Good morning. Thank you very much for being here. Know,e surgeon as you the Surgeon General is with us. The Surgeon General, all of you should know. I did not want you to hear the secret things i was saying. Now can you hear me . Do you want to hear me . [laughter] that is the most important thing. Ajoke i tell all of the time, man was giving a speech to about 500 people. A guy in the back raised his hand and said, senator, i cant review. A medially, a guy in front row jumped up and said i can and i will trade places with you. [laughter] i hope none of you trade places. Sheriff, good to see you. The Surgeon Generals family lives literally in my neighborhood. They are counting on you for protection. We have a lot of st. Marys people. Thank you very much for being here. Opioids is a crisis. Bad news is, is a crisis everywhere. The good news is, it is a crisis everywhere. What i mean by that is everybody in the congress, whether they , same areas,ural arundel,t, or anne l, urban,t is rura suburban, it is a crisis. You can go to the outermost arts of New Hampshire and they will tell you there is a problem. Dr. Fleming is here. I just want to say a few words of welcome to all of you and thank you for being here. The Surgeon General wanted us to do something. He and i talked early on. I congratulated him on his appointment. I will get a little introduction and a second. He said, well, lets do a foreign in Southern Maryland where i know you have a problem. That is the bad and good news. Good news because that means everybody understands it and needs to deal with it. The bad news, it is everywhere and we need to deal with it. I want to thank dr. Fleming who is here. Let me yield to you. Youre supposed to welcome us. I was doing that and i apologize for subverting your responsibility. Thats all right, sir. Were flexible. I am dr. Richard fleming. And the Vice President and dean of the campus. I would like to thank commerce and hoyer commerce member hoyer for asking us to host this venue. I would like to welcome congressman hoyer and Surgeon General adams here today as well as all of you. We are all certainly aware of the Opioid Crisis that affects not just Southern Maryland but everyone nationwide. At the college, were doing our part to try to help. Were currently developing and Opioid Awareness and Education Program which will be available for all of our students as well as our staff. In the event of an emergency, each of our campus have staff who have been trained to carry as well as administer naloxone should a be necessary. This is very important for all of us. If at any time during your visit there is anything you need or anything we can do for you, please let me know or my staff and we will be glad to help you. Once again, thank you, congressman hoyer and Surgeon General adams. Thank you. This is extra ordinarily. Mpressive college it has grown substantially. The Community College in prince georges started in my high school about a century ago. College that is bigger than the university of maryland. I dont how many students we have here now, but it is about 9000. This is a wonderful enterprise making a wonderful impact on young people. I want to welcome all of you here, Surgeon General adams, dr. To my lipsrch baron as the Deputy Director of the opioid Operational Command center. Fran phillips is here, acting Health Officer. Sheriff cameron, ive already mentioned, there was just an article about the incident, Surgeon General i dont think tim, close to doubling from last years statistics . Tom, a very different in mind. Used to be a leader of the state up theand has headed high intensity Drug Trafficking area for very long time in our state, which deals in the district of columbia, northern virginia, and baltimore. Intensitythe high Drug Trafficking, which was the first one to have a treatment [indiscernible] we are joined also by the governors office. Gretchen, i dont think youre seated up your. Where are you . Why do you stand up, gretchen . Gretchen is with the governors office. Thank you for being here and head of intergovernor intergovernmental patience. Bill stevens. Bill . Gloria from the department of social services. In the Health Officer of calvert county. This is recording and this is amplifying. Got you. Today our focus is on a challenge that is straining the resources of our region and causing people the pain. Glad we will be hearing not only from those working to a dress this crisis as all of you are at this roundtable, but also later from individuals who want treatment for addiction. Let me go quickly. Ive introduced some people with the county and state, but we have a lot of you who work with the Hospital Systems and want to go quickly. We will start with dr. Obrien. Obrien. R. [indiscernible] sheriff cameron. St. Marys county Health DepartmentBehavioral Health director. Emergency management st. Marys county. Calvert county. Calvert county Health Department. Calvert health. [indiscernible] the division chief of Emergency Management and calvert county. [inaudible] director of the local Behavioral Health authority in charles county. Kim hill. [indiscernible] director of corrections impress georges county. [indiscernible] still gloria brown. [indiscernible] we have a very, very diverse group. Inms of two graphics terms of geographics. Thank you for being here. A lot of other people the Surgeon General will hear from. The Opioid Crisis to make a correlated incongruence of response. That is why im so glad superintendent hill is here are ae School Systems very large venue for dealing with this crisis. Already were seeing state, local, federal agencies working together to address this crisis. Going to continue to work across the aisle in congress. This is everywhere. It is not a partisan issue. It is an issue for the American People and for all those concerned about the health of our communities. Providers and First Responders of maryland have the tools they need in some instances and in other instances, we need to get them more tools. Last year i partnered with republican Majority Leader Kevin Mccarthy to pass the opioid act that requires the department of health and Human Services develop a set of metrics for evaluation and evaluating the efficacy of opioid related grant programs. In other words, if we want to put money on the table, we want to make sure it works. We need your input and feedback to accomplish that objective. This will help us ensure we are making the best use of our resources and directing them where they are most needed. Let me make a comment. We had not put enough money into treatment. We must put more money in treatment. Identification, Law Enforcement, all of that tim and i have talked about this. We can have millions of Law Enforcement people, but if people keep coming becoming addicted and do not get treatment and do not get off the addiction they have, tim and mike are going to continue to be in the field arresting people. That is not the solution. It needs to be done, but it is that the solution. Theres much more congress can and ought to do. I hope to come from todays discussion with additional insight into what our state i want to thank the governor for his focus on this issue. He clearly has seen it as a crisis and is confronting it. But we need to do more. The additional insight that we of what our state and local agencies date from the federal government my role so i can be more effective to advocate on your behalf and on the behalf of those who are addicted in our state. And the families who are affected by that and the community affected by that. I am proudly out with us this morning our nations Top Public Health official. [indiscernible] i am proud he is a neighbor and friend. When i called them up he said, know, i went i did not know he was such a local. I knew about his activity in indiana. He is a native of Southern Maryland. General adams. Surgeon general adams. Actually, he is an admiral but is a Surgeon General. Go figure. That gives them i guess purple status. Grew up in st. Marys county. He studied biochemistry about physiology at the university of maryland baltimore county. I should have invited from a nebraska. He has to busting with pride. I will see him tomorrow night. Hes a very dear friend. Probably as most of you know, the president about more county. Your institution. Animalms, general adams, adams, received his degree from university of indiana and masters in Public Health from the university of california, berkeley. He is boardcertified in anesthesiology. He was the States Health commissioner appointed by governor pence in 2014. That mightve had something to do with his being the Surgeon General of the united states. In that role, he had a stem of hiv aids in opioid users. Program adopted in the state of indiana which was very difficult. Congratulations to you for your vision and for your courage in getting that done. Dr. Adams was confirmed as our nations 20th Surgeon General september 5 and said the Opioid Crisis will be one of the Top Priorities of his tenure. I want to call you back to dr. Coupe. Dr. Coupe focused on tobacco and aids. He did so in a courageous way, courageous in terms of industry and courageous in terms of aids in terms of political divisions that existed at that time in the 1980s with respect to the age crisis. The Surgeon General can make an extreme your impact extraordinary impact. My belief is the Surgeon General adams will do exactly that. Welcome. We look forward to hearing from you. Welcome, everyone. It is good to see the audience packed today. It is amazing to be here. I want to thank you, commerce and wire, for inviting me to be part of this meeting and i want to thank dr. Fleming for hosting us a your beautiful facility. My first time back in Southern Maryland for an event since ive been Surgeon General. So glad it is an event where we in thet many partners room. It is humbling. We do this in india and all around the state. I went around the state with governor pence and we had convenience and try to bring different folks together. I can tell you yet a diversity represented here that i am in awe of and open can replicate in other parts of the country. Three things i want to focus on in my brief remarks because i want to hear from you all. I dont want to take up too much of your time talking because it is important you all hear from each other. I cant tell you how many times i would go around ace get a as state Health Commissioner and everyone would expect me to have the answer to all of the problems. Once folks started talking, they realize they have their problems right there in the room and in their community, they just had not been in touch with each other before. We have to break out of our silos. I love that you all are exercising prevention, enforcement, and treatment as part of the opioid intervention plan because it is going to take all three. One of those alone . W you are just playingwhackamo le. m going to emphasize stigma it is important we were together to address stigma. Experiences. Hood how many have heard of that . A few. We need to make sure everyone knows about that and partnerships. As the congressman mentioned, i grew up around here. I would to high school here. Both of my parents were school teachers. My father taught and Margaret Brent and my mother taught preschool. I grew up in a family of educators, but grew up working in the tobacco fields, in the hay fields, doing the things that a lot of folks around here are accustomed to to supporting themselves. Saw a lot of challenges that we face in terms of accessing health care, in terms of accessing opportunities that are more prevalent in the big city. I think all of those tie into the Opioid Epidemic. Some of you may know this. A story ofy have addiction. My grandfather died from tobacco use. Tobacco is an addiction. I have an uncle in a nursing home because of alcohol abuse. Yet another addiction. That chefs are probably well acquainted with list out in state prison in jessup because of his drug abuse. Goese os back to it back to unrecognized, untreated Mental Health issues that then turned into a addiction and now resulted in him being put in prison for the protection of the public, but ultimately we have to figure out how we stop that from happening beforehand and also how we had a great discussion this morning with the head of the federal bureau of prisons, how we provide people with the treatment they need. Treatment,ssisted supportive housing, so we can integrate them back into society. 95 of people who come into the jail system, who come into the state prisons, the federal prisons, are going to and up in society all over again. We can either continue that revolving door or bring the right folks together to treat addiction as a disease while still recognizing there are real Public Safety issues we have to address. We have to keep the public safe, but the way we do so is by treating addiction as a disease both in prevention and in testing and recognition and in treatment and recovery. The congressman mentioned indiana. While in indiana, theres a small town it reminded me a little bit like st. Marys county. Very rural. Again, some Difficulty Accessing Health Care in certain places. A town of 4000 people and they are now up to almost 200 30 cases of hiv in just over two years, all related to interaction injection drug use. We were able to limit a Syringe Service program but we were able to do it by bringing people together. It wasnt just about giving out syringes. It was providing access to recovery. Im glad you mentioned we have to devote more resources to recovery. It was getting people tested for hiv and appetite is, working officials. Orstmann the Syringe Program wont work if you dont have Law Enforcement on your side. It was about working with the business community. That is one group i did not fix was only represented that i would encourage you to invite next time you convene, the chamber of commerce. They are driving a lot of the Decision Making in your community. Right now theyre telling us they cannot find enough people who can pass a drug test to show up to work to work for the companies. Theyre hurting from this, too, and we dont want them solving this in their own silos. We want them here working together with all of you. At hhs we have a fivepoint strategy. Mprove recovery targeting the availability and distribution of overdose reversal drugs. I know you are all devoting some money to that as part of your plan will stop critically important. We cant help people recovery if they are dead. Folks realize this. I know a lot of the Law Enforcement folks i talk to are sing therustrated i same people over and over. Ive talked to Law Enforcement folks who have rescued an individual seven, 8, 9 times. That is a testament to the fact addiction is a disease. Addiction is when you know something is bad for you, and you just cant stop doing it. You know it is bad and you cant stop doing it. It is not a conscious choice. I was talking to someone in recovery and he said, telling me not to do drugs is like telling me me telling you not to breathe. At some point your body is going to take over because your brain changes when you are addicted and it is going to force you back in of the same habits unless you get the proper medical treatment for it. We need to work with Law Enforcement and Emergency Personnel to make sure naloxone is available, but do a better job of making sure we have a pathway for those folks will he rescue them from naloxone so they can get recovery, get into meaningful recovery and not just push them back out on the street. I told you i would not go too long. Do you know the best place for a drug dealer to hang out . Two best places. One is right outside the jail when people are getting released. Number two is right outside the hospital after people have been resuscitated from naloxone. In both instances, we have people with untreated addiction who we have detoxed, but we have not appropriately treated and we push them right back out into the hands of the dealers if we dont have a system in place that can help them ultimately recover. Dataed to strengthen collection. That is critically important for the f