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tv   State Officials Testify on Opioid Epidemic  CSPAN  July 13, 2017 2:00am-4:21am EDT

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escalates. a congressional hearing looks at the epidemic next. remarks from the outgoing president and ceo of amtrak, charles mormon. later, a look at international charter schools. "washington journal" live every day. arizona republican congressional eric shwycert talks about raising the debt ceiling. then what christopher wray's leadership could mean. gregory meeks discusses the latest in the house investigation into russia and the 2016 elections. be sure to watch c-span's "washington journal" live at 7:00 eastern thursday morning. join the discussion. state officials from
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maryland, virginia, kentucky and rhode island testified about the nation's opioid epidemic. they talked about specific prevention and treatment programs in their states that target opioid addiction. the subcommittee hearing on oversight and investigations is chaired by congressman tim murphy. good morning, everyone. today the subcommittee of oversight and investigation holds a hearing entitled compating the opioid crisis, battles in the states. mike no mistake, the term combatting and battles are entirely appropriate. our nation is in the midst of a tremendous fight against death and devastation affecting over corner of our nation. in 2015 there were more than 52,000 deaths from drug overdose in the u.s. with 33,000
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involving opioid. 23% increase. in 2015 it was almost seven times the rate of deaths from the heroin epidemic of the 1970s. we've lost roughly 60,000 people to drug overdoses, more in one year than all the names on the vietnam veterans memorial wall. and likely that number is underestimated because much of the data will not be in until the end of this year, 2017. it's staggering. for every fatal overdose it's estimated there are 20 non-fatal overdoses. for 2016 that could be near one million. more than 183,000 lives have been lost in the u.s. from these overdoses between 1999 and 2015. that's about 50,000 -- 500,000 will be lost over the next decade. the roots of the crisis began in 1980 when a letter to the editor published in the new england journal of medicine was
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misinterpreted as evidence that someone was unlikely to be addicted. 20 years later the joint commission on accreditation of health care organizations followed established standards for pain management interpreted by doctors as encouraging the prescribing of opioids. under the affordable care act. a hospital may receive more or less money. as we learned in the oversight hearing in march the opioid epidemic is an urgent public health threat fueled by fentanyl. a clear and present danger to america. two states represented on today's panel. road island and maryland were the first hit by the fentanyl wave. it seems certain that this wave will sweep the nation as it's increasingly attractive to traffickers and easy to manufacture or obtain over the internet. this is an inextremist moment
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requiring all the experience, resources, cooperation of our federal, state and local governments as well as the different industries, professionals and experts to curb this terrible outbreak. with this hearing we'll focus on the actions of state governments to find out what's working, what's not working, how we can work together to save lives. as a panel we want to know the problems and please be candid with us. as you know there are millions of families being torn apart by this. as drug policy expert noted it is at the state and county levels that the real progress will be made. it makes sense of efforts to find inspired solutions be most concentrated there and we should learn from them. state governments have been pursuing innovative initiatives such as inventive use of incentives. structured treatment. prescription drug monitoring. states like maryland are making use of the guidelines to push
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back on overprescribing. kentucky's all schedule reporting system, a web based monitoring system to help prescription use across the state helps state regulators identify questionable prescribing practices by physicians and abuse by patients. virginia has expanded access to the drug that can rapidly reverse the overdose but also can have its own risks. some states with expanding the availability of it by providing third-party prescribing. much of the work of the states should help form the president's combatting commission. the subcommittee held a similar hearing on what the state governments were doing to combat the epidemic. this helped congress enact provisions in the c.a.r.a. act
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and helped -- will help the administration. we put one billion dollars into grants over the next two years, but we want to know if this money is being used wisely and how -- what is working. we're eager to learn about the programs. the state program is just a beginning. our state government witnesses can help the committee develop a more effective national strategy to combat the opioid crisis in such areas as substance abuse prevention, education. physician training, treatment of recovery. law enforcement, expanded access to vivitrol while testing for drugs in correctional facilities. data collection, examining what reforms can be made so that there is better coordination of care among physicians and help prevent relapses and overdose and improve patient safety. we are in one of the worst medical tragedies of our time, perhaps the worst. and although this committee -- this subcommittee has given attention to many other problems in the past, we recognize this is paramount among them. this is a national emergency.
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we look forward to hearing from the states about what you're doing on the front lines of this. i yield to my colleague for five minutes. miss degette of colorado. >> thank you. i appreciate this hearing on opioid addiction. as you accurately said this crisis is devastating america as all of us on the dais have seen it play out in our communities, urban and rural alike. not a day passes without a report about children watching their parents overdose, about librarians and school nurses being trained to administer naloxone to overdose victims or about local and state governments trying to respond to the myriad of issues surrounding addiction, while at the same time trying to stay within their budgets. there is some good news. recently the cdc reported that opioid prescriptions peaked in 2010 and have since fallen by 41%. that's the good news. the bad news is opioid prescribing remains untenably
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high. i am hoping our future investigations will concentrate on this. in addition, as you pointed out, mr. chairman, is the emergence of illegal fentanyl, an exceptionally potent opioid. in 2017 fentanyl overtook both heroin and prescription opioids as the leading cause of death in many places. each of the states who are here today, and i want to thank you all for coming, have faced alarming overdose outbreaks. this committee has done some good work. in particular, investigating the seeming seemingly voluminous amount of pills distributed in west virginia and we're planning to do more. the attorney general in my home state of colorado has joined a bipartisan coalition of states nationwide looking into whether
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manufacturers engaged in illegal or deceptive practices when marketing opioids. coming up with an effective solution to the opioid epidemic will require us to understand the actions of all actors. i hope to hear from some of the states today on what role they believe drug manufacturers and distributors may be adding to the crisis. also, i look forward to hearing from the panel about the impact of fentanyl on the towns and communities in which they work. states really are on the front lines of fighting this crisis, and i look forward to hearing from all of you. i know that rhode island, for example, has led the way in reconnecting people with -- or in connecting people with substance use disorders to highly trained coaches to guide them through recovery. virginia is working to implement a similar peer recovery program and kentucky established a program to provide medication assisted treatment to individuals in correctional
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facilities and to continue supporting them after they're released. maryland has committed to establishing a 24-hour crisis center in baltimore city. mr. chairman, i know these are all great state efforts. we have made some efforts here in congress. and i appreciate you referring to the 21st century cures legislation that mr. upton and i sponsored and that this committee worked on a bipartisan basis to pass. as we move forward, we need to work together to continue to address this. and that's why i kind of hate to be the fly in the ointment and talk about what these efforts to repeal the affordable care act will do to the fight against the opioid epidemic. as you know, the aca has helped nearly 20 million americans obtain health care coverage. in addition it has enabled governors to expand medicaid services tools that are critical
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in the fight. since 20151.6 inuninsured americans gained access to substance abuse treatment across the 31 states that expanded medicaid coverage. this is particularly true for states like kentucky where one report says that residents saw a 107% increase in beneficiaries seeking treatment for substance abuse. many think that the house-passed bill that undermines the aca will threaten people's ability to get opioid treatment. in its assessment, the nonpartisan cbo said the house bill will cause 23 million or 22 million americans to lose health insurance. a lot of these people, they need opioid treatment. there have been discussions, both in the house bill and the senate discussions, about adding some money for opioid treatment. but, for example, the most recent senate suggestion of additional $45 billion to help combat opioid addiction,
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governor john kasich said, quote, it's like spitting in the ocean, it's not enough. we've got to get real and understand that access to health care treatment is what is going to help with the health of all americans, including treatment of opioid addiction. and we've got to move forward to work on this together. i hope we can do that. with that i'll yield back. mr. chairman. >> i'll recognize chairman of the full committee, mr. walton. >> addiction is an kwool opportunity destroyer. it's a destroyer that doesn't pick people based on age, race or socioeconomic status. it does not pick them based on political parties. my round tables throughout the second district of oregon, it didn't matter if i was in a rural committee or a more populated city, the stories were similar. we all know someone who was impacted by this epidemic. in my state more people die from drug overdoses than from automobile accidents. that's not unique.
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according to data analysis drug overdose deaths in 2016 likely exceeded 59,000 people. that's the largest annual jump ever recorded in the united states. and what's worse, some of the preliminary numbers from the states indicate that their numbers within the first six months of this year are already surpassing last year's total numbers, and over the past seven years opioid addiction diagnoses are up nearly 500% according to recent report. despite a report released by the cdc last week which indicates the number of opioid prescriptions has decreased over the last five years, that's the good news, the rates are still three times as high as they were just back in 1999. and the amount of opioids prescribed in 2015 was enough for every american to be medicated around the clock for three weeks. that report also found that counties in oregon have some of the highest levels of opioid prescriptions in the country. of the top ten counties in my state for opioid prescriptions, five of them are in my rural
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district. moreover, oregonians aged 65 and older are being hospitalized for opioid abuse and overdoses at a higher rate than any state in the union. opioid deaths continue to escalate, and this epidemic is simply getting worse and more severe. challenges remain, and we need to get after it. we need to improve data collection. a few states are requiring more specific information related to overdose deaths. we cannot solve what we do not know. overdose preconvention efforts, improvement with respect to the utilization and interoperability of prescription drug monitoring programs. we need to increase access to evidence-based treatment including medication assisted treatment. combatting this epidemic requires an all hands on deck effort from federal, state and local officials and all of us,
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spanning from health care experts to our local law enforcement communities. it's precisely why we are having this hearing today. last year congress took action to combat this crisis by passing legislation including the comprehensive addiction recovery act and the 21st century cures act and states improved programs to strengthen the fight. much more needs to be done. we need to work together to ensure the tools and funding congress created are reaching our states and localities and being used effectively. we hope to hear from state officials today to see how they're utilizing these funds and whether these programs work or not. we greatly appreciate the witnesses who have agreed to appear before us today. we hope to have a constructive dialogue about what the states are doing, how to improve data collection, the initiatives that are working, what isn't working and how the federal government can be a better partner in the collective fight. i look forward to your testimony and working with all of you and our community leaders to help get our hands on this horrific
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crisis. so thank you for being here. with that, i know i have two members that want to introduce witnesses. i'll go to mr. guthrie and mr. griffith. >> thank you for letting me sit in for purposes of introduction. i want to introduce our secretary of justice and public safety in kentucky. secretary tilly. we served in the general assembly together. secretary tilly had a strong reputation, strong work as judiciary chairman in the house working with the senate to produce legislation that i think is landmark and was very important. and we have so much to do in kentucky. we have 1404 people that passed away last year from opioid addiction. it is so much to be done. we are saying thank you for the work that you've done. i know we have enormous work to be done. i can tell my colleagues on the committee and my friends, i can think of nobody else in kentucky i'd rather have sitting where you are leading this effort. i applaud governor beven for making the choice and ask you to serve in his cabinet. i think you'll make a big
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impact. >> i recognize the gentleman from virginia, mr. griffith, for purpose of introduction. >> thank you very much. i would like to introduce secretary brian moran. brian was a prosecutor and then came to the virginia house of delegates where we served together for a number of years. he was the leader on the other side of the aisle but was always a pleasure to work with. appreciate his work very, very much. he became the first director of -- or secretary of homeland security in virginia's history and has oversight over 11 agencies, but he is generally well reasoned. every now and then we'd disagree on the floor of the house but not always. we worked together on a number of things, and i apologize, both mr. guthrie and i have to run to another committee where we have two bills that are upstairs. i won't be able to stay, but i will read with interest your testimony and learn from my colleagues the good words that you have to say and welcome you to our committee and apologize
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that i can't be here because i am defending a bill upstairs. >> with that i'll yield back the balance of my time. unfortunately i too must go to that subcommittee. >> come on back. it's going to be exciting. secretary moran is the spit and image of his brother. recognize the gentleman from new jersey, mr. pallone for five minutes. >> thank you. thank you for holding this hearing. our committee has held several hearings on the ongoing crisis including one in march. since our last hearing many more lives have been destroyed. there is no community that remains completely untouched by the opioid crisis. recently the cdc reported that the opioid prescribing rate has peaked but remains far too high with enough opioids to keep every american medicated around the clock for three weeks. i am glad we have the states here today to hear about what they're seeing on the front lines, what successful approaches they have found that deserve to be replicated and what challenges they still face.
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i would also like to hear from our witnesses about how the federal government can help while it's important the states be empowered to address the particular challenges of their communities our response to this epidemic cannot be 51 separate efforts. we must harness our national resources data and cooperation to get the crisis under control. as we talk about a public health crisis of this magnitude there is an elephant in the room that needs to be addressed. coverage for substance abuse treatment is how an individual in society has a fighting chance to kick the opioids epidemic for good. health coverage is one of our strongest weapons in the battle against opioids, the epidemic and the devastation it causes to our families yet republicans persist in their attempt to gut the medicaid program by capping it permanently and ending medicaid expansion as part of their efforts to repeal the affordable care act. repealing the affordable care act and replacing it with trumpcare would be devastating to 74 million americans who receive critical health care services from the program.
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one in five americans receive health insurance from medicaid, half of all the babies born in this country are financed by medicaid. to the working poor, many of whom are hit hard by the opioids epidemic and are eligible for medicaid for the first time through the aca's expansion, medicaid is the only affordable health insurance available. and state medicaid programs are at the center of the opioids epidemic. in the house passed trumpcare cbo determined 23 million americans would lose coverage, the majority covered through medicaid, with 834 million -- billion dollars in cuts to the program. the senate's version cuts medicaid by a full 35% over the next two decades. the cuts could not come at a worse time from the perspective of the opioids crisis, for states and people who depend on the coverage medicaid provides. there is no substitute for coverage for our states or for people that need the care. as the senate continues to make cosmetic changes to its bill
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with one goal in mind, passing any bill out of the senate, let's be clear. no one time amount of funds, whatever the amount may be, whether replace the sernlt of comprehensive coverage. no cosmetic changes can offset the damage caused by repealing the acc a and putting hundreds of billions of dollars from the program. we must stay vigilant in the priet and remain open to any solution that shows promise. i believe there is no way the crisis can be solved with one-time infusions of resources and it will only get worse if medicaid dollars are removed from the fight. we must invest in the health care system and the critical programs for the long term and medicaid should be strengthened, not decimated. i fear that if the republicans are successful in passing trumpcare we'll end up going in the opposite direction when it comes to fighting the drug problem that's devastating our communities. i thank you and i yield back. i don't think anybody on my side
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wants the time so i'll yield back, mr. chairman. >> thank you for your comments. i ask unanimous consent that the members' written opening statements be introduced in the record. without objection the documents will be entered. two former members of the committee are present. thank you for being here. i believe you said mr. stupack was around yesterday too. this is an important issue to those who are alumna of the committee as well. i'll introduce the rest of the panel. boyd rutherford, lieutenant governor of maryland. welcome. as mentioned before, secretary moran. secretary tilly, and director -- honorable rebecca boss. department of behavioral health care, development disabilities and hospitals state of rhode island. we look forward to our continued discussion to the opioid crisis facing our nation. as i mentioned, i want you to be brutally candid about what the problems are, what we need to do
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and what are the gaps. the committee is holding an investigative hearing and when doing so has had the practice of taking testimony under oath. do any of you have objection to testifying under oath? seeing no objections, under the rules of the house and the committee you are entitled to be advised by counsel. do any of you so desire? seeing none, please rise, raise your right hand and i'll swear you in. [ oath administrated ] seeing all have answered affirmative you are under oath and subject to the penalties in the united states code. we'll ask you each to give a five-minute summary of your statement. mrs. pay attention to the time. beginning with you, governor rutherford, you may begin. make sure your microphone is turned on. >> thank you, chairman. mayor murphy, ranking member degette, honorable members of the subcommittee.
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thank you for the opportunity to join you today to discuss the state of maryland' response to heroin and opioid crisis. tackling the emergency requires a combined response from local federal and state government. maryland looks forward to continue to work together with our federal partners to address the challenge. governor hogan and i first became aware of the level of this challenge while traveling throughout the state during our 2014 gubernatorial campaign. we quickly realized the epidemic had crept into every corner of our state, cutting across demographics. maryland, like most states, has experienced an increase in the number of deaths related to opioids. in 2016, 2,089 marylanders died from alcohol or drug related intoxication. 66% increase over the deaths in 2015. 89% of the deaths were related
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to opioids. maryland has seen an increase in prescription opioid related deaths, and so we have -- we must address this particular element of the crisis. we must focus on reducing the inappropriate use of prescription opioids while ensuring patients have access to appropriate pain management. in maryland there were over 8.8 million total cds prescriptions dispensed in 2016. now, this is 8.8 million in a state with 6 million souls. further, the challenge we face has evolved. as was mentioned, cheap, powerful and deadly synthetic opiates burst onto the market, bringing a much higher overdose rate. deaths related to fentanyl have increased from 29 in 2012 to over 1100 in 2016. in maryland. accordingly, as one of the governor's first acts in 2015
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was to establish the heroin and opioid emergency task force, which he asked me to chair. after nearly a year of stakeholder meetings and expert testimony and research, the task force adopted 33 recommendations. those recommendations ranged from prevention, access to treatment, alternative to incarceration, enhanced law enforcement and more. and they form the foundation of our statewide strategy. building on those recommendations of the task force, the maryland general assembly passed several comprehensive pieces of legislation. in 2016 we reformed our prescription drug monitoring program to require mandatory registration for all cds providers. we passed the justice reinvestment act to reform our criminal justice system to shift from incarceration to treatment for offenders struggling with addiction. what we set out to do was make a distinction between those who we are upset with and those who we
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are afraid of. this past legislative session maryland passed the heroin and opioid prevention act and the treatment act of 2017 which contains provisions to improve patient education, increase treatment services and provide greater access to naloxone. the governor signed the start talking maryland act to continue to build school and community based education efforts to bring awareness to this crisis. educating young people on the dangers of opioids at an earlier age was something our task force felt was extremely important. as i have said over and over again, virtually every third grader can tell you how bad it is to smoke cigarettes, but they can't tell you how dangerous it is to take someone else's prescription medications. with the deadly surge of synthetics on the scene, we saw the death toll continue to rise.
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accordingly, in january of this year, governor hogan established the opioid operational command center, the center brings opioid response partners together to identify challenges and establish a system-wide priority and capitalize on opportunities for collaboration. it is a formal and a coordinated approach utilizing the national incident management system to develop both state and local strategic operational tactical-level concepts for addressing the heroin and opioid crisis. shortly after its creation the governor declared a state of emergency in response to this crisis. by executive order he dedicated -- delegated emergency powers to state and local emergency management officials to enable them to fast-track coordination with state and local agencies. thanks to your leadership and commitment, funding of the 21st century cure act has greatly aided in this effort. these dollars will be used in
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expanding educational efforts in the schools, building public awareness, improving treatment, expanding peer recovery specialist program and increasing the availability of naloxone. the one thing that i would add that we would like to see from the federal government is to consider utilizing fema as an outline of the -- as outlined in the national emergency framework to centralize and coordinate the federal response to this crisis. the national response framework is a guide to how the nation responds to all types of disasters and emergencies. and it would allow federal agencies to work for seamlessly with each other and with the agencies at the state level. we can't afford to have delays due to agency silos and bureaucracies. i appreciate this opportunity to talk to you and await any questions you may have. thank you. >> thank you, governor. secretary moran, you are recognized for five minutes. >> mr. chairman, members of the
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committee, it's very much an honor to be with you this morning and to be able to discuss with you virginia's response as well as working with you to request assistance from the federal government to combat this epidemic. as has all been agreed and said this morning, america is in the midst of an opioid and heroin addiction epidemic. the epidemic does not discriminate. it is an equal opportunity killer. in virginia in 2016 1133 individuals died from opioid overdose. the sad truth is that virginia actually ranks 18th among the 50 states in opioid deaths. sadder still, 17 states are doing worse than we are and in all likelihood the other 32 states will face similar devastation if we don't take effective action now. as secretary of public safety and homeland security i am proud of virginia's sworn law enforcement officers who work 24/7, 365, to keep us safe. what they tell me over and over
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and over again is, we cannot arrest our way out of the heroin and opioid addiction crisis. and we can't simply tell those living with addiction to get over it. why is that? because addiction is a disease. arrest and incarceration of those addicted will no more cure this disease that it would cure cancer or diabetes. there are a number of causes, multiple causes, of this dramatic rise in the deadly epidemic. overprescribing. fairly to safely dispose. easy access and affordability. over the last several years we have seen a sharp rise in illegally manufactured synthetic opioids such as fentanyl and car fentanyl. they contribute significantly to the numbers of death. from 2015 to 2016, the number of fatal overdoses involving fentanyl accounted for 618 of the 1133 deaths in the
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commonwealth. virginia's response. the response began immediately upon governor mcauliffe taking office in 2014. he convened a broad coalition of health care providers, criminal justice representatives and community stakeholders to participate in the prescription drug and heroin use task force. secretary of health and human resources co-chaired the committee with myself. the task force developed over 50 recommendations. i am proud to say we have implemented the vast majority of those recommendations. the full list of which can be found in my submitted written testimony. of course, the work continues in virginia. our executive leadership team works across state government and with regional and local agencies and individuals to effectively align goals, share best practices and work to overcome barriers to success. the leadership team organized a statewide approach to opioid crisis and provided leadership
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from the virginia state police, department of health, and from our local community service providers. again, that is a theme, that this is not just a law enforcement problem but, rather, one that requires health care providers to be at the table along with their community providers, community service providers. they support coordination among local grass roots organizations, task forces and other collaborations in designated areas by cover parts of northern virginia. appalachia and northern roads. let me highlight some of our accomplishments. we expanded the doueployment of naloxone. people are being trained in using the overdose reversal agent through the department of behavioral health and developmental services revive program. commissioner of the department of health issued a standing order for pharmacies to dispense naloxone.
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the department of criminal justice services issued grants to pay for increased naloxone to be used by law enforcement. in fact the city of virginia beach has used naloxone now, and they have had over 60 deployments to save lives in that community. now, our requests. i came into this job with a mandate from my 11 public safety agencies that we would rely on data-driven and is decision making. if we're going to wrap our arms around this epidemic and reverse the devastating trend in deaths and related crime, we need to know what the problems are, where they are and what is working. to do that we need good data. here are some of the identified needs that congress and the administration can help address. our prescription drug monitoring
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program is prohibited from accessing any data from our methadone clinics. we need to know how they work and who they are providing care for and how it is working. provide technical assistance or fund staff positions for states and localities and developing metrics, sharing data and analyzing results. support development of consistent national metrics. incentivize providers and mandate data collection as a requisite for federal funding. change how federal agencies do business. increase support for sa msa and hida. break down funding silos, reduce demand. train law enforcement to focus on mid and high-level dealers and help divert those who are addicted into treatment programs. treatment programs are currently insufficient to address this epidemic. those with addictions shouldn't become law enforcement's problems. they belong in the health care system. examples of programs to further -- to explore further
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include assist localities to pilot, analyze and determine the efficacy of angel programs in police departments, fully fund dissemination of naloxone or other drugs. my time is up. there are a lot of requests. you invited the requests, mr. chairman. i will stop if -- >> we'll get into that as we cover questions too. thank you. secretary tilly, you are recognized for five minutes. >> mr. chairman and members. thank you so much for allowing me to be here. i thank governor matt bevin for the chance as well. he sends his regrets. he has been outspoken on this topic. i will share a quick story. when i first met governor beven it was interviewing for this job. he walked into a room with dreamland under his arm and he said "have you read this book?" thankfully i had. and i said i am trying to reread it because it is, i think, the best chronicling of this problem and how it began that i know of.
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so that, again, illustrates our commitment and our shared understanding of this problem. i want to thank congressman guthrie for the kind introduction. dreamland is relevant to us because the problems has its origins in kentucky and ohio. fentanyl is now the driving force behind the overdoses. we have 13,000 e.r. visits. 13,000 e.r. visits in a state with 4.5 million people. we lose in this country as you have heard the numbers nearly a commercial airline a day. if this were a communicable disease we would be wearing hazmat suits to combat it. i think overdoses and the visits only tell half the story. it devastates community. our state police tells us in the last six years alone we have seen a 6,000% increase in fentanyl in our labs. 6,000% increase.
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i think all of us know the devastation it's had on our criminal justice community. our jails and prisons are at capacity. we have no more room at the inn. the public health crisis is on full display in kentucky. we have a hepatitis c right, a form of viral hepatitis, seven times the national average. right across the river in indiana they had an outbreak of hiv that rivalled that of sub saharan africa. so we passed one of the first southern states to pass a comprehensive syringe exchange program. now in kentucky we have 30 programs all passed by local option in our state. we know that that increases the treatment capacity by five times. when someone just walks over the doorstep of one of the programs and it battles back the diseases like hep c and hiv. sadly kentucky, as the cdc reports, has 54 of 220 counties most susceptible to a rapid outbreak of hiv. what has our response been in kentucky to battle this? taking a bold step as a southern state on a syringe exchange
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program. passing comprehensive legislation on consecutive years on prescription pills and pill mills. second state to battle back synthetics. dealing with heroin directly and fentanyl. being the first state in the country to mandate usage of what we call casper. prescription drug monitoring program. we've become the first state in the country now to require physicians, when prescribing, to limit -- for a cute pain to limit -- acute pain to limit prescriptions to three days. some have done seven, some ten. we limit it to three days. our governor spent some capital on that. we doubled down on rocket dockets and sentencing programs and help for those who are addicted through various forms of treatment. neonatal abstinence syndrome. we have increased funding many times to combat that and help the suffering of those addicted there. we put it in our jails and
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prisons. i mentioned rocket dockets with prosecutors to put them on a separate plane to deal with them in the most appropriate way possible. we increased treatment at the department of corrections by nearly 1100% since 2004. we validate the treatment every year and our return on investment now is almost $5. some of the innovative programs, most recently chronicled in the "new york times" is the way we use next atroen in our jails. we give an injection prior to release and upon release and try to link the returning individual to the services in the community to see if they're medicaid eligible, to see what resources they have to continue that particular treatment. i know a question will be do we link them to counseling? it's not mandated but we do our best to do that. in kentucky validated and anecdotally we are seeing tremendous results from using m.a.t. and counseling together. but counseling in the form of cognitive behavioral therapy.
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like moral recognition therapy. it's being used in our jails and prisons and it's yielding tremendous results. we intend to emulate what's going on in rhode island. we're doing peer recovery and bridge clinic soon. we will do innovative awareness, use a hotline. we're educating our medical and dental schools. overall as i close out and conclude at the end of my time i'll tell you that i think we have the most comprehensive effort i have seen in my 25 years in criminal justice with the kentucky opioid and response effort, core. >> director boss you're recognized for five minutes. >> thank you, chairman murphy. >> is it on? thank you, chairman murphy, ranking member degette. as the departme i oversee the state's
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treatment, preconvention and recovery systems. i am a long member of the drug abuse directors and currently serve on the board. thank you for the invitation to appear to share rhode island's work in combatting the opioid crisis, an effort that's been proposed as a national model. our strategies to address this epidemic are clearly outlined on our website, preventoverdose r.i.org. i'll be sharing slides from this website during this testimony. our goal is to make these efforts open to the public with complete transparency on outcomes and available for replication throughout the country. first and foremost, i would like to thank congress for the action taken last year, passing the 21st century cures act with $1 billion to help support prevention, treatment and recovery. we fully appreciate the significance of this action. addiction and overdose are climbing lives, destroying families and undermining the quality of life across states in the united states. and rhode island has been one of the hardest hit.
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in 2015 newly elected governor recognized the need for the state to develop a comprehensive strategy to prevent, address, evaluate and successfully intervene to reverse the overdose trends. she signed an executive order establishing the governor's overdose prevention and intervention task force comprised of stakeholders and experts from a broad array of sectors. the resulting plan has one overarching goal, reduce overdose deaths by one third in three years. the governor's plan focuses on four strategies which i'll briefly outline and focus on two specific areas. others are described fully in my written testimony. the first is prevention. we take aggressive measures to ensure appropriate prescribing of opioids, promote safe disposal of medication and encourage the use of alternative pain management services. naloxone, rescue. as a standard of care for first
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response. it saves lives by revirusing overdose. our plan supports increasing access to naloxone across various sectors of the state. third, we believe every door is the right door for treatment, and our goal is to increase access to evidence-based treatment. to do this, rhode island developed centers of excellence which provide rapid access to treatment including induction on all fda approved medications for opioid abuse disorder. programs provide thorough assessments and intensive treatment services with wrap-around supports. the program is designed to provide opportunity for stabilization with referrals to community physicians for continued treatment, offering continued clinical and recovery supports through the centers of excellence. the program is supported through private insurance and medicaid. in addition, rhode island released the nation's first statewide standards for treating overdose and opioid use in hospitals and emergency settings. and the rhode island department of corrections is providing
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medication assisted treatment to the population most at risk for overdose. we have worked diligently to increase data waivered physicians in rhode island, for example, brown university medical school is the first in the nation to incorporate data waiver training into its curriculum. finally, recovery. we are looking to expand recovery supports. recovery is possible. to support successful recovery for more rhode islanders we are expanding peer recovery services particularly at moments when people are most at risk. the anchor ed program was started in june of 2014 and is now a statewide 24/7 service. it connects survivors with peer coaches in hospital and emergency environments. they provide continued services and follow up and connection. to date over 1600 individuals have met with recovery coaches
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and as a result over 82% have accepted a referral to treatment. the anchor more programs exists as a suicide peer outreach effort to hot spots, not waiting for someone to overdose to be seen. we are now facing a fentanyl crisis. as you can see in this slide, with approximately two-thirds of overdoses fentanyl related, we must develop new strategies to address the changing face of this epidemic. as we speak, the rhode island governor is signing an executive order expanding our efforts to include more focus on primary prevention, engaging families and youth in these efforts. harm reduction strategies and access to treatment. i cannot state strongly enough that rhode island's strategies rely on sustainable funding through medicaid with parity and sud treatment with essential benefit. any action on a federal level that threatens that palestilan s
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it substantially. i would advocate for continued support of the substance abuse preconvention treatment block grant as the foundation of comprehensive state systems. and finally i encourage continued consideration of targeted funds to address these issues. thank you for the opportunity to testify. i look forward to answering questions. >> thank you all. i recognize myself for five minutes starting with governor rutherford. regarding the 42 cfr part 2, a couple effects. one, as was pointed out by secretary couple facts. one is also as pointed by secretary miranda and others. if someone is using pdnp, off some other opioid own if patrick kennedy talks about the sense that someone shows up with an injury and when asked if that person has allergies or drugs and he says please don't give me any opioids, they do it anywayes. because there is nothing in the
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record, prohibited in had the record. we can list if someone has an allergy. but i consider this opiate sensitivity should be in there as well. the nixon administration does not allow that to be in there. so the person may leave that hospital with a vial of open yo opiates. they can say, i used to be addicted. i can take 20 and overdose and death, or they relapse, or on other medications and end up with a bad interaction. what do you recommend we do with part 2? >> that does have to be addressed. you're exactly right. and secretary moran was correct with that particular challenge. a person who goes in and may be receiving methadone treatment, go in for knee replacement, there is nothing to tell that doctor that this person is also receiving methadone. when they prescribe oxycodone or oxycontin or something of that
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nature. it doesn't show up in our prescription drug monitoring systems as well. so it is a particular challenge. it needs to be addressed. there are areas with regard to hippa that also go to other areas of behavioral health. and i know you have talked about that. when we talk about mental health and challenges associated with getting assistance for an adult family member. once that person goes from 17 to 18, you lose a lot of control. can you help this person. so yes, if you can make some type of exceptions for clarification. there is also a misunderstanding among some doctors as well. >> i think in the medical record -- >> yes, that would be a start. >> another quick question, quick survey. noting that most people with addition have a mental health disorder, i'm wondering if any of you have taken a survey in injury states, do you have a sufficient number of psychiatrists. half of the counties in america have no psychiatrists, no
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psychologists, no licensed drug treatment counsellor, if you know -- if you don't know, tell me. but if you do know, do you have enough to meet the need? >> there are counties in our state that have a substantial short ooj of those types of professionals including drug counsellors. that is a challenge we have. >> yes noor no, real quick. >> it changes in south carolina. there is an insufficient shortage. >> thank you. secretary tilly? >> urban areas, yes. rural areas, no. we have a community network we're proud of. but in the rural areas, they still are finding quality professionals. >> i would say yes there is a psychiatrist shortage. >> shortage for all of the psychic. with regard to that in pennsylvania, data that says that people who are on an matt
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be mat, the question is, are they getting treatment. and in your state too, people reviewing that, and i've heard the treatment is no more than a nurse in the waiting room saying, how are you doing today? they call that group therapy if the doctor says, is everything all right? 40% were not drug tisted in the year they received it. 30% have between 2 and 5 different prescribers. some didn't see a physician in prior days. do have you that in rhode island? is there a way to find out if they are getting real counseling? >> in rhode island open yoit treatment is needed to provide counseling -- >> are they really doing? >> excuse me? >> do you know if they are really doing it? >> yes. the opioid treatment programs review records and make sure they are abiding by the counseling standards -- >> i appreciate reviewing records but i will push on this. i have heard from people who go to centers who tell me their
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list in records of counseling and have no more than someone s saying how are you doing? i'm just curious. >> mr. chairman without actually sitting in on sessions and timing sessions and making sure they are happening we have to rely on the validity of the record with which we review. so unless people are willing to today commit fraud and document something that didn't happen, i have to say that i believe what i read in the record to be true. >> okay. this committee has dealt with so much fraud. >> you're right, counseling has to be an important part of that. so if they are not giving counseling, i think they should. there is no evidence of fraud in rhode island.
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>> my daughter went to brown university and i love rhode island. >> so i want to talk to you a little bit, director boss, about this issue. of states being able to pay for treatment. and this is, the full range of treatment. and i think it applies in all of the other three states too. i would assume that paying for treatment on this scale is really an ongoing challenge facing your state. would that be a fair statement? >> that would be fair statement prior to 2014. but we've seen significant increases in the number of people being able to access treatment post medicaid expansion. >> so the medicaid expansion has helped and we helped 21st century too but we know that there's a lot more work that needs to be done. and in fact, in your statement you said, medicaid has laid the foundation for treatment coverage. is that correct? >> that is correct. >> and so i wonder if you can just tell me quite briefly how medicaid funds are helping rhode island fight this epidemic.
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>> so medicaid funds in rhode island cover medicaid assisted treatment. all approved medications. and injectable and support opt health homes and that's a comprehensive program to integrate health care within individuals receiving methadone treatment as well as all other forms of treatment. there is full treatment from in-patient treatment to outpatient treatment to residential treatment to the use of medication assisted treatment as well. >> thank you. have you looked at these bills that house republicans have passed and that the senate republicans are looking at which would severely reduce the -- well, would severely reduce the medicaid aid to the states? >> i have. >> how would those impact your state of rhode island? >> so. any bill that would reduce access to medicaid and medicaid expansion or reduce access to
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affordable health insurance would have negative impact on rhode island as 77,000 lives are -- >> 77,000 in rhode island covered by the medicaid expansion? >> correct. >> secretary tilly, recent ap announcements show that medicaid expansion accounted for more than 60% of the total medicaid spending on substance abuse treatment in kentucky. between 2012 and 2014, there's been more than 700% increase in substance abuse treatment provided to kentucky residents due to medicaid's expansion. so i guess i want to ask you, it looks to me like medicaid has been particularly helpful in kentucky's fight against the opioid crisis. would you agree with that? >> let me say this. i will tell you unequivocally of our governor's commitment and again examples by the 1115 waiver and our effort at this very moment to expand our
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treatment options there that -- >> let me ask you my question. would you agree that medicaid has been particularly helpful in kentucky's fight against the opioid crisis? >> i would agree -- >> thank you -- >> i'm sorry. i would agree that through a number of sources of funding we would increase treatment dating back to 2004, 1100%. >> let me ask you this. let me ask you this. if the medicaid expansion went away, would that impair your efforts to fund this in kentucky? >> ma'am, i have five major -- >> you're not going to answer my question. so i'm going to ask secretary moran a question. governor mccallive tried to expand twice. i know virginia is making the most out of tools it has. but if you had had medicaid expansion, more money in virginia, would this have helped
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you be able to reach out to more people on this opioid issue? >> simple answer is yes. an emphatic yes. >> why is that? >> more people would have access to treatment. i will give credit to our department of health, using very innovative arts program addiction recovery and treatment services to curarve out a medicd waiver to address individual addiction needs. but with medicaid expansion, 400,000 virginians would be covered and governor mcauliffe attempted to do that at every opportunity. >> thank you very much, mr. chairman. i yield back. >> i recognize mr. collins for five minutes. >> thank you, mr. chairman. i think maybe i will start this question with secretary moran. all of us agree here that opioid addiction is a disease. it is an addiction. and we're all experienced the tragic deaths of many of our
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young children when it comes to overdose and it was just pointed out we also have the fentanyl issue. so my question really is surrounding nar can, as we know it. and can you help the committee understand some key issues on availability because we do hear there may be shortages. cost, who is picking up the tab for this. is it patients? the state? the federal government to give us an overview on how we are at least attempting to deal with that piece. and also if someone is obviously in an od, are they given nar can without really, you don't know. are they od'ing on opioids or fentanyl? >> thank you. we are expanding the coverage on nar can in every community. there is some resistance. particularly from a rural jurisdiction meefrly because they are not the first to
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respond under a large jurisdiction. it is usually emergency medical services. ems does carry it. the majority of our jurisdictions in law enforcement communities and certainly in urban areas now carry it. as i mentioned, virginia beach has a tremendous success rate. they are saving in upwards after life week with the use. that's ems. we appreciate the grants, so we can provide without any cost of the local jurisdiction. now in terms of lay people, our department of health commissionerish you eed an order so someone can go into the pharmacy and receive a prescription for nalaxon. we are attempting to expand coverage in any way possible. it is obviously a life saver and the more people who will have it, more lives will be saved.
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now now there are consequences of that in terms of needs for treatment but the nar can itself is truly a life saver and more people that carry it, within the department of forensic science, with addition to fentanyl, because it is so dangerous and lethal, we have provided authority now for all of our lab technicians to carry it. that they may be subject to a lethal dose when they are analyzing evidence in the criminal case. so again as many people can have it, it is a very significant piece in this entire puzzle. >> we have heard that the fda is considering making nar can over-the-counter. now you just mentioned anyone could go in and fill a prescription but that i guess with certainly indicate they have to have a prescription to start with.
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issued by a doctor and i don't know if there's people sometimes do have concerns with an issue. can you expand on that a little bit? or what you may now know of the fda making over counter and also how does someone get this prescription, which obviously they've got to then fill? >> congressman, that's what standing order did is that you do not need a prescription now. you can only obtain the nar can without a doctor's written prescription. that's the standing order from our commissioner of health. >> that's statewide. >> correct. >> that's what the fda is looking ton expand nationwide and what's your experience with that? are you attracting how many people are these perhaps family members who know that they've got someone that's got this addiction and they are being anticipatory to use that word? >> that is certainly the intent. if you have a loved one who
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is -- who is addicted, you would take the proactive step of obtaining the nar can in case of an overdose. we have been trained, myself, first lady of virginia, governor of virginia, we received revived training, it is very simple. it truly is. and we would encourage people to have access to nar can in case of an overdose. >> that's a great example. i'm just thrilled you shared it with us. maybe that's a message if the fda doesn't move that other states obviously could take those same steps because if we can save lives, then you should be able to go home and say job well done. thank you for saying that. i yield back. >> thank you, mr. claire. thank you chair witnesses for their public service and for the testimony that they share today. before i get to my questions, i would be remiss if i didn't echo my colleague's remarks on the devastating impact that trump
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care in consideration would have in the fight against the opioid epidemic. this mean and might i say very mean bill will rip hope away from people in commune it's cross my district who depend on coverage from the affordable care act and medicaid expansion to help them recover from this opioid addiction. medicaid by far is the single largest payer for behavioral health services under our country. in rhode island, medicaid pays for nearly 50% of addiction treatment medication. in kentucky, 44%. maryland, 39%. virginia, 13%. the bill considered in the senate would cut $772 billion or 26 frers medicaid over the next decade. there's no way this highly efficient safety net program has the same type of funding loss and continue to provide services for all this require it.
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simply put, passing trumpcare would be the singest biggest step back for mental health services in our nation's history. that being said, last year i collaborated with my friend on legislation that expanded, prescribing privileges to nurse practitioners and physician assistants. i would like to thank -- i would like to gather your feedback on how this law is being implemented in your states. director boss, you mentioned in your testimony that rhode island is actively working to provide data 2,000 training to practitioners. have you seen significant interest from nurse practitioners or physician assistants communities in becoming wavered practitioners? >> congressman tonko, i'm not sure i have data on how many nurse practitioners and nurse's assistants have taken data
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wavered training. i know we are actively working with medical schools to get that interest and to increase the training available but i'm not sure i would be able to answer that comprehensively. >> as you areware, there is interest in it? >> absolutely. there is interest and active work with the department of health and within my department to provide those trainings to any and all interested parties. and we've seen an interest in data wavered physicians. we will nuri al-maliki with the nur -- we will be working with the nurse practitioners and schools as well. we track through our overdose website and our regular performance management meetings. number of people receiving the treatment so we are able to look at the increases and through our prescription drug monitoring program, track the number of wavered physicians actively
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prescribing. so we are seeing increases in the number of people receiving the treatment through these efforts. >> i would assume that further expansion of data 2,000 waiver even in higher patient caps or additional classes of practitioners prescribing would have a positive impact on access to treatment in rhode island. >> i would absolutely agree with that. i'm not sure there's enough time for us to document how much increase that will result in. but yes, i do agree and i thank you for your efforts with that legislation. >> our pleasure. and to all of our panelists, what barriers do you face in trying to recruit practitioners to become wavered data 2,000 practitioners? >> start with the lieutenant governor, please. >> well, we talked about in certain cases and certain parts of the state there are limitations in terms of the number of practitioners in some of our more rural areas of the
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state. also some of the feedback, there is still in some cases, there's a stigma associated with the substance abuse disorder and there is some doctors that just don't want those patients. but the lifting of the cap has helped us with regard to being able to provide services for more individuals. the stigma is still a challenge. >> secretary moran, thank you. secretary moran? >> i would agree, most of that information would be within our secretary health of human resources as opposed to me. but we have heard from the practitioner. there is a shortage of personnel to address this issue. and you know, in their defense, it is an epidemic that has really exploded offer the last several years. any assistance you can provide for additional funding and
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flexibility would be much appreciated. common wealth and other states. >> thank you. secretary tilley? >> yeah. i would reiterate with my colleagues and i would also had that we have the phenomenon and a number of physicians, i think nearly 700 who are prescribing. however many of them have not prescribe overs that 100 up to 285 cap and in many of them we don't know as has been stated earlier whether they are requiring counseling. we do know we require counseling in our corrections settings and jails and prisons. we encourage it. we do urinalysis. we don't know, that's one of the things we have to get our arms around, we are doing that now. we have to look beyond why some physicians are not applying to do more in their communities. and again we struggle with same challenges with rural versus urban and in appalachia this problem hit first there. it is more acute there in many ways. so that's a challenge for us. >> thank you. director boss, we are going across the board, can we have a quick response? >> real quick.
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>> thank you. i agree with my colleagues. i would add in our discussions with physicians, we want to dot right thing and make sure that people are receiving counseling and toxicology screen but lack office staff and management to do that so they need increase support in offices to dot kind of evidence-based practice that's needed in order to use it appropriately. >> thank you, mr. chair. i yield back. >> thank you. community likes those words, evidence-based facts. thank you. >> thank you, mr. chairman. thanks to the panel for being here. secretary moran, akofccording t the centers for disease control and prevention, approximately 1 in 5 deaths attributable to drug overdose fail to list specific drug in the deather istivecat c. can you explain why this is problematic and what efforts the common wealth is taking to make sure it has sufficient data of
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the true scope of the opioid epidemic? >> one of the themes of my remarks is need for additional data. the state silos and then of course the privacy provisions with respect to some of the federal laws in hippa. in a criminal investigation, our department of forensic science will do the investigation. we have good dwrat wiata with r to what drugs are involved because they are collected. if it is an accidental death, it eventually goes to the office of chief medical examiner. but with respect to data, it is challenging. and you know, some individuals may not be anxious to reveal the cause of death under some circumstances. family members may not, you know, choose to reveal that type of source. so it is a challenge, one we are trying to get our arms around.
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if we have bet are data, we know how to respond better and what to do and what if anything is working with respect to addressing this epidemic. >> is there anything that you are attempting to get your arms around that data na is working for you, at least with some families? >> well, the problem, particularly with fentanyl, we have enjoyed the presentations because we are not alone, you have seen a dramatic rise in the use of fentanyl over last year. that helps inform not only our health care providers but law enforcement. where is the fentanyl coming from. and if it is located in particular community, there can be a rapid response with education and response and to interdict fentanyl. because it is typically being manufactured oversea answers coming into the common wealth in the country. so that type of information, i think, is critical to introduction of these drugs in
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addition to the health care in response to the individuals. so it is -- i think it is imperative that we collect more data and have access to more data because we can better respond to the crisis. >> director boss, your written testimony, notes that multidisciplinary overdose and intervention task force makes use of a data driven strategic plan to prevent addiction and substance abuse. can you tell us more about how the state utilizes the data to develop its strategy to address this opioid crisis. >> that is a wonderful question. and thank you for asking it. >> as specifically as you can. >> so we have two things that i will point to. we have something called mode. which is multidisciplinary overdose drug response team. basically we look at a number of specific overdoses to look for trends and there is a
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multidisplay tarry team that consists of individuals from brown university, hospitals, department of health, my department and we view cases in-depth in terms of looking at where those individuals were, what kind of treatment services they were receiving if any. and then develop specific interventions as response that we propose statewide. others are surveillance response intervention team. we receive weekly reports on 48 wil 48-hour overdose reporting. all hospitals are required to report overdoses or suspected overdoses within 48 will hours. our medical examiner is able to determine whether or not fentanyl is a factor in the overdoses. as a result we put out alerts to communities when overdoses, whether fatal or not, were in that particular area. we notify law enforcement, first responders, treatment providers and other individuals in the community. that there is an increased
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overdose or fatal or nonfatal in their communities. >> okay. you mentioned that your state lacks comprehensive data even to fentanyl even with this approach you're taking. if i understand correctly, what are hospitals in testing of fentanyl and how can they obtain more robust data? >> so i think the fentanyl question is regarding the drug supply. our hospitals are now able to test forrent in nal as our drug treatment providers. and so we are looking at how much fentanyl is in drug supply and as we see increases in hospital testing in the testing that's done in our drug treatment providers we're able to know what kind of fentanyl is out there but not as necessarily as quickly as we could if it were law enforcement, if we have more rapid response in law enforcement and looking at the drug supply. >> thank you. i yield back. >> thank you.
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ms. kass you're recognized for five minutes. >> thank you to all of the witnesses for your attention on this very serious issue. i think at the outset it is important that america just cannot go backwards on this. this is a very costly s severe problem for families and all of us and to watch what is happening from proposals with the gop on health care would really take us backwards whether that's ripping coverage away that's been provided under the affordable care act. under healthcare.gov. or the very serious assault on medicaid. the most serious retrenchment of medicaid in its 50-year history. it would be disastrous for families to address this crisis. if fact i would like to ask unanimous consent to submit for the record from the national
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association of med cmedicaid directors on the senate part of the bill it states in part medicaid is a successful sufficient and cost effective federal state partnership. it has innovation and improvement of outcomes for the nation's most vulnerable citizens including comprehensive and effective treatment for individuals with opioid dependency. no amount of administrative or regulatory phlegm bi regulatory flexibility can result as a result of the bill. many other accessible and affordable health coverage in is the most comprehensive and's fektive way to address the opioid epidemic in this country. earmarking funding for grants for exclusive purpose for treating addiction in the dependent and health coverage is likely to be ineffective in solving the problem. so i'll ask unanimous consent that that be admitted for the
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record, mr. chairman. >> we're reviewing. we will get back to you before you're done. >> okay. >> because this is very important. now this committee to its credit spear headed the 21st country that did supply financial funds from our states not heard from local experts back home in florida. held a number of roundtables with law enforcement, treatment professionals, er docs, they say the treatment is long-term coverage to treat this as the chronic disease that it is. that's why when you rip away coverage and say instead in its place we will have another fund an opioid fund, where you provide a few dollars to an er, that's not going to provide that long-term coverage that we need to treat this chronic disease. i just today get that off my chest here. right off the bat.
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in fact, director boss, have you a lot of experience with this. do you think we'll be able to effectively address this crisis if this retrenchment on medicaid and ripping medicaid away from millions of americans would be able to succeed? >> i do not believe it would be able to be sustained if we did not offer insurance to the number of rhode islanders that depend on it. i thank you for your pointing out that providing substance treatment alone is not enough. if we dedicate dollars forwards that, that's wonderful. however, often times there are morbid conditions interrelated with an individual's addiction. that if they don't have access to affordable health care for the rest of the body then we're not going to be able to treat the person well enough for any kind of recovery. >> are you able right now to provide the type of long-term
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treatment that is needed for opioid addiction? >> yes, we are. >> in fact you have a program called anchor ed which links people struggling with addiction to recovery coaches. how successful has this program been to helping an individual to recover? >> of the individuals, 82% are receiving refer else to engagement and treatment services. which is pretty phenomenal, actually. and the actual anchor ed program itself is not supported by medicaid but the fact we are not required for the block grant funds to fund treatment itself now that individuals can access it frees up that opportunity that activity for activities that are not supported by insurance. though the program is so
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successful that many insurances including third party commercial insurances are paying for recovery coach prague gram. >> is that a program under rhode island law or something you found to be so cost effective that they are participating? >> it is not a requirement. >> can i ask a follow-up question? recovery coaches have what kind of credentials? >> so we have a certification process for our recovery coaches that are standardized and involves training, a test, voluntary hours for certification in order to respond. they are not degree -- >> okay, not degree. do you have licensed recovery, do you have them in the er as requirement? >> we do not. >> let me ask, does kentucky have them or virginia, maryland?
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i believe there is a study done in michigan and yale, there is providing treatment, not referral, treatment, increases a person following up by 50%. just by saying here is some place to call. 82%, do you know if they follow through? that's my question. i would love to hear that from each state. but i next have to go to next walters. >> before you do, is ms. casters unanimous consent? >> yes, we are fine with that. yes. sorry about that. >> i was saying that information is critically important. what i've heard from a lot of places, they may not follow through. at 82% may not be valuable us to but to know they are actually getting treatment. just like you wouldn't send someone home and say you broke your arm, make sure you see an orthopedic surgeon next week. ms. walters, recognized for five minutes. >> thank you. >> we know despite increased societal awareness that opioid crisis continues to devastate our communities. in my home of orange county,
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california, there were 3 mu61 overdose deaths in 2016. that's 50% increase in overdose deaths since 2006. a majority of those deaths are attributed to heroin prescription opioids or combination of the two. one of the challenges in responding to the crisis is that the stigmatizing of victims which limits their responsiveness to treatment outreach. there is discussion of drug courts. this can treat the underlying addiction as a result of the underlying criminal behavior. i became aware after treatment court in buffalo, new york that is focused solely on opioid interventions. and my question is for everybody on the panel, do you have an opinion, whether some drug treatment courts need to be specialized to handle opioid addiction.
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>> we have extensive drug courts in most of our jurisdictions across the state. they essentially are specific to opioid addiction. and there's been good results from most of those courts. the one challenge that we have is that depending on how long, some of you'our counties that ye involved with the drug court is maybe 18 months to two years. and if you're someone who commits a crime at a local jail and you're not ready for treatment that person will say i would rather do the six to eight months than to have to commit to two years, if they are on the fence of sitting in jail. >> we have over 200 courts. they are used for a variety of different specialties. there's mental health courts. veterans dockets.
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the drug courts, however, provide some coercion. the individual needs to want to address their addiction and then the court can provide that coercive element. and we have a tremendous success rate. we should expand. one issue i could ask congress to help us with, however, is medically assisted treatment. some of our judges in the drug courts are reluctant. as of now, it is required. so we would request on behalf of the judges some flexibility with respect to mandating mat. >> and again i would concur. we have mental health courts, veterans courts and drug courts i that i do expand. we did lose our drug courts due to a funding issue. we are trying to build that up now. often times that offender chooses a shorter prison sentence than that two-year very strenuous program. we are addressing this as well.
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we understand they are cherry picking the best instead of focussing on month are high-risk folks. we have a program called smart that deals with high risk probationers. with a modified drug court that does specialize in opioid and at least one part of it does. that's done at seven palette site. that began with judge steven in hawaii that many of you know about now. i would had that what we are finding as well is again this combination of specializing in medically assisted treatment and cognitive therapies and trying to integrate that model with our existing. and we have the passage of recent legislation in kentucky through the department of corrections. a modified drug court. an entry program that we'll be rolling out soon that will specialize in the opioid adecks. addictions. >> i would agree with my colleagues as well. especially with rutherford in the fact our drug courts have had opioid use disorder for a
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long time. in rhode island the drug court has been accepting of medicaid treatment as treatment for individuals long before it was required to do so. probably the biggest issue of drug court is that it isn't able to reach enough people. while it is effective, the difficulty in getting numbers through that system is challenging and we would like to look at a broader perspective and getting people connected to treatment prior to arrest as our primary focus. >> thank you. >> ms. walters, we have an interesting thought. we add conference in kentucky that offered a legal opinion from one of our law firms there. again as secretary moran pointed out, if the judge denies someone medically assisted treatment which effects their interest if they return to prison, that denial might provoke americans with disabilities act. that's an interesting thought moving forward. it has a chilling effect on the judiciary in kentucky and might
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be more accepting of medically assisted treatment. >> thank you. i yield back my time. >> recognize ford five minutes. >> thank you. such a very important topic.d f. >> thank you. such a very important topic. fi. >> thank you. such a very important topic. i cannot say how much this affects families. i have had patients dumped, blue, not breathing, at our doors. we go into emergency care mode. provide nar can and other cocktails for someone you don't know anything about and they are there unconscious about to die. and thankfully we have saved many of them because we had the medication. we know that one of the primary determinants of successful treatment is that they get medication follow-up and counseling. one of the factors for success is that they have health insurance that has guaranteed coverage for the medications, guaranteed coverage for mental health. that's why it is so devastating
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for me and my patients that we're on the verge of repealing the medicaid expansion, repealing for some states who choose not to have mental health and prescription drug guaranteed coverage that those people who need coverage and want coverage won't be able to have it and it can be a situation of life and death as we know. and in a report on addiction released last year, the u.s. surgeon general found that medicaid expansion meant that millions of americans with substance use disorders now have access to health coverage and subsequently substance abuse treatment. additionally because substance abuse treatment is in a central health benefit which is at risk of going away individuals a small group market participants gain access to those life-saving services. but it's not just about coverage. okay? you can have coverage like in my district, but if you don't have providers or psychiatrists or psychiatrists, if you don't have health care centers and counseling centers or programs
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in those communities that are underserved or in rural areas, then coverage does you no good. you need to also think about making sure that we have more psychiatrists, more psychologists, more mental health providers in those areas. especially for the youth and young adults. according to data from hhs, the number of children in foster care increased 8% between 2012 and 2015. experts suggest this rise is due in large part due to opioid abuse. social services administration estimated over 8 million children of parents with treatment. the "new york times" reported on children who experience the impact of their parents opioid abuse and are raised by grand paints parents or placed in foster care as a result. secretary tilley, can you explain how children in your
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area have been affected by the opioid epidemic. >> with a focus on corrects, sadly i can report that in kentucky as it exist now, more children are living with an incarcerated parent than any other state in the country. have had or have an incarcerated parent. and our prison population largely driven by the epidemic, i think that is the first thing that comes to mind. i also believe that it puts an incredible strain on our cabinet for health and family service possess. we have a record number of children in foster care at the moment. so that certainly is an issue. and beyond that, puts a strain on our community health centers as well. the absence of proper funding for community mental health in this country is a huge issue. it exists all off and is in kentucky as well. we rely on 14 community mental health centers that fan out through the state to provide services to children. we have seen an increase in the focus in recent years on
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addiction issues and increase in proper treatment for children. and so i think that's been kret cal for some -- >> secretary tilley, let me just warn you that by turning medicaid into per capita grant, funding for new addicted folks is going to -- i should say the need for funding is going to increase. states are going to have to make decisions. one, change their eligibility criteria. two, reimbursement rates. and three, the benefits that they would cover and often times unfortunately the mental health and these community center treatments are the first on the chopping block. so it is going to get worse if this bill is going to pass. director boss, sam s can you discuss what efforts rhode island has taken that covers a person's entire family?can you
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what efforts rhode island has taken that covers a person's entire family? >> all treatment providers are encouraged to engage families in treatment. engaging family members is critical in order to have success. one of the things the state has done in engage family members in the development over the overdose task force and plan, and create family and parent task force as well as engaging youth to help us shape our efforts for the overdose crisis in the state. >> have you found positive results on those? >> those efforts are just starting. so i will be able to report back, hopefully. >> i'm very hopeful that we can work together to help the situation get better. >> i appreciate that. there are things we need to work on. but i want to make sure secretary tilley has a chance to respond to what you are saying about mental health substance abuse money the first on the chocking block. is that kentucky's intent? >> that's not kentucky's intent. i wouldn't agree --
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>> i'm just asking you to respond. >> missehistorically mint al health -- >> i understand. but you made statement and i want secretary tilley to respond. >> i would say that absence of funding is not a new phenomenon. i know since the 1990s we haven't had an increase in those rates. i don't think that's a recent phenomenon. >> that's why i want to amplify what he is saying. when everyone is looking at funding getting increased, it increases cost for mental health. >> mr. chairman, thank you all for being here on an important subject. i want to express my dismay and my discouragement at some of my colleagues that view this as a platform, if you will, for political messages about cuts in medicaid et cetera. we all understand it is established.
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this is an epidemic in this country. i have seen firsthand perhaps more than everyone in here collectively has seen the impact that this has had. at no time have i ever asked a patient or thought in any way, is there a republican or democrat or independent? this someone struggling. that's all there is to it. this is a nonpartisan problem. and i just get frustrated by that. governor rutherford, you said something earlier that i'm confused about. you are talking about prescription drug monitoring in the state. did you say that methadone is not on that? >> no. what i was saying is that if you're monitoring, if you go to the prescription -- and you will not see that a person has been prescribed methadone, that they are in methadone treatment. >> why is that? >> their privacy restrictions associated with drug treatment and so this was in place prior
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to our developing these prescription drug monitoring programs and there are different barriers to getting information, be it mental health information or drug treatment or in some cases health care. >> is that something we can help you with? legislatively? >> i think that's what we talked about. that that would be very helpful because a practitioner would not know that someone that they are prescribing an opioid has a problem associated with open yoids. opioids. >> okay. when i was in the state senate in georgia i sponsored the prescription drug monitoring program. can i tell you it has been improved since i left. in fact july fourth -- or excuse me, july 1st of this year, two weeks ago, we started 24-hour reporting. before that we were reporting every week. now we are not in realtime yet but we're getting there. we are making very good progress there. i want to know in the
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prescription drug monitoring programs within your states and secretary tilley, i tell you, i have worked closely with the kentucky board of pharmacy and association very strong, very strong programs there. i compliment you on that. but in your experiences with the prescription drug monitoring program, are you sharing information across state lines? >> we are. i think we have seven border states very unique in that regard. the only state that we don't at this moment is missouri. they've got to be a -- >> yeah, missouri struggled. they were the last one to add it on. the pdmp. >> we are working on that. again i would be happy to supplement the record to confirm that answer for you. but i believe we are sharing with sif6 of the 7 states bordeg us. >> senator moran? >> we have 21 states. >> and most of our neighbors.
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>> and and the state of georgia, we are sharing with south carolina, alabama, north dakota, and someone else way out west. i would tell you, in my over 30 years of practice of pharmacy, i never filled a prescription for north dakota. i know you find that hard to believe. but i mean, it's useful but anyway. it would have been more useful if i could have seen it from florida. being in that area in savannah where we are only two hours away, it would have been extremely useful for the state of florida and hopefully we can get to that point. i want to ask you, secretary tilley, about a program that was interesting, and that is peer recovery specialist and emergency departments in kentucky. can you elaborate on that for just a minute. >>? the expert to my left, he add clans, and i applaud the work in
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rhode island. we add model that didn't meet the goals we wanted. it was not up to par from previous legislation. we looked at what rhode island was doing. we tried the same thing they did, we just didn't do it as well. i think we are fairly ambitious with trying to do both at once. peer recovery coaches or specialists in our ers. and also bridge clinics as well to try to keep people there in treatment until we can get them to treatment maybe outpatient or some kind of other bed outside the hospital. so i think what they are doing in rhode island is certainly a model for the country. we are imlating them directly. >> i apologize i didn't get to you. i have 15 seconds. one thing from a pharmacist's perspective, one thing we didn't cure is to allow states to implement laws on how much can be filled and whether pharmacist can fill partial quantities. that will help. we can throw money at this all day long, but we need to be smart. if we're smart and do practical rational things, like limits.
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i got so many prescription for a dentist of a 30-day supply of oxycontin. they take one or two and rest are in the medicine cabinet. that is not being smart. if we can have a -- states can do that as a result of 2 isst century, or result, that is something we need to look at implementing as well. >> and. >> allowing the pharmacist to only give a partial fill at j n onset and then they can come back -- not that they are prescribing partially but that you have an option? >> that is an option that we are allowed to do. i would take it further. and my office is in talks with the ea about allowing maybe a refill on c-2 for three-day supply. a lot of physician are concerned that the patient is going to run out over the weekend. they are going to be bothered. or not be available and they will go without. that's a real concern and i understand that.
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but at the same time, again, if we are just smart. allow them to call in one refill over the phone. as long as it is limited to a short-day supply. >> thank you. >> recognized for five minutes. >> thank you, mr. chairman. director boss, i just -- i want to go back to the issue of medicaid. because as you know, the republicans are still trying to repeal the aca's medicaid expansion in making a lot of changes to the program. so what role has medicaid played rhode island's effort to provide medicaid treatment in your state? >> medicaid assisted treatment is both for the disabled and the expansion populations all medicaid coverage. individuals. are able to receive three forms of fda approved medications for opioid use disorders. the director of medicaid is a member of our opioid task force
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and has been active in working with managed care organizations that manage the medicaid product to do things like remove prior authorizations for medicaid assisted treatment. it is fully funded through our medicaid program. >> and my colleagues on the other side of the aisle often characterize the medicaid program inflexible for states. we hear that a lot, that it's inflexible. to the contrary, i think it is a great deal of innovation and how states respond to the opioid crisis. would you please tell us about the health home program in your state and how medicaid granted rhode island the flexibility to develop its own person-centered care opioid treatment program? >> there are probably two innovations. and we work with the medicaid office for a period of 18 months to develop the comprehensive care management function for opioid treatment programs to provide to their clients in addressing physical health issues as well as their addiction issues.
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and the process with medicaid was thorough but one that allowed us to use a monthly rate to support the work that was really improving the health care of individuals in opioid use disorder. and we know that people who have opioid use disorders that have conditions don't have the greatest access to care in the community. and the health homes allow those programs which have the greatest access to individuals to provide nursing support, overseen by physicians, case management, to help them get to the needed appointments, dental appointments and medicaid is supporting those efforts with an understanding that improving those outcomes will improve outcomes overall and reduce cost. centers of excellence are also a medicaid innovation. where we allow people to be seen very quickly. and it is the issue. you need have that access to treatment which was noted.
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a person seen in the emergency room needs to follow through and get access to treatment and in order for anything to be effective. centers of excellence exist as medicaid innovation allowing people access to treatment all fda approved medications again within 72 hours and have inkraensiv inkrae intensive services supported with a medicaid rate and recovery supports as individual needs with the intention to move that individual into the community once stabilized and continue to provide the clinical and recovery supports needed again through medicaid supported innovation. >> obviously my concern is that in states most heavily impacted by the opioid epidemic if you have cuts to medicaid then cuts to treatment and exacerbate the process. so i have a minute left. let me ask you, would you agree that deep cuts to addiction
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services, that might result from the senate trump care bill for example, that if, you know, if states decided because of the cuts in senate trump care bill, that those kinds of cuts to addiction treatment would have addressed an impact on the ability to fight this epidemic. >> our recovery, our overdose strategy engages four different component and three of the four would be effected if medicaid were not available to support the access to naloxone. medicaid covers naloxone for individuals. the treatment component is, again, supported by medicaid, our centers of excellence as well as treatment components of that as well. and the ability for recovery coaches to be funded, if not for the treatment covered by medicaid, our substance abuse
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block grant colladollars would to be recovered from those efforts to support individuals in treatment. >> thank you so much. thank you, mr. chairman. >> ms. brooks, recognized for five minutes. >> thank you. director boss, i want to clarify something that my colleague, congressman wahlberg asked you previously. you talked about a data gap with respect no fentanyl in law enforcement. with respect to law enforcement data. in your written taemt you talked about hospitals testing for fentanyl but we don't know how many are testing positive for fentanyl. so the gap in collection on data for fentanyl exists in law enforcement, and hospitals as well. is that correct? >> so the testing for fentanyl in the hospitals is fairly new. and so we're not sure how
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complete the data is. they do have ability and whether or not all of the hospitals are testing or not, i'm not exactly sure. and i think for the most part it is an issue of timeliness. we need to have access to timely data and making sure that if testing occurs, that we're able to get the results quickly and in enough time to respond to a community that may be seeing an increase in fentanyl. >> i guess i have asked others on the panel whether or not you know if your hospitals are gathering data on fentanyl specifically and the frequency and so forth. yes? >> i can't speak directly for the hospitals. i know through our medical examiner's office, through our emergency first responders, they get information with regard to fentanyl usage a little more than 60% of fatalities, overdose fatalities are opioids are related it fentanyl.
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it is a mixture with something else, he can cane cocaine or he. but most of our information is from emergency responders. >> i want to talk more specifically about the criminal justice system and would like to ask you, secretary tilley, the core program you mentioned, that is specific to the criminal justice system in kentucky, isn't it? >> actually, it brings in all stake holders. even education. cabinet for family health and family criminal justice system. but any element affected by the opioid scourge is present on that particular effort. >> i would like to find out from you, briefly, your state's efforts. because obviously when a person is incarcerated, which many family members said that saves their lives, it's sad and we want them to be diverted, and we obviously want to focus on high level and former u.s. attorneys, we also want to focus on the mid- and high level dealers and those exposing people with addictions.
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however, at times we have a captive audience of participants in treatment. and can you talk a bit more about medication-assisted treatment in your facilities and then counseling, is there drug testing that is part of your incarcerated population, juveniles and adults? >> we'll start with adults. again, counseling is required with any medically assisted treatment we do. again, i described earlier in my testimony, i think a pretty innovative program where we assess through a risk and needs assessment those who would need an injection. upon release they get another injection and they are matched with a counselor and peer recovery coach to find the necessary resources to continue that treatment, whatever source it may come from. in our juvenile setting, we do not have medically assisted
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treatment at this time. we at kentucky thankfully have a record low in terms of our juvenile detention population at the moment. that doesn't seem to be near the issue in our facilities, although we do offer that treatment in the facilities, it's not medically assisted at this time in the same way you would see it in the corrections setting. one thing that's very unique about kentucky that wasn't maybe reflected in the "new york times" article is that kentucky houses roughly half its prison population in its jails. we're expanding that medically assisted treatment like you may have read about in kenton county, part of the greater cincinnati, northern kentucky area. i would also add the piece about incarceration, we're trying to use elements like involuntary commitment to try to bypass the need for incarceration for those individuals, again, who stand out to their families as someone who needs a forceful hand, maybe
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a judge's contempt power, to keep them in treatment. >> we'll be submitting questions for the record for each of your states, because i'm interested in knowing more and my time is up, on medically assisted treatment as well as counseling and what you're doing with your inmate population. and i know you're each doing something. but i would love to learn more about it. i want to thank you all for cooperating with each other and learning from each other. critically important. i yield back. >> i recognize mr. costello for five minutes. >> thank you, mr. chairman. some of you may know that the chairman and i both hail from pennsylvania, the chairman from the western part of the state, myself from the eastern part of the state. sometimes people think they're two different states. but having said that, in pennsylvania, the epidemic is particularly acute. and just a few brief comments about what we're doing in
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pennsylvania. then lieutenant governor rutherford, with the enactment of the cures act, pennsylvania received federal funding to address the epidemic $3.5 million for drug courts, $23 million being funded to expand access to medication assisted treatment, increase training opportunities to better connect individuals with additional treatment when they visit an emergency room as a result of an overdose, and also to improve access to opioid use disorder treatment for uninsured individuals. and lieutenant governor rutherford, you spoke about establishing a 24-hour stabilization center in baltimore city. i wanted to ask you about that. what services will be provided at the facility, why do you think it is better suited to have such a facility to treat substance abuse issues rather than in emergency departments,
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and maybe depending on your answer, i'll have some questions following on that. >> the concept at the stabilization center is a place where both first responders as well as law enforcement or family members can take a person suffering from substance abuse disorder, and they may be ready for some type of treatment. the idea is to bring them into a locale, not necessarily in the emergency room, because that is a very high cost approach to addressing this challenge, where they can be stabilized and get them into longer term treatment. so it's an opportunity to get that person, as i mentioned, stabilized. they can reside there for a few days before we -- if there's a bed available to get them into treatment. >> any similar facilities that you might be modelling this off of? >> i believe san antonio has something similar. i would have to get more information and talk to my staff. i believe it was san antonio that i believe was doing something very similar to this.
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>> once stabilized, will the patients then be moved into evidence-based treatment and counseling? >> that's the objective. we haven't stood this up as yet, and we're working with the city of baltimore in terms of the parameters and how this is actually going to operate and what the state's oversight role will be with this. >> is the hope that the treatment and counseling, and you said that's your hope, that the funding that you would be utilizing for the facility itself, would that funding extend to the treatment and counseling, or are you looking at the facility to just be sort on the front end? >> the facility is on the front end. we will look to the other funding sources, be it through the cure act, through state revenue, through insurance, through medicaid, to pick up the treatment aspects of the challenge. >> can you describe some of the challenges that your state
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currently faces to provide beds in a timely manner for individuals seeking treatment for substance abuse? >> well, the lifting of the restriction with regard to medicaid reimbursement on the number of beds in the facility has helped that particular challenge, because we did have situations where we had individuals who would receive treatment through medicaid, and we had beds available in some of our facilities, but we could not utilize those. that has helped. we are working to expand the capabilities, particularly for some of the nonprofits that have services and are providing services, and seeing what we can do to assist them in expanding their access. we have close to 800 facilities around the state. there is always a discussion about getting additional beds and capacity. and so we're working on those things as well. >> thank you. my general comment on this
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epidemic is oriented towards the following. i think there are a lot of variables that contribute to this. i think everyone knows that. i get concerned when we point to one particular actor in this ecosystem and say, that's the problem, because it is manifold, it is complex. and i think what concerns me more than anything is that the life cycle of treatment is much longer than the infrastructure that has been set up to deal with it. and as a consequence of that, no matter how good we might be in the first six innings of this, if we're not good in innings seven, eight, or nine, it ultimately won't matter. and we're just embedding cost into the system without front loading the cost, without acknowledging that on the back end, if we don't finish it off with the right types of treatment and the right types of
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counseling and the right followup off that, we won't be able to drive down the epidemic. i think we've all tried to identify what some of the front end issues are here. but that would be something i would like to submit for the record. mr. chairman, i see i'm well over my time. >> may i respond briefly? you're absolutely right. and some of the thought processes behind the crisis center is, it's a front end, right, it's a front end where the person comes in the door. they're in distress at that point, stabilizing. getting them into treatment, but even after the treatment, one of the things we've heard over and over again from people who have relapsed is they go out of treatment, go back to the same community, the same stimuli, the same issues that they had before. one of the areas we're focusing on going forward, including utilizing cure act funding and state funding, is transitional housing, for lack of a better word you can call it a halfway
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house, where a person can go and continue to get treatment in terms of the counseling aspects of it, but during the day they can go to work, do the things they need to do, but they have to report back to this facility. people have said that is something they need before they go back into the unrestricted society. because all the stimuli is still there. >> thank you very much. >> thank you, mr. costello. it's the policy of this committee to let other members of the full committee ask questions. mr. bilirakis? >> thank you so much for allowing me to sit in on the hearing, i appreciate it, mr. chairman. i have some prepared questions. does anyone else want to elaborate on that, any suggestions as far as the long term, the back end? is there anyone on the panel who would like to talk about that? you mentioned, and you're so correct, transitional housing, and cooperation, obviously, is so very important.
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the patient needs to cooperate, and voluntarily, in most cases. is there anyone who wants to make another comment before i get started? >> if i could, i would add that the front door is very important, because access to care, oftentimes you'll hear families say, i don't know where to turn for help. we're looking at a crisis center model as well. i think that's critically important. you don't know which number to call, you've got a family member, a loved one, and you're not sure how to connect them. it's like someone with hypertension going to the emergency room and getting a pill but not getting a prescription. it's not going to help. without access to care and the kind of supports needed. recovery housing is needed as well. as part of our cures act funding, we're looking at establishing that housing for individuals not able to turn to their communities. we need to treat addiction as a
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chronic disease and not acute episodes. i think the approach to longer term and looking at the long term needed supports are critically important as well. >> thank you. with regard to florida in 2010, in response to the opioid crisis in florida, the pill mill problem, i think you probably know about that, florida's legislature enacted a statewide tracking of painkiller prescriptions coupled with law enforcement, using drug trafficking laws to prosecute prescribers caught overprescribing. within three years florida saw a decrease of 20% in overdose deaths. i want to give pam bond, the attorney general, and others credit for this. but now the rise in fentanyl and its various derivatives have presented new challenges to the state of florida and other states as well. however, we remain optimistic with recent legislative initiatives in florida, these include requires doctors to log
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prescriptions in a statewide painkiller database by the end of the next day. i think that's important, to curb the so-called doctor shopping, and setting aside state funds for medication that can help reduce opioid dependency. so we're working on it. during the august recess, i want to meet with stakeholders and conduct round tables with regard to this issue. do you have any suggestions for me, what has succeeded? obviously, sir, i talked about the baltimore model, and i think that's very important. are there any other innovative ideas or legislative initiatives that you would recommend for my state of florida? anyone on the panel. >> i know you're very aware of the stop act and this issue of keeping fentanyl and carfentanil out of our country, where it's
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manufactured legally, sometimes illegally, shipped in, mailed into our country. the dea informed us that for a $6,000 investment, it's about a $1.6 million profit to press it into a pill is a $6 million profit. again, the cartels, that kind of profit margin out there for their taking, it's very difficult to combat this, if we're flooded with it with impunity. we have to figure out ways to stop it from coming into our country in the first place. again, that's not necessarily florida-specific, but i think this idea that it's contained in the stop act, i won't comment on the specifics, but i understand that would, again, curtail some of that. >> anyone else, please? >> if i could, fentanyl is changing the face of this epidemic and we need to respond in our interventions. one of the things i would comment on is this is a marathon, not a sprint. we really need to take a look at
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prevention efforts as critical to changing the face of this epidemic, and not cutting our efforts in prevention, primary prevention, working with transitional aged youth. if he can stop their use in youth, we won't have them dying of fentanyl. recently we haven't had any new medications, we haven't had any new treatment models necessarily proposed for opioid use disorders. and i'm not sure enough effort has been placed into the research needs of this epidemic. we need to start looking at this as we would the focus on cancer. this is an epidemic. we need research that's going to support the most evidence-based models that are effective in treating this. >> thank you very much. i agree. i yield back, mr. chairman. >> i recognize the gentlewoman for followup. >> i want to commend all of your states for leaning in, for moving forward on this, and for
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trying to find robust solutions. it's really important that we do that. i know almost all the states are doing this. my state of colorado has also started really paying attention. it's the kind of thing where it crept up on us collectively as a society, and so people have had to move really fast. and i just want to commend you. and i also want to reiterate that we're very flattered, i personally am very flattered that you're taking this 21st industry cures money and really making something with it, and developing some programs that are uniquely and appropriately tailored to your states. sometimes when we're in congress, we wonder if anything we do actually impacts people's lives. and when i hear what you're doing, it's really gratifying. and i think it will save lives. you do -- i hate to sound like a
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downer, though, but to say that this 21st century cures money which was $2 billion, it's really well-used i think by the states with these grants to develop programs. but $2 billion is, as governor kasich said, not $45 billion. if you're trying to substitute the medicaid expansion money and other treatment monies that are coming, you can't use the money for that. we have to make opioid treatment and prevention part of our overall mental and physical health care in this country. and what that does take, i'm sorry that mr. carter left, we're not trying to politicize this. what we're trying to say is, if you really want to give treatment to people, you have to develop the programs, which is what something like the cures money is good for.
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but then you have to be able to implement them. you have to be able to give the counseling to people. you have to be able to give the mat treatment to people. you have to be able to build and maintain these housing options that people were just talking about. you don't do that just with fairy dust. you have to do that with resources. and some of the resources can come from the states, but the states are jammed. and so that's why the medicaid expansion has helped so many millions of americans be able to get access to the treatment that they need. and that's why we need to be able to keep that for these populations. so i want you to know that -- and, you know, interthat we really disagree on that either. mr. murphy and i agree on a lot of these issues. he just can't say it as forcefully as i can sometimes. but we know that we need to make sure that all americans can get
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this treatment. and we will commit to you that we were going to continue to work with the state to make that happen. thank you. >> thank you. some questions i want to follow up on. this goes in the category of coverage without access is a problem, as is access without -- excuse me, coverage without access and access without coverage are both problems. to this extent i want to put in the record, i ask unanimous consent, why oxycontin can make pain worse, and another is an article, depression and other mood disorders. i'll let you see that. >> no objection. >> no objection, it will go in the record. i want to reference a couple of those things. there's about 50 million americans with low back pain. 25 million of those take an opioid. when a person has pain and depression, about 40% of them are 300 to 400 times -- percent,
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300 to 400% abuse, misuse or addiction. noting that when we're dealing with people with addiction disorders, and 80% begin with a prescription for pain, but mood disorders are a big part of this. 51% of people on opioids have mood disorders, anxiety, depression, something else. i don't know if any of your states ask physicians to screen for that, i would imagine not, most states they don't. do any of you know if your states, medical societies or hospitals ask them to screen when you're prescribing a medication for pain, you also screen for depression, anxiety? if you don't know, just tell me i don't know. >> i don't know. but i believe that is not available in the precipitation drug monitoring program either. >> do you know if you do that in virginia? >> my counterpart, a doctor in the medical community was using the chart, zero to ten, smiley
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face. we were addressing pain. and we overprescribed. i'm not aware, to answer your particular question, i'm not aware whether or not -- >> those emojis are not to do with mood, they're to do with pain. i find it amazing that the other vital signs, blood pressure we measure, temperature we have an instrument for that, respiration, all these are measured. but when it comes to pain, one to ten or an emoji is pretty primitive. >> we are man datidating two hon the medical community to address pain. this starts in the medical community with better characterization around how you manage pain. >> as far as you know, it doesn't also include assessing mood disorders. secretary tilly, do you know, director, do you know if there's any movement towards assessing prescribing these? >> i think it presents a bit of a pause for the prescription, i did not get a chance to mention the university of kentucky is
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piloting a program, our flagship institution, piloting a program there to start with everything but an opioid in the course of treatment and try to taper, instead of starting with it, tapering down, starting without and maybe moving toward it if it's absolutely necessarily. lastly, to your question, we actually are embarking on that very thing potentially with a statewide mental health approach, a number of best practices across the there. that's one of the things we've discussed. >> thank you. dr. boss? >> i can't speak to whether or not it's required. i can say the state has had major efforts towards behavioral health integration and primary care. i know a lot of our clavshts d collaboratives are screening for mood disorders and anxiety. >> the chance for somebody getting a screen for that is probably pretty close to zero. just as we had the problems with 42 cfr, a doctor doesn't know if a person is on methadone, they don't know if they're on these
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medications. it's usually patch 'em up, get 'em out. i know when i was prescribed a lot of fentanyl and other opioids when i had an injury in iraq, nobody never asked me any questions, take these, take these, take these. i ended up with my own issues there, which i didn't get an addiction but my body developed a dependency. i finally said enough is enough, and i had my own mild withdrawal reaction, it wasn't pleasant at all. you said people get referrals in the emergency room. do you know how many of that 82% follow up and follow up consistently and in an evidence-based program? >> we are not able to measure where the 82% go. so 82% not just are referred to but are connected to and follow through with treatment and recovery supports. >> we don't know what the followup is. >> right. >> that's important to me. look, we've identified a few
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things here, such as we have a crisis shortage of providers. we all agree with that across the nation, especially in rural areas, quite frankly in urban areas too. if you assess providers and say, how many openings do you have in your schedule, they'll say they don't. some providers say i just don't have appointments open for months. someone with substance abuse needs treatment now, giving them a waiting list is not helpful at all. even when we do refer people over, the statistic i see is of the 27 million people in this country with an addiction disorder, 1% get evidence-based care. 90% people with substance abuse disorder don't seek attention. 37 1/2 can't find it, it's not available. of those that do get it, get attention, 90% of those or -- don't get evidence-based care.
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so we have a crisis that's getting worse. and i might add too, i think virginia, you're the only state that doesn't have medicaid expansion, right? so we do not. in this time period in which it was available, i would assume that your addiction rate, your overdose death rates have climbed, correct? and in the state that do have medicaid expansion, maryland, kentucky, rhode island, has your overdose and death rates also climbed? >> oh, yes, yes, sir. >> ours have raised but not as significantly as other states have experienced in these last few years. >> yeah, but look, i want to help, but we need honest data here. look, we don't even have information on if those numbers are accurate, because if your medical examiners and coroners are not doing toxicology tests and we don't have data for 2016 until the end of this year, we just don't know. what this committee likes to do is identify. we need the absolute honest bare bonus problems. if you tell us, look, we don't
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know, this is probably much worse, we don't have enough providers. we had legislation, i want to see it reenacted, to get more psychologists, psychiatrists. we're probably going to have to do things with states and the federal government providing scholarships or paying for their inte internships. who would want to do that? it only requires the best who have true altruism in their blood to fight that. we've got to do it. i want to ask a question with regard to getting drugs back to someone who is not using. even realtors say when you have a home up for sale, go to your medicine cabinet and clear it out. some places will have recovery programs to take you to the pharmacy. there's a product called detera, a drug deactivation system you
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can use in your home. virginia, you have some programs like that where you do drug recovery at home? >> we do, sir. i would congratulate our private sector partners, pharmacies have collection boxes now. ly tell yoi will tell you, dea tremendous job, they were going to suspend their takeback program. they continue their robust takeback program, tons of drugs, it's amazing, i've witnessed this myself. improper disposal in the medicine cabinets, as a father of two children, teenagers, it's imperative that we keep the drugs out of that medicine cabinet, because we've heard anecdotal stories, that's where the addiction begins. >> they go to homes for a party. >> exactly, sir. >> i want to thank this panel
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too. we have a long way to go. unfortunately i think at this point, we're seeing the battles in the states, but we have to be honest and say we have a long way to go in this war, it's still quite a crisis here. and this committee will continue to take this up in lots of different ways. it is just a matter of funding. what good is funding if you haven't got a provider? what's good of jail treatment programs if the person discharged from jail aren't on medicaid so they go right back to the streets or wherever they had a problem before. we've heard problems in certain professions were people in the back room are getting exposed. we have an awful problem in this country and the problem is a death rate that is mortifying. i thank the panel here and i thank the members and remind them they have ten business days to submit questions for the record. thank you for your honest approaches. keep fighting the good fight.
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thank you. >> thank you, chairman. [ indiscernible conversation ]
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federal reserve chair janet yellen will take questions from the senate banking committee tomorrow about the country's economy. we'll have live coverage as she reviews the semi annual monetary policy report and its potential economic impact. it starts at 9:30 a.m. eastern here on c-span3, online at c-span.org, or listen with the free c-span radio app. in the afternoon, the national governors association's summer meeting in providence, rhode island. governors will discuss the opioid epidemic and prevention and treatment efforts. live coverage starts at 4:00 p.m. eastern, also here on c-span3.
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this weekend, on american history tv, on c-span3, saturday at 8:00 p.m. eastern, on "lectures in history," professor juddkin browning discusses george mccollum's failed attempt to take the capital in richmond. >> mcclellan and his army didn't do research on what marching along this peninsula would be like. but he's dead set not to concede anything to lincoln so he basically puts his army on the peninsula in spring of '62, the worst possible place to launch his campaign. >> sunday at 6:30 p.m., on the 325th anniversary of the salem witch trials, historian margo burns talks about the trials compiled in the book "records of the salem witch hunt." >> that's why we know so much about salem village, why we know
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so much about the pleas of innocence, because samuel paris took it all down. there's a reason that arthur miller poached from him, because it reads like a play. she says this, he says that, there's sound over here, we couldn't hear, the girls were flailing around. all those descriptions come from samuel paris because he was reconstituting it from his shorthand. >> in 8:00 p.m. eastern, on the presidency, former "boston globe" journalists on their book, "the road to camelot," inside jfk's five-year campaign. >> i was a junior in college, and it was the first time i ever heard the cord "charisma." and it was because he had charisma. richard nixon didn't have charisma. lbj didn't have charisma. but jack kennedy had charisma. and i think that could have possibly tipped the balance in some people's minds.
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and smart as hell, too. >> for our complete american history tv schedule, go to c-span.org. the outgoing president and ceo of amtrak, charles moorman, discussed some of the challenges facing the federally supported passenger railroad. following his remarks, he took questions at this national press club event. >> now to our headliner of today. he became president and chief executive officer of the national railroad passenger corporation. most people don't say that, they say amtrak. he is the tenth executive to lead amtrak since the company began operations in 1971, prior to taking the helm as a transitional ceo at amtrak, mr. moorman spent four decades at northern suffolk corporation and it

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