I know i dont need to tell people this this room about the scope of the crisis, the victims, family, doctors, Public Health officials, journalists like me and lawmakers like these fine folks have been spreading the word about whats been going on, and were going to begin our program today with a discussion of the policy and the government response. Ill invite you all to sit down now. So joining me on stage pardon me just a moment while i adjust this. First off we have congresswoman diana deget of colorado. She is a senior democrat on the house energy and Commerce Committee, ranking democrat on the oversight investigation subcommittee. She cosponsored coauthored the 20th century cure which put a billion dollars of new general funds into the Opioid Epidemic to combat it. She is the chief deputy whip of the Democratic House democratic caucus. Thank you very much, congresswoman. Senator ed markey is here, of massachusetts, democrat, and member of the Senate Commerce committee which has broad jurisdiction over private industry including the pharmaceutical industry. He has done numerous investigations and authored numerous pieces of legislation to address this crisis. Hes going to talk quite a bit about that. Last but not least, chairman greg walden is with us today, of oregon, republican of oregon. He is he has drawn attention to the Opioid Epidemic as its affected his district in Eastern Oregon. He has also plays a key role in overseeing the Health Sector of our economy. He played a key role in drafting the American Health care act, which is now going through the congressional process. Were going to give you an opportunity to talk about that legislation and the oversight that youve done on your committee. Thank you very much for being here. Let me start with senator markey. This is a question im going to throw to everybody on the panel today, but tell me how you first experienced this crisis as a crisis. When did you understand that this was something that needed your attention and what did you see in your state that compel you to act . It was in massachusetts, it was Martin Luther king day, january of 2014. I was standing in the back of the room getting ready to give my speech and i said to the police chief and the mayor in tanton, whats the Biggest Issue . Well, weve lost seven people to overdoses in just the last couple of weeks. And then i said to the chief, i said, well, whats the issue . And he said, well, theyre now lacing the heroin with fentanyl, and he explained to me about fentanyl. And i brought back the drug czar for the United States the next month, into tanton and the numbers are huge. In massachusetts, in 2016 we lost 2,000 people to Overdose Deaths, opioidrelated deaths. Were only 2 of americas population. If the whole country was dying at our rate, that would be 100,000 people in a year. That would be two vietnam wars every single year. Of those who died, in 2000 70 had fentanyl in their system, that would be 1400 people last year. If you extrapolate it for the whole country, that would be 70,000 people dying from fentanylrelated overdoses in one year. That is now something that is going to hit the rest of the country slowly but surely. Wheaton, massachusetts is a prevalue of coming attractions. Only 30,000 people died from opioid overdoses in the whole country last year. Were three times worse than the national rate, but unless we put in place the prevention and treatment programs we are going to see this epidemic just explode even further. And from that moment in tanton when the police chief and the mayor told me about fentanyl it has been just up creek dip through, all of this ka tras trophy spreading across the country. What year was that, senator . January of 2014. So it was 14, 15, 16, were now halfway through 2017, and the numbers have skyrocketed since 2014 in mass chews massachusetts as they have across the country. If you pick up a copy of todays Washington Post theres a story in there with an amazing statistic that illustrates the scope of this issue. That in 2014 there were 1. 3 million emergency room visits or inpatient stays for opioidrelated issues in 2014. Thats a 99 jump for emergency room treatment compared to 2005. It is a remarkable statistics. By the way, that 2014 number, which is a great story in the Washington Post today, that number is much, much higher today. In massachusetts, and we were the second worst state on that list in the study that the post had today. We have a much worse problem today than we had in 2014. Chairman malden, let me ask you. You represent Eastern Oregon. It is a Rural Community, largely rural, some of the most beautiful country in america. So what is happening there . What have you seen . What was the moment that you realized there was something that needed to be done. Well, i had done a series of round tables a couple of years ago, and i always remember just a couple of examples. There was a woman in hemanston, oregon, rural Eastern Oregon who talked about her addiction to opioid. She is now a treatment counsellor, but trying to get off of it was almost impossible. She wanted to get on to soboxone that she wanted to get off. There was no physician to help her, so she would commute fiveandahalf hours to get treatment to get off. In Southern Oregon i did a round table with addiction specialists, hospital people, Law Enforcement and family, and this fellow sitting in the back wasnt actually part of the round table. But i called on him, said, what brings you here . He said, my son, my son was an athlete in high school and got injured and got prescribed opioids to deal with the pain. And tragically got hooked and went to the cheaper, more potent version of that, you would know it as heroin. He said he succumbed to that. He said my sister was a nurse, same sort of scenario. She got hooked on it. She would write her own prescriptions, forging the doctors prescription pad, got caught, moved on somewhere else, took it up again. The addiction overwhelm her and she too had died. Then you begin to talk to everybody else in your communities, how theyre affected and this addiction explosion thats been going on in oregon, were ninth in the country, fourth among women. But we predate that with the other scourge which was methamphetamine and the kieng and all of that, and oregon lead in this. We did work here in washington on it like were doing on opioid to get the precursor chemicals out. That still remains a big issue in Eastern Oregon. One of the leaders in trying to push back on this, dr. Chuck hoffman is a friend of mine. He was quoted recently in a new series about how he was trained as a physician to prescribe opioids to relieve pain. They were never really trained in alternative pain relief practices. Now it is just right to pill. He is trying as a physician, leading an effort to turn this around. Were also seeing a dramatic increase, by the way, in 65 and older that are being treated as inpatients in hospitals because of this addiction. So it is affecting every age group. Finally, i would say there was a really troubling story as part of this series the august observer ran about a physician who engages in the treatment, and one of his patients is a rancher who keeps preloaded syringes in the cab of his tractor so when hes out there he can just shoot up during the day, and theyre loaded with heroin. This is having unbelievable consequence across our country, and i think were all together in trying to figure out strategies to reduce the illegal pills on the market and to you know, we pass legislation to reduce the prescription amounts that have to be given. I mean theres a lot we can do. Congressman, let me ask you this. You represent a different kind of district. You represent a good part of denver and its suburbs. It is an urban and suburban district. So much of the reporting on this talked about this as a rural phenomenon in communities like in Eastern Oregon. Is that the whole picture or is that not the whole picture . Oh, no. I mean this opioid problem pervades i think people focus on rural areas because they expect that drug and addiction issues will be urban issues, so theyre shocked when it is in rural oregon. But i remember, you were asking my colleagues when did you first when did this hit home. A couple of years ago i was at the book lovers ball, which is the annual fundraiser for the Denver Public library. I was sitting next to the Denver Public librarian and i said, what are the issues youre facing here at the Denver Public library . I thought she would Say Something like, you know, Cyber Security or access to books. She said, you know, we have people overdosing in the Library Every day and we need to get our librarians maloxone so they can give it to people who have overdosed. At the Denver Public library. Now there was just a story the other day in the denver post they finally got the librarians maloxone but they had a guy die in the main library last year. Theyve had a number of overdoses and the librarians just open up their desks and run over. Imagine that. I think what all three of us had recognized is this really does seem to have exploded on the scene. We heard stories about addiction for some years and about and cautions about overuse of opioids, but it really but these stories are just exploding. In our committee, the oversight and investigation subcommittee of energy and commerce, we did a whole series of hearings about a year or two ago on opioids, and it was amazing how many misconceptions there were about the extent and the nature of the problem and how much confusion there was about what you do about it. So it is not always that you have hearings that really educate the members of congress, but i think we all learned a lot about what we need to be doing. Of course, that was part of what informed the care bill last summer that we passed and then the funding that was put in our 21st century cures. Well talk about cures brufl. That w briefly. It was a remarkable bill not only for what was in it, but the fact it came together at all at a time when the parties werent last year and still arent working together on a whole lot in a productive manner, but this was one area where republicans and democrats came together. You worked with fred upton, chairman waldens predecessor on energy and commerce, to make this happen. Talk specifically about the addiction part of that bill and how that got brought into this bill that was also about so much more including, you know, pharmaceutical development and things like that. Well, i mean this was a bill we worked on for about three years, and it wasnt just me and fred. It was also greg and it was ed and democrat and republican colleagues in the senate, so it was an effort to focus primarily on research at the nih and the fda. But as the bill moved into its final stages we realized that there were some funding issues in the house care space where we could really get bipartisan, bicameral consensus. As i said, we had passed that bill the year before that had a lot of really good administrative programs for opioid prevention and treatment, but it had no money. That was one of the biggest criticisms everybody had at that time. When we did the here bill we were able to say, lets really put some oomph here. Lets put a billion dollars in grants for state governments. Listen, chairman, let me ask you this. Talk about the pardon me for putting it in these terms, but it can be difficult for republicans, certainly House Republicans to spend money on anything sometimes, but this issue is one where there was a wide agreement that something had to be done. Talk about what i get the feeling theres been among your republican colleagues in trying to come together. Yeah, i would suggest too in the 21st century curist we did mandatory spending for nih because we believe in medical research, and the big increases in nihs go back to the days of gingrich who believed in research and doubling the nih. There was a pause and now were trying to ramp it back in a bigger direction. Clearly in dianas work and others really passionate about this. These issues dont pick parties when they show up on your doorstep. I think they help bring us all together in common cause. So the billion dollars, my state just gets 65 million in grants out of that. In pretty short order i would argue the money got in there and now it is getting out on to the ground, into the field, hopefully into the hands of the professionals in our communities who know what to do with it to address this issue. There are good mechanical pieces to dianas point. In terms of changing how many people a physician can treat with soboxone, my friend from herm anston who had to go out of state to get treatment, now they can treat more people, they can fill a prescription. That gets excess pills out of the market. These are things we learned back home. They put another 15 billion towards this, addiction and other things, thats certainly in there. It is not always about the money. It is about changing behavior and finding best practices, that was part of the debate i heard, was better understanding the physician prescribing community, what they should and shouldnt do. It kind of goes back to an original study that said, oh, theres no addictive nature to this so feel free. If you go back, the foundation for where we are today was bit i think on a false premise, that it was okay that these pills wouldnt be addictive. Right. Now we know 90 days is danger zone. Yeah. And so we need to do this education. Right. It turns out it wasnt even a study. It was a short letter in new england journal of medicine that the pharmaceutical industry used as an explanation for prescribing these drugs. Senator, let me ask you this. There continue to be bipartisan efforts to address this. Can you talk about what youre working on right now, the interdict act and other efforts in the oversight realm as well to take action . Well, im working with marco rubio on a bill to give customs and Border Patrol the technology they need in order to detect fentanyl and other substances at our border so that project veritas it comes in from mexico or from china that theyre able to do that. I actually said to Mitch Mcconnell two years ago that lexington, kentucky, lexington, massachusetts, it doesnt make any difference. We need a Surgeon Generals report on addiction. So what i suggested to him was the smoking report, the Surgeon Generals report in 1964 was a seminal moment. We need, you and i, we should ask the Surgeon General to do it and he completed it in one year, which laid out now the parameters of the problem and what needs to be done. So to that extent there is a lot of bipartisanship. I was able to pass legislation with rand paul on soboxone, on medicationassisted therapy. That became a part of the law as well. On the other hand, were having a big battle right now about funding in the Affordable Care act and whether or not the slashing of that funding is going to have a profound effect upon the ability for people to gain access to the treatment which they need, the centers for American Progress have concluded that 91 billion under the Affordable Care act would have been spent on Substance Use disorders over the next ten years. That money will not be there if if the Affordable Care act is repealed. So were going to have a huge debate over whether or not, you know, this funding is going to be there because honestly, a vision without funding is a hallucination. You know, youve got to have the funding in order to provide these programs. This debate is now really escalating in the senate because we, the democrats are saying that this Opioid Epidemic, this Substance Use disorder epidemic is something that is going to get seriously shortchanged if the proposal as it is currently constructed becomes the law in our country. Well, let me talk to chairman walden. As chairman of the energy and Commerce Committee you know more than anybody else in the capital about what is in the American Health care act, which is the Republican Health care bill thats now moving through the process. Certainly, you know, that is not a bipartisan effort as we all know. This is the republican response to the Affordable Care act. Youve heard folks like senator markey and even some people in your own party on the senate side talk about the potentially difficult effects this could still have on Addiction Treatment. Just give us some facts as you see them of what this bill would do and whats in that bill to help folks suffering from addiction. Sure. Yeah, thank you. First of all, you have to sort of bifurcate it because what we do know is the individual Insurance Market has a lot of problems on the exchanges. So you have a group of people we want to make sure have insurance or access to choices in insurance, affordable insurance, and right now state after state, county after county, were seeing more and more limited choices, some counties may have no choice. If you are in need of treatment and you cant get insurance, you have really no options or very few options. Were trying to fix that Insurance Market. This is diffic