Transcripts For CSPAN Opioid Crisis Hearing At Johns Hopkins Hospital 20171128

And chairman gowdy, were honored to be a part of the House Oversight and government reform committees efforts find Meaningful Solutions to the Opioid Epidemic. Thank youall for being here today. It is no secret that were in the throws throws of a crisis thats reached Epic Proportions throughout our country. Baltimore is no exception. In 2016 we average nearly two fatal opioid overdoses in this city per day. This is a problem in desperate need of thoughtful answers. As both an anchor institution and steward of health care for our local communities, hopkins takes this problem very seriously. We see firsthand the devastation that substands care at our sister hospital to the east, the number of opioid Overdose Patients seen in our Emergency Departments doubled last year. Doubled. This crisis is very much a part of our reality. What are we doing about it . As an academic medical center, were addressing the issue through the lens of our mission of research, clinical care, and education. First research. Hopkins research runs the gamut from bench to bedside. Starting with the original identification of the opioid receptor in the brain by dr. Snyder in the 1970s, to the multitude of Clinical Trials currently conducted in our behavioral pharmacology unit, were working hard on making impact. Clinical care. Were working on two fronts. Treating the disorder that already exists, and preventing future addiction. In addition to our inpatient treatment units, our Broadway Center for addiction logs about 25,000 outpatient visits each year antiprogram is comprehensive. Addressing not only and the program is comprehensive. Addressing not only issues but Mental Health and family needs. And programs targeting pregnant women, youth, and adolescence. Perhaps as importantly as treating were working to prevent pathways to Substance Abuse from ever opening. We have implemented guidelines of mphasize why prescribing opioids such as limiting the doses on first prescriptions, particularly after surgery, and eliminating automatic rebills phills. While patients are with us in the hospital, we have pain specialists work with them to find alternate modality 80s of treatment for their pain. We provide access to naloxone r patients substance disorder. There. t stopped the third part of our mission, education. As educators were working to ensure the next generation of physicians and providers are taught these best practices and treatment there. The third part of our mission, education. And prevention by incorporating them into all aspects of their training. We realize that the work were doing is just one piece of a vast complicated puzzle. The Opioid Epidemic is after all a Public Health crisis that requires a system wide approach. Among our partners is the Johns Hopkins blueberg school of Public Health. The schools Bloomberg Health initiative launched last fall a generous gift from the philanthropies is Funding Research projects partnering with communitybased organizations and working with policymakers around the country to implement evidencebased comprehensive solutions. We reline expertise of so many other Health Related institutions and businesses from the Baltimore City health department, to our local pharmacies, our payers, and you our elected leaders. I look forward greatly to todays testimony from a dedicated and informed group of witnesses. Im confident that your work here will move us forward to achieving solutions to the crisis. Thank you. Now im honored to yield the floor to the esteemed mayor of Baltimore City and friend of Johns Hopkins, mayor katherine pugh. [applause] first let me say good afternoon to everybody. And to this esteemed committee, thank you for being here. Mr. Congressman, to both our congresspersons, i see congressman cummings, and congressman ruppersberger is also here with us, and mr. Chairman, gowdy, thank you for convening this meeting here in baltimore at one of our most esteemed institutions in the world. And so were really grateful because Everybody Knows at this a crisis. Were in opioid addiction, were suffering from here in baltimore, but the nation is suffering. And it is important that we pay close attention to what we do as relates to the individuals who are suffering from this and communities that communities t destroyed by it. So we know that in Baltimore City we have a big problem, but we know were part of a larger problem. I was thankful to our governor who has convened a group to look at this particular a crisi opioid addiction, were issue. Ng were focused on not only making sure that people dont get involved with drugs, but doing what we can to keep people from overdosing. I have one of the greatest, i believe, Health Commissioners in the country in dr. Wynn, who is really focused on this particular issue. I want to again welcome youall here. I know that this panel will continue to deliberate over this particular issue and i look forward to hearing the results of this panel. So we welcome you to baltimore. More importantly we understand the importance of your work and we look forward to results. Thank you. Now i have the distinguished honor of bringing before you the governor of the great state of maryland, our governor, mr. Governor come on up. Governor hogan, thank you so much. [applause] Governor Hogan thank you, mayor pugh. Thank you, governor christie, as you know governor christie chaired the president s commission on opioid. I want to thank chairman gowdy, congressman cummings, congressman ruppersberger, and ll of our members of the house for coming here today to baltimore. We thank you for holding this important hearing here in the city of baltimore and state of maryland. Also want to thank all of you in the audience for being here today. To e of you who are going before the committee that have enough interest to be here. This is a national crisis. Its something that i have been very passionate about for about four years. When i first decided to run for that have enough interest to be here. This is governor, i was traveling the state of maryland and every single town and community i would go into and ask the local leaders whats the number one issue facing your community . And it didnt matter whether i was in Baltimore City or urban areas or wealthy suburbs of Montgomery County and washington suburbs, didnt water if i was in a small rural town, the answer was always the same in every single place i went. They said the number one problem were faced with is heroin. And opioids. That came as a shock to me but during our campaign we started bringing in folks involved in treatment, education, interdiction, crime fighting. Police officers. And we got all the input we could. As soon as i was sworn in as governor one of the very first thingsdy in january of 2015, was i put together things i did in january of 2015, was i put together an Emergency Task force. They travel the state and held hearings in every part of our state where hundreds of people would show up to testify and tell their stories of addiction and the problems. We came out of that with 38 recommendations, all of which we implemented. Focused on every aspect of the problem. And we it continued to get worse no matter what we tried. We have now we became the first state in america to declare a real estate of emergency. Just like we would for a natural disaster. And it is a national disaster. We just so far this year in our state, 1,180 people have died of overdoses in maryland. And almost every single day dying in parts of our state from one end to the other. For the First Time Ever this is has now evolved from we have actually leveled d. We reduced the number of deaths from opioids. On we for the First Time Ever have flat lined heroin overdoses. T we have a 70 spike in fetinal. We have 850 of our 1,1le 0 deaths are from the new synthetics. As we all try to wrestle with this issue, it constantly evolves and so must our effort to fight it. I just want to thank the governor christie for his work, committee for their work, and interest and focus on this. It is not just a Health Crisis but its impacting and tearing apart families and communities from one end of the country to the other. An all hands take on deck approach. Federal government working with the state and local governments along with people in the private sector and hospitals. I want to thank hopkins for hosting us today, too. I want to thank all of you an a your interest and say that this i called on the federal Government Back when we did our state of emergency and said, the federal government ought to do the same thing. That would be my recommendation to the committee. Weve got to have federal funding. I would say this is the most important problem facing our country. Thank you all for foesing on it. Im going to turn over the floor to chairman gowdy. Thank you so much for being here. [applause] congressman gowdy thank you governor, mayor pugh, pardon the i convenience of having a committee of Congress Come and appreciating the seriousness of the issue that brings us here. The committee will come to order. Without objection, the chair has authorized to declare recesses at any time. Im going to brange from poet kohl a little bit because were in mr. Cummings hometown and because he cares so passionately about this issue, were going to recognize you first for your Opening Statement. Mr. Cummings thank you very much, mr. Chairman. Want to first of all take mention one thing thats so important to me, mr. Chairman, to the members of this panel. I cannot come into this hospital without saying thank you to hopkins for saving my life. Spent 60 days here this summer. A lot in this building. So i want to thank i see a lot of white coats out there and others. Pass the word. I thank you for what you have done for me and my family. I want to begin by thanking chairman gowdy for calling todays very important hearing. For bringing the Oversight Committee to baltimore. I thank my colleagues for coming to baltimore and certainly my colleagues who represent baltimore acongress with me, Dutch Ruppersberger and john sarbanes, i thank you for being here. I have been in congress now for 20 years, and i have been to and seen a lot of field hearings. I have never seen as many members attend any field hearing since i have been in congress. I believe todays remarkable turnout reflects the fact in a the Opioid Crisis that the Opioid Crisis is truly a National Emergency. It does not discriminate based on politics. Feakts red states and blue states. It affects red states and blue states and every state in between. Im extremely grateful the chairman agreed to my request to bring the committee to on the road to investigate the devastating effects of this very difficult problem. I also want to thank dr. Miller and Johns Hopkins for your warm welcome and hospitality. The work you do makes a huge difference in our community and around the globe. I also thank our esteemed guest, Governor Hogan and pugh for joining us. Were honored to have you in our presence. Of course i thank our witnesses, governor chris christie, commissioner wynn, dr. Comperned, and mr. Baum. Thank you for testifying and for all you are doing to help us combat opioids and save lives. A year and a half ago at our committees first hearing on this issue, i warned that so many people were dying in communities across america and that we can no longer ignore this emergency. Today the centers for Disease Control and prevention estimates that more than 64,000 drug ns died from overdoses in 2016, an increase of more than 20 over the year before. To put this in perspective, the death toll from drug overdoses last year alone was higher than ll u. S. Military casualties in vietnam and iraq wars combined. Every 20 minutes, every 20 minutes someone die from an opioid overdose. If todays hearing lasses for two hours, half a dozen lasts for two hours, half a dozen families will have lost a parent, a sibling, or a child to opioids. We have the reports. We have had years of talk. Now its time for action. The American People are looking if todays hearing for us to take action. They are looking to the president and congress and they are asking what are you going to do . Governor christie and the other members of the president s addiction n drug have addiction have given us an excellent blueprint for action with dozens of recommendations. Now its up to us. Republicans and democrats, federal, state, and local officials, researchers, policymakers, doctors, Drug Companies, Health Providers on the ground, and families of the faith communities. We need to Work Together to end this epidemic. There are some things that we can do right now to help prevent addiction and save those who are already who already have this disease. For example, we can ensure that every Single Person who needs naloxone has it. The missions report highlights the importance of eequipping First Responders with naloxone, including police officers, fire departments, and Public Health officials. But heres the challenge. Drug companies have continued the price of this 45 yearold drug and communities have been forced to ration it. In september, i led 50 members of the house of representatives in sending a letter urging President Donald Trump to lower prices for naloxone just as the commission recommended. Unfortunately, we never received a response. The president should act now to ensure that naloxone is available at a reasonable price whenever and wherever it is needed. Lower prices we also need to ensure that every affected person has access to effective treatment. According to the commission, and i quote, today only 10. 6 of youth and adults who need treatment for substance, youth according to the commission, disorder, receive that treatment. Only 10 . There is simply no way, no way 90 l end this crisis of affected are not being treated if we do not act now. A treated if we do not act now. To do this we need funding. Last month President Trump epidemic a Public Health emergency. But he did not propose any additional funding to combat it. We cannot fight this epidemic without funds equal to the challenge we face. Truth. A sad but stark finally, we must recognize and acknowledge the many factors that put people at risk. Woefully inadequate support for our children and our vulnerable residents. Worsening economic inequality. Lack of opportunity. And profound disparities in the criminal Justice System. We cannot solve this crisis until these risk factors are addressed. With that, mr. Chairman, again i thank you for convening this critical hearing and i look forward to the testimony and taking action on it. Mr. Chairman, with unanimous consent, that representative ruppersberger from the state of maryland and representative sarbanes from the state of maryland be permitted to sit in with the committee and participate in this hearing today. With that i yield back. Mr. Cha unanimous consent, [applause] chairman gowdy without objection. Welcome to our colleagues. Also want to thank the Johns Hopkins community for taking such great care of our friend and colleague over the summer. You send him back stronger than ever. Thank youall for whoever had a role in that. Didnt send him back quite that strong but sent him back stronger than ever. Governor chris t. Governor hogan, recent, past and present governors, have witnessed the most devastating drug epidemic in our nations history. Since 1999 more than half a million americans have died from drug overdose. And the epidemic is escalating. Over the span of nearly 20 years, the death toll has quadrupled with the emergence of even more poetent drugs and ever expanding Online Market for illicit distribution. Today drug overdoses kill more americans than gun homicides and car crashes combined. As staggering reality, two out of every three daily death from drug overdoses in the United States involve an opioid, class of drugs commonly prescribed to relieve and manage pain. Actually over 33,000 americans died from an opioid related overdose in 2015, which is an 11 increase from the year before. In South Carolina where i come from, greenville and spartanburg counties in particular suffered more than 100 opioid related overdoses in 2015, and while the numbers in the upstate of South Carolina are fewer when compared with cities like baltimore, behind every number and every statistic is a life with loved ones and friends and potential and aspirations. We have a tendency to use numbers in government and our line of work, but the victims arent numbers. The victims are fellow human beings ravaged by the consequences of drug addiction including the abuse of prescription painkillers. Were a remarkable conof progress and innovation, community, and charity. We can cure diseases that past generations lived in fear of. We can mutt people on the moon and split atoms. Yet were struggling how to respond to this epidemic. I guess we need to start with how did we get here . There are more illicit uses for these drugs there are illicit uses for these drugs and list it uses. Ne is unlawful, the other is legal but with the potential for abuse and misuse remaining. Physicians have a role to play for certain. These drugs are not available legally without a prescription. What are the pharmaceutical alternatives . Is there legal but with the potential ov is there sufficient information shared with patients to avoid misuse and abuse . Frequent exposure and easy access to painkillers has led o dependentcy intolerance with a Substance Abuse disorder to intensify with or without the help of a physician. Addiction to prescription pain killsers is greg expo tensionly. Side of the equation, actors are diverting high potent pills to the black market to be laced with heroin resulting in drugs so lethal si equation, they have been called gray death. Term used to describe the high risk associated with every single injection. Opioid related overdoses are now deadlier than the hivaids epidemic at its peak, more insidious than the cocaine base, cocaine powder epidemic that predated it. So there are a plethora of questions to be asked such as whether were being as effective as possible in the diversion of these highly toxic substances. I actually like doctors. I happen to be the son of one. But i also prosecuted doctors. I want to make sure the d. E. A. And d. O. J. Are effectively going to the source of prescriptions issued outside the course of a professional medical practice. H. H. S. Monitoring ensurers placing pricier less addictive opioid out of reach for patients with acute pain . Are states regulating server homes which can move vulnerable patients in and out of treatment. These are the questions our committee and American People want answers to. The health and safety of our communities all across the nation are at risk. Although almost everything seems capable of being reduced to political exercise in our current environment, i genuinely hope that this epidemic is above that. I hope its about protecting those susceptible to addiction and punishing those fueling the epidemic. A death, especially among the premature especially the premature death after young life, has no political or ideological bent. Victims are victims. Perpetrators are perpetrators. Addiction is addiction. Heartache is heartache. The issue to me comes down to those of good conscience earnestly seeking a solution and those of a malevolent conscious bent who prove fifth off other peoples pain. Its not just the deaths that devastate our families and communities across the health care system. Its also the disease of addiction. It is permeating and threatening in some plays within our country, the very fabric of those communities. At the same time, pain is real. Builder. L for a home and mr. Cummings district or mine with immense back pain. Who cant otherwise get out of without pain without pain medication. How do we solve this epidemic . There is a prevention aspect, there is a treatment aspect, there is an education aspect, there is an enforcement aspect, there is a punishment aspect, builder. Is an oversight and aspect. In march the president signs an executive order cret creating a commission of governors, torge, and professor of psycho biology to recommend policies for the response to this epidemic. Earlier this month the commission finalized recommendations for how the federal government can help stakeholders tackle the crisis and stave off emerging threats. Today well have an opportunity and in ght the report baltimore appropriately so. Well all example baltimore partners and al how they can assist partners an how they can assist with and learn from the efforts occurring here. The devastating statistics may leave us feeling like we have just left. But our country is resilient and we have resources, we have compassion. I think we have the commitment to win this battle with opioid and opioid addiction. I want to thank all of our witnesses, governor christie, you are the governor of the great state of new jersey. As i mentioned to you in the ante room, you are also a former United States attorney. Are you uniquely well suited and we cannot thank you enough, not just for your presence today but willingness to undertake this vitally important responsibility and role. With that you are recognized. Governor christie thank you, mr. Chairman. Ranking member cummings, thank you for your work in this area. Thanks to all the members of the committee for inviting us today. As the chairman mentioned in march the president asked me to chair his commission on opioid and drug addiction in our country. We worked together to name a Bipartisan Group of people to join that commission. I think thats important place to start. I can tell you as the chairman referenced in his remarks and mr. Cummings in his, i am acutely aware as a republican governor in the state of new jersey that there is much that divides political dialogue in our country right now that makes it very difficult for us to get things done. Them. Nnot be one of i read the obituaries that are happening regularly in our and in none of the obituaries do they designate whether the person who died is a republican or democrat. They a and in nonere a son or d husband or wife, mother or father. 2 1 2 weeks. I want to ask all of you and ask this committee, if we had a terrorist organization that was invading our country and killing 175 of our citizens every day, what would you be willing to pay to make it stop . We dont ask that question in this country, and the reason we dont ask this question, in my view, is because we still believe that addiction is a moral failure. We are making more judgments on the people who are suffering and dying and were making judgments on their families. Every time i go to a Drug Treatment Center in my state and i ask someone whos in the midst of treatment, tell me your story, within the first two minutes they say to me, governor, im from a good family. And my response is, why would you think i would think otherwise . The reason why they pleeb that is because they believe that is because the stigma attached to this disease each and every day makes people believe they have to defend their very upbringing, their performance somehow we that believe that this is a choice. I would love to see a show of hands in this audience, who has not made a bad decision in your life . Usually works. Fact is we all have. We havent used opioid or heroin because if it happened we might be in a very different judgment position than some people are today. Addiction is a disease. It is a chronic disease. And it needs to be treated as such and viewed as such. Thats why i am proud the president announced this as a Public Health emergency. Ow as mr. Cummings mentioned we must fund the Emergency Health fund which is at 66,000. I dont think thats going to make it, everybody, in combating this problem. We need to fund the Public Health Emergency Fund to make sure that the administration has at their disposal the resources that they need to implement the recommendations hat the commission has made. There was a discussion in the opening remarks about the role of physicians and Health Care Providers in this. Let me be very clear, this is a drug epidemic that did not start on the corners of baltimore or the corners of my hometown. They started in doctors offices and hospitals across this nation. And while some of it, as chairman gowdy implied in his remarks, are done by folks who have bad intent. Most of it is done by folks who have no intent. Why do physicians and Health Care Providers have no intent on this issue . Because they are not educated on this issue. Across our country in medical schools, in every state in the union, we are not educating our future doctors and nurses, dentists on the dangers of these drugs. We grant d. E. A. Licenses to write prescriptions for these drugs without requiring continuing medical education on opioid addiction. And how it can lead to heroin addiction. I as a lawyer, recovering lawyer but a lawyer nonetheless, i have to even as governor today, i have to take continuing Legal Education every year to maintain my license. And im not practicing. How is it that physicians can have a d. E. A. License and not be required continuing medical education on this problem when 64,000 people died last year . The Commission Recommends we do that. If you dont believe that limits on opioid prescription exception is for people who are terminal from cancer and in hospice. Let me tell you whats happened in new jersey just since we put a five days limit on opioid prescriptions beginning march 1 of this year. Opioid prescriptions in new jersey are down 15 . From march to october. And the number of pills are down 20 . That have been prescribed in just sevenmonth period of time. Those prescriptions restrictions work and they should be instituted in every state across this nation and thats also in the report. I want to commend the president for granting waivers to states now for the oldfashioned, antiquated and ridiculously i. M. D. Restriction. Institutes of mental disease. It says if there is any hospital, Health Care Provider that has more than 16 beds 16 that those folks cannot be reimbursed for the federal share of medicaid because they are state psychiatric hospital. What that means is there are literally thousands of beds that could provide the treatment that chairman that Ranking Member cummings recommended in his remarks that could begin to take that 10. 6 number up significantly but are not open because of this antiquated waiver. States have been asking for this ability to waive this for years. I commend the president for ordering that to be done and tomorrow in new jersey, the head of c. M. S. Will be coming to new jersey with me to announce that new jersey has received their waiver. And hundreds of beds will open within the next six months for people who need drug treatment. These are folks who are the neediest in our society. Those folks who qualify for medicaid. We need to increase physician education across the nation. And we need to decrease the influence of the pharmaceutical industry on that education. See, right now most doctors only get their education from the very companies that are producing the pills they want them to prescribe. Now, as chairman gowdy said, i am a former prosecutor, and that makes me a little bit skeptical and im from new jersey which makes me completely cynical. And so what that tells me is, if the only education physicians are getting are from those people who want them to prescribe these pills and that 2015, 259 million prescriptions for opioids were written in this country, enough to give every adult in this country their own bottle of 30 ills, 259 million, we are 4 of the worlds population and we consume 85 of the worlds opioids. We dont think thats where this problem has started. Listen to the c. D. C. That says one out of every five heroin addicts began with prescription opioids. We need to have alternatives to opioids because as the chairman said, pain is real. For many people in this country. But thats what pharmaceutical companies should be spending their money, not on paying doctors to write more prescriptions for opioids. And so thats why we as a commission have worked together. Dr. Collins, the head of n. I. H. , and all of the executives of the Pharma Companies in this country, in new jersey and got them to agree to a partnership. They will now work with n. I. H. To come up with two Different Solutions to this problem. First, more nonopioid painkillers will be put on the market and be affordable. Second, more alternatives to medication assisted treatment for those already addicted. Right now we have three in this country. There should be more. Those Pharma Companies said they have 43 different compounds among them that could address either or both of these issues. If they are yet, theyre not moving forward. We need n. I. H. To be accelerant for moving this forward and i look to you for money for n. I. H. For that particular program to get these things to market along with the f. D. A. As quickly as possible. If people have an alternative to opioids, both the physicians who prescribe these things for pain and the consumer who wants to avoid addiction, we have nonopioid alternatives, that will be enormously helpful in stemming the tide here. The Insurance Companies play a large role in this as well. As a governor i get folks all the time saying to me, well, why dont you change the regulation of Insurance Companies to make sure theyre covering drug treatment . We have middle class folks in this country who have Employer Provided Health insurance and get treatment. Right now most of them do not. And i say, well, remember this. Only 30 in my state of the Health Insurance policies, employerbased insurance policies are regulated by the state of new jersey. 70 are regulated by the federal government under erisa. We say, why doesnt the department of labor step in . They dont have the authority to do it. The statute that congress assed in the Mental Health parody act, they do not allow the department of labor to fine an Insurance Company or an employer who is not treating Mental Health and addiction parody act, they do with parody and they do not allow the department of labor to investigate individual Insurance Companies. They must go employer by employer. How ridiculous is that . We urge the congress and the commission to give the secretary of labor both the authority and the responsibility to fine Insurance Companies that are not treating addiction with parody to all other diseases and to give the secretary of labor the authority and the responsibility to be able to investigate Insurance Companies directly. Not have to go by employer by employer by employer when we know that we have a number of very large Insurance Companies in this nation that cover thousands of employers. As a former prosecutor, i can tell you, one robust investigation is a lot easier to staff than 2,000 little ones and much more effective. Lastly and then ill leave it for questions because i could go on for a long time. Drug court is a very important part of this. We need alternatives to incarceration. We have put forward in new jersey the largest criminal Justice Reform in the last two years of any state in america. And one of the things weve done is institute drug court in every county in our state. What does that mean exactly . When you come in not as a dealer, not as a violent actor, but as a nonviolent possessor, an addict, you are now in new jersey required by law to go to drug court and you are diverted to treatment, not to jail. Now, if you dont take your treatment seriously and the judge decides you are not utilizing the opportunity thats being given to you, theyll send you to jail. Youll get a chance first to go to treatment. We should have drug court and the Commission Recommends it as well in every Federal District in this nation. One judge in every Federal District committed to dealing with the drug problem in this country. To diverting people into treatment. Giving those families and those addicts who are suffering from this disease hope and opportunity to get better. Im a former prosecutor. Im all for jailing people who profit from this poison. And im in favor of putting them in jail whether theyre standing on a Street Corner in any town or city in this country or whether theyre standing in a hospital or in a doctors office. You running the pill mill, you have a position, you should go to jail just as soon as the drug dealer on the corner should go to jail, but we will not solve this problem by incarcerating addicts. And we must get them the treatment they need to be able to have the tools to recover. In new jersey we have now for the first state in the country to convert a state prison into a drug Treatment Facility. And so now state prisoners who are in their final year of incarceration, who have a demonstrated drug problem, transfer from a standard state prison to the state prison Treatment Facility that we have on the property of fort dix in new jersey run by a certified Addiction Treatment company that works in conjunction with our department of corrections to give people the tools to deal with their addiction before they leave prison so that when they get back on the treat we lower the chance for recidivism, all of these are in the reports recommended for the states and the rest of this country. We are proud of governor baker, governor cooper, attorney general bonsy, congressman kennedy and professor matris who works in a completely nonpartisan manner to make these recommendations for the president and i hope the members of Congress Work with the president and hold the administration and each other responsible for getting something done on this issue. Thank you. Im happy to take questions. Mr. Gowdy thank you, governor christie. We now recognize the gentleman from maryland for his questions. Mr. Cummings thank you, mr. Chairman. Thank you, governor, christie. I want to thank you, governor christie. I want to as i said before the hearing and actually now, an excellent report, i want to talk about me lockson a little bit. That lockson a little bit. Naloxone a little bit. I walked outside coming out of the event and with sb just dropped a man right in front of the hotel and i said, whats going on . This happens all the time. E see people who may be at a party and they dont know person has an overdose and they dont know what to do and i use that as an introduction with respect to naloxone, its a rug that has been used to save lives with regard to overdoses. In your report you all say price increases of the various forms of naloxone continue to create affordability issues preventing state and local governments as well as Committee Organizations from stocking naloxone at the levels necessary to rescue more people from the overdose. Is that correct, governor . Governor christie that is true, sir, yes. Government in the should ban together to have the purchasing power to make bulk purchases of naloxone at lower prices. There is no reason why we shouldnt do this. We do this in many areas of bulk purchasing, whether through the g. S. A. , as you know, or through other entities. We should be able to do it with naloxone. One of the things we do in new jersey is coprescribing, you, your physician, prescribe an opioid to prescribe at the same time naloxone to go to the home because some of these overdoses are not intentional. They are accidental. Someone in severe pain thinks, well, two pills of every four hours is good, four pills might be better. So its not just for the person suffering from addiction. Its also for the person who unintentionally misuses it to have naloxone in the home in an easy form so the folks who live with them if they have an overdose the one you mentioned, its nasal form. Its two pushes of a button. One in one nostril. Push the button. One in one nostril, push a button and you save a life. Mr. Cummings you know, our Health Commissioner who will be testifying in a few minutes is one who has been very strong is dr. Wen in baltimore. You know, the thing that i think bothers me so much about naloxone is that the price was jacked up, i mean, big time when at the very time when First Responders and others were trying to get it because they saw the effectiveness of it. Did you have discussions with any of the manufacture or Drug Companies who produce naloxone . Governor christie we did not in terms of the pricing issues, congressman. What we did, though, talk about was the concept of both purchasing and their willingness to consider the idea of bulk purchasing, lowering prices, so we did talk about that with the manufacturer, a few of the manufacturers and thats why we urged it in the report. We believe its something that can be done and that these manufacturers recognize. And the commission emphasized to them their social responsibility. Mr. Cummings and then negotiation recommendation that you just talked about was in the interim report but i didnt see it in the final report. Governor christie this is some confusion. The way the effective order was written, mr. Chairman, was that the president wanted first an interim report and then a final report. They should not be read as mutually exclusive. They should be read together. I think there are 56 recommendations in the final report, theres nine in the interim report. You made 65 recommendations. So the nine recommendations remain in effect and should be added to the final report. Mr. Cummings good. Im glad you clarified it. I thought you governor christie no, sir. I think you know me well enough to know i think it would be a difficult thing. I remind the white house on a regular basis, this was our report. Mr. Cummings my last question is this. Have you discussed this report at length with the president . In particular, have you discussed this naloxone recommendation . Governor christie we yes, i have. Mr. Cummings what response did you get . Governor christie i did not. Let me fully answer, sir. We have discussed the report. I have not discussed the specific pricing issue on naloxone. My conversation with the president was more on how important it was for all Law Enforcement officers and First Responders to have it. But we did not get into the pricing part of it in my conversation. Directly with the president. But i have had that conversation with other members of the administration. Mr. Cummings thank you very much, mr. Chairman. Mr. Gowdy the gentleman from maryland yields back. The gentleman from wisconsin is ecognized. Sir. Couple questions. This is really a horrible thing. I think its a very publicized problem and its still underpublicized. Did you look at other countries who perhaps did not have the opioid problems we have . Mr. Grothman i was in taiwan like 10 years ago and they almost had no problem. Could i think england has a big problem. Could you comment on the criminal Justice Systems and how they deal with possession or sale or opioids in other countries . Governor christie we didnt look at it from a criminal justice perspective. What we looked at it was from an availability perspective. The biggest difference we see from our country to others is the extraordinary overprescribing of these drugs. We believe a lot was caused by the federal government, to be frankly, with this pain as a vital sign requirement. Where everybody who leaves the hospital has to have a smiley face, you know, on their lack of pain. And the hospitals were evaluated on this basis. So what was going on with a hospital, heck, youll leave with no pain and the best way to leave with no pain is to give you a whole bottle of perk set and get you taking percoset and get you taking it. The very basis of this problem is were dealing with the availability of this med significance. Mr. Grothman do you know how we will get access to sale of opioids . Governor christie sure. The commission can be helpful in that regard because we dealt with other countries on that issue but not the particular one we are talking about. We would be helpful. Well get your staff in touch with ours. Well be happy to help. Mr. Grothman next question i have. What percentage of people who are arrested for opioids, heroin or whatever, are addicted and what percentage is using it . Governor christie i dont know the exact numbers, congressman. What i will tell you is that the rate of addiction in terms of the amount of time it takes someone to get addicted to these, according to the c. D. C. , is as little as three days. O if you have a predisposition for this, within three days of your use you could become addicted which is why the c. D. C. Said, their recommendation is to limit prescription no more than three days because beyond three days you can become addicted. Mr. Grothman have you talked to anybody when you talk to people arrested for heroin, do they say they were addicted in one or two days . Governor christie i will tell you that this young woman the answer is yes. I have spoken to literally hundreds of people across my state in Treatment Centers about this who say the time for addiction is very brief. I will tell you one young woman who is part of our public Advertising Campaign on this issue in new jersey, the young woman who suffered an injury, knee injury, she used per first bottle of pills, this young woman who was a college graduate, cheerleader in college, went out and had her first job and she was addicted within the first week that she was on these drugs. She went from being employed, having her own place to live, supporting herself to within 60 days having lost her job, moved out of her apartment and was living on the streets of atlantic city, new jersey, prostituting herself for heroin. Mr. Grothman we normally in these hearings have lakecook. We do not. In vietnam, as understand heroin was widely used. And something has been said how quickly it was not used by the troops once they got back in the United States. Which would be a little bit inconsistent with the idea that heroin is always addicting. Could you comment on that . Governor christie yeah, i dont think anything is always addictive to anybody. I dont think its always addictive, sir. I think there are people, as we know, who use prescription opioids and some use heroin who use it can use it recreationally and not become addicted. We should be careful using the phrase always or never in this context because you are dealing with human beings who have different genetic backgrounds and makeups, different psychological and makeups and different physiological makeups. We heard Johns Hopkins tell you this is what they do is an art as well as a science. No, theres not always a no on this, sir. I will tell you when c. D. C. Says four out of every five heroin addicts start with prescription opioids and we are talking about the same compound, this is something thats lethal in the ability to become addictive. Mr. Grothman ill give you one more mr. Gowdy if you wonder where the light exists its right there in front of the governor. Although i am in such a charitable mood if you do have one more short question, emphasis on short mr. Grothman sure. One of the things on Free Trade Agreement is of course some people feel achievement treatment is ineffective. Could you give us your opinion of what concity institutes ineffective treatment or how can we avoid ineffective treatment . Governor christie something thats not evidencebased. We should not be operating theoretically here. There is sufficient information across this country in the medical community what works and what doesnt. Medical assisted treatment works for most people that tried it. The way to make sure ineffective treatment isnt happening is through the state regulatory bodies who regulate the departments of Health Across this country need to be very vigilant about regulating what happens in Treatment Centers. And there are places in this country where you have a lot of fallacious treatment. I dont want to be the first to shock you and say that theres fraud in all different areas of our country when theres money to be made. It does not discount the value of treatment. What it does is increases the need for regulatory bodies and prosecutors to go after those people who are ripping off people by giving them false hope with fake treatment. Mr. Gowdy the gentlelady from the district of columbia is recognized. Ms. Norton thank you. I want to thank you and you the Ranking Member for this very important hearing. I want to thank you, governor christie, for coming and for your very forth right report words. Inces no the last administration did come forward with a billion dollars but weve seen no slowing in this epidemic. Indeed, my own district which is not considered one of the most serious districts, the district of columbia tripled in this Opioid Crisis in just two years. This notion of a National Emergency versus a Public Health emergency has emerged christie, governor that the report indicated that this was a National Emergency. Is that not the case . Governor christie well, no. What the report indicates is we believe its a National Emergency that can be addressed one of two ways. Declaring a Public Health emergency under the Public Health emergency act which is what we prefer and under the stafford act. Ms. Norton why did you prefer one or the other . Governor christie who would administer the county fund. One would be administered under the department of homeland security. And stafford is fema. Having dealt with fema during a small storm in new jersey [laughter] governor christie i will tell you i dont believe place based on my experience that fema would not the best to administer these funds and health and Human Services would be better. We felt our job was to present alternatives, but i can tell you my recommendation to the president was to do it under the Public Health safety act so the funds would be in the Public Health Emergency Fund. Therefore administered by folks to i think no disrespect fema but would have a getter expertise at h. H. S. Than fema. Ms. Norton governor christie especially a governor who dealt with fema it makes a big difference. Ms. Norton this region where we are now, maryland, virginia, the district of columbia just had a summit on this issue. Governor hogan has declared a National Emergency or state emergency here. Im trying to find whether the declaration of a National Emergency would encourage congress to in fact come forward with the funding that you indicate you thought was necessary. I mean, your remarks were replete with versions of funding one way or the other. You asked at the beginning of your testimony what would we pay a terrorist, for example, who invaded our country, making that analogy to what opioid has done. You have called, in your testimony, for funding the Public Health Emergency Fund. Governor christie right. Ms. Norton for funding n. I. H. But we sit here and congress is frankly lost focus here. In fact, we are not sure whether the government is going to be kept open. And therefore, nobodys thinking about this issue. Would declaration of some kind of Emergency Force this back to the front burner of the congress of the United States which has not funded anything since last administration funded a billion dollars in additional funding for this emergency . Governor christie with all due respect, i think if Congress Needs different wording to focus its attention then we need a new congress. Ms. Norton what would you suggest . Governor christie if you cant tell from 64,000 americans dying every day this is an emergency because the president did it under the Public Health emergency act than the stafford act, you need to reassess from a governors perspective what youre doing. I recognize the billion dollars that the last administration, last congress put in. Let me put it into context whats needed. In new jersey this year, in new jersey we are spending 500 million. Ms. Norton of your own money . Governor christie yes, state money. 500 million. So i am not quite frankly impressed with a billion dollars from the federal government for the nation when the state of new jersey is dedicating from in a 34 billion budget, we are dedicating half a billion dollars just to increasing availability for opioid treatment, training, naloxone, all of that is being supplied by the state and localities. Now, we need help from the federal government. I want to be clear about the Public Health emergency. It is a National Emergency. Its just two different ways of doing it. Whether its under the Public Health safety act or stafford act. And my recommendation was the Public Health safety act to keep this away from people who dont know about this problem. There is confusion about all this. You want to see real confusion, lets put fema in charge of naloxone. Somebody who is waiting for blankets and food and water in sandy, i dont want to be waiting for fema to be giving me naloxone. Ms. Norton thank you very much. I got the red light. Mr. Gowdy the gentleman from alabama is recognized. Thank you, mr. Chairman. Inaudible] there you go. Mr. Grothman now we can hear you. Did the clock start now or did it start after my colleague turned on the microphone . Mr. Gowdy ask me to yes, were restarting. This is the iron bowl and how upset you are. Dont go there. Its worth at least 15 seconds. All right. I just want to go back to something that was brought up by my colleague from wisconsin about heroin. Initiator and as an versus the overprescription of painkillers. Nd what we found is that opioid addiction is initiated y painkillers like oxycodone and hydrocodone has dropped from 42 from objection owe codone to 27. 8 i mean, to 24. 1 and from 43. 8 for hydrocodone to 28 . In terms of heroin, 8. 7 in 2005 to 33. 3 in 2015. So i think were on two tracks here, governor, that i think the medical community has to address but also the Law Enforcement has to address. Governor christie no question. The report talks about that. Theres no question we need to make sure that enforcement against those i think i said this in my Opening Statement that as a former prosecutor, enforcement against those who are profiting from the poison that theyre spreading throughout our communities has to continue. It has to continue aggressively. And so i dont think theres any theres no reason you cant chew gum and walk at the same time. Fact is we also need to acknowledge that treatment as a part of what our overall spend is across the federal government and State Governments is a fraction of what we spent on enforcement. And so i want the threelegged stool to operate. I want there to be education prevention, interdiction, Law Enforcement and treatment. But right now the prevention education part of the treatment part are short of the leg of that stool. As long as that continues well continue to have this problem. You will not find me being opposed to stricter enforcement against those who are profiting from this but we must draw distinction, in my view, know who is profiting from it and acting in violence and those addicted without those elements. Those people i think in the criminal Justice System needs to be dealt differently than those profiting from it. Mr. Palmer i also think we need to look at this in a wholeistic manner. I dont know holistic manner. I dont know anyone who doesnt know someone, either a friend ho has a Family Member who has someone that has had an opioid overdose. It crosses every boundary that you can think of race, gender, income level, profession. But one of the interesting things is that doesnt get talked about is family structure. Hen you take a look at that, 68 of the population is either married or windowed. Yet, that only represents 28 of the Overdose Deaths. Whereas the never married and divorce population is about 32 but they represent 71 of the opioid overdoses. I would like to see us do a deeper dive into that, start looking at the ages in those categories. But i think thats got to be part of the discussion is the overall breakdown of the family and how that has contributed to this. Governor christie you know, i think as a father of four, married for 31 years, i believe were doing something right. At least were trying to. But i also want to be very careful about this as well because theres plenty of folks who are in the situation i am who winds up with children who are addicted. So theres part of what we said in the report, theres not one Silver Bullet to fix this problem. Whether its the issue you raise or treatment or interdiction, so i think all the things has to be considered and looked at as part of whats leading our country to consume 85 of the worlds opioids. 4 of the population. Theres something happening all across our country thats encouraging this. Theres no question that all those things has to be things that are considered. But i dont want to mislead anybody that there is one Silver Bullet to fix this because theres not. Im confident. Palmer from one of my own personal experience, one of my childrens classmates, a tremendous africanamerican artist, died of an overdose. One of the Board Members of the think tank i ran, i literally sit in the living room with them while the local authorities removed their son from his bedroom when he died. My last point, mr. Chairman, is taking a look at the drugs prescribed through tricare and through the v. A. , ive gotten information from different people about the tremendous numbers of drugs and that are sent out that these people dont need. This is a huge issue in alabama. It gets back to where we started where i started with you. The overprescribing of medicine. If youd like to address that. Governor christie thats a large part of the diversion problem, right, so thats why weve advocated in the report and its happening in Good Partnership with the private sector as well, places like riteaid and wal greens, large pharmaceutical chains that are setting up kiosks in their stores for people to dispose of these unwanted or unused medicines. A lot of time is young man or young woman in their own, their parent gets the prescription for this they dont use it and say, heck, i might as well try this. Or worse they tech out and go to take out and go to sell it because theres value for this. The overprescription of this in every way impacts this crisis in an enorm out extent and thats people who overuse it themselves. Its people who are dont use it but dont know how to get rid of it safely. As a result it winds up hanging around and is available for diversion to either other users directly in their home or to being sold outside of the home. Mr. Palmer thank you. Governor christie i want to mention one other thing about the v. A. We took a field visit as a commission to the louis stokes Veterans Hospital in cleveland and they are doing some extraordinary things in lowering the opioid use by veterans with alternative therapies and other ways to deal with this issue with our vets. We urged in the report secretary shulkin expand that throughout all the veteran hospitals for the very reason you talked about. There are a lot of vets who know they dont want to take this stuff but are in real pain from the war wounds they suffered defending our country and they are coming up with alternatives that are really helping the veteran community in cleveland and we think will help the entire country. Mr. Palmer thank you, mr. Chairman. I yield back. Mr. Gowdy the gentleman from issouri is recognized. Thank you, mr. Christie, for our testimony today. Mr. Clay we still have work to do. We know that the a. C. A. s parody requirement which requires that Insurance Benefits for Mental Health care be comparable to those for physical health care. And i guess thats why you recommended that the d. O. L. Must have authority to investigate Insurance Companies. Let me quote the report. It says the Commission Found there are commercial insurance barriers to medicaid and assisted treatment despite the fact that such treatment is evidencebased. And largely successful. Would you agree that all insurers, both private and public, should work to remove barriers . Governor christie sure. Thats the law in the country. I mean, this is the frustrating thing. Congress passed the Mental Health and addiction parody act. But for reasons that are beyond me gave the executive branch no ability to enforce it. And so were i dont want to be, again, new jersey cynical, but were counting on the good will of the Insurance Industry to cover this treatment thats required but theres no penalty for not doing it. So my view is, as a former prosecutor, the law should be followed. If congress will and the president s will at that time was to make sure Mental Health and addiction is treated with parody, with physical ailments, then the law should be in force. Mr. Clay we should put more teeth in it. Governor christie you bet. We had secretary acosta at a hearing that we commissioned and he asked for this authority. He said, if you give me this authority i will use it. Chairman gowdy, i think, knows secretary acosta is former u. S. Attorney who served with me during the bush 43 administration. I know alex well and im convinced that somebody with his background, experience as a prosecutor in miami, on this issue, would be very, very aggressive if the tools were given to him and i urge congress to give him the tools. Mr. Clay thank you for that response. I represent the state of missouri, and im proud of a lot of things but one issue that im not that proud of is that we have a patchwork for a pdmp in missouri. It may go by county or city. Its not really statewide and its not effective. Talking to Law Enforcement in missouri, they tell me its really become a pill mill and an attraction for users as well as physicians who want to make profits off of that. Tell me how is missouri how do they compare to the rest of e nation as far as being a problem for Law Enforcement . Governor christie it pains me to say this to you but a its the worst state in the nation. [no audio] symptoms that might induce them to describe. If they go to the pdmp and see this patient has had a dozen, two dozen, three dozen from other doctors they can stop them. Ends the problem then. So missouri is a state that is the sole outlier on this issue and one that is damaging to the health and safety and welfare, in my view, of the people of missouri. Mr. Clay and i appreciate hearing that and i will make the effort with our legislature and governor to reinforce it and tell them how much we need to get our act together. Governor christie yes, sir. Mr. Clay final question is h. H. S. And c. M. S. Now get down to the tough work of implementing some of your commissions report and i understand they are calling for states to apply for waivers from the i. M. D. Exclusion. New jersey and utah just got a waiver approved, but as i nderstand it, c. M. S. Has insisted that waivers are budget neutral. So c. M. S. Are asking states to nd cuts elsewhere in underfunded Behavioral Health centers. To me that doesnt reflect the urgency of this epidemic. Can you talk to us about how new jersey dealt with it . Governor christie yeah. We are finding areas and this is part of i think of each governors responsibility is to find places within the Medicaid Program where spending is not being effective. And so i think its a good start. I think once we become convinced at the state level we have done what we need to do in terms of cost savings, that the administration has to make the next decision which is to lift budget neutrality requirements from it. You notice in our report we do not ask for waiver with budget neutrality. We just ask waiver of i. M. D. Exclusions. Thats our ultimate recommendation. I can tell you in new jersey that governing is about choosing. And i do believe that given the level of this crisis i can make the choices as governor that are necessary to make those beds available almost immediately but there will come a moment when youre cutting into bone and not fat. When that happens then i think the broader i. M. D. Exclusion is something without budget neutrality that needs to be considered by the administration. Mr. Clay thank you for your responses. My time is up. Mr. Gowdy the gentleman from kentucky is recognized. Thank you, chairman gowdy. And governor christie, thank you for being here today to discuss the growing crisis of Substance Abuse in our country. The Opioid Epidemic is of particular challenge for my state of kentucky where Overdose Deaths rose by 12. 5 last year alone. I appreciate your work as chairman of the president s commission on combating drug addiction and look forward to working together to make progress on this issue for all the American People. My first question is i would like to discuss the issue of fentanyl which covered for half of the Overdose Deaths in kentucky last year. Coveplcome can you mr. Comer can you discuss the commissions recommendations . Governor christie fentanyl and car fentanyl will take this crisis to the next geometric explosion because the strength of fentanyl and carfentanyl is so beyond normal street heroin that the first use of it can lead to death and often debts. Its so lethal that Law Enforcement officers who come to crime scenes have to be careful in terms of the way they deal because they dont contestimony nate themselves and end up overdosing. In our report we make it clear that this is a chinese problem and we have urged the president and the secretary of state to make this a priority with the chinese in the negotiations they are undergoing right now. China is where most of the fentanyl and carfentanyl is coming from. Sometimes more times than not we found and this is why we recommend an increase in border security, not just at the mexican border, but with the United States Postal Service. The United States Postal Service is delinquent in stopping these drugs. These drugs are being mailed in to the United States. And as are with the other carriers like fedex and u. P. S. And others. We are not having the level of enforcement we need. To your point before, congressman. This is one of those areas where i think we need to be able to step up our efforts. At the Postal Service and at d. O. J. Through the d. E. A. To make sure were stopping this stuff from coming into the country. But we also need to make clear to the chinese that this is an act of war. You are accepteding this into our country to kill our people. There is no other purpose for this drug. This drug will kill people. Any foreign country, in my view who is willfully allowing this to be done is committing an act of extraordinary aggression on our country and it needs to be medical right type of diplomatic response by the administration and the secretary of state and we urged hat in the report. Mr. Comer and i appreciate the report you did. A recent crackdown in the chinese manufacturers and look forward to working with the committee to see what more we can do through the internet and postal system to try to prevent that. My last legislation. Through legislation like the 21st century cures act, congress has provided more support and flexibility to the states who are on the front lines of this battle. From your experience as governor as well as your work on the commission, what advice do you have for congress on how best to support state and local efforts to combat Opioid Epidemic both now and over the long term . I know you mentioned the billion dollars didnt go very far. Divided up among the 50 states. As you know we are in a financial crisis as well in this country. What advice do you have for congress . Governor christie well, first off, i think if this battle is going to be won its going to be won with the federal government, State Government acting as partners. With the State Governments taking the lead. Were the ones who are on the ground. As you said, the problem in kentucky is different than the problem in new jersey. And the problem here in maryland is different than the problem in missouri. These are these are state circumstances, depending upon all the different ways you go about enforcement in your state, the ways you go about treatment in your state, availability. So our view is there should be accountability block grants. That block grants should be sent to the states for dealing with this crisis and that congress should be demanding accountability in return for the block grant. If im given a block grant as governor and i say in new jersey the best way for me to spend this money is x and it will show decrease in deaths, if i show that decrease in deaths, i should continue to get my funding. If i dont my funding should be reduced. Force me as a governor to be accountable for what im doing. With all due respect to congress, you know, its very difficult job to be able to determine individual programs that are necessary and effective in all 50 states. So we have to trust the governors. Because i dont believe this is a partisan issue, i dont think there is a republican or democratic way to combat this, so i think part of it will have to be a leap of faith between congress and governors. If congress is serious about doing this and the president , they need to sit down with the governors. They all come to washington in february. I wont be there but the rest of them will be. And the fact is that we need to sit down and say, listen to the governors as to what they need and Congress Needs to make demands on governors and say, ok, if we are going to be your partner and help you fund this, then what Accountability Measures are you willing to give us so that we can be accountable in the financial situation were in that this money is being spent in a way thats effective to save lives . That should be the determining factor. If that number, that 64,000 continues to go up, we are failing. When it starts to go down, were succeeding. Mr. Comer thank you, governor. I yield back. Mr. Gowdy i have not gone yet either. Share this with my colleagues. We want to be a good steward of the governors time and a good steward of the next panels time so to the extent we can get it done before the red light comes on that would be great for everyone. And with that i would recognize my friend from michigan, mrs. Lawrence. Mrs. Lawrence thank you, mr. Chairman and Ranking Member cummings and thank you, governor, for being here. You know there is a saying in government if you want to know my priorities follow my budget. Many of the organizations receiving funding through the community Mental Health block grant through the Substance Abuse and Mental Health services, and these fundings provide the wraparound services. Were talking about the access to the drug, but those of us in this room and those who have been on the ground with this know putting those services to transition and nurture a person out of addiction back to a healthy life, training, rehabilitation, case management, comes through the Substance Abuse and Mental Health services. Unfortunately the house appropriation bill which we will vote on this month proposes cutting funding for the block grant by is 41 million. 141 million. In our president s budget, proposed cutting it by 116 million. Now, the commission and i read your report. Thank you for it. But you strongly recommend and urge congress to do their constitutionally delegated duty and appropriate sufficient funds. It is being in congress being a former mayor and being in local government, sir, being held accountable for my budget my budgetary decisions, i am complex how we can have this commission you being appointed, doing all this work, but yet we do in our budget would just cut the legs from under this program. I need you to know, in your leadership and in your recommendation to this bipartisan body, this agenda of this budget that cuts the thing that were saying that we are so passionate about, we have statistics, i wanted to say in michigan we have enough drugs, like you said, in the United States to give every person in the state of michigan 1. 8 prescriptions 1. 1 prescription which is 84 opioid pills for every resident in my state. Thats how many prescriptions we write. So but if we really want to make a difference, if they live, we want to get them off it. So i need you to comment on that. Governor christie listen, i think were very clear in the report. We believe there needs to be a greater financial commitment at all levels of government to this problem. Now, you know, the fact is there are lots of other things we can do as well and should be doing that wont cost us anything. So increase medical education. Increase requirements of continuing medical education for d. E. A. Licensees. There are a lot of Different Things that dont. Please, what we said in the report we mean which is that we do not sufficiently fund these programs now and we also recommend in the report that there needs to be an evaluation of all the different programs. You just mentioned one of them. And there are literally dozens and dozens of programs we looked at that are being funded. How effective are they . I can tell you g. A. O. Did two reports during the Obama Administration but said these programs are not being effective in stemming the tide. We know that from the sign behind you is the number of deaths. I think there are a couple things that need to be done. One is to us to hold ourselves accountable for all the good ideas we had in the past. Some of them are good. Maybe some of them werent. Lets reevaluate and reassign that money to places we think can be effective. And then theres going to have to be additional funds given. We made that very clear. I made it clear to the president in my direct conversations with him and every member of congress who asked me about this i said, there is no avoiding having to increase funding to deal with this problem. The question is how and you guys can make that call. Mr. Lawrence mr. Governor, to the panel, we often hear the thing of repeal and replace the Affordable Care act, and i equate that having a cadillac and you dont change the oil or you dont rotate the tires and then when the car doesnt operate you say that the car is ineffect inefficient and you just throw it away. The Affordable Care act provides essential Health Benefit services that actually directly go to the Mental Health parody part but all we talk about is repeal and replace and i dont know if youre comfortable talking about this but i am very comfortable. It is a time for us to have real discussion on this. We talk about the lives that were losing and we are so compassionate and our hearts break when we read the obituaries but we must do the work and i want to be that voice in the room while were talking about this that action that needs to be taken needs to happen. Its not good enough to get a commission together and write an excellent report if you dont fund it. If you dont look at the Affordable Care act that had all those essential services that were saying eliminates, how will we get to where we need to go . Thank you so much. My red light is on. [applause] governor christie one thing i would just quickly respond to that, say to you is, we need to remember that no matter my position on the Affordable Care act has being clear over time. I wont get into all that. Will tell you this, the Affordable Care act ensures a fraction insures a fraction of the number of people that insurance insures and yet congress is not permitting Mental Health and parody to be enforced for them. The fact is we have tens of millions of americans who work hard every day and are able to obtain Health Insurance through their employer and pay for a good part of that as well and theyre not getting the benefit of the law and parody either and so i dont think its just the Affordable Health care act. We are not enforcing that as to the Affordable Health care act. You can continue to watch this House Oversight field hearing on the opioid ep epidemic on our website cspan. Org. We will go to the floor of the house of representatives. 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