot of different crosscurrents. 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 are all looking, i will put my employer hat on, we are looking for how we can squeeze that last dollar out of a health care plan. if we are not going to actually pay for any ap program or those kinds of things, that is a cross current that hurts this. the alignment, the medicaid, you get this to goo to a treatment facility that is more than 16 beds. why have a waiver? when i just change the law? , think part of it is also there is a bunch of things we need to do to be consistent as opposed to having this cross current that says, this is important but i am not acting like it 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 the summit for america's promise. here we are talking about

america's crisis and i don't think people understand that. of your stature at johns hopkins, thank you. [applause] i want to close with somebody who actually knows what she's talking about. [laughter] keep in mind, baltimore is not only the oldest public health unit in the country, on this score, one of the finest. as you said, even if you got a treatment center somewhere, you don't necessarily have the transaction cost covered. this i think is important. 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, two and under of any state in the country. i would like to say it was because of my sterling leadership. it wasn't. poor incause we were so the great depression and a lot of southern states were, that, the government helped us build out the public health network. later, whenury people started suing people over vaccines and we literally provided 85% of the vaccinations for little kids in my state through public health networks. in other words, we were the connection. that is why 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 is not there. ,ot just for what elijah said which i totally agree with. i am all their on medicaid, we need more money for all this stuff. but the public health infrastructure is peanuts compared to the $78.5 billion we are blowing, never mind the lives we are losing. talk about that. for a relatively modest amount of money, could you do good if you had that? >> absolutely. your lifelth save today, you just don't know it. [laughter] oh i do.nton: [laughter] >> we just don't know it. pres. clinton: i agree. i am fortunate in the city to

work with congressman cummings and so many who have helped us with doing things that are very difficult with starting needle exchange. more than two decades ago here in the city. people said things like, isn't that just going to make people use more drugs? while we have seen as the percentage of people with hiv decreasedug use has to 7% from 1994. that is what public health can do. a call to action for all of us in building the public health infrastructure and in general, sometimes the opioid epidemic seems so big, there are three things we can do today. first, learn to use narcan. we can all save someone's life. your been such a great champion of that, mr. president. second, change our language. the way we speak about the issue.

we can about the way reframe our own language around speaking about the disease of addiction for example rather than talking about addicts, simple things we can do to make a difference. the third thing we can all do is think about, what is in our wheelhouse? a hospital, instead of leaving it to another hospital to take the lead, what is it we can do? what is it that we can do as an employer or union or policymaker? i thank you for supporting us in building our public health infrastructure and raising awareness for the issue. pres. clinton: thank you. let's give a big hand. [applause] they were wonderful. i just want to say one thing. the next panel is about the report that the bloomberg school and our community did. the report had very specific

recommendations. the purpose of that is my ongoing obsession with this issue, which is that, too many smart people in america spend too much time meeting and nothing happens. then we all pick something out of this that we can and will do. that is why i began by mentioning the three things we will do. you, this next panel is really good, really impressive, really active. dofigure out what you can and commit to do it as a result of what they say about these recommendations and their expenses. thank you and bless you all. [applause]

♪ [inaudible]

>> goodbye, mr. president. >> goodbye. [inaudible] pres. clinton: thank you. let's take a picture.

[inaudible]

>> hello everybody. we are about to get started with our second panel. trying to be very respectful and not upstage the president. [laughter] that would not be a good thing. good morning, my name is michael, i'm here at the john hopkins school of public health, the dean gave me a fancy title which i will not say. i also have the privilege of being the director of the white drug commission under

president obama. in washington we worked with many of these people on the panel and many people with the clinton foundation in terms of our response to the opioid epidemic. as our president indicated, this is a multifaceted problem that manifests itself on the national, state, and local level. we need a multifaceted response and we have a tremendous group of panelists here today who have been in their own way continuing to focus on this issue at various levels. they will talk about the work they're doing today. let me introduce them. to my left and you're right, erica wilpaulette. forrester,

director for pharmacy and therapeutic safety. hood, the ceo for facing addiction, an organization many of you know. let me start off, i will ask jim to start. like many parents, who have been impacted by this, we heard personal stories today. you are one of many parents who have been personally impacted by this. out of your grief you changed that into advocacy and action by leadership of a national group called, facing addiction. why don't you tell us a little about the group. also to this theme of evidence impact. where do you see where we are now in terms of where we have made progress but where do we need to continue to ramp up efforts to implement what the president said, in that we know what works here.

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

spear within a larger problem which is, all addiction, to alcohol and other drugs. this is not to divert, we must focus on the opioid thing. we ultimately have to tackle this whole problem. it is getting worse and younger. there is a staggering figure about how many people die from opioids. someone dies every watcher minutes.- 4 that is probably understated. addiction to our call and other drugs. people a day. it is jarring. that is a huge airplane. it is often young adults. bright eyed college kids, maybe they are going to europe to do international studies. that is a jet falling from the sky every day.

this country, at this point everyone is concerned about the addiction crisis. i don't know if they care enough. i don't know if they are broken hearted enough and maybe we have to get from statistics to absolute grief. you put that figure in perspective and none of these are value judgments but the first panel mentioned the devastation of hurricanes. what that animal did in las vegas is unspeakable. vegas'inve six las terms of addiction every day in this country. rise to theon't occasion and we simply have to rise to the occasion or, as president clinton said in an earlier speech, this thing will keep us alive. work, michael, to try to presidentnceptual,

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 these different parts. i could paint a picture for you, i will be brief. a picture both frustrating but you think ofse if the journey of a young person in this country from prevention to early intervention to interaction with regular health care, there are clear identified problems. they are in this report. there in the surgeon general's report. there problems of prevention. the wrong programs, we don't go to where the kids are. pediatricians are insufficiently trained. doctors who overprescribed because they only get a few hours of training in med school. some treatment works, a lot doesn't. it is not scalable, affordable, not integrated with the health care system. too much of a criminal justice response in the country that has to be shifted. long-term aftercare is not what it should be. we know what to do in every one

of those boxes, we just don't do it. we just simply 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 private sector response to this crisis. >> thank you. we can follow up on that. erica, let me ask you a question. should i call you reverend or, ok, thank you. our faith institutions have long been engineers of social justice change in the united states and particularly for highly stigmatized people with highly stigmatized diseases. about the faith hivunity response to the epidemic, a lot of us have talked about the parallels of that. .alk about what you're doing i want to go back to what the doctor said in terms of how we

think about harm reduction. many people are not ready to seek treatment but we know we have to keep them alive and keep them healthy. why don't you talk about your the harm reduction approach is you are taking but also a call to action to other faith communities in this epidemic? >> great, thank you so much. it is wonderful to be invited into this conversation. communities of faith have played a significant role and we have in essence, created a community by stigmatizing and shaming folks. 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. receivingrs, i was

hundreds of emails, phone calls, encounters with folks in the church and community, in the halls of harm reduction coalition, where i also work. people said they had never heard the issue talked about in a sacred space. they had never heard the drug issue talked about and imagined with a compassionate response. they had never heard their story in those rooms. they had never heard their child, their loved ones, and their self, called the love it. that is really significant -- called beloved. that is really significant. the church is called to make a space. in order to do that we need to extend radical welcome but we need to make sure that we are

examining and tearing down barriers that limit folks from accessing help. i work at memorial church as well as harm reduction coalition and as a virtue of that double belonging have had the opportunity to listen into both spaces and to identify a deep need that communities of faith, especially in communities that are particularly vulnerable to drug-related harms, they are often the points of access. they are often the ones with the most well-developed social networks. it is really critical. the we have taken on is space in sanctuary project where we work on mobilizing faith leaders across the country to be able to speak prophetically to the humanity of people who use drugs, 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. where thegood example evidence of what we know to be effective is a far cry from what has been implemented. we have known for example, access to sterile syringes and naloxone are proven intervention strategies. what do you see as the significant disconnect between 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. quite honestly, there is 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 long time now. it really is, connection, collaboration, is really the key to addressing this issue. in doing so, it is going to be connection with folks who have lived the experience of overdose, drug use, with families, with the first responders, on the site at these overdose encounters. we really need, this includes harm reduction programs, which are constituted largely of folks from these same communities. community, people with, people who are the experts are the ones we need to be following. we need to be taking our charge from them. >> can i follow up on that? >> sure. >> yes, it is very important. here is one of the things i think would shift.

one of the big things we need is funny. thatf the big things would be dramatic would stop treating addiction is a crime. -- as a crime. [applause] take it out of the criminal justice system, put it into the system.medical we can't get past any of this until we get past the point where everyone thinks every user is a criminal. allow us in law enforcement to cut down supply. to be the link to other organizations and i think we would see a dramatic shift. until the public stop seeallow o cut down supply. -- until the public stops seeing this as a crime, it will be difficult. >> many of us have remarked on the tremendous shift in law enforcement. you're not the first chief wary of heard, we cannot incarcerate our way out of the problem. we have to partner with the public health folks.

how does that change your work at the local level? who are your new best friends? >> i didn't know who a health commissioner clue. one of my best friends in cincinnati helped. i worked with them extensively, along with treatment. we worked with commissioners to push out narcan to every single police officer in cincinnati. over 1100 doses. 7500 uses in a year and a half. we had a great conversation. we were dealing with cops. don't give a needle to a cop. we have this spray. we can do this spray. we pushed that out. he is one of my closest cohorts in treatment. this, wee bad part of inform the families. for us it is real.

we know we can't solve this ourselves. we need the people that can get people into not just treatment, but care. long-term care so they can reintegrate back into society, get jobs, have their life back. what we put it on the backend and get our investment back? >> what do you see at the local level in terms of the major deficits? you talk about how to get people into treatment and the long-term care they need. what is the biggest need your community faces? >> it is funding. we call this an emergency. we don't treat it like an emergency. people 50 to 70 overdosing every week in our area. four or five people dying every week. yes, the money is not there. we have the people. it is not like the community to someone to help. we don't have the resources to

do it. we don't have the doctors, the ones that can go into the community. we don't have that. if it comes down to money, we have an opportunity to have that. i hope we don't that go. this is the time and moment we can shift addiction. i have been saying this for a couple of years. you need to, all of get a hold of your policy makers and tell them to give us the money. this is an emergency. money. this is an emergency. it is not a waste of money. it is an investment of money. >> thank you. kelly, i want to ship a little bit. about as atalked physician got little to no training on opioid prescribing and substance abuse issues, even with all intended efforts if a significant driver. there is a balance approach that i want you to talk about.

we clearly want to make sure we are diminishing unpaid prescribing practices, but not of the pendulum swing so far in the other direction we are under treating pain again. talk about your efforts to reduce opioid prescribing, but still ensuring people have adequate access to pain management strategies. >> thank you for the invitation to be here among all these distinguished colleagues, and president clinton and the clinton foundation. kaiser permanente is a national health plan. although we are not in the entire country, we have a tiny section of the country we try to help. for those 12 million patients we really do want to make sure they are receiving the safest and best care we can possibly afford. what we are -- what my role is as director of pharmacy and therapeutics is i try to use my expertise and background in educating our physicians and our

patients regarding saint prescribing, but more importantly the management of chronic pain. that is where our focus has been. six or seven years ago across our health plan, which is present in eight states and the district of columbia, we have guidelines around chronic pain management. as well as a opioid prescribing. yes, i have heard the comment you are taking away opioids from people and they will be in pain. no, we are augmenting our chronic pain treatment and augmenting the ability to prescribe nonnarcotic or non-opioid treatments. non-medication treatments really. it is not always medicine that will help you with your pain syndrome. we may use significant alternative medicine treatments.

exercise, weight reduction, simple things that can help people with back pain for example. we have psychologist that are way underrated. my daughter is a clinical psychologist in training. i think they are wonderful. we have to understand pain is not just going to be fixed by a pill. it is going to be a combination of factors. a lot of our education has been around chronic pain treatment. we have standard of guidelines for treatments for opioids. certainly we have given our physicians many tools to do the right thing. physician support in our electronic medical records does not only include how to prescribe appropriate doses for short durations, but have all the other specialist referral options and other treatments that can be used for a particular pain syndrome. even at the point of care you

are reminded of all the other things you could do for that patient, if you didn't already do it. we also augmented the specialists and the services that we want to have to help patients with chronic pain. years thatst seven has been significant. the resources we have internalized. all those services are under one roof and a medical centers so people don't have to have the barrier to access, to get outside, to go somewhere if you don't have a car for example. if you're at the medical center and it's all in one place, you can get there. we have a lot of internalization. >> let me ask you a question. the previous panel talked about insurance companies. i have often heard from physicians saying they want to do the right thing and not prescribing opioid, and look at giving folks physical therapy, acupuncture, and often have an

insurance roadblock. insurance does not often cover those nonpharmacological practices. to practice in a setting where we have those internal resources but i totally understand. i have friends and family that are physicians who do not practice in a setting like i do and they have to be very cognizant of what the patient has. they may want to give them certain services, but they know that patient will not do it because they have to pay out-of-pocket. that is one of those flaws in our health care system. we need to expand services for everyone, in all lines of business for all of our health care plans. >> one of the things many of you mentioned in the previous panel -- and i think with many diseases and people the role of personal stories and narratives has dramatically changed the way we see people. it is not a disease about us and

them. jim, erica,nybody, what you see is the role of people with experience in this? people still using, people in recovery, parents affected by this. how do we use those stories to change public opinion and public policy? >> i am happy to take a brief shot. we talk about this in facing addiction. i'm being a little euphemistic. we talk about this as an illness that no one will ever get, no one ever has it, and no one ever had it. except for about 40% of all households in america. clearly the statistics do not put us over the edge. stories will. i got here late last night and went to a restaurant in the hotel. it was empty. the server asked why i was there. within minutes he told me he was diedar-old guy and nearly

many times for now he is on a great course. i needed someone to helping out at the hotel. a sweet little woman said, are you going to this thing? she said i have not seen my boys and 10 years. he has been addicted to heroin. i don't know if i will ever see him again. this thing is all around us. everybody knows somebody. if they are honest, they are probably related. we don't talk about it or admit it enough, but we will get to a point where it will be more than half the country. it would be better if we just got over it and got to work. >> let a talk about this. congressman cummings talked about the untapped potential for people in recovery, people affected by this. maybe jim and others can talk about the role of people in recovery could play in terms of changing people's opinions or how it relates advocacy.

>> one of the things we are trying to do is use your mentors. -- peer mentors. many are training people who have been there and done it. it is one thing for me to say i care i will get you help. it is another thing for someone who has been there and experienced it. is havingerm goal crisis intervention team sick a lot to the mentally ill. perer mentors would be like a crisis intervention team. they could come out and hopefully walk them through the process. it is one thing for me to say i can get you help. it is another for someone to say i have been there, i am at, let's go. that's one of the actions we could take. hopefully fingers crossed is something we can work out. >> i use stories when i teach physicians, specifically post health care with surgeons. stories whereve

you may have seen a patient, and adolescent or young adult with an athletic injury in college or high school. as a result they were put on opioids for a while. maybe longer than they should have. maybe they held onto those after they were done and kept them in their drawer. when there was a party a few weeks later, their friends said you got some oxies? let's go. that leads to someone having an overdose. that is how it starts. prescribing too much, more than a patient needs, especially young adults, college-age -- 61% is wasted, cap in a drawer -- kept in a drawer and at least the trouble. i use those stories a lot. >> i was pleased to see the responders inirst

necessary groups to engage. say as we are talking about stories and inclusion and talking about where we draw wisdom and ways in to communities most impacted if it is necessarily led by folks who have had this experience. the evidence we are talking about is being born out of their experience and their work with one another. it is really incumbent upon us to listen into those spaces and figure out how we can work in synergy with what they are doing. that seems fundamental to make. -- to me. >> we have talked about the role of efficacy. one of the -- the role of

advocacy. the hiv epidemic was a bunch of really angry gay men and lesbians who said we will not take it anymore and really created an urgency around this. many of us have been doing this work and felt like this has not had the urgency that other natural crises or other epidemics have had. maybe you can talk about either advocacyof efficacy -- and how we talk about harnessing the potential for accelerating change. >> will get mothers against drunk drivers. it was a group of, things he's my leg which, -- excuse my moms who pissed off want to change. there is not a large organization like mothers against drunk drivers. it would be great if there was a community grassroots that grew into a national level of mothers

and fathers who could advocate, not just to change the public image of the user, but for policy change. >> i could not agree more. when we look at the addiction landscape, there are a lot of organizations with good people in them doing good work. reasons no one ever built of movement, created critical mass. all these things we are talking about as we look to government -- by the way, we should not rely on government. government does not solve any of these problems. they can help. but no one has ever build a movement and without advocacy and anger and pressure on politicians none of this will happen. greg williams and others on our team who are vastly smarter than the saw this, and in two short years we have stitched together something like 700 organizations.

they interpret present 35 million -- they in turn represent 35 million americans. they can help us understand how we can turn the switch, get them angry with a short fuse. it will take a much bigger group. we will have to become even more cohesive. that will be the answer. we have got to get a large group of people saying it is time for this stuff. >> erica? there is a movement. i look at the work that my -- have beend doing. they have been doing the work that many of us have resisted t got closer for us. framek in that way, the that really lends itself to this issue is that, yes, it is a

public help issue. it is also a social justice issue. that are circumstances make particular people more vulnerable to drug-related harm. in this way it is an incredibly intersectional issue. i think we will gain an amount of strength by being able to find our ways into alliance with other movements. this is very much a racial justice issue. this is very much an issue for folks who have experienced trauma and gender-based violence. this is very much an issue about poverty. we cannot divide the public health response from the social justice response. addressing all these intersecting impressions will be

really, really critical to -- that we are ready for the next time another crisis happens. until these core circumstances and such are addressed, we will not make a move on this. >> i think physicians were since we this movement lived in a cave. they found that six or seven years ago when the data for increasing opioids with directly correlated with increasing deaths, and statistics such as 99% of the world's hydrocodone is in our country or we have 5% of the population. things like that may physicians engaged and listen. honestly the government has assisted us by passing mandatory continuing education credits that is necessary in some states. also mandating -- we mandated it before they did -- restructuring

monitoring process. even prior authorization. i hate having to fill up forms. everyone does. that is a universal thing. but when some state-mandated prior authorization for certain doses and certain quantities of opioids, that did a lot to engage businesses that may not have been aware they were doing something wrong. over the last several years there has been a definite call to action and physicians are definitely engaged at this point. >> we were talking about anger. i told the story. overdoses, and it was not a single gas. -- gasp. we need to figure out who need to be angry at. right now we are angry at the wrong person. we are angry at the user because they overdosed multiple times, but not at the dealer that i

have arrested seven or eight times that put it back on the street. we are not angry at the pharmaceutical company that lies to doctors, lies to society -- good. we have two angry people. we need you to be angry at them. our anger is placed in the wrong place. if we put it where we should be, we can start fixing this. it is not the user. they have a disease. the brain is affected by the substance. we should be angry at the people that did it for greed. >> i love it when our law enforcement officers talk like public health officials. [laughter] >> i am hanging around you too much. [applause] great teaching and law enforcement. all of us are worried at the federal level that despite pariniring drug policy reform wh

criminal justice reform, had we keep the momentum going at the local level to ensure this is a health response and not a punitive response? >> law-enforcement is at a crossroads. what i am saying is not necessarily for the majority are saying. there is a group that is pushing back and saying, wait a minute, this is a crime and i will treat it like a crime. we are arguing within our own realm. in my law-enforcement officer or first responder? this issue has blurred the lines. me, there is no confusion. my job is to save lives, period. i am not the judge. trust me, i have my own sins. my job is to say lives -- save lives. -- iis where the public have been screaming it for years -- it is you. we,should all policy that federal, local, county, state

officials do. when you stand up and say we will treat this differently, thinly in law enforcement will have no choice but to treated differently. that, it's an interesting program we initiated. we started here in from a lot of communities that they are lost. it is not a criticism. they simply do not know what to do about this issue. we don't have a silver bullet. we have some knowledge, some best practices we can pedal around. leaders,together local law enforcement, faith, parents, educators. you start talking about what is working in your community, what is not working, what are the gaps. there are some similarities but depending on the make up of the community they are different. we are working to forge a plan that we can leave behind so within a year or so they will have some cohesive way to tackle this problem in their community, and i to raise additional

funding or redirect funding that exists but maybe is not going to the best and highest use. there is nothing glamorous and no magic, but it's rolling up your sleeves and getting to work. >> i want to follow up on the role of community. you have probably read the book "dreamland." a great book. i got to know sam or the years. one of the lines he uses that i steal from him is that the fundamental response to the opioid epidemic is community. i think all of you who work in various sectors of community, maybe just reflect on your own thinking about community and community coalition. who needs to be at the table? what is important for them to think about as they respond to this issue? all of us of the federal level or used to be at the federal level know that we have a role, but ultimate it is -- ultimately

it is what happens at the community level. that, myou say training is pediatrics medicine after i went to pharmacy school. i think of school and education. middle schools and high schools and colleges, how can my medical colleagues go there and educate. i don't mean just do a lecture once on third period and some kids don't even show up. i be having consistent education in the school be required. all my kids are out of high school now. they were required to take a course in economics in high school. they could not get out of that. some thought it was easy and some struggled, but they had to. no one was required to take a course on addiction or substance use problems we have in this country. yet it affects every single

child one way or another. they know someone or a family member. getting into the community and educating and being there often, have a standard courses, i think physicians and pharmacists are great assets in this community. they could be out there teaching. >> it is a comprehensive committee response. when we started the coalition, the vision came true about a month ago. we knew it was not going to be the four pillars, it had to be every part of the community. it is a complex issue that needs a complex answer. last month i sat in this room and for the first time in 2.5 years we had almost every aspect of our community represented. grassroots, religious groups, universities, doctors, hospitals, let officials, police officers, health departments. i was getting emotional. wow, this is our vision and it came true 2.5 years later. when we talk about the right organizations, it is everybody.

i get this a lot. everyone says you need to tear down the silos. i disagree. we should stay in the silos because those people are the experts. we should have a door to each silo that lets everyone and everyone out and connects everyone. those silos are extremely important. i am not the expert on health or treatment. i am not a doctor. i need them to share the information. if we have a comprehensive community response, then we can make a dent in this. to what i go back understand my charge as a minister to be. that is in holding space and making space. incumbent on -- i speak specifically about the community's -- to breach the

silence around this. prophetically.t this is not an individual issue. this is a community issue. it is being felt across all divides. it does not occur in isolation. dinner i hadto a with some good friends here today and we had the opportunity -- i attempted to take a couple of days off for a soul care for myself. i found myself describing some of the struggles with work. 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 they were people who were working to ensure nobody else's child was going to die from an overdose. they were people that cared about their child, that cared about them. by virtue of having these conversations, having these public conversations, being able to challenge -- for us there are theologiesntrenched that are horribly problematic. know.t >> we only have a few minutes left. i want to end by asking each of you, and president clinton's charge about thinking going forward. what are the one or two or three

things we need to do next that we think is really going to continue to leverage change as a relates to not just this epidemic but addiction issues in general? >> i would singularly put a stigma -- put stigma at the top of the list. these folks are smart. we do know what needs to be done. there is a little bit of inside baseball risk of smart people talking to themselves that don't think we can underestimate -- we should not underestimate the delegating -- debilitating power of stigma. half the people do not think this is an illness, even though we have known it for 75 years. if you do not think it is an illness and it is your problem and why should i care? that is a huge issue. >> how do we get to them? >> a massive education campaign.

i hope it is something we will get to, facing connection with the clinton foundation. we call it a rebranding campaign, which is not to be confused with making this attractive. 90% of the people who suffer from addictions never get any form of treatment. imagine if ever any other illness. there would be riots in the streets. you read obituaries of people under 25. it is a sudden cause of death. shocking. you know what that is. we know what that is. if people are not willing to finish this thing and call it an illness, which is treatable. it is not inherently fatal. we can get there but the first step is to get over the stigma and shame and discrimination that attaches to it. if we can do that, it will be a different ballgame. >> i would like the focus on prevention. at this point, from my

perspective, i think that is where we have a lot of opportunity. raising awareness in the community means education, education, education. again, my background is in adolescent medicine. when we were all about antibiotic resistance, we went out and educated and got the community involved. patients realized it was not a good thing. they went from demanding and antibiotics for a cold to do you --nk i need an automatic antibiotic? yes, this when you do. this one you do. i saw it was mentioned in the report. that was my analogy i was going to talk about today but no well. -- ohwell. we don't have that with opioid use. we have the stigma.

people are still expecting to get the opioids and the pain-free. that expectation has to be changed through education. >> stigma. it is one of the biggest things locking us. i hope within my career we shift the addiction out of criminal justice into the mental/medical health system. it will allow us to get the right people the care they need. >> i will say stigma as well. i think it is the core of this crisis. as long as people are created in the image of the most divine are redacted in behavior, it will not matter what strategy we employ. speaking of the church, we have attached stigma to the drug issue in people. we 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 of the many

burdens that people carry rather than judging the for how they carry them. [applause] i am actually sitting here feeling a little disingenuous that i have not talked about a person -- that i am a person and long-term recovery. [applause] >> i am one of 22 million people. i have often said to the extent we can, we have a personal responsibility to be open and public about who we are. that does change public opinion and does change people's minds. i want to thank our incredible panel today for the work they are doing and for the work i note that they will continue to do. thank you, everybody. [applause] >> thank you. this just about wraps it up.

i am caleb alexander. expected, those were two exceptional panels. mr. president, on behalf of the johns hopkins bloomberg school of public health, i would like to extend our deepest gratitude to you and the clinton foundation for your leadership and commitment to addressing the important issues we have discussed today. five years ago you mobilized the foundation to act. since that time you have been on the leading edge working for change. subtest of the foundation's tireless efforts to raise public awareness of the crisis and help people understand that addiction is a brain disease, not a behavior. i would like to thank congressman cummings, are other esteemed dignitaries, dean alan mckinsey, and all of you that have joined us here in the room and from around the country. thank you for your participation. this event, as well as our newly

released report on the opioid epidemic from evidence to impact took a lot of planning. 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 immunities fight the epidemic through the bloomberg american health initiative. as we have heard today, i 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 have all been touched by this epidemic one way or another and we should not doubt the power of our collective action. son to ajudy lost her heroin overdose. i told her about this event. i asked if i could share his story. she said i am always happy to have steve's story shared if it helps the cause. judy talks about a note she keeps next to his picture.

it says, "if love could have saved you, you would live forever." families should not have to endure the suffering. there is no conflict between reducing our ove -- over alliance of opioids. it will take effort and resources. mobilization. the good news is we know a lot about what works. thank you again for all you do. [applause] >> hello, i am delighted to wrap up today's event. i direct the center for injury research and policy. on behalf of our centers, i would like to add or thank you's to the distinguished panel of speakers that about challenged and inspired us today. to president clinton, we sincerely thank you for all you have done to address today's opioid epidemic and for being

here with us today. your leadership and the work of the clinton foundation, with its power to bring a diverse range 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 the culmination of a long journey that as you heard began with the first town hall in this very room three years ago. we are 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 innocent and harm exists in an environment that allows the harms to flourish. , addiction without access to treatment too many medications from overprescribing, and medication supplied without the

life-saving antidote are a few examples. joined by the clinton foundation and a group of distinguished experts from around the country, we focus on fighting the evidence to solve these problems. was released today to provide the evidence, along with specific recommendations for actions. the challenge we are addressing is how can we act collectively to turn around the alarming trend in opioid deaths so the public is protected and the benefits of proper pain control are delivered safely. we hope today is the beginning of the new journey, one that moves us surely and steadfast in ending this epidemic. with the help of everyone here and everyone joining us online, we are confident 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 would like to invite you to the reception that will be on the first floor in the atrium. thank you. [applause] [crowd noise] >> 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 trump campaign chair paul manafort and his business associate rick gaetz have been indicted -- gates have been indicted by a grand jury for conspiracy against the united states. the indictments unsealed today contain 12 counts, including conspiracy to launder money, failing to register as a foreign statement, all statements and multiple counts of failing to file reports on multiple bank accounts. the will appeared today at d.c. federal courthouse. you can read the charges on our website, c-span.org. president trump tweeted out this response. "sorry, but this was years ago

before the man afford was part of the trunk campaign. collusion." senate democrat leader chuck schumer warned president trump to not interfere with the investigation, saying if he does so, congress must respond, swiftly unequivocally, and in a bipartisan way. house democratic leader nancy pelosi says the indictments of paul manafort and rick ga tes underscore the need for now -- for an outside commission. we will have coverage of today's white house briefing with sarah sanders. it is scheduled to begin at 1:00 eastern, about 20 minutes are now. live coverage here on c-span. defense secretary james mattis and secretary of state rex tillerson will testify on military authorization powers before the senate foreign relations committee. live coverage starts at 5:00 p.m. eastern on c-span and online at c-span.org. you can listen with the free c-span radio app.

coming up tomorrow, testimony from google, facebook and twitter on russia's use of social media and its influence on the 2016 election. that is at the judiciary subcommittee live tomorrow starting at 2:30 eastern on c-span3. thursday's washington journal, we were live in austin , texas. former texas state senator when the davis will be our guest, starting at 9:30 a.m. eastern. while we wait for live coverage of today's white house briefing, a look at this morning's washington journal and the political polarization in the united states. he is a former ceo of national public radio and the author of "republican like me." good morning.