Agency, dea, to try to get scheduled narcotics on to electronic prescribing. And after years of bureaucratic battle, finally the regulations came out. I think that facilitates via electronic prescribing Prescription Drug monitoring, when you no longer have to go and ask for the paper scripts from individual doctors or from individual pharmacies, you can look at a database and you can see, wait a minute this, fellow is a podiatrist. Why are they prescribing oxycodo oxycodone . They prescribed 500 capsules last month and now theyre prescribing 5,000. Wait a minute. This person has gone to five doctors in five pharmacies for the same prescription. Whats going on . It opens investigatory doors. And yet, years later, its now electronic prescribing for all this stuff. The Prescription Drug monitoring programs dont seem to have yet really come online as a proper investigative tool to give us the common sense information that we need to make these determinations. What are the best next steps that we should be pursuing to try to get this program to a place where were getting these warnings before we have to go and run up a fake pain clinic that sold 100,000 prescriptions . You should be able to catch that a lot sooner if youre actually watching the data as it comes up. Whats our what are our best next steps . Miss volkow let me ask you first because you talked about this very well. Well, i would say that we should put the resources that are necessary to make the systems the way they should be. Immediate information right away and access to data that is relevant. Theres no reason technologically that we cant do it. Privacy concerns . The prif privacy concerns are equivalent to those you have in Electronic Medical records. That is there anyway, were just not accessing it in an innocent fashion . Correct. Dr. Clark. Working with onc and rhode island promulgated Electronic Health record integration interoperability programs. We have a small portfolio. We work with the department of justice which has the lions share or the primary focus. But we have been working with rhode island to improve access to pdmp data for Health Care Providers by integrating Rhode Islands fugess into Electronic Software used by hospital and physicians offices and by integrating the functions in the pharmacy dispensing software of a pharmacy and sharing data with other states, including two geographically bordering states, this has to be to make this effective with new technology you dont necessarily get greater efficiency unless you iron out the bugs. Were working with Rhode Island Health department to address this so we can establish models that we can share. I think mike fine, director of health, is probably the best person in the country on this. Thank you Michael Botticelli for nodding your head. And Andrew Kolodny is nodding your head. Im glad to hear rhode island get some cheers here. Let me wrap up by thanking Phoenix House has an Important Role in rhode island. And to urge that as we particularly as dea does the enforcement in this area, lets not throw the baby out with the bath water. Lets do remember that these drugs have a purpose, to alleviate human suffering. My particular concern is that when you have people who are weak and not particularly good advocates for themselves, particularly elderly people, in nursing homes, if they run into an episode of very, very severe pain and you have ratcheted it down so tight that you need to wake up a doctor at 2 00 in the morning to prescribe them their medication, in the real world, theyre going to suffer for hours until somebody can be found to come in. I hope that you will be balanced and thoughtful and precise in the way we go about pursuing this and not risk the beneficial effects of these drugs in the pursuit of eradicating their abuse. May i respond briefly . I believe the clinics and the practitioners that we investigate and prosecute are not doing any type of medical care. You would not want an elderly person, let alone a healthy person go to them. What we see are drug seekers go to them. Theyre just facilitating addiction. I dont defend the pain clinics for one second. Thats a racket out there. If you have a situation where you need a doctor to prescribe somebody at 2 00 in the morning in a nursing home and you have to wake somebody out of bed, thats a problem i think. A legitimate nursing home that has been there for years, you need to think of differently than a pain mill that got stood up six weeks ago. Thank you, senator. Senator udall. Thank you, senator feinstein. Good to be here with you. Good to have you here. Let me thank you and senator grassley for focusing on a tremendously important issue. This testimony weve seen, this chart that i think was in your package, this astronomical growth is astounding. In light of senator klobuchars discussion with me, i want to first turn to you, doctor and ask you on Prescription Drug monitoring issue, i think you wanted to Say Something there. So i hope that you have an opportunity to do that. I did. Thank you for asking me. Most states as we have heard have Prescription Drug monitoring programs. We can invest in interstate data sharing. Unfortunately, they are not being used. They may be one of the best tools we have in country for bringing this crisis under control. And except in new york, kentucky and tennessee, the three states that made it mandatory for doctors to use them, they are just not being used. If there is some way that you can incentivize states to make it mandatory for their physicians to use them, i think that would be very helpful. Use what . Prescription drug monitoring. Well, we ought to do that. Thats something that we can do. Thats what you are saying we should do, we should make that mandatory. Absolutely. Unfunded mandate. A worthwhile one though. Let me i had an opening statement, too. Madam chair, i will ask to put that in the record and go on to questioning. I think such good issues have been raised here. Last month, and this goes to dr. Rannazzisi, last month i dont think you are a doctor, but anyway. Last month senator portman and i sent a letter signed by 14 of our colleagues to attorney general holder urging the department of justice to draw on the many evidencebased strategies that are being successfully employed in states to address heroin and opiate addicti addiction, the opiate addiction epidemic. Can you explain what efforts are under way to find solutions that are working in the states and then expand them nationwide . I think for starters, the states have taken a lead in having Prescription Drug summits, not only for the prescribers, pharmacists, nurses, but also for community leaders. The states have basically leveraged their Community Coalitions and have them out there doing education. Using that as a force multiplier, we get the word out to schools. I think the states are doing a remarkable job. Were working together with an investigation related to rogue pain clinics and rogue practitioners. I think that this problem, if we dont work as a team, both state and federal, local investigators and regulatory boards, its going to get worse. We are we have more collaboration with regulatory boards and state and local task forces now than ever before just to address this problem. Florida is a perfect example. I think the states and the federal government together are doing a fine job. Well, the great thing about our system is having the states as laboratories. As you said, theyve come up with some very good examples that i think we can spread nationwide. Dr. Botticelli, drug abuse i have a very large native american population, 23 tribes in new mexico. Drug abuse in Indian Country is a significant problem. According to a survey, the rate of nonmedical use of Prescription Drugs among American Indian or alaskan native adolescents was almost twice the national rate. During fiscal years 2006 and 2009, the High Intensity Drug Trafficking Areas Program provided a small amount of discretionary funding for a native American Program to combat Drug Trafficking on tribal lands. Is this something you would be willing to consider as director . Sure. We have been significantly concerned in terms of Substance Use and particularly this issue on tribal lands. We have been working with the Indian Health service to increase capacity around medication assisted treatment. We have also actually gotten great cooperation from the Indian Health services in making sure that all of their prescribers are appropriately trained on safe prescribing. We have great coordination with that. We are working and we will continue to work with how we might look at discretionary dollars to focus on that population. Thank you very much. Thats a perfect, i think, collaboration between the Indian Health service and you to move this whole issue forward. Thank you very much, madam chair. Thank you very much, senator. Appreciate it. Senator markey, welcome. Thank you for inviting me. I very much appreciate it. Drf botticelli, thank you for your good work in massachusetts. Thank you for your good work for the country. As you know, we have been a pioneer in massachusetts in programs that distribute that lox naloxone widely in the community to those who are likely to observe an overdose. These programs save thousands of lives. My understanding is that some physicians, first responders, Community Volunteers have expressed concern about being held liable for lawsuits if they administer this drug in emergency overdose situations. Have you also heard these concerns . I have. If we were to eliminate those liability concerns, do you think we could increase the number of people who are ready, willing and able to save the lives of people who overdose . I do. I think guaranteeing some level of immunity for people who respond to an overdose is a strategy that we should continue to investigate. I agree with you. I dont think anyone should be afraid to save the life of a Family Member or a loved one because of legal liability. I recently introduced a bill called the opiate overdose reduction act. Its a really simple solution to a problem. It extends protections to people who step in to save the lives of a person who is overdosing by administering a drug and that we need a National Good samaritan law so that people will step in. How many lives do you think would be saved if we had such a law . We know one of the prime issues why people overdose and die is failure to call 911 in an emergency. Clearly, signaling to people that they shouldnt be afraid to call 911 is a significant advancement in how were going to reduce overdose deaths. So a Good Samaritan law would really help here . Absolutely. Do you all agree with that . Yes. And i think thats really something we can do to pass a law which does provide that Good Samaritan protection. Dr. Volkow, isnt it true that for opiate addicts in prison, the treatment approach that works best is combining medication assisted therapies with communitybased treatment at reentry . Yes, indeed we have the best outcomes on prisoners that when they leave the prison system to go into the community, were initiated on methadone and are sustained with it not just in their ability to stay off drugs, but also in decreasing the number of overdoses because that transition from prison into the community increases the risk of dying from overdose Something Like 13 or 17 fold. There are currently very few medication assisted therapy programs in our prisons . Unfortunately, that is correct. What do you think are the barriers to expansion of medication assisted therapies in federal and state prisons . I think that it does relate to a culture that we observe in many of the Treatment Programs that rejects the use of opioid assisted programs. It is the belief that you are changing one drug for the other when, in fact, we know they are very different and theyre beneficial and cost saving. Mr. Botticelli, after a life is staved from an overdose, people with chronic addiction need to be linked into effective ongoing treatment for their conditions. I understand that you were instrumental in massachusetts in helping to increase access to medication assisted Treatment Programs within Community Health centers. Do you believe this model, the massachusetts model, can be used to expand access to these therapies across the country . I do. You know, one of our challenges is how do we continue to expand access without building bricks and mortar. And our federally qualified Health Centers are uniquely situated to look at doing that. We found that by giving minimal assistance to federally qualified Health Centers, we could increase by 10,000 the number of massachusetts residents who were able to get very effective treatment with the rest of the services they needed. Do you agree, doctor, that expansion of medication assisted therapies into primary care settings such as Community Health centers would be helpful . One of the things that we supported is integrated treatment, which would include federally qualified Health Centers. The other thing we would support is the transition from criminal Justice System back to the Community Using medications which buys both the addict and the community enough time so that the person can reengage in followup treatment. What often happens is the person uses shortly after being discharged from the penal facility and then they overdose. So if we could have injectable drugs administered prior to discharge, we would have a months time to engage and a Community Health center or a substantial abuse treatment plan that would be using the drug to help facilitate reentry into the community. Thank you. May i continue . Go ahead. Thank you. Dr. Volkow, im kind of surprised at how remarkable it is that we have so few medications available to treat addiction. Im concerned that our desire to find treatments that completely eliminate drug use may keep us from finding treatments that will reduce drug use or reduce the Harms Associated with drug use, harms like incarceration, family instability, difficulty holding a job. What do you think is needed to further the development of treatments that reduce drug use or related harms . Well, its unfortunately a paradoxical situation because we have a disease that has a tremendous impact in terms of morbidity and mortality. Science has identified several potential targets that if developed could be beneficial for the treatment. We do not have the interest from the pharmaceutical industry in developing medications for a srs series of reasons. One of the recommendations is how to incentivize a pharmaceutical industry in order for them to invest in the development of medications. The targets are there. You have a condition that actually is chronic. So one of the arguments that they would not be able to recover their investment is not even correct. The institute of medicine went further and identified ways that they could the government could incentivize pharmaceuticals without it costing a single dollar to the government. But they have not been implemented. If i may ask one final question. Of all of the prescription opiate painkillers prescribed in the world of 6 billion people, 90 of them were prescribed in the United States, 4 of the population of the world has 90 of the prescription opiate painkillers. What does that tell us about the United States . What does it tell us about our society . I think the numbers speak for themselves. I dont think they that we can argue we have more chronic pain than other countries. The numbers are telling us something very clear. We are overprescribing. While at the same time it does not negate that we are not necessarily properly treating patients that suffer with chronic pain. I thank each of them for their tremendous service. At the end of the day, theres one thing we can do and that is pass a Good Samaritan law. I think thousands of peoples lives would be saved immediately across the country because people would not be afraid to just inject someone or to give them that the help that they need for fear that they would be sued if something went awry. We know that most people would just thank god that the fear is gone. I think firefighters across the country, policemen across the country, they would be more willing to rush in and apply if do you it in a timely fashion, you save the life. Then you need to deal afterwards with what happens to the person. Do you have a bed for them . Do you have the treatment for them . At least you kept them alive. Then we have a responsibility subsequently. We dont have either right now. Until we put both in place, i think this problem is just going to continue to escalate. Thank you, madam chair. Thanks, senator markey. Just in conclusion, three things jump to me. Of course, thats the pill mill that exists. What proportion of the problem is the pill mill . I think we always say that 99 99 plus of the practitioners that are prescribing, the doctors, are doing a great job doing what they do. But that very small percentage of doctors that have crossed the line are truly hurting a lot people. I cant give you a percentage because i just dont know what that number is. But what i do know is if you have a rogue pain clinic in your community, youre going to see overdose increase, youre going to see the general problems that you get with any other type of openair drug activity. It is openair drug activity. We talked about medical Education Programs preceding. Should this be done through the ama, the state medical socials . Any opinion on that . Yeah. If i can answer about pill mills. It is important to recognize i think we have to close down pill mills. They account for a large number of the overdose deaths. But in terms of the overall strategy for controlling this problem, the people who go to pill mills are usually either addicted or already addicted or they are drug dealers or could be both. So that you could shut down all of the pill mills and it wont get at the problem of creating new people with cases of addiction. Thats where doctors who mean well are more of a problem or dentists who give a teenager 30 pills when they needed one or two. It kind of takes us to the question that you are asking about medical education. If we want dentists to give one or two pills instead of 30, if we want doctors to recognize these are not good treatments for headache and lower back pain and fibromyalgia, they are need very good information on this. Unfortunately, the bulk of the education on this topic right now is not teaching doctors that using these medicines longterm is a bad idea. The cdc put out programs like that, but its a minority of whats out there. The bulk of the education is really telling doctors that if you follow certain rules when you prescribe, it will turn out rosy in the end. If you use a pdmp, if you check urine, the patient wont wind up addicted. Close monitoring is a prudent thing to do for the people who are on this treatment, but it doesnt turn it into something thats safe. These strategies dont prevent addiction. The Education Needs to be that these are not good treatments for most people with chronic pain. Do you think we should mandate the states to mandate that medical programs essentially to mandate physicians licensed to use drug monitoring programs . Yes, i absolutely do. I think new york, tennessee, and kentucky did that and use went way up. In states that dont require a prescriber to consult the database before writing a prescription, very few doctors look at the database. A doctor thinks they know what an addict looks like. They think they know what somebody with this disease looks like, and they dont. Thank you very much, everybody. I think it was a very good hearing. We have some very good notes and food for thought. Thank you very much. Its appreciated. The hearing is adjourned. Today live coverage of the Funeral Service for former Washington Post editor ben bradlee who died last week at the age of 93. Well have live coverage at 11 00 a. M. Eastern on cspan. The Heritage Foundation hosted a discussion on trends in jobs, the economy, and opportunity in the u. S. Live Coverage Today starting at 12 30 p. M. Eastern here on cspan3. Tonight on cspan3, washington journals big ten series continues at the university of illinois at urbana. At 8 40 p. M. , we look at an event about war starting with a discussion on war and civilians. Thats followed by a look at the legacy of former afghan President Hamid karzai and a panel on finding jobs for veterans. That starts at 8 00 p. M. Eastern here on cspan3. Here are just a few of the comments weve recently received from our viewers. I really appreciate the airing of all these debates. Its really given me insight as to the diverse views of all the other representatives and candidates to the u. S. House in other states and other districts. You know, i really enjoy to see the different viewpoints that come from different parts of the United States and, you know, its a really great thing to be able to watch them. Yeah, i watched the debate. I think it was on cspan2, paula bradshaw. Thats what i want to hear politicians say is the things she said, and i wish youd put that on regular cspan about 6 00 p. M. At night. Please put that program on at 6 00, 7 00 every night until election day so we can hear the truth about things. I just watched the nick rayhall jenkins debate from west virginia, and i am so tired of this campaign. I am so sick of these politicians who cannot tell the truth. And continue to let us know what you think about the programs youre watching. Call us at 2026263400. Email us at comments sea cspan. Org or send us a tweet. Like us on facebook, follow us on twitter. Our look at drug abuse in the United States continues with a discussion about alternatives to jail time for people convicted of possessing illegal drugs. This hour and 15 minute event was hosted by the Heritage Foundation. Thank you, john. Thank you everyone here and everyone watching on tv or over the internet. We are pleased to be able to present this program today because it involves some very important issues, and we have some very distinguished panelists. Let me say that for some time now society has been bedevilled by three problems, alcohol abution, illicit drug use, and crime. The intersection of each of those problems magnifies the adverse effect of each one. But state and local officials in south dakota and hawaii have found some creative ways to try to address those problems through two very innovative programs. 24 7 sobriety and hawaiis opportunity with Enforcement Program also known as h. O. P. E. Those programs seek to achieve three rather elusive goals in the criminal Justice System. To reduce incarceration, to reduce recidivism, and to reduce Substance Abuse. To reduce incarceration, the programs place offenders on probation. To reduce recidivism and Substance Abuse, they rigorously and frequently drug test for alcohol or other illicit substances in order to determine whether or not people have stayed sober and clean. Both programs have proved very successful in achieving the goals they set out for themselves. And in the meantime, both programs have also proved very cost efficient. These creative programs deserve our careful consideration because they are reasonable and humane ways of addressing several of the problems in our criminal Justice System. And i am very fortunate to say we have three experts on these type of programs here. First immediately to my left is the honorable larry long. Judge long is a native of the Mount Rushmore state. He graduated from South Dakota State University and the university of south dakota law school. From 1973 through 1990, he was a Bennett County states attorney and prosecuted hundreds of felony cases. From 91 through 2002 he served as the chief Deputy Attorney general for south dakota and in 2002 was elected the south Dakota Attorney general. Since september 2009, he has served as a circuit judge in the second judicial circuit. Judge long created the 24 7 Sobriety Program that you will hear about today. It is a zero Tolerance Program for alcohol abusing offenders that gives them a chance to dry out and walk right without going to prison. The program has been recognized as being effective, efficient, and humane. In 2008 the council of state governments saw the merit in the program by awarding it an innovations award. It was awarded the john p. Mcgovern award in 2009. The national Highway Traffic Safety Administration gave it the life savers award in 2010, and the Justice Department gave judge long an innovation and approvement award in 2013. To his left is the honorable steven alm. Judge alm is also a former prosecutor and now sits as a judge in hawaii. From 1994 to 2001 he was the United States attorney for the district of hawaii. He took the bench in 2001 and has been a circuit judge in honolulu ever since. In that capacity, he established the h. O. P. E. Program haas means of using probation, aggressive drug testing, and the imposition of certain swift but moderate punishments as a means of deterring illegal drug use and crime. He runs both the h. O. P. E. And the Adult Drug Court programs for hawaii. Like the 24 7 Sobriety Program, judge alms h. O. P. E. Program has received numerous awards. In 2007 h. O. P. E. Received the special merit citation. In january 2009, judge alm received the mcgovern award presented by the institute for behavior and health for the most promising drug policy idea of the year. In 2013 the Kennedy School of government at Harvard University named h. O. P. E. As one of the top 25 innovations in government. In fact, just this month judge alm received an award and is here now only after receiving that and will be able to tell you about that and his program. To judge alms left is dr. Robert l. Dupont, a graduate of the Harvard Medical School who completed his residency in psychiatry at harvard and at the National Institutes of health. Dr. Dupont was the director of Community Services for the district of Columbia Department of corrections from 1970 to 73. He served as the founder and administrator of the d. C. Narcotics treatment administration. In 73 he became the first director of the National Institute on drug abuse and the second white house drug chief, a position now known as the drug czar. Dr. Dupont left the government in 1978 to found the institute for behavior and health, a Nonprofit Research and policy Development Organization devoted to the reduction of illegal drug use. Dr. Dupont is also a xlclinical professor of psychiatry at the Georgetown University school of medicine and Vice President of ben singer, dupont and associates, a leading National Employee assistance provider. He has devoted his career to an analysis to the link between april diction and corrections and to the creation of opportunities to reduce drug and alcohol abuse, recidivism, and incarceration. Please join me in giving them a hand as well as listening to what each of them has to say because each one will talk about very important Public Policies and how we can deal with them. Thank you. [ applause ] good morning. My name is larry long. In south dakota, the criminal Justice System is fuelled by alcohol and by repeat offenders. From fiscal year 1999 through fiscal year 2010, 37 of all felony convictions in my state were drunk driving. A felony drunk driver in south dakota has accumulated at least three dui convictions within a tenyear period. That defendant has been through the criminal Justice System at least twice and been convicted of drunk driving before he gets his third offense and makes it to a felony level. That defendant is a repeat offender by any measure. After i was elected attorney general and took office in 2003, the governor asked me to serve on a work group to tackle south dakotas increasing prison population. I dusted off and proposed an Alcohol Testing program i had used nearly 20 years previously in Bennett County which was my home and where i was the states attorney for nearly 18 years. That proposal became the 24 7 sobriety project. The original goal of the 24 7 sobriety project was to keep the defendant sober 24 hours a day, 7 days a week, and as we started experimenting and piloting the program, our target group was repeat dui offenders, and that was anybody who was arrested for dui who had a prior conviction within the previous ten years. The tools that we used for that experiment, for that pilot, were the conditions of pretrial release or what lawyers refer to as bond conditions. And there were five of them. First of all, the defendant was told you cannot consume alcohol at any time, any place, under any circumstances. Secondly, you cant go in a bar and by a bar we define that as any place where alcohol was available for purchase and consumption on the premises. The third condition was that you will show up at the Sheriffs Office every morning at 7 00 and again every evening at 7 00 and you will take the breath tests so we can verify that you are complying with condition number one. And the fourth condition was if you skip or fail, you will go to jail and the fifth condition then was you will be released the next day. We will put you back in the system, and you will start over. The design of this system was to operate like an electric fence. How many of you, a show of hands, have touched an electric fence . Okay. How many of you have touched it a second time . Okay. Its not more complicated than that. Okay. Well, so we started down the process of putting this program together, and we immediately ran into some issues. First issue is south dakota is a very rural state, and some of our people who were testing twice a day lived more than 30 miles from the test site, and that required them to travel 60 miles twice a day in order to comply with the test requirements and that was a problem. So what we did was we adopted a tool, and that tool is the ams scram bracelet which is a bracelet you wear on your leg, and it gathers the emissions from your sweat glands and it tests them for the presence of alcohol on an hourly basis, and that allowed these people to be tested as part of the program and not have to travel. The second problem we discovered was that many of the participants were switching from alcohol to some other drug in order to maintain their high or whatever, deal with their issue, but yet be able to pass the alcohol tests, and so then we implemented a urinalysis Testing Program as a supplement to our Alcohol Testing program. Those people had to test about twice a week, but that also identified a third problem, and the third problem was some of south dakotas in fact, many of south dakotas counties are very small, and often the Sheriffs Office only has one fulltime sheriff and maybe one or two parttime staff, and so urinal sis requires more staff than that, so we also adopted the drug patch or the feds use this patch regularly and federal probation uses it a lot. In any event, so we adopted the drug patch also into our arsenal of tools to run our program, and we were successful enough in our pilot that by 2007 the south Dakota Legislature had approved our program and authorized it for use statewide. As it stands now in south dakota, the 24 7 sobriety project is available for all crimes, not just drunk driving, and, of course, that represents and reflects the reality that there are lots of crimes that are alcohol related that have nothing to do with drunk driving, but yet those people are good candidates for our system. The program is available at pretrial or bond level. It is also available for judges to use at postconviction as a condition of a suspended sentence, and it is also available to the parole board so that the parole board can release individuals under supervised release for alcohol and drug use as a condition of being discharged from the penitentiary. Now, the question then is are we doing any good . Ill call your attention then to the first slide. It may be a little difficult to read, but weve been doing twice a day testing in south dakota since february 1st of 2005. To date there have been over 34,000 participants in south dakota. They have been tested 7. 1 million times. And the passing rate for that group is 99. 2 . What that means is for every 100 tests that are performed, over 99 times the person shows up on time and blows a clean test. Our urinalysis was implemented in july of 2007, there have been over 4,000 participants there. Those people are tested on average about twice a week, and that passing rate is 96 . The drug patch is not used widely, but we have had 265 participants, over 2,600 tests have been administered, and that passing rate is 82 . Now, i should have another slide. All right. These two stats are for the scram bracelet and for an ignition interlock that we have recently implemented into our system. We put the scram bracelet into effect in october of 2006. To date there have been nearly 7,000 people in south dakota who have worn the scram bracelet, and they have worn that for slightly over 1 million days. The individuals there have been fully compliant. The 77 stat is i think the one most significant. Those individuals of the nearly 7,000 individuals, 77 of those people have been fully compliant. In other words, for the time that they wore the bracelet, they have had no tampers and no confirmed drinking events. The ignition interlock is a device that we have just recently put in. Theres a mistake in my slide. It says october 10th of 2014. Thats a little premature. It was actually put in effect on october 10th of 2012. To date there have been 276 participants and we have a success rate there of 95 . So in the short term, i think weve done some good. In the long term i think weve done some good as well. We have done some recidivism testing within our own data to determine how weve done, and by recidivism, we identified or defined recidivism as the length of time from the completion of the 24 7 Sobriety Program to the next arrest for dui, and we were and the participants in this recidivism are individuals who are were convicted of second, third, or fourth offense duis, and at all levels for all participants there was at least a 50 reduction in the rearrest rate for participants of the 24 7 program, so one year, at two years, and at three years. Each individual who participated in 24 7 irrespective of their length of time in the program were 50 less likely to have been rearrested for dui. Now, my favorite slide though is this one. These are alcohol related traffic fatalities in south dakota from the years 2000 through 2013 inclusive. Now, if you look at the charts, the bars in red represent 2000 through 2004 which is the five years before we implemented the 24 7 program. The average death rate annually there was 83. In the nine years from 2005 through 2013 inclusive, that rate has dropped to 55. 3. Now, theres a lot of reasons for that. We all wear our seat belts better than we used to. We all drive safer cars than we used to. Im sure there are other factors, but i think the 24 7 program is part of that equation. We test 2,200 people a day for alcohol consumption, and i am confident that that has an effect in terms of the reduction in traffic deaths in south dakota. So thank you. [ applause ] good morning, everybody. Good morning. Im steve alm, a judge in honolulu. I was a career prosecutor, and hawaii has got to be the only state with a path to the bench typically is through the defense bar, so i was the first career prosecutor to be appointed to the Circuit Court bench. So i eat lunch alone a lot at first. But i was the last case of the Prosecutors Office is the murder of a police officer. Then i was the United States attorney from 94 to 2001. I bring that up because starting Something Like h. O. P. E. Is a challenge. Doing things differently and being a career prosecutor gave me the credibility to do it. Felony probation, we had about 8,000 people on felony probation on oahu. Lots of problems. We have good pos, caring judges, its the system itself is broken, and this is similar across the country. At sentencing a judge would read all these conditions of probation, and probation is the alternative to prison at sentencing. Community supervision for four or five years. But the judge says no alcohol, no drugs, see yourp o, pay your restitution. The problem is some people will do fine on that. Many people will fail at that. When they fail, the problem is the po has two choices, the Probation Officer. Work with the person, encourage them, threaten them, cajole them. You tested dirty for methamphetamine, our biggest i will lee drug. You understand thats a violation of probation. Yes. If this keeps up next year you might go back to court and get five years in prison. Dont worry, ill stop. The person leaves the Probation Office understanding this is not a serious system. You know, im going to keep getting high and keep doing it until something stops me and they know it will be a year or two before anything happens because the Probation Officers choice is either talking to them or writing up the violations, coming back to court, and asking me to give them the five or ten years in prison. So its all or nothing. Some judge famously once said, you can either at sentencing send them to prison or send them to the beach. S in not a knock on Probation Officers. They just do not have a tool to do anything quickly. So the first week on this felony trial calendar in june of 04 i looked at this, motions to revoke probation with 20 violations, finally thep o had given up, spent a couple hours documenting all the violations, got the person arrested, brought them back and recommended to me every time send them to prison for five or ten years. Theyre not amenable to probation. I thought what a crazy way to try to change anybodys behavior. I thought to myself, okay, this doesnt work. What would work . I thought about how my wife and i had raised our son, how were we raised . Your parents tell you what the family rules are, and then if theres disbehavior, something happens immediately. It doesnt have to be severe, but it has to be swift, it has to be certain. Then you and your kids learn to tie together bad behavior with a consequence and learn from it. So that was the simple idea behind all this. So in the future, this is june of 04, we kicked off the program in october of 04 with the idea that if they come in and test positive for drugs and admit it, they get arrested on the spot. They go to jail, we have a hearing two days later, prosecutor, public defender and ill probably het them out because they came to the courthouse knowing they had messed up. They have to call a random drug test hotline. If their color is listed, they have to come in and get drug tested. Their color comes up once or twice a week. Drug courts are a whole separate conversation. Drug courts are great. They can be very effective with whatever population theyre working with, but drug courts often deal with a pretrial population, a lower risk population. We have now shifted our drug court to a highrisk population but in drug court you see them every week, its a status conference. In h. O. P. E. I only see them when they violate. So i am able to supervise a large number of people. This program started on october 1st of 04 with 34 offenders. I told them at the first hearing everybody in this room wants you to succeed on probaths. Your attorney does, the prosecutor does, i do, the taxpayers of hawaii want you to succeed. Its 45,000 a year to lock you up in prison. Whether you get there in prison for years is up to you. You control yourself. My guess is unless somebody put a gun to your head nobody can make you do anything you dont want to do, right . They said, yeah. And so i said, but i can control what im going to do and that means in the future you are likely to go to prison if there are any violations of probation. Youre likely to go to jail if there are any violations of probation. And so you can look at h. O. P. E. Probation. Org. A bunch of docs started a nonprofit to show videos and explain this better. I told them we want you to be successful, so if you violate, were all human beings, we can make mistakes. If you violate but you admit to it right away and you deal with it right away, the jail sanction will be very short. If you dont show up at all and the Law Enforcement folks have to look for for you, its at least 30 days. You are an adult. Youre going to make your own choices. Law schools across the country talk about procedural justice. It usually doesnt happen. The criminal Justice System is really not set up for that. The more the severe the consequence are, the more due process is going to be, the longer it takes anything to happen. Hope probation is swift, certain, consistent, and proportionate. We are convinced one of the chief reasons it works is we are treating people fairly. Were treating them like adults. And so i thought at the beginning it just made sense, lets target the toughest population. Hope is not its not a boutique court. Its a strategy to do probation. So we started with 34 offenders, and we said lets get the people most likely to fail, or the ones we need to watch the closest. So sex offenders, Domestic Violence offenders, people that have had histories of drug use. Thats who we want to focus on. We dont exclude anybody from the program. If theyre violent, thats fine, we want the Probation Officers to refer us the toughest cases. Thats what we do. We focused on the highest risk to begin with, 34 people. We started with no extra funding. We asked everybody to work smarter and harder. Because i was the federal prosecutor, i got the u. S. Marshal to use his Fugitive Task force to serve warrants for this program. I told them, you dont show up for a drug test, im going to issue a warrant and he you get arrested youre going to do 30 days in jail. If you show up and admit to it. You get a few days. Were trying to shape behavior. Some of these folks are knuckleheads. It takes constant go to jail every violation. Lets be clear, the truly violent and dangerous, the ones who dont stop stealing, should be sent to prison at sentencing. No probation system is an alternative to that. And i was the toughest sentencer in the building, the most consecutive sentences. So i had that credibility to start with this. But thats a minority. Probably 25 , 30 of people should get sent to prison at sentencing. But that means 70 should be supervised in the community. If you do that right, you can save taxpayer dollars, you can help offenders and their families avoid going to prison and you can reduce crime. Thats what we did. We started with 34 offenders. We went to the legislature 18 months later. They gave us 1. 2 million. By then, we had the statistics from the attorney general showing people on this program were testing positive 80 less often, they were missing appointments, same thing. We thought intuitively got to lead to other better results. When they gave us the money, we used most of it for drug treatment. And theres an old joke in court that Expert Witness is a guy from out of town with a briefcase. So our Attorney Generals Office can keep statistics. But a couple of years later, dr. Angela hawken got a grant from the National Institute of justice and the Smith Richardson foundation to do a randomized control trial study. Identified 500 people in main branch probation with drug problems. Twothirds got put into the program. Hope. The other third were left on probation as usual. Now, it had a name by then. I had a contest among the p. O. S and court staff. We had a lot of entries. The earliest one was yank and spank. Head of the sex crimes unit. My 15yearold son said fail and jail. Accurate but not aspirationally. Somebody suggested hawaiis opportunity probation with enforcement. I thought thats great. Good acronym. Dr. Hawken did this study. Three quarters men, violent crime, property crime, drug crime, 16 to 17 prior arrests. A year later, she looked at the results. And half as likely to be arrested for a new crime, half as likely to get revoked. 72 fewer positive drug tests. Biggest number is, half as many people were sent to prison for a years. That is a system that is clear, its transparent, it lays it all out. One of the fascinating things weve discovered about this program is, most people can stop using drugs without going to treatment. If they know theyre going and this is, judge long has found the same thing in south dakota. People can stop drinking without going to treatment. And drugs or alcohol for us. If they know theres going to be a consequence every single time, most people will make the decision not to use. And if so, that saves the precious treatment beds, or slots for the people that cant stop on their own. So our Treatment Programs love this. This is a chart that dr. Hawkin did. Remember the study group was 340 people in the hope study group. Of that and they were identified because they were active drug users. Current drug users. 60 of the tests were for meth. 51 of that 340 did not have a single positive test the first year. Another 28 had one. Most of these folks are not in treatment. If they want to go to treatment, well use our money. We got 1. 2 million from the legislature. We use most of it for treatment. If we want to go to treatment well help them, fine. If they think they can stop on their own, i give them a chance to show us that. And let them do that. That means showing up and testing clean. If they can do that, they dont have to get a reference, they dont have to get an assessment, and they dont have to go to treatment. If they stop if they use a couple of times, then im going to say, hey, looks like youre having trouble, right . Use, jail, use, jail for a few days. And then they say yeah i got to go to treatment. Then they go to treatment. Then theyll be more honest in their assessment how often they use. And the last time they use. When theyre in treatment theyll persevere because they know theyll get arrested if they leave. When people hear about hope they think its a program with jail. Jail is a part of it, but if you have a system set up well you dont have to use it as much. The offenders know this. Because and the basic sanctions are a few days if you admit it, if you deny it, and we have to send it out to the lab, youre either in denial or youre wasting everybodys time youre going to get 15 days. You dont show up at all, its 30 days. Some people are going to fail at hope and go to prison. The good news is, many are going to be successful. Change is really hard. So this is not easy. Its spreading across the country. There are now 18 states, about 60 courtrooms doing hope. Washington state has put its entire highrisk now 17,000 people into their version of hope. Parolees and probationers. So its one of those situations that drug testing is hugely important. Its part of it. We have our drug testers come in at 6 30 in the morning. Anybody who wants a drug test before going to work can get drug tested. But these are males watching males. Females watching females. We had one young lady she taped a vial to her rear end she tried to substitute in the test. She got caught, of course, so i gave her 30 days in jail. I told her, you know, miss, youll have to find new friends because that other sample was dirty, too. So what can you do . Anyway, because i only see them when they violate, i currently supervise about 1900 felons in the program. Theres people, 7,000 every sex offender on oahu if theyre not in prison and put on probation, theyre in hope. They dont all have drug problems but we want them going to treatment, we want them staying away from victims, we want them following through geographically and otherwise. Im thrilled to be here. I look forward to any questions. And when you have a system that reduces victimization and crime, it helps offenders and their families and saves taxpayers millions of dollars. Its like, this is what were in the business for. Thank you very much. [ applause ] im bob dupont and im just very, very pleased to be here. Let me start by thanking paul larkin who made this possible, and heritage. This is a tremendous opportunity to present some very exciting ideas. Im very grateful to paul and heritage for making this possible. I began my career 46 years ago, a few blocks from here, after i had finished paul was saying at Harvard Medical School and the National Institutes of health, i decided i wanted to commit my career to helping people in prison. Because i had worked with them in my residency, and i cared about those people. And i was very interested in doing what i could to help. So i went to work as he said for the d. C. Department of corrections. Head office is a few blocks from here. And in that context i discovered the relationship between heroin addiction and crime in the city. And became quite involved in drug abuse treatment. As paul said, its been quite a ride since then. But i have kept my focus on the concern that i had 46 years ago. And i want to tell you what were talking about today. Its the best new idea in 46 years that i have seen. This is history. This is very important what were talking about. This is not just another clever idea. This is something scalable and profoundly important. I want to talk some more about that. But i want to talk about innovation. So you can think a little bit about what youre seeing, what youre hearing. I said to paul and to steve and larry, they didnt know any experts in the field when they did this. I dont know whether you listened to that. They came from an experience working with the offenders without expertise, both of them. And i said to them, thank god you didnt know any experts like me, because you never would have done this. I would not have advised this. I would not have thought of it. And neither would any of the other experts. Because it didnt happen. It came up from their experience. They had a problem and they had new ideas about what to do with it. Thats one lesson. But the second lesson i want to give you is maybe even more important, because lots of people have good ideas. What youre looking at is two men who have devoted their lives for a decade to the development of this idea, and spreading it. That the charisma that they have, the ideas that they have, the determination, the ability to get whole institutions involved in it, is very precious. And what we have here today is two people who have come up with this new idea, and have devoted themselves to it, and coming here today to talk about it. I am very pleased. When i left the government, it was founded with my wife, our job is to find new ideas that will reduce drug use and problems related to drug use. This is our number one priority. Thats how important it is to me, and to us. I want to talk to you a little bit about what it is that makes this special. Because it may not be so obvious to you. One thing is to focus on drugs and alcohol, is the absolute commitment to no use. Thats rare. People talk about that. Most Treatment Programs drug Treatment Programs in the country have continued drug use routinely in the Treatment Programs. The idea that you would set that up as a standard and have consequences for it right away, thats unusual. But thats what this is. Thats one thing thats important. Another is the use of technology. The drug testing. Theyre talking about the use of a rapidly developing technology to identify drug use, and integrating that within what theyre doing. That also is very striking in terms of this. The most stunning, though, is the concept that drug addicts, and alcoholics can change their behavior, can stop use with immediate consequences that are predictable, with or without treatment. No expert would say that, would have thought that. But they have demonstrated that it is true. And with respect to the treatment, one of the things that i guess i could say, im an expert at treatment, weve had a lot of experience with it, the most likely thing when you refer a drug addict or alcoholic to treatment is he doesnt go. And if he does go the most likely thing hes going to drop out. And if he does finish it, the most likely thing is hes going to relapse. That is the reality. Now, what theyre doing is making treatment work. Ive been to see the people who go to treatment from these programs, and the treatment people love them, because they go there. They finish the programs. They dont use. They listen. Why is that . Because of the context, what they have put together makes an entirely different kind of experience. So this swift, certain, moderate kind of sanctions makes a tremendous difference in the behavior, and it sets a model that is very important. Now, im going to end with a i started off with the criminal Justice System. And my commitment to that, the drug and alcohol use. But i want to shift i call this the new paradigm. Its not just its treatment, its the managing of the care of the Substance Use. And there is another example that we at ibh have been studying of this model in an entirely different patient population. And that is the nations physicians. Can you think of a group demographically more different than felon, convicted felons, than practicing physicians . Many of them i guess are felons too, but thats a different story. In any event, what happens with physicians in this country when they have a drug or alcohol program, they go into a state program there in all the states that involves mandatory random testing for five years. Any use, any use of alcohol or drugs in the five years, and theyre taken out of their practice. Any use for five years. All of them. And that has set the standard for good longterm outcomes. In the fiveyear study, we found 78 of the doctors with random testing, every day they have to check just the way steve was talking about, where they have to go in, 78 had not a single positive test for alcohol or drugs. Of the 22 who had any positive test, twothirds never had a second positive test. These are drug addicts and alcoholic physicians. That is stunning. And that says something important about how to deal with this problem. But anyway, i just want to say again how proud i am to be here with heritage. How grateful i am for the leadership of these two men. And how excited i am for the potential within the criminal Justice System, these 5 Million People on probation and parole, this is a scaleable, affordable idea were talking about. And that is very exciting. Thank you. [ applause ] before i ask any questions of the panel, i want to give judge long and judge alm an opportunity to say anything they want about what anyone else has said. Dr. Dupont has been a great supporter of this in the very beginning just like pew, just like ondcp and practitioners in the field get this. They know what theyre doing doesnt work. When they hear about something that seems logical they get into it right away. Judge long and i didnt know about each other. There are a lot of similarities to the program so i was thrilled at that. Im trying to work with the folks at home to get 24 7 started. Hes working, of course, in south dakota to get hope started. He started a program with juveniles which is really exciting to me. Let me ask judge long, and judge alm, what would you say in response to someone who claims this program is being soft on crime. That the better way of dealing with these people is just sending them automatically to prison. How do you respond to that . My experience with the public is, the public is not particularly offended by people out on probation. What they are offended by is people out on probation that they perceive are not being supervised and not being held accountable. And my program holds them accountable. And the feedback i get, at least from the families, is, you know, every time ive spoken about hope, or about hope, about 24 7, Family Members come up to me and they say, gosh, larry, i wish that program had been around when my husband was drinking, or my dad, or my brother, or my son. Or some variation, you saved my childs life. And so ive never apologized to anybody for the way weve structured this program. We trade jail time for sobriety. And i think thats a fair trade. If they can elect to drink, and well put them in jail, and if they elect to not drink well let them go home. And everybody wins. This has been a program to try to reduce crime, reduce Substance Abuse, so its not a right or a left kind of a thing. I think actually, weve never tried the Court Political parties. Nationally, the republicans, like the right on crime group, pat nolan and others because theyve been seen as tough on crime so they can be a little more creative. If people dont understand the system, this sounds like its soft on crime. You test positive for drugs, you get three days in jail, or two days in jail. What they dont realize in a normal probation system or parole system, there is no consequence. So when people, you know, who know the system, they instantly get it. This is not only not only is it a consequence, but its a consequence every single time. So people are going to learn from it. So it really is harder than probation as usual or parole as usual. But the public doesnt know anything about any of this stuff. But as judge long says, they want results, they want consequences. So when they hear about this, theyre all in favor of it. Can i Say Something . Certainly. One of the problems within the criminal Justice System is concern about this aggressive testing. Its going to fill the prison. Its going to fill the jails. The biggest Sales Problem that these two gentlemen had was this aggressive testing. The people in the criminal Justice System say we have so many failures now, youre going to triple our failure rate. The interesting and important finding is exactly the opposite happened. Because of the change of behavior that goes on. Dr. Dupont, let me ask you a question. Theres a concern that in many of the state criminal Justice Systems, the system itself has become the Mental Health system of last resort. How do you deal with that problem if and where its true by using this program . Can it be used in that sort of circumstance, or is it not usable in that circumstance . Okay. I think you know, i am a psychiatrist. I am committed to Mental Health. I have a practice of my own. Im concerned also about Mental Illness and its treatment. One of the biggest problems with the seriously mentally ill in the country is just like with the drug addicts, its compliance with treatment. Which is a huge problem. And what i i use the term therapeutic jurisprudence. What im interested in is using the criminal Justice System to achieve Health Outcomes for people who you cant do that with, without the criminal Justice System. In other words, that leverage makes a difference in compliance with treatment and taking the medicine and all the rest of it. So i see this as a model, a positive model for Mental Health in the criminal Justice System also. And i would like to see that be developed much more actively. This is the way to go, and it will work just as well with Mental Health issues as it does with Substance Abuse issues. And the way this translates in court is, mr. Soandso, you may have a chemical imbalance. Some other issue. If a Mental Health professional wants you to take your meds, understand this isnt burger king. We dont do this your way. Youre not in prison, youre on probation. That means youre going to have to follow rules. Part of the rules is you take your meds. If you dont take your meds ill put you in jail. Then theyll take their meds, be more medication compliant. Everything else in their life goes better. For the ones, the most severe Mental Health issues that is a real problem for people to deal with. No program is perfect. Its just when we look at it is, hope, 24 7, are they better than the current system. Do they work better. And im convinced they do. And the Defense Attorneys do a diagnosis say this is the best thing. Its clear. The consequences are clear. Theyre much more likely to be medication compliant. And to see a therapist, too. Yep. Let me ask a question for the whole panel. Can these programs be replicated in other states, or is there something peculiar about south dakota and hawaii that allow them to work there . Do you think they can be replicated elsewhere . How would it be done . Well, 24 7 is operational in south dakota. Its operational in north dakota. And its operational a in montana. There are Pilot Projects that are currently in various stages of development in i think 10 or 12 other states. Theres a Pilot Project going on in london, interestingly enough. Ive been trying to get a free plane ticket to go to london. To speak. I havent been able to pull that off yet. But im still trying. Ive had this discussion with some of the folks from nhtsa several times. And there is a concern that south dakota is a rural program, because it works in south dakota, it works in north dakota, it works in montana, which are large rural states. But my advice to anybody is, pick a city and try it. Start small, pick a small area in a big city, and see if you can make it work. There will be problems that you will run into that i havent thought about. If you simply run into the problems and decide youre going to fix them, then it will work. Thats how we started the 24 7 program. We knew there were going to be problems, we just couldnt anticipate what they were. We simply dealt with them as they came up. We found a scram bracelet which drugged a hole. We found a drug patch which plugged a hole. You know, you can deal with them if you are committed to get the system and make it work. But thats my philosophy thats the philosophy we started with, and that works. I would echo that. Like Everything Else in life, where theres a will theres a way. So the challenge with this is some places think, oh, were already doing that. When you talk to them some more, okay, you are. When is the expedited hearing in your jurisdiction. Oh, in two weeks. Is the person in custody . No. Youre not doing this. It has to be on the spot. Thats how you tie together behavior with the consequence. But i would echo, start small, get all the moving parts in place. Call us, you know. I travel once or twice a month on somebody elses dime to explain this to them. Including london a couple of months ago. And i was then they started 24 7 first, because they have a huge problem with binge drinking, fighting, and the like. Where were going to try 24 7 in hawaii, hopefully, with a felony violent population. Because alcohol is the biggest problem in the criminal Justice System. Guys stabbing each other, fighting with each other, terroristic threatening and alcohol is replete with that. Especially with certain groups. So thats what were looking forward to. If people start small, they get their ducks in a row, were convinced human nature is going to be, you know, consistent, its going to work. When i started this, people said this is never going to work with people who had done prison time for a lot of jail time. They can do time standing on their head. I said, yeah, they can when they have to. Human nature being what it is, they dont want to do it today. So id be willing to bet that human nature is more similar than dissimilar. Like i say, there are 18 states doing this now. In indiana its called hoosier opportunity probation and enforcement. This is possible. Where theres a will, theres a way. Let me just put an exclamation point on that. When i started, everybody thought i was crazy. The only thing i knew is that i had done this before in Bennett County 20 years before, and i knew that it worked. I grew up in that community. I was putting my classmates from high school in custody. I knew these people when they were sober. And after 60 days of sobriety, you could tell by looking at them, that they had quit drinking. Their color changed, and if youve known an alcoholic, and youve seen them quit, you can tell by looking at them that they have. And when i first launched this, i literally begged and grovelled. And i was the attorney general. But i had a couple of old friends who were judges, one of whom was a recovering alcoholic, and they did this for only one reason, and that was because i was the attorney general, and they thought it was prudent to humor me for a few months. And then the thing would fall flat on its face and then they could say, larry, we gave it a try. But thats the commitment that you have to make. And you just have to find someone who is as committed as you are, and if you find that person, you can get it off the ground. Let me ask one more question before i turn it to the audience. Id like dr. Dupont, if you could answer this first, but its for the whole panel. What is the proper role for the federal government in this regard . I think facilitating the spread of this idea, and i think the federal government is already doing a lot, and can do much more. But i think theres also lots of room for the private sector, especially the philanthropic groups like pew has taken a terrific lead in this. As i mention, ive been in this for a long time. Right now is a remarkable moment in history. You notice when paul introduced this program today, he talked about the Heritage Program to reducing incarceration. This is part of that. Very understandable. The country is coming together on that purpose. Right and left, and all across the political spectrum, in an exciting way. Its a great time to be interested in corrections. The same thing is happening with drugs. The drug issue isnt the center of attention the way it never has been before right now, and there are prospects more of that, i think. I think there are opportunities now that are great. One of the things, before i let go, and that is that, the issue about the Substance Abuse problems is lifelong. These programs are relatively short, even if its four or five years. What happens to the people when they leave . When theyre not being supervised . That is the big question to me. Its not whether while theyre supervised they are better. They have shown that. Most people didnt know that. But the big question is, then what . And thats an open question. Well see. But ill tell you this, in my time in the field, the thing that makes a difference in the stability of abstinence in stabilizing lives is has called recovery and its the 12step programs of Alcoholics Anonymous and narcotics anonymous. Those are extremely important. I would like to leave everybody with the understanding of how important that is in maintaining lifelong sobriety. Because that is the big issue in the Substance Abuse field. The federal government has been great already with this. Its in the bipartisan budget bill earlier this year. Hope is part of that, 4 million. The Justice Department is sponsoring replications. Part of the demonstration field experiment and tom fight was instrumental in getting that done in texas, arkansas, massachusetts and oregon. And just being a bully pulpit. And talking about programs that work. Helping. And part of that budget money is going to set up a Technical Assistance crew to help out with that. As well as starting some new sites. But when we try to get a site in a state to do it, i tell them you have to be the emissaries for this. Wendy davis in fort wayne, indiana, shes the one to tain the other folks in indiana. Theyll believe her. Her folks with talk to p. O. S there. Her Law Enforcement folks can talk to other Law Enforcement people. The federal government can play a great role in many ways. Theyre doing it already. But the real growth is going to be in the states as they spread the word. Well, the federal government certainly helped me get mine off the ground. The national Highway Traffic Safety Administration had more faith in me than the judges that i was trying to convince ought to do this. They gave me a grant to get my program off the ground in the minnehaha and pennington counties which are the two largest counties in south dakota, because those Sheriffs Offices convinced themselves that they needed extra help in order to implement this. I didnt have an appropriation. I didnt have any money. And so nhtsa was very instrumental in getting mine off the ground. Also, when we implemented the scram bracelets, they bought 100 bracelets for me and those are 1400 a pop. And they havent asked for them back yet, and i appreciate that. But they also gave us a charge we had to figure out how to pay for them ourselves, and that turned out to be a challenge that worked to our benefit. Because we had to then deal with that. So i certainly owe them a large thank you. And i think theyre helping me yet. Let me see now if there are any questions from the audience. Let me ask that you identify yourself, and ask the question and get right to the point. The woman back there. Hi. An lean frazier with National Association of criminal defense lawyers. Two quick questions. One for judge alm. Can you talk a little bit i think i may have missed it in the beginning about the folks who actually are able to get into hope . Are they is everyone required to do drug testing, even if drug and alcohol was not part of the initial offense . And the second part is, weve done a report on problemsolving courts specifically drug courts and in our report we found that a lot of drug courts around the country do the cherry picking. Meaning they pick the people who they know will get through the system because theyre lowlevel folks who are really not users. Theyre sellers. So the program is successful because of that. But the people who really need the treatment arent getting that. And really quick for mr. Dupont. Im of the belief we cannot solve societys ills by putting people who are addicted to drugs because it is an illness in prison. And people who have Mental Illness in prison. Id like you to just talk a little bit more about that, and why you think having that an option is a good thing, considering people who do get in the system, who have Mental Illness, are not getting the treatment that they need. People who have addictions to alcohol and drugs are not getting the treatment that they need in prison. Because they cannot they cant do it. They dont have the capacity to do that. Thank you. Well, first, i wrote an article for the champion magazine a couple of years back, our local association of criminal defense lawyers wrote a side bar as well as the Drug Policy Alliance wrote a side bar. We dont add any conditions. If somebody is put on probation, in the presentence report, if theres a connection, a nexus with drug and alcohol use, thats a condition of probation. Thats the way we start. Probably 85 of the cases in court have that. If so, theyre going to get drug tested. If thats not, we dont add it. So theyre not on the hotline, theyre not doing it. If during the probationary period the person shows up smelling of alcohol, or some other nexus, well add it. The second part is for drug courts. Drug courts can be great. As you talk about often theyre cherrypicked, have a veto over who goes into it, we have shifted our drug court to be for the highrisk group. And so, you know, in an article i wrote for the university of oregon law review, it said at the website if you have analogous the hospital, hope is the reward the drug court should be your icu. If people are failing at probation they get put into hope. If they just cant stop using in spite of going to a Treatment Program or two thats who were putting into our drug court because they are headed for prison. Drug court becomes kind of the last step on the continuum on the righthand side. You have wraparound services, the drug court is the best potential thing you have. You have to focus on the right population for it. And thats what were doing now. Four years ago there were 52 people in our drug court. Now there are 200, including 50 with a dual diagnosis problem. One of the things in drug policy that drives me a little wild is to think that the choice in drug policy for treatment or prison. And so people are asked, which are you in favor of . Treatment or prison . About drug policy. And i think that is a very false choice. People are in prison because of some criminal behavior that theyve had. Many have Mental Illness that definitely contributes to or Substance Abuse that contributes to the criminal behavior. To me thats an opportunity for an intervention and help of those people. And what i would like to come out of this meeting and this concept is not to choose prison, or treatment. But to say, the goal is to make the two Work Together in a way that does better for those people than either alone. Thats what this is about today. And i think to do it the other way, that theyre somehow antithetical misses the opportunity that comes from the people who are already there, im not talking about putting somebody new in prison, theyre already there. Lets find ways to use that, and the place to start is not prison per se, but the community corrections. I think this is a model that will work very well in the interest of people with Substance Use disorders and Mental Illness. Sir . Im a retired analyst who got interested in drug policy about 43 years ago. As a matter of fact, ive never heard a better presentation. Now that you mention the name of Mark Kleinman from kucla who i believe is one of the original prone poents of project hope, i know wrote a book on this issue about when it fails, any comments about this contributions . Hes our friend, all of us. Absolutely. Hes here with us today. And we wouldnt be here without him. He is the one whos gotten everybodys attention. He got paul interested in this field. So three cheers for Mark Kleinman and his role. I had never heard of Mark Kleinman when all this started. But six, eight months into it, we started looking around the country to see people talking about this. Somebody from the Attorney Generals Office said, youve got to read what this guys writing. I think he had a paper called abstinence, or something. It sounded kind of sort of similar to what we were doing. I called him up. I said im a judge in hawaii. He said thats interesting, give me a call at the end of the year. He remembers this conversation differently today than i do. I called him up in december and said were up to 93 people. We got 80 fewer positive drug tests. He was thrilled. Because he had been talking about this for 20 years. But couldnt get anybody to pay attention. So he talked to the national s institute of justice at the time. At that time, Jake Horowitz and Marlene Beckman came out to hawaii to check it out. Mark has been responsible for much of the good press that has come around this. He knows more people in the press the wall street journal did the First National story on it. Its because he knew a reporter. Marlene beckman came out and i said, youre here to just see were not making the figures up in the office. She said, thats about it. So. So good for mark. Let me second the kidos mentioned. I met him at a conference at yale a few years ago. Was intrigued by his work. Read it. And became persuaded because it sounded to me like it was an eminently sensible way to deal with these problems. Next question . John . John malcolm here at heritage. Two quick questions. One, you talked about the expedited process. Do people who fail a drug test, or alcohol test, have to appear in your court before theyre revoked, or does it happen the moment the test comes back . And my second question, which is, did you face any resistance when you implemented these programs from prosecutors, Probation Officers or the defense bar . Well, first, its a 3. 75 rapid drug screen cup. They piss into the cup. Its an instant response. If they deny it and say, i dont know how that happened, it must be a mistake, well seal the sample up, send it to a lab. For a gas chromatic test, they are not taken into custody, theyre given a court ten days later in my courtroom to show up. If they come in, theyll get 15 days, if the lab confirms it. Because theyre in denial or theyre lying. At the warning hearing ill tell them if you ever mess up on saturday night and your test is monday, leave your car at home, dont bring your kids with you, come in, bite the bullet and do the two or three days. Dont use, but if you do, think through your next steps. My challenge at the beginning, i think probation this is hard for judges. Because youve got to give a consequence every single time. But as short as possible to tie the behavior to the consequence. It was just me, so that wasnt a problem at the beginning. That became a bigger problem when we went to all ten felony judges. Probation officers lose discretion at the front end. This can be a challenge for them. Our folks, a crisis can be an opportunity. They were willing to try something new. If you and i both smoke meth and go in and admit it, well both get arrested. It doesnt matter who we are, our race, our backgrounds, whatever. Were both in. And thats why i think this program works. The offenders think theyre being treated fairly. The Law Enforcement guys, because of my background, they were willing to serve more warrants. Once we got data showing fewer new arrests, fewer prison, they were sold on it at that point. But those are the three groups, judges, Probation Officers, and Law Enforcement that have to change. Prosecutors typically like it, because now theres accountability and consequences. Defense likes it because their clients dont go to prison as much. So thats been my experience. I got some initial blowback from the prosecutors. They thought, were going to have all these probation hearings. Youre going to flood my courtroom. Of course, i was attorney general at the time and i just made a commitment. Ill send my people to take care of those hearings for you. But i promise you, its not going to be an issue. Thats how i dealt with it, because i had force in both the major communities. But the in the 24 7 aspect, because were testing for alcohol, the typical Holding Period is only 24 hours anyway. And we streamlined it to the point where in Minnehaha County at least, for the first violation we hold them for 12 hours, and we let them go and they never see a judge. I mean theyre just held 12 hours and then theyre released. The second time theyre held 24 hours and then theyre released. Now the judges dont see anybody and they dont see the judge unless its their third offense. And then something is probably going to happen, because then theyre getting into that aspect of the case where theyre starting to be identified as somebody who cant quit. Rather than who is choosing to like try to beat the rules. Any other questions . Sir . Im Richard Vaughn from the office of National Drug control policy. This question is for judge alm and dr. Dupont. Its about to hit your first decade anniversary, ten years of hope, if you take a step back and look ten years forward, how how how much bigger and larger can this initiative spread around the country . Thinking about the 5 Million People on probation and probably, 2 Million People in prison . If you look about think about how many people you think would do well on this program, how how big would you like to go and how do we how do you go forward the next ten years in serving that need . You get a good idea, your foot should be on the accelerator, right . Weve just were hopeful. Well start a pretrial pilot. Soon. I think in ten years, theres an even chance that this will be the way pretrial, probation and parole are done in most parts of the country. We need more data. We need more randomized control trial study. Some official in washington looks at hawaii and thinks people sitting under palm trees and mai tais and theyre nice criminals. We have the same criminals as everywhere else. As this works in other places, its not a judge alm thing, its a human nature thing. I really think with and the drug czars office has been very helpful, gil has been a great use of the bully pulpit to export just like pew, just like nij, because people recognize it. But the more research you have, the better. And thats ongoing now. So i really think as we show the savings in money, Washington State is showing huge Dollar Savings in not having people sit for three or four weeks before a hearing. As long as the crime rate doesnt go up, that is going to carry on. Theyve got 17,000 people in the program. Im very optimistic about the future. And now with good data rolling in, i think its just going to get better. I would like to pick up on this too about rich baum in person in particular and his role in ondcp. Hope and 24 7 have been part of the u. S. Federal strategy since 2010. And so the ondcp role in this has been very, very important. And it is very much appreciated. I also want to follow up on a comment about doing this for everybody. You know, really, the hope model, and the 24 7, are not for the person who does something once, is a relatively minor offense, comes in to probation, or supervision, does well, goes out, and thats the end of it. Its for the people who have problems. Who have repeat offenses. Who have not gotten that message. Who have serious Substance Abuse problems. So its not saying everybody in probation is going to do hope. Its saying hope is for the highrisk people. Hope is for the people who dont get it quickly. You notice for example, steve alm was talking hes got 8,000 people in probation. Hope is 2,000. And drug courts are 200. Its not everybody its the tough end that were talking about. Thats where the recidivism is. Thats where the high costs are. Thats where this value is. And i think thats really important to think that its not everybody whos in hope whos on probation and parole. Following up to that, what is it, 20 of any group is responsible for 80 of the use, or the product. In probation and parole across the country they probably are responsible for Something Like half of the hard drug use around the country. So we could have a real impact on the amount of use. If it went nationwide it could have a real impact on the narco terrorist type drug cartels in mexico. Because we our demand for it is fueling their activity. If there are no more oh if there are no more questions, let me ask one last one. Oh, yes, sir . Thank you very much. Jeff michael with the national Highway Traffic Safety Administration. I want to thank you, all three panelists, for the very informative presentation. From my particular perspective, im interested in particularly interested in that part of the Substance Abuse problem which takes place on our highways. Which is an important one. But not the only one. We recognize the benefits of 24 7. We dont have many programs that have that the potential that 24 7 has. We are believers. We, of course, dont have authority to implement across the country, states and communitie tthcountry, states a communities do that. But were trying to lead in this direction. The scaleability issue is a big one for us. We really need to demonstrate to other communities that are larger that handle greater volumes of serious offenders, that they can do it, too. Can you say anything about the, you know, the potential outside scale of such programs . Could such programs handle the potentially hundreds of thousands of offenders across the country . Well, i sioux falls is the Biggest Community ive ever lived in for any length of time. So i start from there. The largest problem they have is parking. Okay . If youre going to test more than 600 people at the same site, you need to have a big parking lot, that much i know, okay . But i know theres a pilot going on in des moines, for example, which is a somewhat larger community. Ive understood that theres going to be one going on somewhere in one of the communities in florida, which im sure is larger than des moines. And i guess i have to go back. Youve got to pick a spot, with a big parking lot, and you have to try it. But you can scale back the target audience. We scaled back. We started only with duis with a prior conviction. And we knew from the numbers in south dakota how many people that was statewide. We also knew how many it was by county. So we knew the at least when we started, the numbers were never going to get higher than that. Now, of course, what turned out was that the judges immediately started seeing the efficacy of using it for situations other than drunk driving. The spouse abuse theres a huge correlation between Domestic Abuse and alcohol abuse. So the judges were using it there, too. And they were using it for burglaries and thefts and other alcohol related misconduct. And of course, it produces great benefits there as well. So and, of course, not telling stories out of school, nhtsa was not particularly happy with us for using their money to deal with spouse abuse and burglaries. But we worked that out. We put all that together. But the bottom line is, youve got to pick a spot, and try it. And if you want me to fly to florida and speak, ill be happy to do it. Let me thank each of the panel members. It was a true privilege for me to sit here with people who have had such distinguished careers, and who have devoted such a large part of their careers for coming up with an innovative way of addressing the problems of morbidity and mortality on our highways and in our communities. Please join me in thanking them for coming here to give us the benefit of their knowledge. [ applause ] and i thank paul larkin and heritage for making this happen. [ applause ] the Heritage Foundation hosts a discussion on trends in opportunity in the u. S. Live Coverage Today starting at 12 30 p. M. Eastern here on cspan3. Tonight on cspan3 washington journals big ten series continues at the university of illinois at urbina. At 8 40 p. M. We look at an event about war starting with a discussion on war and civilians. Thats followed by a look at the legacy of former afghan President Hamid karzai and a panel on finding jobs for veterans at 8 00 p. M. Eastern here on cspan3. The 2015 cspan student cam video competition is under way. Open to all middle and High School Students to create a five to sevenminute documentary on the team the three branches and you, showing how a policy, law or action by the executive, legislative or judicial braj of the federal government has affected you or your community. Theres 200 cash prizes for students and teachers totalling 100,000. For the list of rules and how to get started go to studentcam. Org. 2014 marks the 50th anniversary of the Surgeon Generals report on spoking. The first time the federal government linked tobacco use to lung cancer and heart disease. Next acting Surgeon GeneralBoris Lushniak discusses the latest report on tobacco use. This is an hour. Good morning, everyone. Welcome to the white house. Im dr. Howard koh the assistant secretary of health for the department of health and human services. Thank you so much for joining us on this historic day to honor the 50th anniversary of the Surgeon Generals report on smoking and health. To begin the program, its my pleasure to introduce cecilia munoz, assistant to the president and director to the domestic policy council. The office which coordinates domestic policymaking in the white house. Prior to this role, she served as Deputy Assistant to the president , and director of Intergovernmental Affairs at the white house. And before joining the obama administration, cecilia served as a community leader, as senior Vice President at the National Council of boraza, the largest latino civil rights organization. Please join me in welcoming cecilia munoz. [ applause ] thank you so much, dr. Koh. Good morning, everybody. I should start by welcoming you all to the white house. This is a great day. And we mark today, the decades of Public Health research, policy and Community Efforts that have dramatically reduced tobacco use in this country. The commitment of those of you in this room and your colleagues across the country, to ending the tobacco epidemic is truly inspiring. And im just very proud to be here to acknowledge your accomplishments. I want to be sure that you know how important this work is, to this administration, and to this president. Improving the Nations Health is a goal of every president. Its a priority for this one. He has spearheaded legislation and used the bully pulpit to help make our children, parents, friends, families, communities as healthy and able to meet their potential as possible. Thats why he led the effort to sign into law and implement the Affordable Care act. The law is not only helping to improve health by making conk more affordable but its improving access to Tobacco Cessation coverage for millions of americans. Thats why we made sure the Affordable Care act included new opportunities and new tools to support prevention and to help people to quit. Weve made unprecedented investments in community prevention, including new campaigns that are reducing tobacco use, like the tips from a former smoker initiative, which would not have been possible without the Health Care Law. That also is why the president signed the Tobacco Control act, to give fda new authority over tobacco products. Thats why we increased the cost of cigarettes and are proposing a new tobacco tax that will help both reduce smoking, and support new investments in kids. But we know that theres a lot of work still ahead. And as you will hear today, far too many young people are smoking, and tobacco use remains the largest cause of preventable death in this country. So as we pause today to acknowledge how far weve come, lets also remember the lives lost too early due to tobacco and our shared commitment to protecting our kids so that their lives arent cut short. We look forward to partnering with you and this work as we build a tobaccoFree Generation. Let me conclude by thanking you to the dedication and commitment to the health of our kids and let me also thank the many Public Health leaders in the audience who have fought tirelessly for years to help improve Public Health and end the tobacco epidemic. With that, it is my great pleasure and honor, really, to introduce the secretary of health and human services, a tireless advocate for the health of our children, secretary kathleen sebelius. Madam secretary . Good morning. And thank you, cecilia. Not only for being here today, and hosting this great event at the white house, but cecilia is head of the domestic policy council, and is overseeing this unprecedented coordination of work across Government Agencies on a whole variety of Public Health issues. None more important than what were here today to talk about. So thank you for your leadership, and your support. I want to start by extending a special word of welcome to the family of dr. Luther terry, our ninth Surgeon General who 50 years ago began this effort to warn about the dangers of smoking. And the link to Public Health. Were joined today by members of the terry family. Id like them to stand and be recognized. His sons michael and luther, along with luthers wife melinda, grandsons, luther terry, and luther terry iii, granddaughter agnes and her fiance unadrew. Just to tell you, agnes recently graduated from the Harvard School of Public Health. So dr. Terrys legacy continues not only here, but in the family. So welcome to the terry family. I also want to welcome two of our former Surgeon Generals, dr. Regina benjamin and former Surgeon General dr. David satcher. So thank you. Can you stand and be recognized . Playing very Important Roles in pushing this effort forward. We also have ambassador Michael Froman with us today. Ambassador froman is our trade ambassador. And thank you for being here. Mitch zoeller who heads up the antitobacco effort at the food and drug administration. Mitch is over here. And two very special hhs health leaders, who are close advisers to me on a regular basis, but have worked on this issue for a very long time. Who you wont have a chance to hear from today, but i want to services, bill core. [ applause ] and the General Council of the department of health and human services, bill schultz. [ applause ] i can tell you, the two bills make sure this item stays very focused in our department. You are going to have a chance to hear from dr. Howard koh, our assistant secretary of health from dr. Tom friedman and dr. Boris who is the acting Surgeon General. They, again, are incredibly involved leaders in this whole process. We have made a lot of progress in the 50 years since the first Surgeon General report in smoking and health. We are still a country very much addicted to tobacco. This addiction, this epidemic has serious ramifications for our families, our communities, our Overall Health and the health of our economy. So, today, we are calling on all americans to join in a sustained effort to make the next generation a tobaccoFree Generation. Our message to the American People is this, there are things each of us can do in our communities, our schools, our businesses that make a significant contribution to ending this epidemic, saving the lives of loved ones and making the next generation tobacco free. I would like you to think for a moment about what the loss of one life means to a family. What it means to a neighborhood. What it means to a community. Year after year after year, tobacco use claims nearly half a million american lives. Across the world, tobacco kills 6 million of our fellow human beings every year. Now those are more than just numbers. There are parents, colleagues, friends, neighbors, Global Partners and our children. Now, thats not to say we havent made progress. Our Tobacco Controlled efforts over the past five decades prevented by some estimates as many as 8 Million Deaths in this country alone. Our nations smoking rate is half today what it was in 1964. But, the fact of the matter is, even with this progress, tobacco use is still the leading cause of death and disease, both in our country and across the world. If we look around the room, the likelihood is, all of us have been touched in some way by the loss of someone in your lives due to tobacco use. One thing we know for sure, if we fail to act, well continue to lose the lives of people we love. Statistics tell us, most americans who die from smoking this year began smoking when they were kids. Every day we know that more than 3,000 children under the age of 18 try their first cigarette and nearly 1,000 of those children become daily smokers. If we fail to reverse those trends, 5. 6 million American Children who are alive today will die prematurely due to smoking. 5. 6 million young americans. There are very serious economic consequences as well. You might have heard the recent report on npr that looked at Tobacco Control in oregon. For every pack of cigarettes smoked in their state, they pay an estimated 13 in lost productivity and medical expenses. Think about that for a minute. Every single pack, 13. Thats just one of our 50 states. As a country, the total Economic Cost of smoking now topped 289 billion every year. Billion with a b. Billion dollars every year. I would argue, as cecilia already said, no president has been as committed to ending the epidemic of tobacco related deaths as president obama. Since the first days of this administration, five years ago, we have taken a coordinated approach to help tobacco users to stop smoking, keep others from starting and use Regulatory Authority to protect consumers. In 2009, he signed landmark into law. Fda can regulate it. Many of you in this room were involved in that effort for decades and decades. Can you standup to be recognized. Standup, please. Howard, standup. You were part of this. Tom, standup. [ applause ] now, because of this new law, the fda has been able to implement a number of life saving reforms already. Tobacco companies can no longer give free samples to get kids hooked or use bogus and misleading terms like lite, low or mild as marketing campaigns. The reforms languished in washington for decades. In 2009, president obama was able to sign the bill into law. The following year, the president signed the Affordable Care act, a number of key provisions. It requires Insurance Companies to provide Tobacco Cessation services to customers. Allows medicaid people to have it with no out of pocket costs. The Health Care Law invests to support Community Based projects across the country. Iowa, for example, is getting support for evidence based Tobacco Controlled innovations geared toward low income, rural populations. The Affordable Care act invests in Public Education campaign that is promote prevention and help people quit smoking. One of those is cdcs tips from former smokers campaigns. If you havent seen the ads, they are incredibly powerful. Here is what we know about them. Over the last couple years, the campaigns graphic messages helped con vinls 100,000 fellow americans to permanently quit smoking and convinced 1. 6 million more of our friends and neighbors to begin the process of trying to quit. They have a real impact on lives across this country. Research suggests we are able to add as many as 500,000 years of life to the american population. Thats a pretty significant am pain. We know one of the single most things we can do to save lives is decrease smoking by increasing the cost of cigarettes. As part of the 2009 Childrens Health insurance, we brought the federal excise tax to 1. 01 per pack. This budget tacks on an additional 94 cents. It will discourage more and save more lives. This is a twofer. This would allow us to provide Early Education to 4yearolds across the country, while strengthening health and education initiatives for infants and toddlers. So not only would we have the opportunity to save more lives by reducing tobacco use, and we know that use is particularly reduced in young smoker who is are price sensitive, but we can also benefit the next generation by making the best single investment we can in their future, at the beginning of a childs life. So ultimately these actions will be most effective if theyre paired with local efforts across our country. Over the past 50 years, we have been able to transform smoking from an accepted National Past time to an acknowledged health hazard. We have succeeded in driving smoking out of commercial airplanes and out of a growing number of restaurants, bars, college campuses, buildings and other work spaces. With the lives of 5. 6 million children in the balance, its time to take these efforts to the next level. President obama believes that a tobacco Free Generation is well within our grasps. Dr. Lucniac believes a tobaccoFree Generation is well within our grasps, and i believe this as well. What we know is this. The federal government cant do this alone. We have to have a very significant role to play, but its not, by any means the only role. We need an all hands on deck approach to take tobacco out of the hands of americas youngest generation. We need the partnership of the business community, local elected officials of the academic community, the medical community, nonprofit organizations and a committed Health Advocate and citizens in communities across the country. We need more schools to follow the lead of colleges and universities like the university of south carolina, which adopted a tobaccofree policy. The universitys associate Vice President for Student Affairs and academic support is with us. Will you standup or raise your hand . Thank you very much. We need the engagement of young people, like ryan washington, a proud gonzaga eagle from Gonzaga High School here in d. C. Ryan serves on the d. C. Youth coalition. Lets hear it for ryan. Thank you very much. Across our country, individual americans are taking critically important action. Theres statewide efforts under way like in kentucky, the bluegrass state. Sue is working across the aisle to make it smoke free