Using it. We need to make sure that everyone has the training. The other thing is, this goes across age groups. In 2013 the most commonly prescribed drug was the generic version of viking, not an antibiotic but a narcotic. So with that said, you know, i appreciate all of your comments and agree with the dr. , doctor anderson, we need to address the situation going forward. Can you expand in your experience. Sure. Your microphone, touch the button on your microphone. We offer patients coming in very clearly with the course of treatment that we would recommend at the time of the assessment. A myriad of reference in the National Area if they choose , but we use it typically to detox to get the patient opioid free. With a sufficient period of time which is difficult to achieve in an outpatient setting, but we can begin to use up your opioid antagonist or opioid blocker, if you will, and administer that in an extendedrelease formulation that lasts for 30 days. It is interesting your comments about 2872 since i am one of the ones working on it, and thank you. Were still working through this trying to expand access to treatment. Wewe have a process that would need to continually work on. We should consider money as part of a reason why did you are not to do things as a relates to drug treatment. I understand the practical aspects. I mean, what might you suggest . What would your suggestions be to expand access to outpatient treatment for these problems because clearly as you know, we have methadone, you been offering , and the locks and. I keep confusing the two. Trying to expand access. If you dont think we should make sure that everyone is able to offer all options for treatment medically, what should we do . I may have misspoken. All three should be available and i use all three on a regular basis. We use it all the time. Those of us who have knowledge and board certification, you would not want a general surgeon doing cardiothoracic surgery just like we would want to help our colleagues in primary care by stabilizing and then helping to maintain them over a period of time in that fashion. Bolstering. Thank you, and i yield back. Thank you, mr. Chairman for holding this hearing. We are very fortunate to have you and indiana has unfortunately, one of the statesstates leading the country and prescription opioid heroin drug abuse, quite a discussion that day we purchased 25 appreciated his participation. Their intent to encourage medical and Health Professional schools that was four years ago we are still struggling with getting our medical schools and continuing medical education programs, embracing this concept. Could you pleasecould you please discuss not only your efforts, but i would be curious on the panel, what are we doing wrong . Why can we not get med schools and continuing medical education and other Health Educators to focus on the prescribing practices. Would you please start . This is not a new issue. It was set in 2011. What challenges, obstacles, what do we need to do to get up covers on board with this . We appreciate your interest specifically in this matter. I would say that the need is clear. It is my understanding, as we look we are constantly looking at curriculum which is an important issue. I have had conversations with our medical school dean about this issue, but i know that there are other issues that are in competition for that time, but itime, but i think there is no question about the importance of this education. Certainly as we look at issues around the importance of education and the subscribers around this issue, continuing education is not in dispute. It has been in implementation, particularly as it relates to reimbursement and the logistics around getting it in place. I do not think there is disagreement about the importance of education. I have been involved in Higher Education before coming to congress and understand that there is a lot of discussion and work that goes into providing curriculums. However, when our med schools are saying they get three to five hours possibly in med school, it is simply not enough, and at this point to come up with one set curriculum, i think is a problem. Lets do more. And so i am curious, do we need to be requiring it . Does it need to be mandatory . Should there be certain hours that all prescribers are required to take a year. I am a lawyer. There are some what are the other panelists thinking . This is troublesome for me, not just for physicians, but what should we be doing . Any ideas . What can we do to fix this problem . We have been talking about it far too long, and educators have not resolve the issue. Two very practical possible solutions. Consolidate the efforts of adding to the curriculum for pain and addiction based on the governing body for the National Medical schools rather than having a heterogeneous group of schools come up with there own curriculum. This has been put out there as a recommended curriculum. Is there and available in many locations. But you need to have them mandate that this is a parta part of the curriculum. It is currently not. Unlike my colleague who went through medical school, i did not. Are there other parts that are mandated, or is it all left up to each individual med school . I am certain there must be a lot of mandatory curriculum items. Why would this not be one of them . Every student has to rotate through the core curriculum which has not changed in 100 years. When you look at it, it is internal medicine, general surgery, and the connections between those, pediatrics and you rotate through critical care, inpatient care, and outpatient care. Adding on specialties has always been an option. They see it as a highend specialty. And tell you mandated so that they stand next to someone doing this theyre is no way to glean from a book how hard it is to talk to some of these patients who have had a horrible early life, and if you mandated, they will find it. There is someone Board Certified in pain or addiction to do this. Im sorry. My friends will not like me. Physicians who prescribe controlled substances should have mandated acm. Ii am curious and see that my time is up. I am curious if anyone disagrees with that notion . Absolutely not. No. I dont disagree. Thank you, and i yield back. The chair thanks the gentle lady. Member of the full committee is recognized for five minutes for questions. Thank you. Thank you for this thoughtful discussion. I understand the drug Addiction Treatment act was passed to expand access to Addiction Treatment by integrating it into the general medical study. For. For doctor waller, can you describe how dated 2,000 expanded access to Addiction Treatment services . Yes, sir. Thank you for your hard work. We have good partners. One of the things that it has done is allowed for clinics such as mine, which i work for a medical system. I am an employee of a Hospital System and i open our doors and see patients based upon referrals and deliver the highest quality of care. Both for pain and addiction and all of the psychosocial aspects. From a primary care aspect it allows them to treat in place and especially in the rural part of america, there are no methadone clinics, inpatient treatment clinics, and in my home state we have an Upper Peninsula that is devoid of treatment. This is aa large portion of the population that is left without. Being able to not make this field withfeel like a criminal act, not be fearful of the dea walking into your office while you are seeing a patient for hypertension, and the availability of the medication to prescribe is key. It is expanded in many areas, but we have a lot to go. In terms of expanding, expanded access in some ways, but the law did set certain limits, and it is clear that we have outgrown those rules. Asrules. As you know, 96 percent of the states and the District Of Columbia had opioid abuse or dependence rates higher than the treatment capacity rates. I am concerned that the crisis has outgrown those rules. Could you explaincould you explain how the current of 100 patients has limited our ability to respond to the current Opioid Epidemic . Two areas we have dug in deeply. The 1st year you can only see 30. He isyour certification and the next year you can apply for 100. For that, those of us who are specialty trained out pretty quickly. And so we early within our areas. And primary care we have a large percentage of doctors who have chosen not to write this medication. What it looks like is a large amount of capacity. 400 23 primary care doctors. It is consistent. They do not feel like they have training, support to evaluate and initiate treatment in patients and stabilize them. They feel comfortable with maintenance, but the reason we dont see that is because they do not feel like they have the appropriate knowledge and backup. They do a good job with this. Once they learn about the disease, their ability to treated is good, but it must be stabilized therefore raising the for peoplefor people who do this is a specialty and have board certifications. And then allow us to not have a barrier, seven month waiting list to see patients. If you have an opinion on the current prohibition of certain other professionals that might assist here, nonphysician providers including nurse practitioners, physician assistants, does that limit Patient Access . It absolutely does. I have two physician assistants and my office who are the of my patient evaluation seeing patients as i am sitting here, but we are limited in what that they can do. They are frozen and cannot see a knew patient and start them, even if they are under my supervision, i cannot pick up a phone and they dont have the legal right to write that prescription. Starting in a way which is appropriately supervised so that they have someone to go to for difficult patients and can onboard knowledge and training is important, but to be able to write this for a practical standpoint has to happen. They are moving forward the biggest part of our healthcare system. Thank you, and with that, i yield back. The chair thanks the gentleman, and that concludes the questions of the members were present. There will be other members who have questions and followups that we will send you in writing. We ask that you respond promptly. Members should submit there questions by the close of business tuesday, november the 3rd. Members have ten Business Days to submit questions for the record. Very informativevery informative and important issues we are dealing with. Thank you for your expert testimony which will help us as we proceed to move the legislation, the subject of the hearing, and i want to thank each of you for coming and presenting your expert testimony today. Without objection, the subcommittees adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] on the next washington journal, the gop leadership races and the highway transportation bill. Cspan presents landmark cases, the book, a guide to our landmark cases series which explores 12 Historic Supreme Court decisions including marbury versus madison and others. Landmark cases featuring introductions, background, highlights and the impact of each case written by tony mauro and published by cspan in cooperation with cq press. Landmark cases is available for 895 plus shipping. Get your copy today. Vice President Biden took part of a program and George Washington university. Thank you, and good morning. Good morning. Good morning. That is much better. We will have some fun with this. One of the greatest legacies of the administration is what became known as the modern vice presidency. No two occupants of that office a better represented what that really means than the two gentlemen we have here today. Please join me in welcoming to the stage Vice President joe biden and Vice PresidentWalter Mondale. [applause] [applause] where do you want me . Wherever you want. That is not for me to sit. [applause] okay. Welcome. Can i start here . I want to welcome my old friend, joe biden with us here today. We have been friends for many, many years. I was in the Senate Caucus the day you arrived. I think you were 29. My god. You were 29 and two days early being eligible as a United States senator. Through all those years we worked together, we have been dear friends, a part of the Progressive Network of america. And when you were selected as Vice President we sat down and talked about my experience with the office, and you have taken the vice presidency a big step forward. [applause] aided enormously by your extraordinary experience in the senate, chairman of the Judiciary Committee and Foreign Relations committee. You knew your stuff. I have enjoyed watching how this all works out for the betterment of the obama administration. You no all of these things. I love you. It is mutual. [applause] we will have a great conversation this morning about the vice presidency. A long history in this country, as you know. Unfortunately, it was a constitutional afterthought, really and illdefined office. It was basically an office and obscurity and derision, the subject of bad jokes. That is over . [laughter] i am getting to that part. John adams call the office, the most insignificant office that ever the invention of man contrived. A little wordy, but we get the meeting. Nelson rockefeller called the standby equipment. Other Vice President s called it the 5th wheel of government. I cant say what another man called it. Needless to say, no one says those things about joe bidens best joe bidens vice presidency. He has evolved almost on a daily basis, does not do state funerals, and when he speaks everyone knows that he speaks for the president. In every sense he has come to represent the new modern vice presidency, and it presidency, and it is a great pleasure to have him yesterday. [applause] now, we will talk about how this was shaped, and i will ask Vice President mondale to go back to those days when you 1st talked to then governor carter following the election when you had more serious discussions about how you and he saw the office. One of the key elements what became our special vice presidency i did not want to be involved in the details of the government. And so i tried very hard with the president to try to sell this idea. And not just the surface stuff, but the tough things that could only learned. With the president doesnt talk with those the present talks to. The big breakthrough was in the west wing. I neveri never spent a lot of time in baltimore. Thats good for you. The other thing was to prevent the staffs from dividing up. We tried to blend the two. Two other things that added to your credibility. And the other thing he said based on the unhappy experience. The reporter start writing this question. It really worked. How do you build off this experience. And the president asked me food be bedded. And he said, i need to know right away. I said, i dont want to do this. And he said, how much time do you need . And i said, i dont need any time. He said,said, go home and talk it over with your family. In the 1st person i called was fritz, the 1st person that i called. And i said, tell me about you and president carter, and he wanted great detail and gave me a memorandum. He laid out what he thought were the essential elements to make it work. You all no, the vice presidency is totally a reflection of the president. There is no inherent power, none, zero. And it completely, totally depends on your relationship with the president. When i started off, vick had a great advantage to go back the president and i debated 13 times in 2008 trying to get the nomination. If you look back, the only two people who did not disagree on a single substantive issue were the president and i. We disagreed a degree, but never on a substantive issue so it started off where i knew that i was simpatico the president elect, and secondly, we had a genuine relationship. When he asked me i asked him why he wanted me to be Vice President and he said two things in this order. Number one,one, you will always tell me the truth and be straight with me, there will be no varnish on what you say. Secondly, i need help governing. Thirdly, your experience in Foreign Policy will be helpful. And then i called you again, as you remember. Joan was a gigantic help to my wife, jill, and really extremely thoughtful because that is another very difficult job. It is almost demeaning, the title, being the 2nd lady. And jill was new and young and joan was an enormous help. What you both basically said was, it matters that you have a personal relationship. I do not mean that you partied together or go to the movies together or whatever. It is that you have a relationship built upon a genuine top personal affection. The two things about your administration and hours, i cannot recall a single word being written where barack obama and i have been leaking out of the white house that there is dissension because we did what you suggested. I had an advantage. Most of most of the people for example, right from the outset, i called you about picking the cabinet. And we spent 14 hours a day some days on the 80th 80th80th floor, whatever it was, on a highrise Office Building in chicago putting together a cabinet. And the president from the outset said you have a veto right. He asked my opinion on every cabinet member, and we were in total agreement. And a number of the members i knew better than the president you because i had worked with them for a long time. So we integrated staff from the beginning. Senator kaufman, then my chief of staff is here today with me, ron claimed who had been my chief of staff was there, and a guy named mark can sting letter in a Judiciary Committee. And the three of them sat with his people, and we made every decision together. I was certain from the outset that this would be collegial. And so what happened was that from that point on we had an advantage. My grandchildren and his children a