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tv   NGA Forum on Prescription Drug Abuse  CSPAN  February 24, 2016 11:06pm-12:29am EST

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still is, eventually became the term earmark, and we went through the bills and started the pig book, it went all the way up to $29 billion in 2006. and every year that we can find earmarks in the appropriations bill, we release a congressional pig book around april or may. >> sunday night on c-span's q & a. governors from across the nation were in washington, d.c. last weekend for their annual winter meeting. one of the discussions focused on opioid abuse. this is just under an hour and a half. >> good afternoon, folks.
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i'd like to get started. this meeting is called to order. i want to thank everybody for joining us today. i'm charlie baker, i'm the governor of the commonwealth of massachusetts and the chair of the committee and i'm honored to be joined today by our committee's vice chair, new hampshire governor maggie hassan. my directions say to my left, but you're obviously to my right. melinda becker, legislative director for the committee. and i should please see her after the session if you have any questions related to our discussion. today marks the third time the governors have come together at an nga meeting to discuss the nation's opioid crisis. it's one of most urgent public health and safety challenges facing our states. i'm not going to bore you with
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all the facts and the statistics and the stories on this, because you're going to hear more than enough of that from some of the folks who have agreed to come speak with us today. i do want to leave most of the time for them. we've divided the session into two panels. the first one will talk about the impact of opioid abuse on families and how governors can support the loved ones of those who are coping with addiction. and we'll turn to federal industry partners who will discuss how they are ramping up their efforts to tackle this crisis. before we go to our first presentation, i want to give governor hassan a chance to make some opening remarks. >> well, thank you, governor baker. in new hampshire, we certainly recognize that combatting opioid addiction requires changing the way we've always done things and it requires that we make those changes at a pace that is faster than many people are used to,
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but we also know that doing anything less is unacceptable amidst a public health and safety crisis that claimed the lives of more than 400 granite staters last year alone. claimed the lives of three residents of the city of manchester, new hampshire, thursday night. that is why we have continued in new hampshire to work across party lines on a comprehensive approach that supports law enforcement and strengthens prevention, treatment, and recovery. including the re-authorization of our bipartisan medicaid expansion plan which is essential to expanding treatment capacity. the urgency of this epidemic is reflected in the governor's priorities for addressing the nation's opioid crisis, something that we will be discussing further in today's session. while governors are working hard
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to tackle opioid abuse and overdose in their states, this is an all hands on deck moment and we cannot win this fight without the critical support of federal partners and the private sector. our recommendations as governors include preventing and identifying addiction, expanding access to treatment, and the life-saving emergency overdose treatment narcan and strengthening the law enforcement response. we also highlight the need for new federal resources to help states and communities stem and reverse the tide of this horrible epidemic. as is the case in many of our states, some will say that we can't afford this additional investment. governors believe that we can't afford not to make this investment. in addition to making recommendations to the federal government, governors have come together to underscore the importance of private sector leadership in changing the way we treat pain and addiction in this country. prescribing medications
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excessively or just in case is not acceptable. and continues to fuel the opioid epidemic. and today the national governors' association is joining with the american medical association in calling for swift action to end the nation's opioid crisis. we agree on the importance of pain management and substance use, disorder education, beginning in medical school and continuing throughout a provider's career. and we believe that state prescription monitoring programs are an important tool for preventing and addressing the opioid abuse. we also agree on the need to close the treatment gap and expand access to millox own to save lives. i'm very grateful to dr. patrice harris of the american medical association and all of our speakers for their participation today and i look forward to the
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discussion. thank you. >> thank you very much, governor hassan. it's now my privilege to introduce our first speaker, joanne peterson. miss peterson is the founder and expectative director of learning to cope, which is a non-profit based in massachusetts that supported in part the state fund. i can tell you this, anybody who's ever been to one of their meetings is never quite the same. they are compelling. they are tragic in many cases, and they are hopeful in others, but they are by far moving. and joanne, we're pleased to have you here today to talk about what you folks have been up to. >> thank you so much. >> push the button. there you go. >> thank you so much, governor baker, governor hassan, and all of the prestigious members here today who are here to talk about this enormous epidemic. it's an honor, really to represent all the families that are going through this around
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the country. and also to represent my own family who has grappled with addiction over many years. my son today is in long-term recovery and i couldn't be prouder of anyone on this earth. he lives a great life. so recovery is very possible and i just would like to begin with that, because a lot of people do find recovery. so i did start this, really, 15 years ago by accident, i didn't ask to. i was thrust into this like so many other families, being blindsided by it, and this has really been going on for many years. in the late '90s, it began with the 80-milligram oxycontins that were out there, so available. and the schools weren't prrpd prepared, police officers, teachers, communities. no one was prepared and it
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seeped under the doorways of homes and it took them a long time to figure out what was going on. so this crisis has gone on for way too long. and it's evolved and changed over the years, but it's one thing that is a definite is it has grown every year, every day, and the death toll rises to startling numbers every year. within our groups in massachusetts alone, just the past few months, some of our families have lost two kids, not one, but two. and the most recent is a family out in the western part of the state that just buried their daughter in august and now has just buried a son about two weeks ago. so this is an enormous issue. it affects every state, it affects every community. and it chooses people. we don't choose it. i'm really grateful to be from the state of massachusetts where governor baker and secretary suters and so many in our state
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have worked so hard, including director boticelli in his position now, and years back. people are talking about it now. the stigma is finally changing. it's still there. but it's changing. but i can tell you first hand that when you have a son or a daughter that you're watching on a daily basis lose their life, lose their dignity, lose everything, and you're just trying to reach them, and you can't, that drug is so powerful, whether it begins with a prescription from an injury in sports which is a very common way that this is started. or if it begins with an experiment, either way it can become a way of life and it's not an easy way of life and the family tends to get forgotten a lot of times. you might see them in the emergency room, sitting there for 12 hours, begging for a bed,
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only to walk out later on, knowing that there's nowhere for their son or daughter to go. and then to go to bed at night with one eye open, knowing that they'll run out the door the first chance they get. and then waiting for that phone call, are they going to die tonight? because you know that that powerful addiction is calling their name, and they get to a point where they can't help it. they run out the door. they go get more. and now unfortunately, lately, a lot of times they're buying something that they think is heroin and it turns out to be 100% fentanyl. and a few of our parents who have gotten their medical examiner's reports back recently says 100% fentanyl. so i'm speaking for families today. i'm family, your family, everybody's family. i'm asking the medical community, when they write out a prescription, to think about it,
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like somebody would think about gun safety. a prescription pad can be a very, very dangerous thing. it's necessary. people need pain medicine. i'm totally aware of that, as many people are. but you shouldn't be prescribed things without asking questions. you know, do you have addiction in your family? are you in recovery? or even being educated, this is an opiate, it's highly addicted, lock it up, don't leave it in your medicine cabinet. you know, there needs to be better prevention in schools, real-world prevention. it should be in science class. it should be taught to children, that there's something called addiction that affects their brain and changes their brain, rather than showing them the drug, just talking about their brain. narcan is a very valuable tool. we're the first parents organization in the country,
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thank you to massachusetts being so pro-active, that we're able to pass out narcan at every one of our -- we have 23 chapters across massachusetts. we have about 80 parents who are trained to give narcan out, thank you to the department of public health in massachusetts. we've had over 80 saves. that is families saving their own family members' lives. and they know the most important piece is calling 911. and then we're there to try and help them get treatment. that's where the problem really can begin, once you save their life, then it's really tough to get a bed. it's getting better. there's a lot of work that's being done that we're very grateful for, but there's that gap, and there's also -- opiate addiction, it takes a long time. you need long-term treatment, and i can say that from teeing
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it myself, and living it, watching somebody suffer. without that long-term treatment, it just costs states more money because then they're in and out, in and out, in and out. i think i'd like to leave everyone with that thought, if you invest the money into it, maybe in the end, it will cost less, and maybe in the end, people will get their lives back. and i'd like to also mention siblings in families, they are a really underserved population. they don't get a lot of attention when their parents are so busy trying to save that loved one's life. and it's not easy to just let go. if your son or daughter had diabetes and they weren't taking their insulin and they were eating chocolate chip cookies and drinking soda, you wouldn't tell somebody, just let them go, there's nothing you can do. they need treatment. they need to learn how to manage their condition. and that's what we're there to
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help do. and if everybody gets educated, grandparents, parents, aunts, uncles, friends, communities, neighbors, we might be able to some day really squash this epidemic that has been killing far more people than accidents and homicides in this country. and i'm really afraid that if we don't get a handle on it now, what's going to happen in ten years? and then all of the orphaned children out there, there are thousands of young children out there that are now orphans. they have no mother, no father. there are grandparents out there, trying to afford taking care of grandchildren that will probably never retire, that have spent their retirement funds. so i urge everybody to learn as much as they can about how they can help their state and i'm honored and i thank you very much for allowing me to be here today to speak for the families. thank you.
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[ applause ] >> so joanne, her little start-up as 23 chapters in massachusetts. that should tell you a little bit about how prevalent this. two other things, just to note quickly, one is that joanne mentioned that more people are dying of opioid overdoses than automobile accidents and gun shots. and in massachusetts, in 2014, it was 1,300 people, which was basically four people a day. four people a day. there are very few things i can think of, where you can come up with four people a day. and the one other point i would make, she talked a little bit about the difficulty associated with the treatment process and the treatment pattern. we did a study of everybody who entered a detox facility in
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massachusetts and about 40% of them were in and out of a detox facility at least four times over the course of a year. so there's certainly something associated with what happens after that, that we clearly need to get better at. and there are plenty of places in health care where we used to just accept the fact that kids with asthma got hospitalized. we used to accept the fact that people with diabetes would get hospitalized. that people with congestive heart failure would get hospitalized. then we decided that those were actually failures on the part of the health care system, if somebody with one of those issues got hospitalized. if you look at what happened to the hospitalization rates, especially preventable hospitalization rates, across a lot of chronic conditions over the past 15 years or so, hospitalization rates have crashed. and the reason they crashed, people came up with far more effective approaches to treating people in community-based settings. and i think this is one where i'm anxious to see somebody on
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the provider side, on the addiction side, on the plan side, andrew, come up with some interesting models that others can replicate and adopt. because we're going to have to think differently about this if we're going to be successful. do people have questions for joanne? and thank you again for your testimony. governor shumlin, you talked about this in your state of the state, i believe, four or five years ago. you were way ahead of the curve on this. is there anything you might want to share with joanne? >> i just want to thank you for your courage. because i think that one of the challenges we're all facing in this battle is the stigma. and when moms come up and tell a story that you just did, it lifts the veil for lots of other moms and dads and brothers and sisters and grandparents who are taking care and custody of kids and all the tragedies we know about because you had the courage to speak out. so i just say thank you.
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>> thank you. >> let me just add one small thing to that. and again, i appreciate you being here. i think what you touched on, governor, is true enough. we have to be more overt in addressing this. this is not -- too often there is stigma associated with it and people want to keep it under wraps. yesterday we broke ground on a facility in kentucky that is going to be front and center. that is intended to serve those who are wrestling with exactly what you've described. and it will be literally right there where people can see it. it's not hidden away in the recesses of a health care organization somewhere. 197-bed facility. it's brutal, though, that this is where we have to spend resources and monies. in our state, a state that is very capacity constrained, financially, on many fronts, we are dedicating 60% more dollars than we did even last year to addressing this problem in each
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of the next two years. not really because we have those dollars, but to the point that was made earlier, you can't afford not to do it. and that's really the rub, and that's really what we find ourselves battling. and the one thing -- and i apologize, because i'm going to have to step out here in a moment, i'll be back. but the one thing i hope we wrestle with when we talk about this, unless we're truly, truly serious, and it goes right back to what are we prescribing. we know how unbelievably addictive these drugs are. if we are serious about addressing it, we have to be seriously willing to consider whether or not these drugs are prescribable in this country. and until we start asking ourselves that question, we're not really going to be doing anything except playing a shell game. so i would hope that in the course of the conversation today, and in the days that come and in the days affected by all the conversations that will be had after the fact, that we really, really ask ourselves this question. >> any other questions or
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thoughts for joanne? governor hassan? >> i'd add my thanks, joanne, to you and all of the families. one of the things that's happened in new hampshire in the last year, is when there's been an overdose death, now families, even in the obituary, have been coming forward so that people reading the obituary can understand what happened. again, trying to remove the stigma and acknowledge it as a disease. the other thing that i think we're learning from families and people in recovery who have been so brave in telling their stories too, is that in addition to the treatment to get somebody clean, the real acknowledgement that recovery is really a long-term management of a chronic condition, and we need recovery resources, not just treatment resources, that are ongoing, has been a really important piece of education, i think, for policy makers throughout our state. so i thank you and so many of
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the other families, and individuals in recovery, for really being willing to take this to the front and center. it's really important. >> thank you. >> yeah. especially agree with that, joanne. every time you speak to this, you speak for literally thousands and thousands of people who may or may not have the courage to tell their tale and their story. so thank you again for joining us today. >> thank you. >> so let's talk about federal policy. we are pleased to be joined today by michael boticelli, who happens to be a native of the great commonwealth of massachusetts. he serves as the white house drug czar, and michael, it's always a pleasure to see you and look forward to your comments. >> thank you, governor baker, and governor hassan, not only for today's panel, but for your leadership. i've been to all of your states at least one time to talk about this epidemic and to hear the real-world impact. and i too want to thank joanne peterson, i've known joanne
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since she started "learn to cope" a very long time ago and i can't be prouder of the work that you've done and the way that you inspire, not only me, but all of us to continue to do work on a daily basis. so i really want to thank you for all the work that you do. i think we know and we've talked about this, that making progress on this epidemic really requires a comprehensive and multi faceted response. there's no silver bullet here and we have to be doing a wide variety of things, but we need to coordinate work at the local, federal and state levels if we're going to make progress. as we talked about today, i think we all know kind of the magnitude of the over-prescribing of prescription pain medication, as a key driver for this epidemic and reining in over-prescribing is one of our mutual goals. i want to thank dr. harrison for the recent call to action, encouraging fissiphysicians to -
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we think that this will -- is an area where we can work with the governors, this is going to require legislative action from congress. but now 11 states require some level of mandatory education, and i would encourage governors to look at this as part of their state response. as many of you know, the centers for disease control will soon to be finalizing prescriber guidelines will help decrease the overprescribing of opioids that has been occurring nationwide. but we also know, in addition to inappropriate prescribing, we know that the vast majority of people, about 70% of people who start misusing pain medication, get them free from friends and family. so we think about drug disposal becomes a priority for us at the federal level. just last week and you'll hear more about this, we were very pleased to stand with walgreen's to announce they will be putting disposal kiosks in over 500 of their stores nationwide. we worked very hard with the
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drug enforcement agency to actually look at, to allow regulations for more expanded and ongoing drug disposal, and while they'll continue to have give-back days, we think there's an opportunity for both federal action, but state and local action to continue to expand drug take-back days. as governor baker talked about, having prescription drug monitoring programs has been a successful strategy that many states have implemented. we now have 49 states, we still have one that we need, but we also know that we have to have really good, high quality programs that are able to share data with electronic health records and also interoperable across state lines, so we continue to work with hhs, and we have 36 states that are able to share data across state lines. but we also know that we need physicians to use the information in those data sets. and many states are mandating their prescribers to look at
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these databases. we all agree and the governor talked about the fact -- both governors talked about the fact that we need to expand treatment. we know that we have many people who are not able to access treatment. we know that treatment by and large is still acute and episodic and it doesn't provide for the full continuum of care. and the administration over the past few years, the president has been very aggressive in terms of increasing funding. you know, the president traveled to west virginia in october and heard from a parent like you, joanne and acknowledged that despite all of our efforts, we still had a big treatment gap. 11 days ago, i was pleased to announce probably the single biggest investment in our treatment system in the united states, and he put forward a $1.1 billion proposal for fy '17, to close the treatment gap, but to also make sure that states had a continuum of care. not just the acute treatment,
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but to look at all of the rehabilitation and ongoing recovery options. the vacht majority of that money will be for state agreements to support state systems for treatment. so this is in addition to our other efforts to look at expanding millox own distribution. one of the areas that we've all agreed on, not only do we need access to treatment, but the expanded utilization of assistive treatment is particularly important. we know from all the evaluations that when people with an opioid disorder on on medication assisted treatment with all the other recovery support that they do far better than those who are not on these medications. these medications are often underused. we need more prescribers to prescribe them. we are working on at looking at how in a prudent way we can look at lifting the cap of patients on it, and are also interested
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in working with congress and governors to modify the current legislation to allow nurse practitioners and physicians to prescribe. part of the president's proposal for this year was to put $10 million into demonstration grants to look at nurse practitioner and physician assistant prescribing. we know many of your jurisdictions and part of the growth of this epidemic has been in rural parts of the country, where we don't have treatment providers, where we don't have physicians, and we need to continue to focus on expanding access, particularly in underserved populations. just this summer, health and human services put out a $100 million grant announcement to support expanding treatment in community health centers, because we know it's a prime opportunity to look at getting people care. as all the panelists have talked about millox own, reversing overdoses has been an important priority. i'm proud to say that i came from a state that trained the first law enforcement department
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in the country and the first family in the family support group in the country and we've seen a huge uptake and again with many of our leadership, particularly by first responders, to administering millox own. we now have 36 states that have introduced legislation to look at expanded millox own access and i think we need to continue to work together to make sure not just first responders, but anybody who's in a position to witness an overdose has access to millox own. and we've seen very, very good state laws that have allowed for pharmacy-based access and third-party prescribing, so that's really important for us to be able to do that. we've also seen a tremendous response from law enforcement in this issue, not in terms of just reducing overdoses, but also working with community members and affected people in terms of getting them into treatment. i think many of you, and not to harp on massachusetts, but there's a police chief in gloucester, massachusetts who
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started an angel program and they and their officers look at getting people into care and it's been a huge, i think, change from our law enforcement officers to know that we can't arrest and incarcerate our way out of this problem. that we have to have a much more compassionate response to people with addiction and it can go a long way to diminish the stigma if people feel free to ask for help. but part of what we continue to focus on are looking at what are the opportunities through grant programs because we know the cost of millox own can be prohibitive for many people. but we want to make sure we're doing everything we can to widen the expansion. the other area that becomes important, so it's not just overdoses that have been a significant consequence related to this epidemic but we have seen and i'm sure all of your states are experiencing increases in viral hepatitis as a result of drug use. many of you saw what happened in indiana this summer that had
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about 185 people in a county of 9,000, that were infected with hiv as a result of injection drug use. we worked in partnership with congress. so after decades congress repealed the federal ban on federal funding for syringe access programs and we have states, indiana, kentucky, that have passed legislation that allow people to have access to clean syringes. this has been a tragic, tragic example of the potential for dramatic increases in infectious disease supporting this. the other piece we talked about, it's not just a public health issue, but we know the impact it's had on law enforcement. and we need to continue to work in partnership with law enforcement. we've seen great examples of law enforcement and public health working hand in hand on this issue. but as joanne talked about, not only are we seeing overdoses as they relate to prescription drugs, but we've also seen drimt increases in heroin and fentanyl
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overdoses. we have to work with law enforcement to reduce the supply in our communities. we are happy to announce this past summer, additional funding for our high intensity drug trafficking areas, to work both with public health and public safety. and we'll look for every opportunity to expand that. so needless to say, this is one of the president's top priorities. i think many of you heard him refer to it in the opening of the state of the union, as an opportunity to not only work with you, but to work with congress on this epidemic. we certainly -- and he certainly recognizes the magnitude and the urgency and looks forward to not only a more robust federal response, but how we can work in partnership with governors and states. thank you. >> thank you very much, michael. we're going to work our way through the other folks who generously agreed here to be part of this panel and then open it up to questions for all of them, if that works for you
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folks. dr. harris, the floor is yours. >> thank you. governor baker, governor hassan, on behalf of the physician and student members of the american medical association, it is my privilege and honor to be here and share with you solutions for ending our nation's opioid epidem epidemic. i'm dr. patrice harris, i'm a practicing psychiatrist from atlanta, georgia, the chair of the ama board of trustees and the chair of the ama task force to reduce opioid abuse. the ama, the ama task force, america's physicians and medical societies across the nation unequivocally understand that this is an urgent public health epidemic. we believe it is our professional and ethical responsibility to help bring an end to this epidemic, which has claimed the lives of more than 250,000 americans since 1999. tens of thousands of people are
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dying preventable deaths every year because of opioid misuse and overdose, including heroin. our sons, daughters, husbands, wives, friends, neighbors, our patients. more than 78 every day, and this is not acceptable. together we can and must end this epidemic. now the ama understands the many causes of this epidemic, but let me focus on the one where physicians can have the most immediate and meaningful impact. today, i will highlight five recommendations from the ama task force to reduce opioid abuse. a call to action, if you will. that the ama president sent this week in a special e-mail to hundreds of thousands of physicians, residents, and medical students nationwide. first, we want to urge every physician to register for and start using their state's
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prescription drug monitoring program. these tools are not perfect, but they can provide important information that can help physicians care for their patients. the results of an ama national survey released on thursday found that nearly 90% of physicians said that pdps help them become more informed about their patient's prescribing history, including whether that patient is receiving multiple prescriptions from multiple health care professionals. second, the ama urges physicians nationwide to enhance our education and training around safe prescribing practices. the hippocratic oath reads, "i will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon's knife or the chemist's
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drug." if i believe that a medication will not be helpful, i will tell my patient no. whether the medication is an opioid, an anti-depressant or antibiotic. our prescribing conditions must be deliberate and rooted in the art and science of medicine. on our website, the ama has gathered more than 100 state and medical specialties' specific resources to provide physicians with a one-stop shop for the best and most up to date education on safe prescribing practices. let me be clear, however, that many patients benefit from opioid therapy for both acute and chronic pain. when a physician determined that an opioid is called for, the ama supports patients receiving the lowest effective dose for the shortest effective duration.
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this national epidemic presents many challenges which is why we need to work collaboratively, your all hands on deck analogy, to ensure that policies designed to help, don't unintentionally hurt. the ama understands that are too many pills in the public's hands. but if we enact policies that overly restrict access to necessary pain relief, we may be pushing people toward other non-medical, undesirable alternatives. we have to work together to strike the right balance. third, the ama is urging every physician in the united states to co-prescribe millox own to patients at risk for overdose. governor baker, governor hassan, you and many of the governors here today are well aware of the tens of thousands of lives saved by millox own. for the past several years, the ama has worked closely with several medical societies to
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enact more than 20 laws that provide greater access to millox own. there are few state legislative efforts that have had as much momentum as millox own access and we're proud of what we've accomplished. we strongly urge all governors in states without millox own access and good samaritan laws to introduce and enact ama model legislation that would help save lives from overdose. physicians can also do more. if we see a patient at risk for overdose, we need to co-prescribe millox own to that patient, plain and simple. the fourth and fifth recommendations focus on treatment and stigma. miss peterson, thank you for coming today. your sharing your story helps with that. i urge everyone today to speak out against stigma, patients in pain and patients with substance use disorders deserve care and compassion, not judgment. the ama applauds your effort to
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increase access to treatment in your states. patients in pain and patients with substance use disorders are our patients. they are not fakers or junkies or addicts, they are people who need our help. stigma dehumanizes and demeans. it does nothing to treat and cure. administrative barriers also do not help treat our patients. it is distressing to me and i just heard this yesterday at a meeting in pain society, when i hear my colleagues say they couldn't get a patient's physical therapy approved or that behavioral or cognitive therapy was denied, or other non-opioid therapies are subjected to yearly limits or other administrative barriers. we need to work together to ensure that policies support optimal treatment and break down barriers to non-opioid and
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non-farma clojic therapies. we need to support policies and practices that will have a meaningful impact. in closing, a few words about broad national efforts. last october i was proud to represent the ama and stand with the president and director boticelli in west virginia, a state where i was born, and commit to achieving several key goals to end this national epidemic. to have a measurable impact on increasing the use of pdmps, do enhance physician education, to increase access to medication assistive treatment and to increase prescribing of millox own. we support increase funding for states to enhance their ability to provide overdose prevention and treatment options. this national epidemic needs more of this type of commitment. but we all know money alone will
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not end this epidemic. the nation's opioid epidemic is unacceptable. physicians must not only take responsibility, we welcome that responsibility. and we welcome your continued partnership in this effort and thank you for the opportunity for me to be with you today. >> thank you very much, dr. harris. much appreciated. so, dan, walgreen's has already been mentioned as an innovative player in this space. would you care to expand on that? >> i would love to. >> i thought you might. >> good afternoon, everyone. governors baker and hassan, thank you for having me here. i'm dan luce, the national director of affairs with walgreen's. we're talking today about solutions. we know the problem. we know what medicine is going to do. i'm happy to talk about walgreen's going to do. it's always nice to talk about doing the right thing. i announced over the last couple
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of weeks a couple of things we're going to do. one of which is called safe drug disposal. when those medicines are left in a home in a medicine cabinet and forgotten about and then a teenager or child comes in and says, let's try some of this, we need to get them out of the medicine cabinets and get them disposed of. the other thing is, if someone has an opioid addiction or heroin and faces a problem where they go too far, millox own needs to be readily available and get that person the health they need and get them back in treatment and get them to the right spot they need to be. we're trying to provide what we can at the pharmacy level, a solution to really deal with the fundamental problem of getting the meds that shouldn't be on the street off the street. and then when someone does have an adverse reaction, making sure we can help put that millox own in the hands of the caregivers as soon as possible. the accessibility of pharmacy,
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talking to your pharmacist, i'm worried about my kids, can you help me get the millox own in my house in case i need it? that's where we're trying to do, for that solution. the two key things, safe drug disposals. we'll have about 500 receptacles in about 500 stores in 39 states and d.c. by the end of the year. the rollout will start on the west coast, and work our way across. one of the questions we always get, though, when you have a group of distinguished governors here and you say 39 states, why not 50? >> state law. >> what's going on here? that's what my ask is going to be today. how can you all help us get to 50 states as quickly as possible? because some of the hurdles weren't big hurdles. it's legislation, it's pharmacy rules, epa, waste/hazard disposal. we can fix those things with your help and we can probably take the timeline to make them happen, a lengthy timeline, and
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condense that dramatically if we can all work together to find some solutions. the millox own without a prescription again will be in 35 states and the district of columbia by the end of the year. we have a few states already, new york, massachusetts, rhode island, indiana, ohio. and again we'll work with the remaining states. one of the obstacles we face on the millox own issue is the fact that for pharmacists to dispense it, we have to have an arrangement. some of the states don't have that yet. we'll need your help to go through the legislature to get that in place so we can do that. i'll tell you, though. it's amazing how fast things can work. governor baker just happens to be here, but this is from just last week. we decided we can't put our kiosks in massachusetts. what's gone wrong? so we look and say, it just requires a waiver. we get the waiver from the
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state. it says, if you want to have a permanent receptacle in your stores, you need to fill out this waiver. but the waiver said it can only be for law enforcement, like a police station and community pharmacy wasn't there. so within three days, working with the governor's staff, lesley darcy and others, we were able to get a new waiver put together that included pharmacies, so now the process is in place. so it went from a state that might have a problem, to a state that's going to be part of the process. and then -- >> the message is, you need a governor who is hosting an event on opioids and solutions to happen right around the time you ask for a waiver. [ laughter ] >> my wife always says, you gotta know the right time to ask. so on the millox own, one of the big issues is, you know, a lot of times when it rolls out, and the state develops a program for pharmacists to dispense millox own. they say, we want to have a training program. we agree with that, but if you
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use a state-based training program, that requires us to have our pharmacists participate in a program, track it, we don't know how effective that's being and when the pharmacists finish. it just extends the timeline. when we have an online program there, we can send it to our pharmacists, they can do the training, electronically record it, and it connects to the timeline by using the programs that are already out there. as we talked about, growing problem, 2014, there was almost 48,000 deaths from overdose. 60% of those were opioid related. so it is a growing problem, and a growingkiosks, this is the pl today, again, the green states, we've gone through the legislations, the process, and we're ready to go. we roll these out over the course of 2016. the red states, we want to be having dialogue, a conversation about how do we find a solution, where's the barrier, let's fix
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it, get it done quickly. and millox own, again, this is mainly a focus on how to establish a protocol, a state-based protocol. if you have one protocol for all pharmacies in a state, where it's available quickly, you could have the whole state, the source of pharmacy for your whole population quickly, but it requires a single state-based protocol, instead of each pharmacy to collaborate with, especially on an issue like this, which you would to expedite as much as possible. because there are states out there who want to say, how do we fix our red to green situation, our senior director for government relations, i put his contact information there and casey, and i do the pharmacy affairs, the three of us will be willing to work with any of you to expedite this process and make sure these two vital programs will be available to all states as soon as possible. >> that's great, dan, thank you very much. and we appreciate your leadership and your organization's leadership on
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this issue. that said, i want to give my colleague, my former colleague and my friend andrew dreyfus from blue across blue shield of massachusetts to talk about this issue and what they've been doing in the commonwealth. >> thank you, governor. let me just begin by thanking the nga for bringing us together and for inviting blue cross blue shield to be part of it. i'm pleased to be invited back and this time by my own governor, charlie baker. i know governors across the country have displayed extraordinary leadership on this issue, but governor baker has faced this with unusual energy and conviction. our neighbor in new hampshire has done the same. so i'm here to speak both on behalf of the blue cross blue shield system and talk a little bit about our commitment to this issue, but also describe the lessons we've learned from a first in the nation breakthrough
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program responsponsored by blue blue shield of massachusetts. collectively, our system covers 1 in 3 americans. we're the only insurer to hall of famer health coverage in every zip code across the country. because of this reach, we've developed deep ties to every local community in america and we know first hand the devastating toll upon this epidemic. that's why we're here today and why we want to work with you to drive national awareness of the problem and to develop solutions that can be implemented in every community nationwide. i'll discuss these issues in a little bit of detail and there's more in your materials. first, the blue system plans to tap into our industry leading data capabilities to give the public a much more complete picture of the prevalence of addiction and the impact on the entirety of the health care system. given our vast network, we believe we can offer unique insigh insights. second, we want to educate
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americans on the impact of opioid use and how to prevent it. we're partnering with pbs to produce a documentary that will help people identify the early signs of addiction and how and where to get help. through national and online distribution, we'll reach millions of americans. third, we plan to unite our resources in the blue system by bringing together our top executives to ensure that we are sharing our best practices and reaching our members and their communities. in addition to these national initiatives, individual blue cross blue shield companies are on the ground in local making a difference every day. blue cross blue shield of western new york has a program called painkillers kill. a campaign that increases awareness of painkiller use by providing resources to the medical community and the community at large, including continuing medical education, a middle school curriculum and a 24/7 hotline. in florida, florida blue has a
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prescription drug monitoring program that's curbing doctor shopping by asking providers in the community to report when a controlled substance is dispensed. and anthem blue cross blue shield has a comprehensive management program, including a wide range of approaches, including in patient homes. i want to tell you for a minute about our plan in massachusetts. in 2012, recognizing the emerging problem and seeing that too often our own members were getting prescriptions inappropriately we convened a group of pain management experts, physicians, addiction experts, pharmacists and others to look at the problem. our goal was to develop an affordable, accessible program for pain care on the one hand, but to reduce the risk of addiction and reduce the diversion of prescription drugs. the program had a few key features. first, we said that for every
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time an opioid was prescribed, there should be a treatment plan between doctor and patient that considers non-narcotic treatment options. second, we ask that a risk assessment for addiction be signed by the patient. third, we ask that an opioid agreement between the patient and the prescriber outlines the expected behavior of both parties. fourth, we said that a single pharmacy or pharmacy chain be identified to use for all opioid prescriptions. and finally and perhaps most importantly, we put in place a prior authorization. for all new short acting opioid prescriptions and for all new long-acting opioid prescriptions. after three years, we've seen the number of opioid-based medications decrease by an estimated 21 million doses. that's 21 million doses. the number was so high after the first year that i asked our team to validate the numbers again and again. we've seen a 50% drop in
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long-acting opioids and a 25% drop in short-acting opioids, with very little or no limits on access to pain for those patients who need them. but we know that our responsibility does not end with reducing the supply of drugs, which is why we're also committed to finding new and innovative ways to treat our members and provide them with the care they need. we hired an expert in addiction medicine at our plan to help guide our efforts and she works with physicians and other providers in our network, as well as our customers and our members. in 2014, we launched a new program we called the reach program. those members who have either opioid or other addiction issues or other mental health problems who choose to participate, have access to traditional and non-traditional treatments and interventions, including 24/7 access to a care manager, peer counselling, living skills training, family support groups, co-pay assistance, and even
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transportation to and from health care appointments when they need it. and we're meeting our members where they are. last year, we moved all barriers for behavioral health admissions from emergency rooms. if a physician believes that admission is necessary, our members will be admitted without any requirements or administrative hurdles. and to our agreement with two of our largest detox and addiction providers, we now contact our members while they're still in the facility, to identify potential gaps in their care and ensure they understand the treatment plans after discharge. i'm proud of the work that the blues, including our own plan, have done, and continue to do so in the areas of both mental health and substance use, and we look forward to continuing these efforts in the best interest of our members. thank you very much. >> thank you, andrew. and thank you for the blue's leadership on this. questions from the governors? governor shumlin? >> listen, i want to thank all
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the panelists for their helpful suggestions, comments, and offers to cooperate with us. and i guess i -- governor sandoval and i chaired this committee, i guess it was last year, or the year before -- last year. we had a very similar conversation. and i'm encouraged by the bipartisan acknowledgement that it is up to governors to act and make a difference on this issue. i think we have a huge opportunity. and i think there's some reason for hope.
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