Transcripts For CSPAN Washington This Week 20240622

We are live of the Greenbrier Resort in West Virginia today. Our continuing coverage of the National Governors Association Annual summer meeting being held this year at greenbrier. The association is composed of executives from the states territories, and districts of the u. S. It is chaired by governor hickenlooper of colorado and the vice chair is governor herbert of utah. The form that is about to get started focuses on state efforts to combat drug use. Steve bashir is chairing the session. But Coverage Today on cspan. If i could have your attention, lets take our seats so we can get the joint session started. First of all, good morning, welcome. I am governor steve bashir from kentucky. I chaired the health and Human Services committee. We will call this meeting to order. Welcome all the governors who are here. This is a joint session of the health and Human Services committee and the Homeland Security and Public Safety committee. Joining me as vice chair of our committee is vice chair governor bill haslam of tennessee. I am pleased that we have been able to come together with the Homeland Security and Public Safety committee for todays discussion regarding the nations opiate crisis. I want to thank the leadership of the other committee governor, rick snyder of michigan and for partnering with us on this important topic. There are a few administrative tasks to perform. The briefing books were sent in advance, including the speaker bios and updates. The proceedings of this meeting are open to the press and all meeting attendees, please violence your cell phone please silence your cell phones. Sitting at the table are Melinda Baker and justin stevens, you can see them after the session if you need details about any of the issues we discussed today. Before we go into our formal presentations, i want to turn to heather, the staff director of health and Human Services and the Homeland Security and Public Safety committees. Heather and her nga colleagues will provide key updates on key state issues. From the health and Human Services perspective, we advocated actively for an extension of the Childrens Health Insurance Program which congress s did extend in april for two years as a part of a larger deal to overhaul medicaid payments. That extension maintains existing programs, flexibility, and planned levels for states. That was a key priority that we were able to conflict. One of the other things that aj just committee has been engaged in its efforts to reform the childrens welfare system. At the same time the Homeland Security and Public Safety committee has been working with congress to maintain National Guard personnel and prevent the further transfer of apache helicopters until after congress has time to consider the recommendations of the Army Commission currently doing its work. Currently be house and senate are conferencing their bill they planned to have a final bill in the fall. Nga has been in advocating that the bill which would event the further transfer of apache helicopters be included in that bill. In addition to National Guard matters, the committee has been working to promote the states role in Cyber Security and foster greater collaboration with the government and the private sector. Those are the two main parties that i wanted to cover on the federal relations perspective. I will pause quickly to see of there any questions before we proceed. Ive happy to answer anything afterwards. I now turn to my colleagues from the nga center of best practices. Good morning, governors. I just want to give you a very brief update on how the work in the Health Division is going. We continue to be very busy. We have over 20 projects going on around the country. There are two products i wanted to highlight for you this morning. The first is medicaid transformation policy academy. This is a very intensive work with alabama washington, and nevada where we are working handinhand with the states to negotiate broad new authorities. These are authorities that we never had before that will allow governors to have a lot more flexibility in the way they pay for and deliver services in medicaid. We are very very close to agreement with at least one state, and in addition, we are working hard to negotiate in some cases billions of dollars of of front investment for the federal government from the federal government for the state and medicaid and medicare dollars. It is very powerful work. We plan on inviting you with a fake torillas report out victorious report out. In addition, we will allow all of you to use a new process to get to use with medicaid waivers much more quickly. It is a big project, we are excited about it. We are also launching, in two days, i next round of work that is aimed at the highest cost, highest spending medicaid patients. These people are spending millions and millions of dollars and have terrible outcomes. Several states around the table, your leadership staff, will be working with is on those projects. That is for the next year and a half. It is the second part. I just way to highlight, in that project in particular, Prescription Drug abuse has come to light as a very strong component to the reasons that these folks abusing services and costing a lot of money on having terrible outcomes. Todays discussion is very relevant, both from a cost and quality perspective. If we can tackle this problem it will be one of the biggest facing state governments and budgets. Now we will turn to the director of the center on Public Safety. Good morning, governors. My division has worked in close collaboration with frederick division. We close to policy academys edwards with 13 states. Governor hickenlooper cochaired the first academy. Through the academies, states have passed legislation and passed Public Service campaigns and improved coordination across state agencies and with stakeholders. To provide guidance for the states on how to address this problem, we have put out a few products. We put out a brief a few years ago on strategies that states can adopt to battle Prescription Drug abuse. Currently, we are partnering with the urban institute to provide a guide on evaluation. Through evaluation, states can better assess what they have implemented and ensure that the and divisions are having their intended effect. Certainly, the problem of Prescription Drug abuse has been grabbing headlines but Substance Abuse is a serious problem across the country. This is especially true for children in the Child Welfare system. Later this year, we will be launching a new policy academy on improving child safety and preventing child fatalities. In addition, my division will be working again with frederick and his team to build on the success of the policy academysies and the momentum that i think there is nationally on this issue around the use of haireroin. According to the center for Disease Control and prevention three out of four users started on prescription pain pills. Since 2010, the rate of death involving heroin have tripled. Our speakers today will be talking about this issue in more depth, but to the extent that frederick or i can be of assistance to you, dont hesitate to reach out. Thank you. Jeff, frederick, and i will stick around afterwards. Governor beshear, back to you. Governor beshear thank you. Lets turn to the topic of todays joint the many meeting. That is over the opiate abuse. We know it is a Major Health Crisis that affects all of our communities and every one of our states. Because of the rise in prescription. Use and heroine abuse, Prescription Drug use and hair when abuse, Drug Overdose deaths now surpassed Motor Vehicle accidents as the leading cause of death in the United States. Hair when deaths heroin deaths at triple between 2010 at 2013. Kentucky has its problems in this area. We have long been plagued with high rates of drug addiction both Prescription Drugs and Illegal Drugs like heroin. Over the past two years, two things have happened that are giving us more hope and confidence in the future. One, we passed and implemented programs that attacks the problem from every angle including treatment Law Enforcement, and health care. Secondly, what we are fighting is that our stakeholders are working together like never before, both inside and outside of our state. Back in 2012, we passed what we call house no one, which targeted Prescription Drug use and misuse. We tightened the regulation of pain clinics and ran a bunch of pill mills out of the state. We required our medical professionals to use our statewide electronic monitoring system, and we allowed for a better sharing of records among agencies in kentucky and other state. Earlier this year you know this addiction situation is akin to the gain of whack a mole. You attack it on one level and it pops up somewhere else. After two dozen 12, we became pretty successful in the brisket drug abuse area and really crackdown, and have seen tremendous progress, but now heroin is raising its ugly head and killing even more people than Prescription Drug abuse did. Earlier this year, we took a similar approach and a legislator on heroin. We passed senate bill 192. Among other things, this bill increased prison sentences for heroin traffickers, but also allows us to identify addicts. I think we have figured out that we cannot incarcerate ourselves out of this problem. We have expanded addiction treatment. We have allowed local option Needle Exchange programs. We have increased the abil availability of a clock glocsome. Last month i announced the allocation of 10 million for programs aimed at fighting drug abuse, including programs to help inmates pregnant mothers improve prosecutorss of joe drug dealers. Governors across the country are leading similar efforts to address the crisis bringing together lawenforcement criminal justice Professionals Health agencies, providers, and other Key Stakeholders in order to implement ct the committee has since maintain a focus on Prescription Drug abuse, bringing Lessons Learned from states to inform policymaking at the federal level. At the most recent nga winter meeting, governors approved a new policy that calls on the federal government to work with the states in a National Response to drug abuse. Todays discussion reflects the reality that we are no longer confronting an epidemic of research and drug abuse by itself. But, andn alarming resurgence of the use of harewood. Studies show that there is a link between use of heroin and perception drug abuse. Next week in kentucky, we expect to hear positive news from an evaluation on our efforts to change the landscape of Prescription Drug abuse. We still have a long way to go to fully address the opiode problem and the recent spike in heroin. I look forward to todays discussion and hearing from our panelists on additional strategies that we might be able to implement in kentucky. Im turned out to Governor Snyder and if you would like to make some opening remarks and introduce our guests. Governor snyder thank you. I would like to start by thanking you and the Committee Members for the great work you have been doing on this through the health and Human Services com committe. It is important. Thank you for your effort and perspective. I would like to recognize governor mcauliffe. We have worked well together on a number of issues, including several security, but this is another issue that is important to us as governors and citizens. This is a great venue to have a discussion. I would like to thank everyone for coming today, in terms of the other governors, the audience, and a paneli the pa the panelists. In michigan, we found it to be a tremendously growing problem. To give you some perspective, as i travel michigan, i often ask people what is the Biggest Issue you face . I was in rural michigan and two different shares pointed out that their greatest problem was Prescription Drug abuse. That is the starting point of all of this. We need to do more. Im proud to say that last year we passed a bill dealing with opiate antagonists where we have our ems people carry something with them in order to address the problem. However, if you have to use that, it is much later than it should be. We need to do more for prevention and treatment and on the Public Safety side. With that, lets get to a distinct panelists and learn from them. I look forward to this because in michigan i have created a task force that is reporting this fall on legislative and other actions to be taken. This could not be more timely to hear from people who are experts. With that, i am proud to say that we havent established panel. I am proud to introduce congresswoman mary bona. From 1998 to 2013, she represented californias inland empire region. She founded the Prescription Drug abuse caucus and cochair of the treatment caucus. A cofounder of the collaborativ opiate policy she maintains a commitment to recovery. Thank you for being with us. Also with us as dr. Debra howery , director of the National Center for injury prevention and control. In that role she leaves the cdcs efforts to preventing Drug Overdose deaths, working closely with states. Just prior to joining cbc in 2014, she served as vice chair and associate professor in an emergency medicine at emory school of medicine, as well as associate professor at emory school of Public Health. Thank you for joining us, doctor. Finally, i would like to welcome someone from the Law Enforcement agency, id active of the a detective of the Massachusetts Police department. He has spoken about his Program Throughout the country. In 2013, he received the white house advocates for action award for bringing Law Enforcement and Public Health together to disrupt the use of drugs and recidivism. Thank you. Again, welcome to our panelists, and im looking forward to the discussion. Governor beshear lets start off with congresswoman bono. Congresswoman bon thank you. It is great to see my former colleagues. If i remember, i was really kind to you, and a hope you will do the same to me. My gavel was very light that day. I am without a gavel now. I am honored to be here to share with you my thoughts on the opiate crisis. I applied you for focusing on the deadly epidemic, and i encourage you to throw everything cute you can add at it. I here with you today as both a former elected official who spent almost a decade. E focused on Prescription Drug use, by am also a passionate parent. Just like far too many parents, my introduction to this problem started in my own home. As a fulltime working mom, a member of congress, and i knew my amazing son was grappling with issues, by did not understand what they were and what he was going through. Whone day i received a call from my son who said, mom, i need your help, i have become addicted to pills. You can imagine how this felt. I still think for that colin consider myself to be one of the lucky ones to receive such a call, but i grieve with the many parents who are not as lucky as i w. It was a journey that we made public by doing National Television and print interviews. After that my office and i became somewhat of a begin for parents going to the grief of losing a child or for parents simply looking for help. To this day, i credit my son for speaking out, and allowing me to do the same. I have developed a very special passion for our youth, their suspected susceptibility to the powerful drugs that we have all seen happen too often. Shortly thereafter, it congress man from kentucky and i created a caucus. Many solid strategies are emerging to deal with this crisis, and is not one that i have read about that i disagree with. There are widely agreedupon strategies on Monitoring Programs, Access Research into personalized medicine, and Good Samaritan laws. I support them all, by will focus my thoughts on a few other things. First, in addition to supporting communitybased education, they cannot be overstated that there is strong need for messaging from leaders like yourselves about the dangers of medications and illicit drugs. We hear an awful lot about avoiding gluten, artificial fats, cigarette smoke, and more, but we are not hearing and off, if at all, about thinking twice before popping a pill. The medical Com Community needs more educatio on these drugs as well asn disease and discussion. Forgive me, i use addiction and adict interchangeably. Physicians and other providers are on the frontline line of this issue. Providers, particularly those whod treat a High Percentage of patients suffering from any sort of pain have the latest guidelines. While they must continue to make sure their patients have access to clinically necessary and beneficial treatments, it could be in ethical if not a legal obligation that they guard against their abuse. Secondly, we need to overcome the stigma associated with recovery. Those in recovery needs the full support of their friends and family, society as a whole. Recovery needs to be easily accessible with affordable options for anyone seeking help. The Betty Ford Foundation of the program that they have created called corde 12. I personally considered to be the Gold Standard and encourage you to look into it. I know from experience that they need to be far greater understanding of treatment. The notion that we get someone in rehab and they will emerge 30 days later with fixed cures is not the reality. It takes serious hard work from both the individual and the family. Should relapse occurred, it should be seen in the same ways that we look at recurring cancer. It is sad but true. It should not be stigmatized and we should look out to anyone who need support. That recovery should include doing all we can to establish recovery schools and sober housing for college students. Whatsonce a young person can leave rehab there should be safe and supportive options for them to enter. Thats a portion of last a lifetime that support should last a lifetime. I encourage you to participate in the addiction rally on the national mall. I will be there to show my support for everyone and anyone in recovery. Recovery deserves celebration not stigma. The last point i will make regards collaborations. I have been reading what youre states have been doing and applied each of you. Together with the trust for americas health, i have created the collaborative for opiate policies. We are a Health Care Provider treating patients with pain, family members who have lost loved ones, forced the officials addressing the problem on the streets every day, Treatment Centers helping people rebuild their lives, and medical manufacturers. The collaborative seeks to stem the misuse. We need an important meeting of the mines in order to advance solutions. Id buy each one of you to join. We could really use your support. Each of you should ask how the many federal agencies in charge of controlling drugs could allow this to happen on their watch. A congressional Prescription Drug abuse caucus could use your support with that. To sum up, i once saw a very good video about the film will problem in florida. The reporters summed it up in a way that struck me. Imagine if 100 dead dolphins washed up on a beach every day. People would be outraged and demand action. And imagine that continuing day after day, year after year. This is not about dolphins washing up on the beach, it is about our kids and our families. Imagine them washing up on our beaches. We must know everything we can at this epidemic. I thank you for listening and stand ready for your questions and anything that i can do to help with this task. Thank you very, very much for allowing me to speak today. Governor beshear thank you congresswoman for your work in congress and continuing that work up to today. It is important. Next, lets hear from dr. Houry. Dr. Houry thank you for inviting me here today. Im excited to be here on behalf of the cbc. This is one of our key priority areas. I would also like to mention that for our agency as a whole this is one of our top three priority areas. As someone who has been on the front line for over a decade in an Emergency Department, i watch this epidemic growing and changing. I have seen the faces. The work we are doing at cdc and partner with our collaborators here, i know we can have a difference. Im excited to talk with you about that today. In the year 2012, there were 259 million prescriptions for opiod ids. To put that in perspective that is enough for every u. S. Adult to have their own bottle of pills. As we have seen that increase in deaths, we have seen a quadruple in that time. With think hes a prescriptions, we have seen an increase in deaths. Sometimes, pictures tell the story better than words. The picture i am about to put up , i want you to watch. Look for your stay and watch the changes for your state and watch the changes. In this case read is not good. You can see the rate spreading across the country. Dark red is the highest. You can really see how this epidemic has spread across the nation. It does impact some areas more than others such as the southwest and appellation regions, but you can really see every state has experienced a significant increase. Earlier this month cbc released vital signs on heroin. We have a talking about about heroin, by think it is important that we realize why we are seeing the increase. It is because of opiod painkillers. People who abuse opiod painkillers are 40 more likely to be addicted to heroin. It makes sense, it has the same effect on the brain. By focusing on opioid prescribing, we can impact the heroin epidemic. There are often unintended consequences. As seen earlier this year in indiana in scott county, the hiv epidemic. 170 individuals now diagnosed with hiv because they were injecting opioid prescriptions. Although this is an extreme example, it could happen in any community in the United States. States must be ready to respond to this. I would not be here though if i do not think we can make a difference. Im very optimistic that we have the tools we need to have an impact to curb this epidemic. As mentioned by many of the governors, overdoses now exceed car crash deaths. That is because overdoses are going up, and we have also seen car crash deaths going down. This was a concerted effort working with Law Enforcement and states. Cdc will use the same effort that we use the car crashes on opioids by monitoring the problem, looking for the high risk communities, what are the risk factors to identify those most at risk, and identify effective interventions and take that to the state level. Im very excited that next month we will be announcing our state program. It builds off our Pilot Program that we had this last year. 16 states will be receiving 750,000 or more for the next four years. We will be working closely with the states to improve their Monitoring Program so that they are easier to use, more realtime, and additional work with Health Care Systems in the state, whether it be the medicaid program, or around guidelines to make sure those are implemented around safe prescribing. What we learn from the pilot unit is to have flexibility for the states. We have worked in a Rapid Response project. We look forward to having this opportunity to work with the states. Our hope is in fiscal year two dozen 16 to make this a national program. Again, we are excited to have this opportunity this upcoming year to work with the 16 states directly. We know this is the right approach. If you look at statebased interventions, we see when prescribers are required to use the programs, 75 decrease in the number of patients that sought out multiple doctors. Tennessee saw the same results. 36 . Florida, when they began to regulate pain mills or pill mills, they saw a 50 decrease in oxycodone deaths. It is using these best practices, we know this will work. Other key activity that cbc will undertake this year is developing chronic pain opiate prescribing guidelines. This gives doctors told at their fingertips to know when it is appropriate to prescribe these medications and what it is not, and how to do it in a safe and effective way looking at the dose, time, things like that. What can we all do with this . I think there is a lot. We are already seeing a lot of these great practices. One is to promote best practices in states. I know such states like oregon which has already been implementing this through medicaid providers, and arkansas when the guidelines come out in early two dozen 15, it would be fantastic if states use these in their programs and Regional Health care programs. In addition, encourage authorities to stop the work for prescribers, whether it be the state medical board or Law Enforcement. Finally, really improve well informed opiate prescribing by making Prescription Drug Monitoring Programs easier to use. Again, as someone who has had to use one, there is a long way that we can do to make them more userfriendly and more effective. You can work in your states to do that. I look forward to having further discussion with you at the end of this panel. Below is my Contact Information so we can talk about how to reach out to your states directly. Thank you. Governor beshear thank you, dr. P r final presenter, lieutenant glenn. Lieutenant glenn thank you, and it is an honor to be here. I bring greetings because back in 2009 i believe we took the bull by the horns and came out to say that we had an epidemic in the city of quincy. I can describe exactly what we did with that and how it blends into what is happening today. What we ended up doing is we refocused and took a humanistic approach animals exhibitor approach. We did change some of the terminology, and it was difficult to do. In the passed we would call a person junkie, abuser, etc. And we arrested them. We changed it from junkie to family member, we personalized it. We go back and forth with the terminology, i know. With over does, it is a poisoning, it has an adverse affect on the body. Hopefully we can get the person to recovery. We do not think everyone is going into treatment, but as a set from the beginning, in order to go into treatment, they have to be alive. That is what we try to do in the Law Enforcement field, get the person to be Emergency Department for treatment. We came up with this prevention treatment, much as the governor spoke of. Yes, we are out there arresting the people who are dealers and traffickers. We do have a Good Samaritan law that was admitted to the 12 which prevents the arrest of the individual or someone aiding them in assisting our calling 911 for help. We know in the past that we would show up to the scene and have a dead person sitting in a chair or lying in bed with identification and hand, and there was no one else there. That life could have been saved. We want to try to do that and reduce the fatal overdoses. We collaborate with the parish. I stole that from bill brad en. We have to collaborate in this issue. We have seen the deaths in the streets now. We collaborate with the department of Public Health in massachusetts outreach programs Police Officers such as myself, other Law Enforcement agencies and administration. We went to the table and spoke. The beauty of that is we went back to the table again and continue to speak, and we came up with this program. The department of Public Health allowed us to enter into the Pilot Program, which was the first that allowed Law Enforcement to administer doses. We will show you the results in a few minutes. This is how we work well together. It is the Quincy Police department, the department of Public Health. These people who are overdosing belonged to someone, they are brothers and sisters, mothers and fathers. Some of the statistics you have artie seen, so i will go past that. A great mouth at the doctor showed up there. Im glad that massachusetts was representated. In 2013, three people die every day in massachusetts as a result of an overdose. I think we will be up to four or five in 2015. That is every day. Some of the results here this is a little crowded, but what i wanted to bring out the statistics. We started in 2010. We had 47 deaths in the city of quincy. The following year, when we introduced more noxon on the street we reduced the deaths. The myth that was there that if you are a a substance abusing you will come to quincy because we have no locks on naloxone we have not seen that. In fact, at the time of the flight, we were about 7 repeat clients, meeting that someone reversed more than once. That is a very low percentage. We are very high in the percentage of the reversal, a high 90 on reversals. It was administered to 433 individuals and we have reversed 416. Those are individuals who we gave an option to go into some other treatment. Or at least, we turn them into their family a llive. That in itself is amazing. One quick story we have a vigil every year. A woman came up after the vigil and said, you did not read my name off. I said, that means you are alive, thats good. She said, i know. 17 month ago i overdosed and a Quincy Police officer reversed me. I overdosed again about a month after that, and i was reversed. At that point, it was her tipping point. She went into treatment and has been recovering now for 14 months. That is a success, when someone can come up and say that we were able to turn around. I know this is all in your material, as far as prescribed by doctors and providers. Over 71 came from a family or friend, meaning that there are too many drugs out there in the medicine cabinet, we want to get them out of there. The common risk is obviously the age group. We have a huge influx between 1726, and then mid 40s on up. There are many drugs involved, it is not just heroin. No locksaloxone will work only with the opiate family. These next lights demonstrate what the opiate does. The simplistic description is it attacks the receptors in the brain until the respiratory system is nonexistent and you die. When you are in the overdose day, you are not breathing. Officers are fully trained in delivering naloxone, the brain starts breathing again, we have the reversal. Documentation will be provided for counseling, and so forth. Again, we are not naive to think that everyone goes into counseling, we know that. We have to give them a chance. And every Police Cruiser on the side of the Police Cruiser, it says protect and serve. We protect and serve all. We hope to get them to the hospital for further treatment. There are two formulas, one is a nasal spray, another is an autoinjector. They are very similar, the same medication, different loads. Autoinjector is very simplistic and use like an b penn epipen. Ive always ask, why do you do it . I go against the grain and say why not . If someone was in a diabetic emergency, we would provide some kind of sugar product to them. If someone is in an opiate overdose the i never saw the results of this. This is our job. Im just a cop. I have seen people overdose and i within families, generation after generation. A lot of good people. This is not just for the addict, the Substance Abuser, there are people who are accidentally selfmedicating and over who this will work for also. That is how we protect our community with one more tool in the box. I want to thank you and leave you with a few thoughts multidisciplinary approach. This is a disease and not a crime. We do have to work together. Theres no doubt about that. I always like to leave on more of an uplifting note. We did have a reversal two years ago, the Boston Red Sox when they won the world series. We were in boston helping them why are you laughing . [laughter] we were helping with some traffic issues, an individual ran across and said, i know you have naloxone, my girlfriend is overdosing. Around the corner, administered and took her to the hospital. That is the perception that the public has now of the police that can help, not just enforce laws. We will enforce laws also. We are looking at this as a disease and have done that since 2009. I think that is great. I do not think we have to worry too much about the world series parade this year in the quincyboston area, but you never know. We are always prepared. Thank you for your time. Governor beshear thank you lieutenant. Lets open things up now for discussion. First, let me call on the vice chairs for any comments or questions that they might have. Chairman . Governor mcauliffe thank you all for being here today. I want to thank you mary for your time and congress. You chose where to spend the rest of your life and you chose the commonwealth of virginia, i appreciate that. A good low tax state. I do want to thank you for being here today. In virginia, we have done obviously very similar to what the other states have talked about. A couple of things that we added to our legislation all of our first resort is now have access to naloxone, but we also had to protect them civilly so they could not be sued. It was a hesitancy for many First Responders. Other thing we have called for is a dramatic increase in our drug courts. Obviously we no longer look at this as a lawenforcement issue we have a holistic approach to it. It is about health care, communities, saving money to keep people out of prison. I want to thank my secretary of Public Safety who is here with us today. He headed up a 32 Member Task Force to address these issues. My question to you, dr. , if you just read the cbcdc report, it says the increase in heroin is coming from the least likely people that you expect to be heroin attics. My question is are there Different Things that we need to be doing in intervention earlier and how do we help our Law Enforcement deal with this epidemic . Dr. Houry thank you for the question. I actually read your task force report. For people dealing with heroin as well as opiates, there are three things to focus on. What is stopping them from ever being addicted, that is keeping the substance is off the streets. Thatthe slide that the chiefs showed, a lot of people are getting these medications from family members, that is one way they can access them. Safer prescribing. The second thing, for people already addicted increase treatment so that we can help them really treat their addiction and get off the drugs. The third thing is naloxone. Making sure that the First Responders have access and the Good Samaritan laws will outlive that. I think it is important to look at what we can do to stop people from getting that. A lot of them will reverse in overdose, but if we can prevent them from getting to overdose that is why i think is an ultimate goal of around the venture. Thank you. Governor haslam i was struck at what you just referred to and the comments of 71 coming from family or friends. Break that down a little more for us. How much is the original prescriber an accomplice . How much is it being taken without them knowing . Tell us more about that, and any other insight as far as things you have done to collect unused descriptions. Lieutenant glynn the prescriptions were legally written. The issue that comes into play sometimes is that people dont always follow the directions on the prescriptions. Usually they stopped when they feel better. They put them in the medicine cabinet. Friends come over, they take them out, sometimes pill parties, you have no idea. People will start taking pills out of them. Other than that, there are prescription stolen out of medicine cabinets in open homes when Real Estate Agents have open home. It is one of the Fastest Growing areas of stored prescriptions during those times. No longer is somewhat out with a flatscreen tv, they go to the medicine cabinet and leave with pills. It is not all of the pharmaceutical companies or the prescriber, it also is selfawareness and taking care of those prescription. The second part of your question on what have we done with access prescriptions excess prescriptions. We have a box where people can anonymously bring in unused prescriptions and we destroy them. If you dont come during the year we have ongoing programs to assist. The public has been very perceptive. We also have senior pickup days where we go round to the Senior Citizen buildings and pick up on use prescription jugs also unused Prescription Drugs also. Governor malloy thank you. I just wanted to share a couple of things that we have done in connecticut. We did pass a conference comprehensive opioid sills that puts a lot of us but billy on the doctor to check on the Computer System before they write a prescription. It is mandatory. Also education requirements on the subject, making sure that opioids that are tamperresistant or consistent with systems to make it less likely that they be abused by that person or subsequent acquirers. We had done our narcan bill in response to ems local Police Departments and troopers. I can report that as of five days ago in the current year, 36 calls were service, 37 persons receiving medical who were in medical distress. This is just from our state police. In the build i previously referenced, we are also making a possible for anyone to go to a pharmacist, explain the situation at home with respect to abuse, and receive knocknarcan to have it available to administer themselves in the home setting. We think that will increase the usage. Let me just say something. 3637 states have more people dying of Drug Overdoses than they do in car accidents. Think how much money we spend in making our roads safe, whether the snow removal, writing tickets, or having troopers on the streets or local police. We do everything we can to prevent those. We are now seeing increases in death as a result of primarily opioid and heroin abuse, and we just have to step up our game. That is what we are tried to do in the state of connecticut. I think this opioid deterrence proposition, where we might have to spend a little more to make sure this is available is an important thing to do. One other thing to other things i would say. We have worked in new england three years in a row, new england governors have worked together to break down some of the problems. What we found is people who dr. Shop in multiple states. If youre not talking to your neighboring state, youre missing the point. We saw that in particular with respect to hartford and springfield, hartford being one of the largest cities in connecticut and springfield in massachusetts. The number of folks who were doctor shopping in both jurisdictions was remarkable. The information was not being shared. Having a better sharing system i will give you a for instance. Connecticut had an opioid sharing platform with 16 states but none of the New England States participated. We had to break down that wall. We also reached out to the eastern premieres of canada. We understood that number one they were incentivizing the prescription by medical policy of opioids that were not tamperresistant. Just the opposite of what you want to be doing. And, there were people in maine and New Hampshire and vermont and i presume elsewhere, who were also coming across the borders with that tamperresistant going there and coming back with tamperresistant. These are some of the things that you might want to be aware of. Lets do everything we can. The final thing, just because of our age, and i missed that both comments, i had to leave for a moment, sophie said this already heroin is purer than it has ever been. You do not have to shoot up. It is cheaper than it has ever been. Both of those points may have been made. This is the third point of that. People are dying on their first usage. We are having it happen on a regular basis. Young people think they are going to live forever, think they can tolerate anything. They experiment with heroin and if there is not someone to administer narcan, they are dead. Were seeing 18, 19, 20, 21yearold. We see people other toy for his birthday parties die on first users. We see them in graduation parties from college die from first you usage. This is a big problem because of the expense and because young people think they will live forever. When we were going up, we all fight you had to shoot this up and you would be a junkie in a they are very different propositions, and it is so darn cheap. Final point on opioid abuse, i think this is what you are referencing, but it is people our age who are the fastestgrowing of users abusers. How much is prescribed is very very important. You have a tooth removed, there is no reason for a doctor to write a twoweek or 30 day prescription for an opioid. There is no reason for it. If you still have pain after you had a molar removed, come back to the office and we will renew the prescription for another three days. Lets stop writing these longterm perceptions. Other questions or comments . I agree with governor malloys point. We also have dropped drop boxes throughout the community. You know, we all worry about national security. We are worried about isis, and terrorism, and Cyber Security. But the enemy within the nation is the addiction issue of our population and how it is running wild. Whether it is our children ending up in department of Human Services custody because mom and dad cant take care of them anymore. Whether it is a school child who is having trouble learning or falling behind in school or someone is not available. Maybe it is grandma or grandpa taking care begins because the parents have an addiction issue. Or maybe it is those living in poverty, or those who are not in the workforce. I think 62 of the people who could work do work. In other word in other words a large portion of the population who could work dont work at all. I think this is a big National Debate about how are we going to create a national a stronger america. The enemy within ourselves is our Substance Abuse problem. I realize a couple of things we were going to have to have a National Debate on is working with judicial systems and our judges, if someone has a Substance Abuse issue it is not someone we are scared of, that might harm us in our homes maybe a friend or relative that has an addiction issue, do we put them in prison for 20 years . With hardened criminals so that they come out worst . Or do they do we have that person address the core issue that they are facing which may be Prescription Drug abuse hopefully not heroin, but it is the reality of what it is. How can we do things better with our criminal Justice System to be smart on crime, but get tough on crime for those that we are scared of, but how can we do a better job of getting people treatment . One of the things in oklahoma i have been encouraging people to do is to look at how we can help people get Substance Abuse treatment if they are not true criminals. They are just people who have a problem as you are talking about. Trying to remember the new word to use substance challenged, trying to remember. Would you call the . Lt. Det. Glynn substance disorder, i think sometimes we get caught up on the terms a little too much. Some parts of the country do not want to use the term addict, or relapse. Substances order. Substance disorder. Especially with the criminal justice as, because we all know how much it cost with someone in prison. We all know what the outcome can be when someone serves a long term in prison. We want to keep those that are dangerous to our communities locked up, absolutely, but how can we help this family members identifying addicts versus, its a son, its a father, is a colleague, its a friend. How can we change the dialogue in america to where we actually help people who just have an addiction issue . I think it is one of our biggest challenges. We have so many bigger issues like terrorism and things, that we are really really worried about. We have a Weekend Society because we have made people addicted as you showed on your map. Dying because of the things. We are weaker as a nation. Governor mcauliffe . Governor mcauliffe how do we do a better job at raising Public Awareness . The key issue is to get people understanding the issues. Rep. Bon first of all i noticed your state is one of the better ones. I have several very personal thoughts. They may not be very direct but im going to say them. First, in this time of the legalization of marijuana, i think our kids are hearing a lot of representatives. They are hearing it is fine, its good. I think the message on drugs altogether is a little bit warped. Believe me what people ought to say, you know this stuff is all stupid. We are not hearing that message its just stupid to do it. First lady reagan, a lot of people say is not successful. But Something Like that, where people are saying it is just stupid to do it. We are not hearing that. Even the legalization of marijuana, fine. Lets have a debate separate. But i want to say it is stupid. Im not very popular, especially with some of my kids friends but i say it everywhere i go and we have an argument at the dinner table. I congratulate you for your state being one of the less transitioning and the colors that is the bread. That is deep red. In congress there is a great help bill. The comprehensive recovery act. It used to be known as white men fort house im actually fine with senator portman being the lead on that. It is gathering a lot of steam. Tremendous bipartisan support. Within that bill again comprehensive Addiction Recovery act, there are guidelines reforms. Congressman brenner is a cosponsor in the house so the sentencing guidelines reforms are in there. We need a little bit more support to get it to the markup level. As you said, throughout the country right now, it is hard to get senators and congress would focus on this, but we are doing our best. I think weve got a really good chance at it. But again, the notion as we are all saying, addicts are people who suffer from Substance Abuse disorder ought to be treated not incarcerated. I think that is one of the foundational points within the bill. I will be happy to send that to your office and see if you can weigh in with your delegation, if they might want to jump in and cosponsor. Dr. Houry just adding to your question of communication, what has been done well. We worked with kentucky with operation unite, and there is a social Media Campaign called rx problems. Its just getting people aware that it could be her neighbor. Its not some scary picture that you are used to seeing. We have people telling their stories of how they recovered from addiction. So helpful that you can see your neighbor, your colleagues in that. I think just getting the message out there more with those stories of recovery, as well as story of stories of loss. We have people talk about the children they have lost to addiction. Governor tomlin . My administration, for the last five years, has spent a great deal of time working on this problem. We have had some successes and we continue to strive just as much. But we have had some successes at closing down hill mills hell pill mills by changing the rules and so forth. I agree with governor malloy. I know the kentucky and West Virginia is worst. I want to try to share the information so you dont have people crossing the borders and going to another state. One of the things we have been able to do is see a decline in the Prescription Drug abuse, but it has moved to heroin as you have indicated. We passed the naloxone deal because of the increase in hiv cases. We have started to implement some Legal Exchange programs because i think a lot of people look at this as promoting drug abuse. But look at what you get if you dont. States will be paying to treat her for many years to come. One of the other things we have found out is, five years ago that we really did not have a communitybased Treatment Centers that we needed around the state. We have been able to work with the legislature, now we have communitybased services. A lot of it is really needed for women and children. Those are now in place, or most of them are. We try to expand those services because people really wanted to get off of drugs. They really did not have the local help, or the whereabouts in some places. I think those will continue to be helpful to us. We are also, within the next 30 days, we will have a state hotline. If you need help and dont know where to go, dont know who to help you who can help you that will give people the ability to get help out there. People get vulnerable and dont know where to turn. It is up to us to be able to supply that people who really have a severe issue to get clean and stay clean. I think it is something that all of us will have to contend with for a long time. Its probably something we cant to navigate in three, or five, or 10 years. But something we will have to continue to monitor as the available availability of different drugs comes about. We have time for one more question. Governor hutchison . What an important topic. I want to applaud my former colleagues, mary bono, for her leadership on this. Thank you for your leadership. I wanted to make a couple of observations. One is, i understand the seriousness of this issue. I understand the message. We have to treat them as people with addiction problems. But also crime problems. But i would encourage you, and i think you do, but recognize the Important Role that Law Enforcement plays. Whenever people have an addiction problem, it is rare that they just say hey, ive got an addiction problem. I need help. It is generally when they are confronted by a Law Enforcement officer that they first confront their addiction. In a drug core graduation, usually the first person who is bancfirst is the lawenforcement officer that put them on the path to recovery. Its that balance that is so important, but sometimes i think lawenforcement get eat about the head that they are part of a problem rather than part of a solution. The other point and dr. Howery made this observation about the Important Role of the state medical boards. If there is any Lessons Learned across the state its that medical boards are independent. They are made up of physicians. They have a serious responsibility, whenever you have a physician that has a prescription abuse problem. Disciplinary action they take, if there are any good examples or models as to how state medical boards address this, he would certainly be interested in that. Finally, im familiar with methamphetamines and the length of time that is needed for treatment. But if you have somebody in a Drug Treatment Court in in a drug treatment, what is the optimal amount of time for recovery for someone with opioid abuse . 30 days is not enough . 60 days is not enough . Is it a year program . What is the recommendation there. I know i have raised a couple of different issues. Dr. Howery, dr. Houry, if you have a comments . Hon. Bono im not a clinician obviously, but one thing im hearing is theres no set time. If people think theyre going to go in for 30 days, or put their kid in for 30 days, 30 days bear out. My honest opinion is that it is a lifetime. Folks, once they have any sort of Substance Abuse disorder, they will battle it for the rest of their lives. Thats why early prevention is key. It can be, depending on the motivation of the individual, sooner rather than later just to final thoughts i would like to share. Everybody in the addiction world pretty much recognizes that somebody with Substance Abuse disorder, and addicts, to seek help they have to what we term seek bond hit bottom. That can mean a lot of Different Things a lot of different people. You can mean using losing your job or getting arrested. It can be a whole host of things. If it comes from lawenforcement, that god bless them. Hopefully that person will then recognize my life is not getting better, it is getting worse. Lawenforcement, you are right it is very important. I just watched to close, since this is my last filibuster never made it to the senate but i can try. There is hope for addiction and for people in recovery. There is a fantastic book out there right now called fearless. It is the story of a young man who was addicted to methamphetamines and cocaine. Uppers. He had addiction, and he went on to become a member of seal team six. If you can beat an addiction and become a member of our nations most elites euro fighting group, and unfortunately he was killed in action, but his story is extremely powerful. He became one of the best in our nation. Everybody, read fearless, and find inspiration. These lives are worth saving, however many times it takes. Thank you. Just one comment on that. Speaking from the bottom i guess, where we see most of the people. 30 days is not long enough. Its great, but thats just one prong in a multipronged task. There are a number of relapses also, and we have to understand. Its not a failure. As far as drug core, it is a young problem program. The judge has absolutely no problem putting the back in a house of correction. They actually joke about it at graduation. How hard it was to go through judge soandso put me back in jail. That was another turning point for me. One quick example of the fact that they do belong to someone a couple years ago i received a package at the police station. It was nicely wrapped. It was the holiday season, christmas time. I had one of my detectives go in another room and open it. [laughter] they brought it back to me. It was from an individual i had arrested numerous times. It was a christmas present. It was pajamas. Very nice pajamas. It took that person to a point to see me as a human being, as i saw them as a human being. I looked further on and i kind of chuckled, because there was a beige metallic security tag on the leg of the past. But that the thought was there. That was one of my biggest tipping points, to think of everyone as a person that has multiple issues. Some more severe than others. They are still clean and sober after three years. It is a multipronged, and that was one of the stuff that they had to college, to show some appreciation. I dont think it was just a brief appreciation of me, it was appreciation of Law Enforcement and general. So i just wanted to close with that statement. Dr. Houry i think there is both the good and bad that dr. Spaceman comes to state medical boards. We certainly want state medical boards to work around those that are scrapping too much, but doctors also worry about if they are not prescribing patient complaints. We need to ensure the doctors are protected from that. I dont have a happy story to share, but it is difficult when you are on that front line and somebody is asking you for that prescription, to say no. I think we really need to help empower doctors to say prescribing guidelines and the state medical board. To have that the civil conversation with the patient it is very easy to get in and say, here you go. And then you dont have that in unhappy patient. Ive done that. Ive referred patients to play pain clinic for addiction. But that is tougher to do. We need to have an awareness of what this growing problem is. We are going to have to close out the session. I wants to thank everybody for participating in this. I think it is obvious that this is a fundamental problem in our society, that is not going to go away. Unless we stay focused on it at the state level, as well as the federal level, it is just going to get worse. If no one in your family or no in your extended family, or no one of your friends has ever been affected by this, consider yourself lucky and take a deep breath and say a quick prayer because it is going to happen. It is everywhere now. I wants to thank the nga for focusing on this. This is something we need to stay focused on. We need to continue to learn from each other, because there are a lot of good things going on out here in the different states, and we we passed our legislation we pulled from a lot of places. We did not try to reinvent the wheel. We wanted to make sure that we were covering the waterfront but i cant stress enough how it takes everybody every stakeholder in this, to make it work. Its got to be a huge bunch of stakeholders that are involved in this. Lets get around of applause to our speakers. Thank you. [applause] any closing comments . No. Very well done, and thank you. Ill just echo, thank you to the families. And thank you mr. Chairman, i know this is your last summer. On behalf of all of us, you made us proud to be governors. Thank you. [applause] then we will stand adjourned. [indiscernible] [indiscernible] if you missed any of this first session of the day, this and other sessions of the summer nga meeting will reair tonight, starting at 8 00 eastern here on cspan. Our live coverage of the National Governors Association Summer meeting continues, live at 1 15 young eastern today. The governors will be examining skill training to enhance their state economies. And a health panel coming up live. All coming up today, here on cspan. The Washington Post is reporting today that former secretary of state will testify on october 22 for the House Committee investigating her role in the connection with the death of four americans in benghazi, liberty libya. The testimony will be public. Clintons supporters have charged the republican majority with conducting a fishing expedition looking for damaging material that might be used against her as she runs for president in 2016. She has offered to testify in public, Committee Chairman Representative Trey Gowdy officially preferred a private interview. The committees next meeting is scheduled for this coming wednesday. The witness will be john feiner, chief of staff for the state department. We will have that for you live at 10 00 eastern, again, on wednesday, on our companion network cspan3. Is almost as if they were matter oriented matter. Freedom breeds and equality. He is always to the right at all almost always in the wrong. Filmmakers Robert Gordon and Morgan Neville talk about their documentary, best of enemies, on the 1968 debate between conservative william at William S Buckley and gore vidal. Its very unlike today. Today, i believe there is someone saying, you know, the numbers are dwindling. Talk about hot topics. Hot salacious topic number two. Where is then, i dont think that was the norm in tv at the time. I dont think these guys needed that. As you mentioned the moderator was a distinguished news man, who i think was really kind of embarrassed by this. He was moderating, and he disappears for sometimes five or more minutes at a time. Today you would not have a moderator not stepping in every 30 seconds. I think really everybody at abc just stood back and let the fire burned. Sunday night at 8 00 eastern and pacific, on cspans q a. On wednesday, house Homeland Security Committee Chair mike mccaul of texas talks about how the use of social media has changed Homeland Security counterterror the counterterrorism operation. He also commented on the threat of islamic extremism. He is followed by a panel that discusses these topics in depth, among the speakers former Reagan Administration general who was a member of a recent panel charged with reviewing the fbis panel of recommendations. This forum was hosted by the Heritage Foundation. It is just under 2 hours. Let me thank you all for coming. It is actually a nice day. Thank you for being inside on a really nice day. There could not be a more timely time for this event. We have breaking news yesterday about the terrorist figure being taken out in syria. So, evaluating the state of the threat now, and what goes on particularly in light of potential he a deal with iran there cannot be a better time to do this. We had a terrific panel, and congressman mccaul. Im introducing congressman at congressman mccaul first. He is going to make his remark. It is sad that we never get to talk. We are going to have a conversation so he can flesh out some of the issues. Then we would like to bring everyone into the conversation. We will do that for about 15 minutes. Then we will bring our panel up. Sometimes you just have to read the bio. One time i was introducing rumsfeld and i actually forgot the bio. I just said well, here is the secretary. That did not work out so well. I actually have the bio here. Lake introducing secretary rumsfeld, walking through representative mccaul bio is important, because what he has done on these issues is very admirable. He is serving in his sixth term as a preventative of the 10th district of the u. S. Congress. In 2013 he became the hundred and 13th congress in. He became chairman of the Homeland Security committee, which has oversight of the department of Homeland Security. And all the Core Missions that protect the American People from terrorist attacks. He is also the chairman of the usmexico interparliamentarian group that meets every year. It discusses issues and events involving the two nations. Working to ensure national security. He recently discussed a whole range of issues, including the key issue of countering bio extremism. He was also the cofounder and cochair of the congressional hightech conference. And he cochaired the commission on the 44th presidency, which developed recommendations for president obama on Cyber Security. Having been involved in this enterprise, that we call Homeland Security since 9 11, there are a few people who have invested themselves more in this vision. We are honored to have him here today. [applause] rep. Mccaul thanks jim. I want to thank heritage. We are also honors to have attorney general and beams here and beams he is transitioning out, what an honor sir. I have five teenagers. At so when it comes to Homeland Security issues i feel like i have a lot of arsenal execute on the home front. But i want to thank the Heritage Foundation for having me. I cant think of a better for them to deliver the speech. I normally dont give prepared remarks, but in this case i am. I am going to cover a lot of territory. We will have a very robust q a discussion and dialogue about the many issues facing us. Yesterday we took out the leader of the cores on group Corazon Group that was hugely significant. Plus the greatest external threats to the homeland in the United States. I commend the military for their efforts in doing that. Last weeks terrorist strike in the american heartland. This was the type of event we have been worried about probably the most lately. A radicalized sestak, not on the radar, launching an assault here on u. S. Soil. Killing United States marines and a sailor. This individual was inspired by a hateful ideology, and he attacked soldiers who risked their lives to protect us in the name of freedom. Our hearts go out to the families and friends who were killed in chattanooga. Our constellations cannot outweigh their loss, but we can honor the memory of the victims by confronting the roots of the violence we saw last week. And refusing to allow complacency to follow in the wake of terror. That is why im here today. I hear to tell you that radical islam is on the rise. Brought to our doorsteps. It could happen in chattanooga it could happen anywhere anytime. I agree with british Prime Minister david cameron, whose of the this week that we face the struggle of our generation. The deceitful, perverted brand of islam is expanding globally, and at great cost to the free world. We need to act decisively to defeat it. First i will talk this morning about how this new age of terror has altered the Security Landscape on the home front and spread rapidly throughout our communities. Then i will address the second front in our struggle with extremists. And how important it is for us to take the fight to the enemy and challenges ideological core. But first, i am disappointed to announce that i believe we are losing on both fronts. Our enemies have the momentum and they have thrown us offbalance. The numbers do not lie. Last year was the deadliest year on record for global terrorism with a tax rising by 35 over the Previous Year in terror and terror deaths worldwide nearly doubling. The motive behind the terror third is the rise of isis, as well as al qaedas persistence. By any measure we have failed to turn the tide against them. Their Global Recruitment has soared. Their territory held or expanded, and the number of plots against us has spikes. The pace is so staggering that i directed my Committee Staff to begin issuing a monthly Terror Threat snapshot. Cataloging the rise in extremist activity. Since the president declared isis to be the jv team of terror last year, isis went from a single terrorist sanctuary to having a direct presence or affiliates in 18 countries. The groups rapid rise has inspired more than 25,000 citizens from at least 100 countries. To flock to syria as foreign fighters, a figure that has tripled since last july. Officials now estimate more than 250 americans have sought to join, or succeeded in joining extremists in syria. Terrorist groups have succeeded in spreading their influence because they have evolved. Gone are the days of bin laden where extremist plodded through couriers in caves. We are now seeing a new generation of terrorists. Radicalizing and recruiting online, across borders. Americans are especially concerned that we are losing on the home front. Groups like isis has started to permeate our society with terrifying speed. There are people right here in our country intent on striking. Captivated by an evil and twisted ideology that strives vulnerable minds to unconscionable acts of violence. We have seen more than one dozen isis links terror plots in the United States, including recently thwarted lot plans to set off pipe bombs on capitol hill. We had Law Enforcement officers conduct mass shootings, detonate bombs at new york city landmarks, and live stream a murderous rampage at a college campus. We even disrupted terrorists plotting to attack july 4 celebrations in the United States. In fact, more than 60 isis supporters have been arrested were indicted in the United States in the last year. That is more than one per week. And now the fbi director says that he has opened isis investigations in all 50 states. The majority have never set foot in a faraway safe haven and were recruited by isis online or distributed the Group Social Media propaganda. With over 200,000 isis tweets per day, an astounding number. Her over two hundred thousand isas tweets per day. How can we possibly get a handle over this. The chatter is so high. The volume is so loud. Its difficult to get a handle. This is not terror as usual. This is terror gone viral. I commend the fbi, Homeland Security, and state and locals for their disrupting of plots. And as we saw in chattanooga, we cannot stop all of them. In this age of peertopeer terrorism, authorities are searching for suspects using secure apps we called dark space to communicate and crowd source their calls. They are inspiring operatives who never have crossed the borders of syria that cross over borders of the internet to conduct act of terror. Ciber commanders now regularly send out internet directives and mrs. To their followers, as we shop saw in garland, texas. Sometimes our first indication of a law is an internet hashtag. You need to have a frank conversation in america about the violence threats posed by social media. Extremists have migrated away from telephones and onto new platforms. But our laws and policies have not kept pace, making it more difficult to uncover terrorist plots. They communicate in darkness, and we cannot shine a light on the darkness to see what the communications are two attack in the United States. I dont claim to have all the answers to this. I have started a working group with the fbi and homeland and did justice and justice and the hightech community to get some answers. What i do know is that we all share some Common Ground with silicon valley. We want to see terrorists brought to justice. This has to be the starting point in an urgent dialogue to find solutions for the lawful monitoring of violent extremists well at the same time protecting civil liberties. We also need to do more to stop the spread of fanaticism before it leads to violent plotting. We spent billions of dollars to detect and disrupt terror plots. We have dedicated few resources towards combating and preventing the radical the radicalization of the root of terror. This is called the crucial prevention aspect of counterterrorism. Sadly, while extremist recruiters are moving as broadband speed, we are moving at bureaucratic speed. The administration has not appointed a lead agency in charge of combating domestic radicalization. Few resources or personnel are even allocated to it. When asked by our committee, top departments and agencies can only identify a few Million Dollars being spent, at around two dozen people working fulltime on this issue. That is basically a. That means we have arrested twice as many isis recruits in the United States this year than there are fulltime officials working to prevent isis from radicalizing americans in the first place. In a high threat environment, i believe this is on a couple unacceptable. Every day we wait we cede more ground to our adversaries. I will not stand on the sidelines asking for more research while terrorist plot inside our community. They murder our people, murder our military. Kill our u. S. Marines and serviceman. Last week our committee my committee decided to push forward a bill. To combat of the viral bead of extremism. For instance, our bill would give dhs the tools to combat isis and al qaeda propaganda here at home. Through counter narratives that show islamist terror for what it really is. It would also help dhs encounter local communities to spot signs of radicalization and help them develop off ramps to discourage individuals from being lured overseas to fight with terror groups, or for being convinced to commit acts of violence at home. Recognize the best Homeland Defense is good offense. To win this war against islamist terror we have to take the fight to the enemy overseas. I spent the last weekend in tampa, florida meeting with our generals and leaders. Top intelligence and operations officers from u. S. Central command and special operations command. I am proud of the work they have done to dismantle terror groups, and their focus on defeating isis, and their recent victory in taking out the leader of the Corazon Group. But the white house strategy under which they are operating is flawed. It only gives them the authority to contain isis, rather than to roll back and defeated. I was in turkey, and they said we need to drain the swamp so we can squat swat the mosquitoes. We all know isis will replenish. That is a fact. For the numbers we have killed they have replenished in equal amounts. We all know that they will expand globally until we have eliminated, as a source, iraq and syria. Right now we are fighting with one arm held behind our back. Under the current strategy the rules of engagement are apparently too high to strike important targets, and the number of military trainers is too low. The president has taken options like ground troops, off the table, telegraphing weakness to our enemies. As a result, isis has been able to hold key territory in syria and iraq despite our airstrikes and the Iraqi Government is beginning to rely on shia militia, iran proxies, to fight back. A developing which empowers iran and could prolong the struggle by inflaming sectarian tensions with the sunnis. I expressed this concern to our iraqi leaders several weeks ago when i was in baghdad meeting with the Prime Minister. It is clear that without expanded American Leadership and regional assistance, they are running out of options to win the fight. The bottom line is this right now i believe that we are losing the war against isis. And the wider war against islamist terror. The president s strategy has failed. The evidence of failure mounts with every terror lot in america , every attack against our allies, every emerging terrorist sanctuary used to radicalize or recruit soldiers willing to die in the name of a depraved ideology. The time has come to overhaul our counter isis strategy. It is time for the president to level with the American People. About what the threat really is and what is needed to win this generation long war with radical islam. Today i want to outline a basic framework for both. Starting with a campaign against isis we must take immediate steps to strengthen our efforts including increasing the numbers of u. S. Military trainers in iraq, and expanding partner participation by fostering campaign through forward air controllers. We must move the rules of engagement beyond zero collateral damage, authorizing American Military personnel to accompany and assist the iraqis in combat, including ramping up the number of special Operations Forces and accelerating the delivery of forces to Kurdish Forces and sunni tribes. Even with these improvements more will be needed to win this campaign. The president s a rack first strategy has left us with a credible im sorry, has left us without a credible ground force to fight isis and its main stronghold in syria. Recently defense secretary carter announced, this month that we have only trained to 60 60 Syrian Rebels to combat this group, which can range from 30,000 to 50,000 strong depending on who you talk to. One of the reasons we have so far fewer recruits, is that reportedly we make them pledge not to fight the assad regime. An absurd policy, especially when their hometowns are being attacked by assad. In short, we lack a serious ground force in syria, isis itself boasts an estimated 30,000 man army. Today i am calling upon the president to stand up send out a Multinational Coalition to clear the terrorist century in syria. We need a combined air and Ground Campaign with syria now. One composed of embedded operation forces, western traders and advisers, special operation forces, and most important way, Regional Military partners, including indigenous partners. The coalitions immediate mandate should be to strengthen the opposition so that they can take the lead in taking back their country. Not just from isis, but from all sunni extremist terror groups. This Coalition Must also force a sod to step down. We cannot a sod assad to sit down. His brutal oppression is one of the main Drivers Behind the growth, rapid growth of isis in syria in the first place. He continues to decimate the moderate syrian operation, including with chemical weapons recently. We need these moderate sunnis to fight these extremists. With a sod out of the way, assad out of the way internationally backed rebels stand a much better chance. Before taking action, the coalition would first need to develop a post a sod transition plan. Syria cannot go the way of libya , which has fallen apart in the absence of security at a strong central government. As a result, Coalition Action in syria must be paired with a viable plan to stabilize the country and prevent it from becoming a vacuum. We must step up moderate, inclusive parties for success and sideline extremist leaders. Our regional partners would play a central role on the ground at his coalition. I have spoken with syrias neighbors on many delegation trips, both in turkey, saudi, jordan, and other allies who are willing to put forward these resources. Willing to put forward combat troops on the ground. But they asked me, what is your shoji . And i start thinking, do we have one . Has we dont. They want the assurance that assad will be out of the equation, because they will not do anything that will empower or embolden the regime. These countries cannot live with an extremist century next door, and the spillover in terror. Some agrees to stabilize the syria and fight isis by committing their own ground troops. This is, after all, their backyard. It is their mess. I think it is incumbent upon them to clean it up, under American Leadership, and for us not to have to carry their water. But there is no substitute for American Leadership, and right now there is no other nation capable of rallying a coalition to this cause, other than the United States of america. I was pleased earlier this year to see arab leaders proposed the creation of a Regional Military force to tackle the spread of violent extremism. But such an organization is years away from reality. Regional partners are not ready to do this alone. We cannot afford to wait for the president piecemeal strategy to play out, a strategy he admits will take years. We need to take the lead and assembling this coalition of nations. Like we did in the persian gulf war. We also cannot forget the Core Principles needed to win the wider war against islamic terror the reach of isis and al qaeda extends far beyond their primary territories, yet the administrations global counterterrorism approach can be best described as a whack a mole by drones. It may be lowcost, but it is also shortsighted. Make no mistake, we have eliminated key terror leaders through targeted airstrikes including the head of al qaeda in the Arabian Peninsula yesterday, im sorry, earlier this month. The leader of the group in syria, the leader of extra operation. But these terror groups are getting better. They quickly are replacing fallen leaders. We can chase these fanatics through the gate of hell, but to win we must defeat there in city is ideology. To do so we need to identify and deceive their ideology. We need to work urgently with regional partners to develop all pledged plans before power vacuums turn into extremist hotspots. And we must counter the ideology of the core of islamic terror. We have seen it spread to all corners of the globe, in the same way ideals like communism and fascism led to decades of disruption. By exposing the naked brutality of life under islamic terrorists potential recruits will realize that they are heading to a prison instead of a communal paradise. This is a counter narrative that is not happening right now. The dod is trying, it is not happening at the dhs. We need a president to outline the whole of government strategy. The strategy should draw on all elements of American Power to promote liberty and Human Dignity as a great alternative to oppression, fear, and terror. History has shown that authoritarian systems are the wellspring of fanaticism. Political and Economic Development are the only reliable longterm antidotes to terror. Which is why american foreignpolicy must be geared towards achieving a balance of power in the International System that favors the expansion of free states. We have learned the hard way that leading from behind lead us into danger. Indeed, weakness invites aggression. It leaves us to face more enemies on our city streets, rather than on the battlefield overseas. I do believe we are in for a generational struggle, as Prime Minister cameron talked about. But i am comfortable that our country will prevail, our ideas will prevail. Every time we witness events like we saw in chattanooga americans vowed not to be intimidated or coerced by violence. We sent a clear message to fanatics if you try to bring terror to our shores, we will bring justice to yours. That is the result of the American People, and our resolve will leave to eventual victory in this war against islamic terror. Thank you very much. [applause] thank you. Thanks for the opportunity to sort of followup and unpack a little bit. The first question i want to ask you, is really by putting your statement in context. When president obama got elected, we really never really understood what his counterterror strategy was going to be. For the first years of his strategy we joked it was kind of like. Bush like. But then in 2010, the administration put its interest on how it is going to fight the war on terror. Between 2010 and now, we have been doing president obamas strategy, and your assessment is, it has not worked. There are more terrorist attacks. They own more territory. There bigger threat than they ever were. Realistically, the odds of president obama saying, yeah, i got it all wrong, and doing selling different between now and the last year and a half of his presidency are probably pretty slim. Arent what we really doing here, or what you are really arguing for, is a vigorous debate about what the next resident is going to do to address this echo rep. Mccaul i think you are spot on. His narrative was to and the war in iraq and close guantanamo. He failed to identify negotiate a forces agreement in iraq, unlike what we did in germany or in korea. It became a dangerous hotspot because we had no security left in iraq. That coupled with the political malfeasance of the Prime Minister, secretary clinton traveled to baghdad, Condoleezza Rice me, one time for three hours. That was the creation of isis. That created the threat that we see today. The president cannot get his head wrapped around isis. This was not about the happen under his watch. It defies his campaign narrative, and so i think the strategy for him is running the clock out, not having a strategy to defeat and destroy isis has isis enters our hometown. I think that is a huge mistake. It makes it dangerous to the homeland. I want to see one of the driving issues in 2016 the i want to see this be one of the driving issues in the 2016 debate. Im not seeing it right now. Im not seeing a lot of candidates and with experience in National Foreign policy. Usually it is about the economy. But this election i predict that this issue will be one of the driving debates in issues in the 2016 president ial election. And rightly so. I think every american i think the phrase you should be better off than you were before, i would ask the question, do you feel safer today . I think most let me bring in a related issue, and get your assessment of the iran deal. Iran is the other great destabilizing force in the middle east and we have to live with the aftermath, so i would like your assessment of the iran deal and what you think that holds for the future. Rep. Mccaul i sent a letter to the president , secretary of state kerry, urging them to go through the Congress First before dropping this at the United Nations security council. Samantha powers called me for a hearing where i brought this up. Within days, they submitted this to the un security council. They have proved this document defining and circumventing the will of the American People through its representatives in congress. This is flagrant. It defies the spirit of the law we