Second, i would support those on the front lines with the resource that is they need. We work closely with Law Enforcement, with our nonprofit partners. We have made requests of our state and federal partners. We know what works best in our communities. Support thoesz on the front lines with getting the treatment that we need. The third is i would change culture, something that might take a little bit longer. We need to change that by asking the difficult questions. Why is it that we have a pill for every pain. How can we change the mentality that patients have and we need to ask the question, what pain is it that we are treating . We are not just treating physical pain. We are also treating deep trauma and dreep disparities, Mental Health issues that may need to be addressed in other ways. We know what works. We just need the resources to get there. I would do it. Would you tell people what safe injection site is . It is a facility they can be monitored while they are using drugs. It is a Harm Reduction approach as a Needle Exchange which we have had. There is one in vancouver. There is evidence saying it is one approach taken to reduce the number of Overdose Deaths. Because it is a Public Health approach it is something we would explore in Baltimore City if it were legal. We dont really want to go to jail. So i dont know that it will help or hurt. So in urban areas where there are people who are injecting drugs like baltimore. Yes. It is suburban and rural. We just saw a big fight over there should be a safe injection facility there. I think its very unlikely people are going to commute into town to inject in a facility. I think if they built it nobody would come. You many areas where there are waiting lists for Addiction Treatment which can effectively treat opiod addiction and you have this. There are interventions that would be much more effective. And tell us what youre going to do. There are many different policies. I heard an economist talk about the problem recently. He said theres no magic bullet, we need a magic buck shot. You have to prevent people from getting the disease and see that the people suffering from the disease have access to effective treatment. To prevent opiod addiction so we dont indirectly cause addiction. Theres quite a bit that can be done on a state and federal level and for the pistmillions are addicted you have to make sure they have access to effective treatment. Im not talking about rehabs or detoxes we will not be able to reduce Overdose Deaths and then one other point. We are failing in every aspect responding to this problem but we also need better surveillance of the problem. We need to know how Many Americans have opiod addiction. Over a million americans receive add hospital treatment for opiod addiction t. Estimate is 2. 5 million. The total under estimate is certainly well over 5 million that are addicted. We need to be able to measure the estimate of new cases occurring each year so well know whether or not our efforts to prevent opiod addiction are working. Thank you so much. Thats about all the time we have. Thank you so much for joining us. We look forward to speaking with you more in the future. Thank you. We want to introduce our sponsor segment and bring to the stage joe burger, health and Consumer Solutions and dr. Wilson compton. So we have heard a lot of stra statistics. I was driving to the airport yesterday and heard the most recent statistics on central ohio and that the opiod deaths to go from 350 last year to 500 this year. We continue to be faced with this problem. Today im join bid dr. Wilson compton to discuss evidence based treatment strategies and to treat those who become addicted. Thanks for joining me. Glad to be here today. So lets start. What are some of the biggest areas of progress we have made . We are making some progress gu we still have a long way to go. I think you just reminded us even as we are making progress in a few areas the number of deaths continues to increase. It has every Public Health official and every policymaker concerned. How can we do a better job of addressing this Public Health crisis . We do see some improvements. One, the overall number of prescriptions written for opiods has begun to decline. It is in the willingness and overall overprescribing of these medications. We ned to decrease the number of prescriptions significantly. The second hopeful sign is we have seen an improvement in the use of these medications by teenagers. About 10 or 15 years ago we saw about 10 of 12th graders were misusing it for intoxicating properties. That number has dropped to under 4 . It is a terrific improvement. This is the future. These are the people that will go onto misuse and really develop Serious Problems that end up with addictions and deaths that we are seeing now. I think its very hopeful. Good. We have heard about medication assisted treatment a lot. I would like you to talk about what that is for our audience who arent as familiar. I think its a great question. What is medication assisted treatment . Basically it means using a Prescription Medication to combat the disease of addiction. It is a blocking agent. They come in two different classes. They allow people when dosed properly to get back functioning and save their lives. It has sort of the opposite effect. It is a blocking agent and now this new formulation can last as long as a month with a single injection. Are there trends . Are some becoming more popular . Are some being used less . Whats happening in that area . We would like to see these medications to every patient that needs them on demand. Thats the goal is to increase availability so if you or a loved one or you show up in an emergency room they can get you treatment on demand. Unfortunately that is not the case. We have seen increases in both methadone availability. They have to be in specialized methadone programs. We have greater number of prescribers and due to we see increases in the injection. There are tremendous barriers and a lack of educated children in additions to take care of this care. Whats keeping us from getting more broadly available . The fundamental issue is the stigma around addiction. We need effective medications that can combat it. I think forums like that that educate about the medical nature of this disease can make a big difference. We both live in the Research World lets talk about what you think needs to be done and talk about what youre doing to help us understand the problem better and address the problem. Im very proud of the work we are doing to address this Public Health crisis. I sort of put it in two main buckets. One is we have treatments that have effects. We have treatments that are useful. We have prevention approaches that can provide the tools they need to raise healthy children to keep them from moving. Why are we doing this . It is sort of the key research question. What can we do to improve the access and availability of the current treatments . As much as i like the current treatments and im thrilled we have this. They are not asfective or as good as i would like. This is a longterm condition people dont take their medications to benefit from it. They can provide tools to be the solutions if we invested in research successfully. We talked about how it is a bigger rural problem than maybe an urban problem. What are some of the ways we can help that Rural Community access treatments more effectively . We heard its easier but what about the rural settings . We struggle to get health it is really difficult. Theres some ak desz to general medicine. Sit to use part time practices. Other forums of helping people enter recovery. Research could help with that. It is with other novel ideas. What Public Health do you see having a positive impact . There are multiple policies and practices that need to be implemented. What can we do to change the availability of medications to treatment . Some states still have regulations that require to fail nonmedication treatment before you can even start medications. I want my patients to have access to the effective medications when they have the problem and not have to fail some other ineffective approach before they can take what might help them. Thats one example of policies that change. What can we do to make sure it is accessible when people have an overdose . In other places where people may experience this death . So thank you very much for joining me this morning. Thank you to our audience for coming. We are focusing on such an Important Health issue. I encourage you after the speakers are done to talk to our subject Matter Experts outside and now its time to turn it back over to the Washington Post for the next discussion. Thanks very much. [ applause ] in this segment we have ann pritchett. Well talk about the role in the epidemic and what might be done about it. If you would like to tweet us questions we can take them off of here and ask. Lets start with the premise that this country that has more opiods than it may need for legitimate pain control. Why is that . We have seen changes in that space releasing but clearly more needs to be done. There is insufficient use of Prescription Drug monitoring programs. They are state run programs as well as identify inappropriate prescribing behavior. Only 42 of 49 states require access those databases. We need to do more in using the recourses we have had. We saw they reduced the quota. We have a disconnect in they said there was a cushion and reduced the amount they lowered the quotas. At the same time we have a report saying when you look at drug shortages the majority are for pain medications. This is a very complex issue that we need to get our hands around collectively. I think we have seen tremendous progress from the administration where we have the fda announcing the new fda commissioner saying they will review what their role is in terms of the crisis that we have it is so it would be alternatives that arent opiods to allows to develop abuse deterre deterrent. Before we get to those, when we read or unfortunately some of us see on the ground and others experience that 780 million opiods are sent over a five year span, certainly the distribute tos know that that is occurring. The retailers who are selling them in drugstores no we that is occurring. Dont the manufacturers know as well . Shouldnt they intervene . I think everyone in the supply chain has a role to ensure that only as much medication is being provided. I think theres a disconnect that thats not currently occurring. I think there needs to be more 6 h more coordination engaging in these areas. I think theres a collective responsibility. Events like this bringing attention to these issues and that we have an issue that is focused on this. We have a congress over the past couple ofl years has come to the recognition that it is bipartisan issues, not political issues and we need to address them wholistically. I think we need events like this to bring ongoing dialogue about our collective roles. In what fashion are they engaging with the government in. I would say a number have been engaging in the discussions in terms of developing medication alternatives, that we have been active i engaged. Should there be mandatory prescribers for pain and addiction . We know its not popular among some provider groups but as a Risk Mitigation strategy for opiods it is to provide trainers yet what we have seen from the fda is only about they werent able to meet their goal of 80,000 prescribers taking that training over a twoyear period. We think it is critically important that there be a focus unfortunately no one likes mandates. Reality is they need better education about the treatment of pain and about addiction. Studies found medical schools only found a handful of hours. Thats that huge gap in our system. Our view is very strongly that you should only that physicians need the education needed to determine when its appropriate, when it isnt and they are relying on clinical guidelines on what dosage and for how long. I would say one of the areas we have been engaged in is educating, one of the challenges is a lot of people think because its a prescription medicine its safer than Something Like heroin which is not accurate. We need to educate the public about dangers. It is very disturbing that about half of those that use opiods get them from a Family Member or friend. Patients should take their medications as directed and have their discussion with their provider and that they need to secure their medicines and dispose of their medicines and certainly sharing medications is not appropriate. Okay. Lets talk about the medications themselves, those pills. Abuse deterrent pills or other forms. Is it possible . Can you make the medications unusable by abusers . I would say before i came to pharma i came more on the illegal drug side. We found those that want to do ill will have always one step ahead of the game. I do want to correct something. A lot of people think if its an deuce boous deterrent it means it cant be abused. Thats not correct. There are a variety of forms of abuse deterrent. Its one of the reasons why the fda requires post Approval Research so we are continues to collect real world evidence to assess how well they are working and their level of abuse deterrence. Thats one of the things that they are intented to focus on, how do we develop better abuse theres a lot more that needs to be done. Abuse depernt formulations we believe are one part of the tool kit. They are partly successful. Maybe you can tell us what it is and the possibility for using opiods that kill pain but dont provide the euphoric effect. There are about 40 abuse deterrent medications. A number of those are opiod deterrent agents. I would say one of the Biggest Challenges is when you look at the opiods that are on the market none of those have the abuse depernt formulations. Why wouldnt well, the fda recently finalized that. We are hopeful there will be generics. There is a lot of regulatory uncertainty. The fda doesnt have a black and white of here is the criteria of being an abuse deterrent formulation. We also have a disconnect in terms of when you look at the commercial coverage policies for these products. What you generally see is that the generics you generally see that it is two or three fear 4. Theres not kind of a calculation from that from the per specific ef that we need to be considering the for abuse. The fda said its a key priority to approve yet when it comes to the payment policies of these medicin medicines. I want to make sure i understand. 96 of the drugs that folks take routinely do not have any kind of abuse deterrent. Correct. So if a kid takes one out of my medicine cabinet there is nothing that would keep thim from crushing it up or cook it and injecting it. Right. We support mandatory education because we are developing new abuse. They need to know what the risks of medications are. I could say we have seen over the past couple of years it altered clinical guidelines. We had cdc release the guidel e guidelines on how do you treat chronic pain. We have these changes we need to ensure previebers are up to date as well. Educating the public as someone who has had by Substance Abuse issues, when im meeting with a doctor im perfectly comfortable saying is there a potential for you know, is there an alternative . I think we need to educate patients and care givers they need to be asking the questions that we need to empower them to be aware that medicines need to be taken appropriately. They need to be asking prescribers so they are being appropriately treated. And perhaps your loved one can ask them for you. It is one of those that increasingly youre take care of your parents. It is important among actually. We have two issues. Its not medical use and then its the issue of those being treated for chronic pain that become addicted. I would say one of the changes we have seen over time is simply focus on nonmedical use and how do we prevent addiction on those including pain medications over a long period of time. So i think of it as ibuprofen. It wont work for post Surgical Pain or late stage near end of life pain. Whats the development . We have about 40 different medications that hold promise but i would say when we are talking about lets say Breakthrough Cancer pain late stage having seen my grandmother suffer from late stage and fe a fentanyl is the only thing that would help her with that pain. I would note that former fbi director had a reporter that was bringing a they said hundreds of thousands of counterfeit fentanyl pills are coming through mexico and canada. As we heard from one of the prior candidates it is more powerful than morphine. We have a challenge of needing to address that patients have access to the medicines they need. So thats lot of progress that needs to be made. We need to take a holistic approach. We need to make sure they have the clinical guidelines and to be clear opoids are a critical medication. We do need to balance that including nonmedication alternatives. Other therapies that are appropriate. We are getting close to the answer. I want to ask you two more. We are getting a number of questions about cannabis. I think the point is to try to get me to say canabanoid in front of all of these people. There are some medical products available. We have looked at the pipeline. I want to say its a half dozen products that are in the pipeline that are in that space. There are companies enjoying and it has both practical, potential and affordability in. I think im not in a poe stisigs to comment on that. Okay. Gre great. Did in in the last second. Whats your list . Whats you list . We are given you all of the power. It is a multifaceted problem. Of my top five on the list its that we need to improve education for prescribers. It means on an ongoing basis. As part of that continuing to educate the public to increase awareness of opiods and we need to mandate the use of Prescription Drug monitoring programs. Studies