A lot of areas where we can move forward. Thank you all very much and thanks for having me again. National Governors Association also held assumption on scripture drug abuse Prescription Drug abuse in the u. S. Mary bona also created the Prescription Drug abuse caucus. This is one hour and 20 minutes. If i could have your attention, lets take our seats so that we can get our joint session started. First of all, i am governors Steven Beshear from kentucky. I chair the mga health and Human Services committee. Welcome to all the governors who are here. This is a joint session of the health and Human Services committee and the Homeland Security and Public Safety committee. Joining me is vice chair of our Committee Governor bill haslam of tennessee. Im pleased we been able to come together with Homeland Security and Public Safety committee for todays discussion regarding the nations opioid crisis. I want to thank the leadership of the other committee, governor Rick Schneider of michigan, governor jerry mccall of virginia for partnering with us on this very important topic. The briefing books were sent to governors in advance. The proceedings of this meeting are open to the press and all meeting attendees. Please silence your cell phones. Seated at the table are Committee Legislative directors melinda becker, justin stephens. You can see them after the session if you need copies of the materials or further details about any of the issues that we have discussed today. Before we go into our formal presentations, i want to turn to heather halsted, who is the staff director for the health and Human Services and the Homeland Security and Public Safety committees. Healther and her nga colleagues will provide updates on key federal and state issues. Thank you governor. We made progress on a number of priorities. From the health and Human Services perspective, we abdicated actually for an exception of the we abdicated for extension of the ad vocated for extension of the Childrens Health insurance program. That chip extension maintains existing flexibility and planning levels for states. That was a key area we were able to a college. There were also discussions to reform the Child Welfare system to invest and services that keep children safely out of foster care. At the same time, Homeland Security and Public Safety committee has been working with congress to making an Armed National guard personnel. Currently the house and senate are conferencing their bills. We plan to have a final bill in the fall. The senate bill provision, which would receive additional personnel, prevents further transfer until 2017 be included in that final bill. In addition to National Guard matters, they have been increasing a role in a Cyber Security and greater collaboration with the federal government any private sector. The two main priorities i want to cover from the federal relations perspective. I will pause quickly before any questions before we proceed. Happy to antianything afterwards. I turned to my colleague from practices. The director of our health division. Good morning governors. A brief update as to how the health and Work Division is going. We have had well over 20 very intense projects going on around the country with hundreds of your leadership staff. Two projects i want to highlight. First our medicaid transformation policy academy. Their intensive work with alabama, washington state, and nevada where we are working hand in glove with the states to negotiate broad new plans. These are authorities the states have never had before that will allow governors to have let more flux of the league pay for and deliver services in medicaid. We are in agreement with at least one state and look to negotiate in some cases billions of dollars in upfront investment from the federal government. Its very powerful work. We plan on providing you with a very victorious report in february during the winter meeting january. We will be releasing a roadmap for all states that we are hoping to reach agreements with hhs that will allow you all to use a new process to get to medicaid waivers more quickly. We also are launching our next round of super utilizer work in two days. Its aimed at the highest cost, highest spend medicaid patients. They are spending millions of dollars and have terrible outcomes. That will be for the next year and a half. We are ready did two years and had some pretty impressive results. Prescription drug abuse, opioid agrees, heroin addiction have come to light as very strong components to the reason these folks end up using a lot of these services. Todays discussion is i think very relevant from a cost perspective and equality perspective. We will be able to solve one of the most important issues facing state medicaid budgets. Now we will turn to jeff mcleod. Since 2012, my division has worked in close collaboration with fredericks division. We posted two policy academies in several states. States have passed legislation launched Public Awareness campaign, trained providers on safe and effective prescribing practices. We have put out a few different products. We put out Six Strategies states can adopt to address Prescription Drug abuse. We followed up with some new recommendations. Through evaluations, states can better assess the ask the success. Certainly, the problem of Prescription Drug abuse has been grabbing headlines. Substance abuse in general is a real problem as it relates to the safety and wellbeing of children, especially children in the welfare system. We launched a new policy academy on approving child safety and preventing child fatalities. My division will be working again with frederick and his team to build on the success of the policy academies and the momentum that i think there is nationally on this issue on helping states deal with the rising use of heroin. According to the centers for Disease Control and prevention three out of four new heroin users started on Prescription Drugs. If frederick or i can be helpful, dont hesitate to reach out. Back to you, heather. We will stick around after to answer any questions. Governor beshear, back to you. Lets turn to the topic of todays joint Committee Meeting which is opioid abuse. Its a Major Public Health and safety crisis that affects all of our communities in every one of our state. Because of the rise in Prescription Drug abuse and in heroin abuse, Overdose Deaths now surpassed Motor Vehicle accidents as the leading cause of death in the united states. Heroin deaths have increased especially quickly, nearly tripling between 2010 and 2013. Kentucky has its problems in this area. We have long been plagued with high rates of drug addiction both to prescription painkillers and Illegal Drugs like heroin. Over the last few years, two things have happened that are giving us more hope and confidence in the future. One, we passed and implemented a couple of wide ranging and multipronged programs that attack the problem from every angle, including treatment education, Law Enforcement, and health care. Secondly, what we are finding is that our stakeholders are working together like never before, both inside and outside of our state. In 2012, we passed what we called house bill one, which targeted drug abuse and misuse. We ran a bunch of pill mills out of the state. We required our medical professionals to use our statewide electronic prescription monitoring system. And we allowed for better sharing of records among agencies in kentucky and other states. Earlier this year, this addiction situation is akin to the game of whackamole. You attack it in one direction and it pops up somewhere else. We have been pretty successful in the Prescription Drug abuse area and we have seen tremendous progress. But now, heroin is raising its ugly head and is killing even more people than Prescription Drug abuse did. Earlier this year, we took a similar approach in our legislature on heroin. We passed senate bill 192. Among other things, this bill increased prison sentences for heroin traffickers, but it also helps us identify addicts that can benefit from more treatment than from lengthy prison stays. I think we have all figured out that we cannot incarcerate ourselves out of this problem. We have expanded addiction treatment. We have allowed local option Needle Exchange programs. We established a Good Samaritan provision to encourage friends of overdose victims to call 911 and get help. Last month, i announced the allocation of 10 million for a programs aimed at fighting eight and treating drug abuse, including programs to help inmates, pregnant mothers, improve prosecutions of drug dealers, help Public Advocates drop alternative sentencing plans, and expand Substance Abuse treatment at the local level. Governors all across the country are leading similar efforts to address the opioid crisis, bringing together Law Enforcement, criminal justice professionals, Health Agencies providers, and other Key Stakeholders to develop and implement comprehensive strategies. The health and Human ServicesCommittee Held a session on state efforts to combat Prescription Drug abuse during the 2014 winter nga meeting. The committee has since maintained a focus on Prescription Drug abuse, bringing Lessons Learned from states to inform policymaking at the federal level. At the most recent nga winter meeting, governors approved a new policy that calls on the federal government to work with the states in developing a comprehensive National Response to Prescription Drug abuse. Todays discussion reflects the reality that we are no longer confronting an epidemic of Prescription Drug abuse by itself. But an alarming resurgence of the use of heroin. Recent federal Data Confirms that the link between rising rates of Prescription Drug abuse and heroin abuse go together. Indeed, almost half of those who use heroin also abused or had dependence on prescription opioid painkillers, making them the number one risk factor for heroin use. Next week in kentucky, we expect to hear positive news from an evaluation of our efforts to change the land of Prescription Drug abuse. But we still have a long way to go to fully address the opioid problem and the recent spike in heroin. I look forward to todays discussion and hearing from onal strategies that we might be able to implement in kentucky. Im going to turn out to Governor Snyder and ask if you would like to make some opening remarks and introduce our guest. I want to start by thanking you and your other Committee Members for the great work you have been doing on this or the health and Human Service committee. Its important. So thank you for your effort and your perspective. I also want to recognize my partner in the leadership of the Homeland Security and Public Safety committee. We work well together on a number of issues, including Cyber Security. This is also an issue thats critically important to all of us as governors and citizens. This is a great venue to have a discussion. I want to thank everyone coming today in terms of the other governors, members of the audience, and distinguished panelists. I look forward to learning today and being stronger and better thanks to the knowledge you will share with us. This is a major crisis and that is the attitude we need to take towards opioid abuse whether it be Prescription Drugs or heroine abuse. In michigan, we found it to be a tremendously growing problem. To give you some perspective, as i travel michigan, i often ask people what the Biggest Issue they face. Two sheriffs pointed out their greatest problem was Prescription Drug abuse. Thats the starting point of all of this. We need to do more. I am proud to say last year, we passed a bill dealing with opioid antagonists where we actually have our emf people carrying that with them to address the problem. If you have to use that, its much later than it should be. We need to do more in terms of education, prevention, treatment, and the Public Safety side of this together. Thats why doing a joint meeting is particularly important and i am proud to be here. With that though, lets get to our distinguished panelists and learn from them. I look forward to this because in michigan, i have created a task force this spring that will lead into a legislative and other packages of actions to be taken. This couldnt be more timely in terms of hearing from people who are experts. I am proud to say we have a very distinguished panel. I am pleased to introduce congresswoman mary bono. Among the many a competence during her 15 year congressional career, she founded the congressional Prescription Drug abuse caucus and cochaired the congressional addiction, treatment, and recovery caucus now a principal at a Consulting Firm and cofounder of the collaborative for effective prescription opioid policies congresswoman bono maintains a strong commitment combating Prescription Drug abuse and promoting recovery. Thank you for being with us. Also with us today is dr. Debra houry. Director of the National Injury prevention and control. In that role, she leads the cdcs efforts to advance Public Health approaches to preventing Overdose Deaths, working closely with states to expand the use of effective interventions. Prior to joining cdc in 2014 she served as vice chair and associate professor in the department of emergency medicine at Emory University school of medicine, as well as associate professor at emorys school of Public Health. Thank you for joining us. Finally, i would like to welcome someone from the Law Enforcement community. Retired lieutenant detective patrick glenn, who is a Founding Member of the Norfolk CountyPrescription DrugMonitoring Program and director of the quincy program. In 2013, he received the white house advocacy for action award for bringing Law Enforcement and Public Health together to disrupt the cycle of drug use, crime, and recidivism. Thank you and congratulations for your fine service. Welcome to all our panelists and im looking forward to the discussion. Lets start off with congresswoman bono. Would you start our presentations . Good morning. Its wonderful to be here with all of you and to see my former colleagues. Thank you for testifying before my committee a couple years ago, governor beshear. If i remember, i was extremely kind to you at that time, and i hope you will return the favor to me. [laughter] my gavel was very light that day and im without one now. I want to thank all of you for taking an interest in this topic. Im honored to be here to share with you my thoughts on the opioid crisis. I applaud you for focusing on this academic and i encourage you to throw everything you can it. Countless lives hang in the balance. The hushhush nature of opioid overdose death has for far too long been preventing the serious Public Health issue from receiving the urgent attention it needs. I am here with you today as both a former elected official who spent almost a decade focused on Prescription Drug abuse come a but i am also a passionate parent and family advocate who has personally wrest