Transcripts For CSPAN2 Panel Discussion On The Opioid Epidemic 20170901

Withstood the issues of traduce and going through the a Opioid Crisis the key to remember is in the midst of this crisis and in the midst of the burgeoning number of individuals who are dying as a direct result of using opioid this still represents a comparative drop in the bucket with 50,000 lives lost last year due to opioid is a small number however compare that to the 80,000 lives lost due to the alcohol and 500,000 lives lost due to cigarettes the leading cause of death people with addictive dizzies of recovery is a smokingrelated illness so the major issue is tobacco the second most significant remains alcohol. The Media Attention to the Opioid Crisis is waterfall to abri attention to addictive disease but remember there are 3747 per day crashing and the media is focused on a car crash. We need every chance we get were also paying attention to the 747 full of people and we dont just look at the car crash. Coming back to the 50,000 lives lost due to opioid lets figure out where that comes from so we have a panel today we all have about 10 minutes i will take as little time as possible but i want to set the stage the Opioid Crisis rose out of a perfect storm that three things went wrong. First, doctors for many years were reluctant to prescribe because they didnt want to see people get addicted but they were told by a large to the pharmaceutical industry these are the long acting opiates that work well to treat patients with pain. Never mind the fact there is no literature to indicate opioid provide adequate treatment. They dont work there is no literature that says that they do. But the initial reaction is that makes me feel better. So when people feel that way they come back and ask for more and the doctor says it is working. If they are turned down the patient is dissatisfied that is part to of the perfect storm. At the same time, we have physicians and medical facilities being told the way they would do well over be certified to get a gold star is to make sure that patients were satisfied. The patient said that 30 worked well i want dirty war 80 tell the patient now you already had a one month supply is the patient satisfied . No. So they would leave a black mark instead of a gold star so we ended up with thousands of individuals taking opiates for a condition of which opioid are not indicated. We need to stop that. Doctors were reeducated programs giving out opioid like m ms were closed down so what happened to all of those individuals that were taking opiates every day who could no longer get them from their family physician and . They went to the street. When they went to the street what they found was part three of the perfect storm that the United States turned from importing marijuana to exporting marijuana because apparently we grow good marijuana. Because of at handed it is increasingly accepted we at an abundance of the plant we send hours across the border the department of justice pointed out these folks who sold us the marijuana need other centers of profit and so to accomplish that they send us cheap heroin that the exact time our patience could no longer obtain prescription narcotics from that will meld they would go to now they go to the streets with cheap pure heroin or you even get fentanyl if you dont die. These were the three steps the broadest to the point where were at now. As we have been educating his community and have seen a drop some of the ec that equal if not greater increase in the use of street opioid like heroin. Leer not even close to stopping this crisis i dont think we will be at that point and tell the country recognizes Addictive Diseases is Addictive Diseases independent of drugs if it encourages the use of chemistry that is killing tens of thousands of people and in that context say we still love deducted addictive drugs. The of the Deputy Director and dr. Clark and the oxford house our reach greater . And that Clinical Psychology professor and afford to hear from the panel today i apologize they only have 10 minutes to cram in that information. [applause] it is a pleasure to be here i have been a fan of oxford house for many years. And we had a new opera house back in the 90s. Cannot desk criminate and to be a little bit of an expert in the of field and i was so pleased that day succeeded that is my personal connection and i saw them and that is one of the themes we have this fantasy those treatment problems is a wonderful beginning to turn the of life around is a longterm process taking months or years to Reenter Society for those memories beginning to fade to be minimized for social activities for work and family the way they occupied mental that is why it plays such a key role in recovery. How we need to Pay Attention to the process to address the underlying issue. Which is addiction in so many people. Our job is to bring science to the Health Problems so how can that bring the solution . We certainly now plays a role of this destructive power of the opioids. We have noticed that is part of the reason it generated that addiction is somebody elses issue. So death is the number one reason but it is also infectious disease. It is complete the driven so now makes it harder to snort. So then they injected it regularly and has a half life. 4 of the community was eventually infected by hiv. Not just of a high risk group, but the entire community. It was quite astounding. We have deaths, infections, to add further its not just opiates, its a combination of opiates with other sedatives. We know whats killing people is not just the harrowing, phenolic Prescription Drugs, the combination was sedative agents. Its medical combination so some of my colleagues are helping to feel this by supplying both the opiates and the sedatives that help causes. Also leo nadel absence syndrome. Babies that are exposed in your notin utero during pregnancy art high risk. I visited charleston, West Virginia with hospitals, one in ten babies, that means every day they were seen babies who are suffering from opiate withdrawal when their board. Fortunately we have reasonable treatments and ways to help, but its an indication that natalie that baby might have difficulty but the family needs help. We been paying attention to babies but what can we do to mobs to help them get the recovery that you have found in c. Thats enough about the background, what are we trying to do about this . I would love to say that we have the solution. Unfortunately the data dont suggest that. It suggests a number of people dying of overdose increases. First the prescription pills, i would suggest as economic forces. We say illegal marketing practices by pharmaceutical as one example that engage in egregious practices to promote these products and then it meant so many millions of people were exposed in misusing them, then a number become addictive that have deadly outcomes. The other economics is for heroin. Heroin is remarkable product. Were seen new distribution routes. I mentioned i lived in st. Louis. When i was there and working in the addiction field in the 90s we didnt have much of a heroin problem, thats not true in the last 15 years. Because there are so many people taken the pill and misusing them, there is a recognition that theres an untapped market for a cheaper, regularly available opiate that could be sold on the street thats what heroin represents, so, snow in cities like st. Louis the date used to have a problem. Fat now has had two lives, we sought in an outbreak in the mid to thousands for theres another number of deaths in philadelphia, chicago and other areas all brought about by one site that manufactures that no illegally. When that was set close down, the outbreak pretty much disappeared, there are now tens of thousands of companies that manufacture fentanyl in china. It was illegal to manufacture fentanyl up until early march. Our state department and others have been helping to change that. So we get cooperation to reduce the flow. We have a ways to go. It is 50 times more important than heroin. One grand, tiny amount is like 50 grams of heroin. That means it can be shipped in the mail, it can be shipped in commercial carriers. Thats a fancy way of saying fedex, and other ways to ship packages across borders. Shipped directly to the states, canada and mexico, the wall street journal, theyre all about business reminded us this is a business. The raw products cost about 1000 of fentanyl can be sold on the streets for about 1 million. Thats a big profit margin. That motivates a lot of behavior. As much as we can focus on the supply we better do something to help people with recovery. I want to end by emphasizing our department of health and Human Services and the federal government under doctor prices leadership has laid out five main priorities. New approaches to pain. The key driver, can we do a better job to treat pain . Yes we can. The second approach will be improving prevention, treatment and recovery services. What can we do to focus on the reit process and eliminating it. Can we save lives more readily by providing the antidote . I wonder how many oxford houses has locked so in their facilities. I hope most of them do. Its not that their residents might have a problem, but youre going to know people that you. You will have friends that have an overdose. Having this medication available is a key part of saving lives so people can then make those gradual steps towards recovery. The fourth is to improve our data. We talked about how many deaths in the u. S. From the overdose, my latest data from 2015, we are now september 2017, 20 think we could have numbers from 2016 by now . We like to speed up the process. Im pleased to see that research is being supported. Im thrilled with the treatments we have in the Recovery Support services we have, we need more, we need to know how to implement them as efficiently and effectively as possible. Im kinda pleased with the medications we have for treating harry one and opiate use in general. But they dont help everybody. Many people fail who are on these medications. Can we do a better job . Thats what i hope our research and how we can treat them better will lead us to. Some transformations that we dont have to see so many tens of thousands of people dying every year. Thank you. [applause] thank you doctor, will move on to doctor clark. [applause] thank you, it is a pleasure to be here again. It has been a long time, last year. I appreciate this audience and will be talking again laters and i dont have slides perhaps lights later. Both the doctors addressed a host of issues associated with the epidemic that we have been discussing. I want to take a different perspective and point out there is an issue called the social determinants of health that gets forgotten. Also the issue of how do we adequately treat pain. And we made reference to that earlier. Thats a large issue, indeed it affects peoples desire to use opiates. We brought in a host of new individuals who previously were not using opiates. Keep in mind, we have 60. 9 Million People 55 my people who are cigarette smokers, 22 million who are marijuana users, 4. 3 million who misuse pain relievers. Not the largest of individuals. So Doctors Point was well taken, we have to deal with the fact that our society embraces this use. How it should be administered, what we should do, thats another matter. With regard to Prescription Drug, we have according to the data sensibly within the next two weeks we will hear 2016 data. There are 97. 5 million past year user a pain relievers but only 20. 2. 8 admitted to misuse. We have to deal with the issue, anybody here have pain . Anybody here want to enjoy that pain . So, there are people, psychiatrist you made all sorts of individuals i dont want to dismiss her idiosyncrasies but if we dont deal with it issue of managing chronic pain then we are not going to deal with this issue. I know the institute has a working group trying to come up with non psychoactive substance that will help treat pain and i know the cdc has come up with guidelines to treat pain. The fact is, we dont know how to treat chronic noncancer pain adequately. People say take motrin. Motrin hurts if you take too much of it. They say take tylenol or acetaminophen. While acetaminophen hurts if you take too much of it. So im not a proponent of the opiates, i cant stand the things, but the fact is, im also not a proponent of people suffering. There seems to be a mistrust and distrust of consumers. The pills work for responsible consumers, you show up and say i have a pain and they give you all the pills in the world. Thats not a responsible consumer or prescriber. Theres mistrust and distrust in but my fears if we go from one end of the pendulum to the other and single out the consumer is the bad guy. We have Prescription Drug monitoring programs and people want access, they want to pitch on registry they want access to information, they want all of they can get from you. So there vilifying the consumers is not a solution. We have people who are exploiting the vulnerable, doctor made reference to indiana and it was a matter of opiates in a matter of also matter methamphetamines. Looked at the jail records of who is being arrested for what. , bunch of folks were being arrested for methamphetamines. They were inches snorting and injecting the heroine, anybody know about the way you do that, the, you inject the combo. The fact is, when we start focusing on one substance alone as doctor was pointing out, we ignore the larger issue. If people are being abused physically or psychologically if they have no solutions, then they tend to use whatever makes them feel better. We need solutions. I see an arthur how some of the solutions, you may have seen from your materials things like accountability, responsibility, integrity, honesty, community, support, respect, these are things that make for good dr. Patient relationship. Employers are mindful and respectful of employees, not let me see if i can get the next 26 hours out of you. You look at mineworkers, they dont have cancer pain, but there hunched over for years they come out all the have is pain. And there were surprised that they use opiates. Has anybody ever worked in factory . I do when i was in college. After eight hours my my9 my mind was non. I asked, can i do this every day of the week they said theyre interested in the assembly line, not me. So my points use, we need to offer some solutions. Solutions in the principles, the patient needs to be responsible and accountable. So does the doctor, the hospital, the drug company, the system needs to be accountable. Honestly, the dr. Needs to tell the patients about them. [applause] if you need physical therapy, you should really get physical therapy because i was another problem, there given out pills instead of alternative solutions. Will it cost a hundred dollars the pill plus 5, what you think the Insurance Company is going to do. So i wind up with the notion of gratitude because the principles function well if our Larger Community adopts those, that way when someone is backsliding initially the locks on in your facility because people do crash and burn. Its not a perfect disease. And the efforts are not always flawless. But, if you have an environment where peoples support, opportunities and people know that if they follow they have recovery on the horizon, then, i think we can deal with chronic pain if we havent on a society that recognize that we put people in building environments and they need relief but not necessarily drugged, so your principles should inc. The larger thing morgan and do is not another pill necessarily, not another big brother Surveillance System but a society that treats each other with respect and dignity and holds people to accountability and responsibility than we have our solution. [applause] good morning. Have some bad news, i have a powerpoint. I dont have a prompter so be looking over here i present. Im with Harry S Truman college of chicago. Osha had my glasses, going to be squinting and looking at my notes. Please bear with me. When i think about what constituted a crisis thing about the prevalence rate and i have to go into more detail on the statistics or data discussed, this comes they have some data on the National Survey of drug use and health, data that was presented about one year ago today reflecting 2015 data. I have slides, i will be terribly technical theres a lot of drug use going on. Its for a comprehensive report to classify psychotherapeutic drugs into four categories. Prescription drugs that are paying killers known as an ugl angela takes. And the sedatives typically use to help us go to sleep. If you look at the chart, and surprising, almost 45 people in the United States are estimated for using these, and you might be thinking this is an epidemic, maybe they dont use on as some of them in attendance, they throw them away or they take a mess prescribed. The issue here is misuse of Prescription Drugs. Only 7 of folks in the United States are estimated for misusing their Prescription Drugs. Those frequently misused, pain relievers. It doesnt get better. When you look at people who use other drugs, alcohol included, tobacco, stimulants, folks who use heroin have a High Frequency of misusing Prescription Drugs. Which of the four categories do they tend to misuse more . Painkillers. At about the same right. Theres a lot of drug use going on the terms of meeting criteria for an opiate use disorder in the very top is alcohol they were talking about opiates, you can see its like. 6, that translates to about 591,000 people meeting diagnostic criteria by the way of heroin but whats more alarming, three times the rate more for other opiates. Thats what im gonna be focusing today. Theres all kinds of opiate use, we focus a lot on heroine, but a lot is going on with other things thats been misuse. This shows initiation of drug use. People might be starting with Prescription Drugs must be painkillers. So that probably explains the use of these drugs. One introduced data that was produced a few years ago when some researchers gave testimony to the United States senate focusing on americas addiction to heroin and Prescription Drugs. She presented compelling scary data, the chart shows the increase in Prescription Drugs that have been assigned in the past 20 years or so. Thats in the millions. I dont have my glasses on, think its about 74 million prescriptions in about 20 years later its about triple. You see a red and green line corresponding to specific drugs that were prescribed. This is a serious problem. This graph seems complicated but from the 2,922,011 they showed a trend of drug use across four opiates, think one categories oxycontin, and then heroine, now, this refers to the percentage of people who reported they use these opiates to get high in the past 30 days. About 10 of people that were surveyed said they used her want to get high and the just about 50 or more reporting there using Prescription Drugs there changes going from the left to the right, talk about trends of drug use. Doctor says in her interpretation of the data and i quote, the emergence of chemical tolerance perhaps combined in a smaller number of cases with increasing difficulty of obtaining them illegally may explain the transition to the abuse of heroin which is cheaper and easier to attain the drugs. Theyre getting a hold of the drugs, its hard to come by so lets go to the communities and get the dont because its cheaper. But when i read it, something stuck out, first, chemical tolerance to prescribed opiates, have you ever once heard anybody talked about the chemical tolerance toward heroine . Other things that speak out, things like perhaps in a smaller number of cases. In other words shes very smart, we have to be very careful when we interpret data. We have to be cautious with the language but she makes a point that there leading to a transition to abuse data suggest people are using Prescription Drugs and lead some to using heroin and then they overdose. It shows trends over time, but nowhere in the report and research we talk about statistics, we find something significant that means we need to do something other than chance. Its not a chance occurrence. It often has something to do with the evidence were looking at. When i look at the chart this shows normal trends across time. No rhyme or reason for changes the frequency. Ive highlighted two sets of data points that suggest and support the notion of a switch from prescription to heroin. If you look at the graph toward the bottom you see from one point theres a slight increase in heroin use. That corresponds to the other lines above it. Decreases in opiates, we see that in the second highlighted column to the right. People are increasing their heroin use because there getting less access or decreasing Prescription Drugs. Thats interesting. The dr. Also says, and if you read this on the website, that heroin abuse like opiate abuse is dangerous because of the addictiveness and the high risk of overdosing. She is saying, Prescription Drug abuse and heroin abuse are highly addictive. But then we read, in the case of heroin, and now the danger is compounded by the lack of the purity and its possible contamination of other drugs. We know in recent years there mixing the dose with federal and people are dropping left and right. But when i read this, say im a u. S. Senator im not used to looking at research, i want to walk around with the idea that heroin resource for you. But, what about the person dangers of prescription opiates, that doesnt seem to ring loud to me when i Read Research articles. Something as researchers we need to do. Researchers were behind the curve, but we need to be accountable for some of the dangers of the epidemic, i want to draw your attention over to the graph, there are at least seven points to look at where you can draw conclusions, the only basis i can see that supports a claim of a switch from Prescription Drug used to heroin are the two a shoji. But look at other sets, it shows when people increase heroin there increasing their prescription opiate use. There are three data points that show the opposite effect, you can draw the conclusion that the Prescription Drugs are plentiful and because of that ill reduce my heroin use. So researchers need to be careful in interpreting data points. If you look at the screen again, look at the goldline, it shows the increase in heroin overdoses by 50 in the ten year time, thats alarming. We definitely have a problem. So, sorry dont have my glasses in conclusion you can see it that were seen people dying from overdoses. So researchers are coming around and starting to see the stuff. The disturbing trend is associated with the growing number of prescriptions in the market, prescription opiates like other medications present health risk, but there are also clinical allies. Clinical allies . Thats interesting. One thing and the testimony is over 13000 people died from opiate drugs, but its not considered an overdose. Is referred to as an unintentional death. If you have died by heroin its an overdose but by prescription opiates its an unintentional death. These drugs are clinical allies and we need to be careful, i think theres something to it, remember the first chart i showed you, what people are using the drugs and they dont have a problem. Theyre not that 7 who abuse them. Even if we go with the we know more prescriptions are going out you might make the argument that this might be the gateway that, maybe over time people will become more addicted. What about people in 12 Step Recovery . Its interesting about giving them a Prescription Drug for any reason because they tend to misuse prescribed drugs. People i know this is where the experience come in, i know a lot of people in 12 Step Recovery. Their pain is real, some researchers say Pain Management is also important for people who have opiate use disorder or other types of addictive disorders, it bothers me that i know some people with clinicians that would drugs seek to examine pain, how would we just english whats legit and whats not, what disturbs me is my friends go see doctors and sam a recovering addict i dont need anything that will alter my move. Their physicians are telling them, this is not narcotic, its not addictive. Its a muscle relaxant. They say i felt like i was high. They need to be careful not to say this is not narcotic, the me talk about diversion, diversion is the act of sharing, selling or illicitly using substances. Its not just misuse of prescribed drug talk about getting drugs on the black Market Selling them, not just using them against doctors orders. Three drugs have been of interest to researchers, medication assisted treatment drugs. Drugs used to help people get off opiates. Methadone, in a to others. One study found that those who received methadone, those taking were twice more likely to engage in diversion practices. Another study found theres an increased risk of overdose among people in diversion practice. Its not like its lethal overdose, you think about its like playing russian roulette without spinning the chamber. One of the most disturbing reports i read from the people who engage in diversion practices again medication treatment types of medications feel this is positive and limited geordie said they were morally right to do so and they could do so without getting detected. Last week, death rates will try to wrap this up as soon as i can. Thank you for the indulgence. This chart came out from a colleague theres two lines, broken line, the bottom line showing trend in lethal overdoses due to methadone. The top lethal overdoses in relation to prescribed medications but they dont describe what theyre talking about. This is alarming. We go from the bottom line terms of methadone 1999 to 784 deaths by 2014 it gets up to three or 400. Some people say around 2007 and 2008 regulations to decrease the rate of that there saying were showing decreases in the death rates of methadone. In a two or three year time. But when you look over 15 years this like getting a 6inch dagger in some respect, pointed out 1 inch and saying hey, we made a difference. [applause] know when it comes to the other opiates its off the hook. Were talking about i cant read the numbers, 14000, 838 over 14 years, its only a 300 increase not 400 , but the numbers are high. Look at the highlighted 2010, those rates are comparable with what the dr. Presented. Theres consistency looking at this epidemic when you look at the numbers for this report may see a lot of deaths due to opiates, not just the heroin. Methadone sure, its use for Pain Management, sees morris a medication to treatment. At the numbers, never looking about 18000 people dying, this is 2014. Who take heroin out of the equation thats a huge number. Or people are dying now from heroin, but by prescribed opiate medications. One more study, one year later hear the rates in austria the rates of heroin overdoses and prescription opiates not including methadone. It went up by 25 in one year and by over 30 for prescription opiates. So this is whats going on. We turn on the tv over People Magazine is a harrowing crisis. No mention of how people are dropping like flies due to prescribed opiates not for pain but for opiate use disorders. A good friend of mine, andy chapman i explained what i was presenting, the first thing out of his mind, is not an epidemic, is a normal person like most of us, he says john, you have the data, why are you reporting the death rates of people on these prescribed drugs . That remains to be seen. In conclusion, theres a greater access to a greater use of opiates particularly opiate medications. Medications used to treat this problem are being misused and diverted death rates continue to increase, but we continue to promote the medications. Im not a real dr. Like doctor get low. But in my crowd is a code of ethics but we need to cut that site if i went along with the idea that these therapies are really beneficial and im not a believer, but lets just say for the sake of argument these things to provide benefit, we must embrace it with not doing harm. I know theres a harm, the numbers dont lie. People are dying from the medications were prescribing them. Silence equals death and we need to talk about this in us researchers need to be more accountable about how the medications show risk and death, show harm. If we have that we might be in a better position. Lastly those who are taking Dietary Supplements might say this could cause harm. It pales in comparison to the harm that we know is going on with the use of prescription medication. Thats all i have. Thank you for your indulgence. [applause] good morning everybody my name is lori, the regional manager in louisiana, mississippi. [applause] i am not a dr. , nor researcher, but what im going to speak to you about today is my experien experience, said doctor clark mentioned something about we need a solution. What i believe is that the solution start right here. With everybody in this room. [applause] theres a little saying, be the change that you want to see in the world. That is what i strive to do every day. I strive to be the change that i want to see in the world of the people that i love the most witches alcoholic and addicts. People were trying hard to change their life. So, i am an opiate addict, i was addicted to prescription medication, and then i had also been on medically assisted treatment which did not work for me, im not saying it doesnt work for anybody just not work for me. My addiction brought me to homelessness and incarceration. I lost anything everything. Probably to incomprehensible i was unable to make decisions, i cannot put two thoughts together. My purse for several months of recovery i spent in jail and when i got a jail is very fortunate to move into an oxford house. So, one of the things ive learned over the last ten years is to be openminded to different forms of recovery. Thats were changes coming in. Theres all 12 Step Recovery is not the only recovery out there. Theres different recovery out there one of the things i want to focus on todays for us as individuals and not as a whole to focus on other ways and paths to recovery. They have this new thing called refuge recovery have you heard of that . And then i have smart recovery which is also a newer form of recovery, the 12 step program, faithbased programs and then the medically assisted treatment. All of those, those are just some of them, but all those forms of recovery can all lead to the same result. And thats abstinence from any drug thats out there. Another thing, i want to speak to you as individuals, like give yourself the time and oxford house. I lived here for seven years, i know thats a really long time. But i know me, and you know you and you know that its going to take more than three, six, nine, one year of recovery for you to change and stay sober for the rest of your life. I took that time for me. It was important. I made sure i was stable i wasnt moving in with somebody that i can make everything work for myself. Its one of the biggest things we focus on is being selfsupporting, not just for your acts o oxford house, thats for you to be selfsupporting and selfsustaining and not depend on the system to take care of you. Those things are there to help you and im going to close with this, the other part of his giving back one of the biggest ways that i gave back before i started working i did for which is opening houses, its one of the most rewarding things you can ever do is provide six, eight, ten beds for people that need it. We have 110 houses in louisiana and 20 mississippi and those are the houses im a direct regional manager over. [applause] we dont have a lot of staff down there, so we depend on the people that live in the houses to open them make sure they get the furniture and stuff like that, but it gives you a sense of purpose. We have to have a sense of purpose to stay sober. We can just work all the time and not have something that is going to give us a sense that were changing the world. So a chill to take this back to houses into the chapters and stuff like that. You can make a difference in the opiate crisis today, you can be an example to your best friend that still out there, your sister, your mother, your child all of these people, everybodys different but i know that we can be an example of what recovery looks like. And all that comes from within and be in the change that you want to see in the world. Thank you. [applause] how are you doing . What is a family . A lot of people poured their heart out and do me a favor, part of the thing would be cool if you just did one thing and take ten seconds, take a deep breath, let that out, and be grateful. [applause] be grateful that we made it. Call them graphs and stuff, that gets me depressed i would like to see a graph on you. You, everyone in this room is 100 successful today. [applause] 100 . I know im saying this but the little thing on the pill bottle that says alcohol may intensify this effect, do not operate machinery, anyway, ill get past the, was chilling me appear because as were talking about a perfect storm, what created a perfect storm of opiate disasters whats going on. Its not just opiates, alcohol has been a disaster for thousands of years. But, the world population, the population of the world with simple math doubles every 25 years. Twentyfive years ago we had three points on billing people, now we have you better buy some real estate. The world populations doubles which means the problems double. Thats scary. So everybody is here has put together a lot of work to get here. A lot of people put together work to put this on. For 42 years oxenford house has put together a lot of work to make sure everybody here has a house to go to, a safe place, a system of operations, theres been untold volunteers house president s and secretaries, all that for 42 years im thinking it dawned on me, we have been creating the perfect storm to combat this this is the perfect storm to move forward that democratically run system of operations that catch and everybody. This is a great solution on the planet in your part of that. Give yourself around of applause for that one of the reasons, i could qualify myself, you see these beautiful cities, Portland Oregon is a beautiful city, is anybody here from the . I ran the streets when i was coherent, portland, oregon changes after about 10 00 p. M. Its a different city. Most people dont see. All the things going on, and i saw a little bit when we had our convention there, going down the parks if you look in the corners and the shadows its there and it comes out after 10 00 p. M. Its a different world so, its always been there and i guess theres a famous saying, when the student is ready the teacher will appear, theres also good recovery in portland, oregon weve all been in the shadows so its always been there, the opiate crisis i was the product of the opiate crisis of alcohol may intensify this effect. I was a product of that the entire 80s, many jails and institutions. I wasnt quite in my family a few of my family spend the ones they gave up on. How cool is that that where the hardest cases and we are here together working together, thats amazing. I would love to see a graph on that. The cool thing about oxford houses that we are different in that we motivate, we hold each other accountable there saying you need someone who is the house manager, you given at a canon alcoholic of some authority to ever have a piece of that, there like thats a mess. So we do this, we vote who comes in and who goes out, to motivate and support of oxford house has been unparalleled and yes we have accountability and some consequences if you dont pay your rent you will live here. But the power of the group has been exponential in my recovery. We were just giggling about that. We might get in trouble later but we were giggling you know we are the kind of people that you know someone says johnny, johnny overdosed. And he got that from tackle. And we would like will where is because thats not going to happen to me that is the duties we have we immediately want to know where he is. That is crazy it is craziness you know, one foot in the grave constantly. And everyone is giggling because they know exactly what im talking about. [laughter] yeah and what i have learned has been the most valuable thing in my recovery is that i should never ever say anymore, i got this. I got it you know . I aint got nothing. I aint got nothing what i say now is, we got this. We got this right . We going to do this together. I will end with this and then i will shut up. I do not have graphs and things like that. Im so grateful every time my butt wakes up in the morning and i am not in jail. I got a license with my picture on it. I got a credit card with my name on it. Its awesome [applause] people move in is like smoking cigarettes. People want to quit, they do not want that but they just, it is so familiar. That they keep going and keep going. I smoked for 32 years. Camel filters. Do you think that they would buy me a hat . No [laughter] that is a lot of money man so moving into oxford house, moving in with our family, we do this together. I look at you now. Im looking at the perfect storm. The perfect storm. The only way we are going to move forward, when you give a person the option to succeed or die, youre probably going to succeed. If those are the only two options. In i have a story. In 1519, cortez took his plunder. Over to the yucatc and the soldiers were that is a long ocean hide from wherever cortez lived. And the warriors, they were like we are tired. And he said get off the ship and burn your boats. Burn the boats. You dont have an option. You have no back door. The only way we are going to do this together, if we all burn our boats. We have got no other option. We dont have a back door. Weve got to move forward and we have got to do it together. That is what i got for you man. Thank god you are here [applause] we have more coming up and wiggling a couple of minutes over. I would like to take a moment to point out, we are talking about two things. The importance of recognizing our strength blends with one another and we have a perfect storm. A perfect storm in houston, i do want all of us to keep in mind the fact that our folks down in houston, our peers in houston do not have the ability right now to rely on their group the way they have been. Right . Their access to their peers, their access to their groups, access to methadone or whatever they are taking, all has been cut off. For many of them. So our hearts and thoughts go out to all of our peers in houston. Were going to open our doors so we can help them out the best we can. [applause] hi you guys. Im going to change everything i was going to do. And that is what we do. [laughter] i want to thank all of you for inviting me today. And those of you who did because i feel this is my personal withdrawal program. I just retired one month ago for 30 years at my job. And [applause] you are so nice to invite me back and keep going although i am no longer the Substance Abuse director. But whats great about this panel is that these are the people that are part of the solution. Doctor clark, almost 15 years ago he called me up to the meeting and said there is a spike in methadone deaths and something is happening around the Appalachian Mountains and you are one of the states that better get up here. And we met with medical examiners and Health People and treatment people, to try to figure out what was going on. It was just the beginning of the tip of this iceberg. And so, a lot of us have been trying to work on figuring this problem out for quite a while. It is a very big problem. Also it takes our researchers and my state would not be anywhere without them helping us with no signs and it takes the integration medical leadership and what we were doing because it was gone for a while. Now we have physicians and other Health Practitioners that are really helping us. I am proud to say that i just checked with kathleen and it is not bad that she was in North Carolina but we dont care. One her and we are keeping her. We have 239 houses as of today. That means we started [applause] we started doing this houses the day paul was talking about, the requirement went in the grant for we are one of the states that has a Revolving Loan fund and i say we keep adding money to it but thats okay. [laughter] it means we are opening more and more houses. But i want to talk about how oxford house is part of the solution. Particularly in our state and i hope it will be true in other states. Like kathleen and tony are in the advisory council. Curtis was actually appointed by our secretary to our opioid study task force. He was representing not only oxford house but the voice of recovery. Actually, work 11 the issue of stigma and the biggest part of stigma happened to be trying to talk to treatment providers. That is a particular problem of our field where we have a lot of different beliefs. And behold them very strongly. But we do have to learn to work together. I really appreciate what oxford house has done particularly in the last two years for leadership at the state level on all of our groups. Our chief justice who was the appointee of the group, now our attorney general has taken it up. A big deal for state to try to figure out how to improve the health of their citizens. And our governor, Governor Cooper is now on the opioid task force. So we will be working hard to implement some of our strategic plans. I like what paul said this morning. One thing thats really important about organizations at oxford house is one of those important things, you have to have a story. There has to be a story and there has to be a leader. And everyone has to hear the story over and over again. That is how you build momentum. I think oxford house is one of those great organizations. I also say what oxford house is done North Carolina to respond to the needs of our state. We have homes for women and children, homes for reentry, homes for veterans, our newest homes are on college campuses. Their recovery homes. And we are looking forward to oxford house being continuing to be part of the solution on the Opioid Crisis. And it is an issue with medication and oxford house and i think you all are working on it. I know your position is that each house decides for itself what the state needs to do or know or referring agency. Which houses can accept someone like that which they cannot. And what are you doing to improve of your education to be watching for the signs and symptoms . There are overdoses and houses. We have had a number of those last year in North Carolina. Infectious disease, i read a story last week about increasing amount of syphilis in places where it had been thought to have been completely eradicated. But it is from the needle sharing behavior. So a lot of challenges for you all and houses. Not to mention that as we get medication assistance treatment, it is a new kind of provider that might be people that do not know about this. You know for a Primary Care Clinic to talk about oxford house they do not talk about peoples housing. They should because it has to be everybodys issue. Food, shelter and a meaningful life. But that is a new group for you to talk to. I also want to introduce Robert Morrison who is right there. Raise your hand. Rob is the executive director of the association of state alcohol and drug authorities. And until 30 days ago i was the but now i am nothing. [laughter] but im glad rob is here because when i was asked to do the panel the first person i called was rob and i said okay, where is my most recent report on respondents opioid issue . And they have reports. And that is what they track. And that is what they provide assistance with. Between providing direct handson assistance to the state to implement something, which you have to help us do, there is a lot of money out there that they just put out that congress provided through the cures act. It is almost too much money to be absorbed quickly. So we have a lot of ideas. It would be a terrible happening if the money gets out there and nothing changes. But nothing changes on the grass, more people are being arrested than ever. Which is one of our most Typical Solutions for this kind of problem. We have to make it work and we need you to work with us like our oxford house in North Carolina does. To make it happen and ive got to do all of these other pages. That i am not going to talk about but i do want to say that you are the solution. What you all said is true. The first oxford house conference i came to was in new orleans where i got the shingles on texas, i forget where it was. But i thought, ive never seen all these people in recovery in one place in my life. But it was a tiny little group and look at you now. Congratulations [applause] thank you so much to our panel today and thank you all for coming to see us. I will see you all this afternoon. [applause] [inaudible conversations] next on booktv, a look at some of the books that members of congress are reading this summer. Beginning with author, ron and george washington. Then James Mcpherson on the civil war, battle cry of freedom. And then Elizabeth Rosenthal author of an american sickness. And Supreme Court Justice Sonya Sotomayor talking about her memoir. My beloved world. You are watching booktv and cspan2 with top nonfiction books and authors. Booktv, television for serious readers. Welcome to another night of booktv on cspan2. On prime time. Tonight we are looking at books being read by members of congress. Paul ryan put out his reading list. Heres what he had to say. Every year booktv asked members of congress what they are reading this summer. Heres a look at some of the books that House Speaker paul ryan has in his summer list. He is reading washington a life by bestselling biographer ron is an indepth look at the president of the United States. Also in his list is strong fathers, strong daughters by pediatrician doctor meg meeker. She highlights the importance of the father daughter relationship. Booktv wants to know what you are reading. Sinister Summer Reading list via twitter at twitter. Com booktv or facebook. Com booktv. Booktv on cspan2, television for serious readers. Speaker brian mentioned rons book on george washington. That won the Pulitzer Prize in 2011. And we want to show the author presentation now on booktv. Lets washington was dign