Good morning. Thank you very much for being here. As you know, the Surgeon General is with us. The Surgeon General all of you should know. I dican you hear me . Do you want to hear me . That is the most important thing. That happens i tell a wonderful joke, he was giving a speech to 500 people and a guy in the back raised his hand and said senator, i cannot hear you. Immediately the guy in the front row jumped up and said i can and i will trade places with you. [laughter] of you tradee places. Good to see you. Many of the Surgeon Generals family lives in my neighborhood. They are counting on you for protection. [inaudible]t of crisis, the bad news is, it 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 represent a rural, st. Marys or calvert, or anne arundel, whether it is rural, urban, suburban, it is a crisis. You can go to the outermost arts of New Hampshire and they will tell you there is a problem. I am so pleased 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 give a little introduction in a second. He said, lets do a form 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 congressman 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 an 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 it 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 an extraordinarily impressive college. It has grown substantially. The Community College in prince georges started in my high school about a century ago. It is now a 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. Fleming, birch baron to my left 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 dear friend of mine. Used to be a leader of the state police and has headed up the high intensity Drug Trafficking area for very long time in our state, which deals in the district of columbia, northern virginia, and baltimore. He heads up the high intensity 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 here. Where are you . Why dont you stand up, gretchen . Gretchen is with the governors office. Thank you for being here and head of intergovernmental relations. Bill stevens. Bill . Gloria from the department of social services. And 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 deep pain. For communities throughout maryland and our country. I am glad we will be hearing not only from those working to address 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. I am dr. Obrien. I am the ceo of Walden Behavioral Health in Southern Maryland and the president of the maryland addictive disorders counsel. Sheriff cameron. St. Marys county Health DepartmentBehavioral Health director. Emergency management st. Marys county. Calvert county Health Department. Emergency management, st. Marys county. The president and chief ofion Emergency Management in Calvert County. [inaudible] i am the director of the local Behavioral Health authority in Charles County. The director of corrections in prince georges county. Rep. Hoyer we have a very diverse group, all over the district i represent. Of uniformedber officers here, thank you very much for being here. Opioid crisis demands a comprehensive response. That is why i am so glad superintendent hill is here. We are seeing state, local, and federal agencies working together to cover this crisis. I will continue to work across the aisle in congress. His is not a partisan issue it is an issue for the American People and all of those concerned about the health of our communities. Health providers and First Responders of maryland have the tools they need in some instances and in other instances, we need to get them the tools they need. Evaluating the efficacy of programs. If we are going to put money on the table, we have to know that it works. We need input and feedback to accomplish that objective. Let me make a comment. We have not put enough money into treatment. We must put more money in treatment. This. E talked about we can have billions of law but if peopleople keep coming becoming addicted and do not get treatment, kim and mike will continue tim and mike will continue to have to be in the field arresting people and that is not the solution. Congress can more and ought to do. Governor fornk the his focus on this issue. He clearly has seen it as a crisis and is confronting and. But we need to do more. The additional insight we get , what our state and local agencies need from the federal government, that is my goal so i can be more effective in advocating on your behalf. The families who are affected by that and the community affected by that. I am glad we have our nations Top Public Health official. He has [indiscernible] proud that he is a neighbor and a friend. I read is biography is a biography and his activity in indiana. Adams, actually, hes an admiral, but he is a Surgeon General. Go figure. He grew up in st. Marys county. Biochemistry and bio physiology at the university of marylandBaltimore County. I should have invited freeman nombrowski 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 of Baltimore County. An extraordinary institution. Dr. Adams, general adams, admiral adams, received his degree from university of Indiana University and 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. Was now the Vice President of the United States. That mightve had something to do with his being the Surgeon General of the United States. I dont know that. In that role, he had a led a successful effort to stem hiv aids in opioid users. He had a needle sharing 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. Koop. Dr. Koop 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. Welcome, everyone. It is good to see the audience packed today. It is amazing to be here. I want to thank you, commerce congressman hoyer, for inviting me to be part of this meeting and i want to thank dr. Fleming for hosting us a your for hosting us in 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 have got many partners in the room. It is humbling. We did this in indiana all around the state. I went around the state with then governor pence and we had governor pence. 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 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 . You are just playing whackamole. Im going to emphasize stigma. It is important we were together we Work Together to address stigma. Adverse childhood experiences. 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. Awent to high school here, rural high school. Both of my parents were school teachers. 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. I personally have a story of 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. I have a brother that the s are probably well acquainted with who is now in state prison in jessup because of his drug abuse. It goes 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. Medicationassisted treatment, 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. Back in to end up 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 that 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 230 cases of hiv in just over two years, all related to injection drug use. We were able to implement 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 hepatitis, it was about working with Law Enforcement officials. 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 see represented here 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. Improve 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. Critically important. We cant help people recover if they are dead. I hope folks realize this. I know a lot of the Law Enforcement folks i talk to are getting frustrated seeing the 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. Take a deep breath, see how long you can hold it. 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 we need to do a better job of making sure we have a pathway for those folks when we 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. We need to strengthen data collection. That is critically important for the folks in this room so you can keep track of your progress so you know what is going on. President trump mentioned this last week. The data reporting is so bad that our death rates are probably twice what we think they are. Probably from opioids. Were not doing a good job of keeping track. If we dont keep track, we cannot solve the problem. Supporting cuttingedge research. That involves nih and institutions such as the college of Southern Maryland. What the congressman was talking about, making sure were keeping track of how the programs we are implementing are doing so we can continue to make them better so we can spend money in the right place. We know were not going to have enough money to solve this epidemic if we dont do it more efficiently and more