senator alexander: the senate committee will come to order. we are holding our sixth hearing in this congress on the open wheeled converse. talking about what is working in their state is governor larry hogan from maryland and governor kate brown from oregon. we thank you both for taking time from your very busy schedules to be here. to ahearing is a follow-up roundtable that senator murray and i hosted last week with 13

governors who were here from the national governors association meeting. or you do senators of both parties attended sometime during that roundtable, is a large gathering of senators. to hear from the governors about the open we would crisis. senator murray and i will each have an opening statement, and then i will introduce the witnesses, and we will hear from the governors and senators who will each have five minutes for questions. in january, i dropped by a meeting at the tennessee governor's residence in nashville. the governor had invited the heads of all of ours dates -- our states' institutions who were involved in educating doctors and they were talking about planning how to discourage the over prescription opioids. the governor told me in our state of 6.6 million people there were 7.6 million opioid

prescriptions written in 2016. and that even though the state has reduced the amount of open wheel it's prescribed, that is a very high number. the number of overdose deaths is still rising because the abuse of fentanyl. according to a recent report on the centers of disease control opioidvention, "it -- overdoses spiked 37 -- 30% between july and september 2017 across our country. this is an evolving crisis that has affected nearly every state. systemic challenges faced by tennessee might be very different than from what oregon or maryland faces. states are the ones who come up with the best ideas on how to tackle the problems because states are on the front lines. it is usually the federal government's rolled to encourage and them, cut red tape, and create an environment where

states and in -- and communities can innovate. that's true with opiate crisis. governors are coming up with solutions, leading the fight against problems their states face. for example, governor hogan and maryland have allowed all pharmacies to dispense naloxone, the drug that stops a drug overdose and open a command center to coordinate the state and local government's response to the crisis. governor brown has franchised the prescription drug monitoring program and is working with the state legislators for mentorship programs for individual s struggling with addiction. congress has taken steps to support states. in 2015, we passed protecting our infants act to help ensure federal programs are more effective in helping expectant

mothers struggling with opiate abuse that they receive more help so they have healthy babies. in 2016 we passed and addiction and recovery act to give new authorities and have grants for naloxone and provide a toprehensive response treatment and recovery. in 2016 we passed the cures act, which included $1 billion over two years. congress is considering approving additional funding as well. in december, senator murray and i sent a letter to every governor and state insurance commissioner asking if these laws were working. and how the federal government can be a better partner for states. we have heard back from 21 governors and 11 state health officials. in addition to the feedback, we heard at the roundtable this week, the governor suggested

additional funding to show -- funding for states to share data and their prescription drug monitoring systems. this was something we talked about last week. this is one of the most promising government areas where we can be healthy. terry mcauliffe suggested we supported research on non-opioid pain management. i have encouraged dr. collins to use a additional gorsuch money that congress has appropriated to focus on finding a non-addictive painkiller come and senator murray and i have introduced legislation last month to give him more flexible of the in funding to do that. this committee hopes to approve that piece of legislation as well as others later this spring. so that we can recommend those bills to a full senate to vote on. it is helpful to have the input from governors here today. as well as responses from other governors and state commissioners. i looking forward to hearing

what oregon and maryland are doing to address this crisis and what lessons can be learned. senator murray? you, andurray: thank thank you to our witnesses for making the trip out today. thank you to both of you. i am glad we are able to bring two leaders together to face initiative, to come from not only opposite sides of the aisle, but also opposite sides of the country. we look forward to hearing from you today on how you're working on your states to address the opioid crisis. throughout our hearings so far we of voices with different and important perspectives on this epidemic and whether we have been speaking with government officials or families medical professionals, or data experts, journalists, academics and individuals who personally may have lost someone after opioid addiction, or people who have personally overcome it, the have seen this crisis impacts everyone.

the 115 people who die each day youngpioid overdose are and old, from all backgrounds, and all over the country. while this is a national problem, empowering local officials with the tools they need is one of the most important solutions. we have seen after far too long that we cannot recent -- treat this as a law enforcement issue. to address the crisis, we must treat it as a health care issue, as a child welfare issue, and a drain on our local economies. it is clear this disease is not only on the -- only hard on the patients facing it, but it didn't ask families and communities, including parents like becky, the mother we listened to in a recent hearing who tragically lost two sons to opioid overdose. thrown intoives are a certainty when a parent is battling addiction, and the grandparents and relatives who stepped up to raise them in this

hardship. educators like the principle i was in the spoke with in everett who had seen firsthand thus drain this crisis puts on the students at school. we have heard how heartbreaking, how far-reaching this crisis has come come and it is clear in order to find solutions, we will have to reach just as far. we have heard in our last hearing how beneficial it can be prescriptiones' monitoring systems can talk together and work together. we discussed making technology more interoperable. we can collaborate more effectively on the challenges we face. this is a lesson that goes beyond data. it is not enough that we have technology in one state that is able to talk to technology in another state, we need to make sure this is happening on a human level. we need to make sure not only good eight at, but good ideas are being shared, that is what today's hearing is about. an example of the potential of shared idea comes from my home state.

in king county, washington, we have been running a diversion program that gives law enforcement a new resource in the fight against edition. onputs struggling patients the road to recovery instead of into prison. the approach does not only help the people themselves recover, as it is one patients -- but one patient put it, it makes us feel human again. after seeing that program succeed and learning more about it, another county opened a similar rehabilitation program. these programs are model for the similar grants authorized to the comprehensive addiction and recovery act that was passed last congress. that is just one example of how congress can take what's happening in states and use it to benefit more people. as this committee undertakes another effort, i believe we can find room for similar progress between states and washington, d.c., and as more states learn

what is working, i believe conversations like this can help a short and ideas are being put to good use for families everywhere, which is why we are so eager to hear from both of our witnesses today. and so grateful that you can join us to discuss the efforts you have underweight in your state to address this crisis and what lessons you have for other communities and its and those of us who are working on this nationally. i believe the discussion today will offer interesting insights as we continue here to look for common ground and common sense solutions to help those struggling with the menace of opioid addiction. before we begin, i want to summit for the record testimony tribe who have been doing important work to address the opioid crisis to call attention to the challenges our tribes are facing in responding to this epidemic. i look forward to this hearing. senator alexander: so ordered. thank you, senator murray, governors.

our practice is to summarize remarks about five minutes, and that will permit more time for conversation back and forth between you and the senators. 62ndrneur hogan is the governor of maryland. he is republican. he has more than 25 years of private sector experience. in response to the crisis, he signed an executive order creating a task force which developed 33 recommendations. his administration has implemented many of these and we look forward to hearing these efforts. our second witness is governor kate brown, the 38th governor of oregon and previously served as oregon secretary of state. governor brown has convened an opiate epidemic task force.

it is requiring license prescribers use the states prescription drug monitoring program. we look forward to hearing about her work. let's begin with governor hogan. governor hogan: thank you, chairman alexander, ranking member murray, distinguished members of the committee. thank you for your focus on this issue and thank you for giving us the opportunity to provide testimony here today. this is regarding what i believe is the number one health crisis facing our nation. we have been sounding the alarm and shining a spotlight on this issue for about four years now. it was during a campaign for governor in 2014, as i travel all across the state of maryland, i would go and meet with local officials and community leaders, and i would ask them, what was the number one problem facing their community.

everywhere i went, whether it was in the wealthy suburbs of washington or the inner city of baltimore or we were in small towns and rural communities, the answer was the same. it kind of took me by surprise, but we learned about the magnitude of this problem. my first actions as governor, we established an emergency opioid and heroin task force, which came up with 33 recommendations, much of which we implemented we r-prong approach of education, treatment, prevention, and enforcement. inas the first governor america to declare a real state of emergency on this issue because we decided we needed to treat this crisis just like we would treat any other natural or man-made disaster. we have already committed in our small state more than $500

million towards fighting the heroine, opioid, and substance abuse epidemic from all directions. yet in spite of our efforts, we had nearly 2000 people die last year. that is far more than those killed by firearms and motor vehicle accidents added together. the good news is with our efforts we have been able to bend the curve downward on prescription opioids and on her one, but a new and -- herald one, but a new and even more deadly tribe is growing out of control in america, and that is fentanyl. up 70% lastwere year. the martin girardi of this fentanyl is being shipped in from china or it is being smuggled in from mexico. we cannot stop it without the federal government stepping up. this crisis is going to take an fromands on deck approach the federal, state, and local

governments, along with community and faith-based organizations and others in the communities. and we need to be working together on this issue. i urge you and your colleagues to make increased funding for a topioid crisis priority. maryland and many other states are all working to provide naloxone to all of our local jurisdictions, but greater federal support would help make this life-saving medication available to even more of our first responders, police officers, an emergency room personnel. i would like to recommend that the federal government encourage advertising, public service campaigns to educate the public about how lethal fentanyl and these other drugs are, and we also need more targeted and aggressive federal enforcement interdiction efforts when it comes to fentanyl and these other open yours through initiatives like this and i can't -- like the synthetic

trafficking. as this crisis evolves, so does our response it. murray,with senator this crisis is not just a health crisis. this is tearing apart families and communities from one end of the country to the other, from maryland to oregon and every place in between. ultimately this is about saving lives. and it will take a collaborative, holistic, and bipartisan approach to a college that. so again, thank you for having us, and we look forward to the dialogue and answering any of your questions. senator alexander: thank you, governor hogan. governor brown? governor brown: thank you so much for having me here today. i am honored to be sharing the dais with my colleague governor leary hogan. by providing our states'

perspectives, i hope we can underscore the urgency of the crisis that has touched every single corner of every state in our entire nation. part of what makes opioids so dangerous is the fact that there is so much of it, and it is not hard to get. as easily asin reaching into the average family medicine cabinet. that is what happened to max of southern oregon. he was a poet and a chef. when he was 17, he got into a car accident and was prescribed opioid painkillers. what started as there be became self-medication and spiraled into abuse. from prescription pills, he moved on to heroine. his mother julia was devastated as she watched the grip of opioids consume his life. he died of an overdose at age 25. max'shard to look on story. what if we lived in a society

where he was not change for having a problem or for reaching out for help? what if he had had access to better treatment? what if the first responders had had life-saving overdose drugs? addiction is lying to circumstance, but the high cost of fiction -- of addiction is born back our children as parents are unable to care for them while struggling with substance abuse. right now the federal government recognizes the problem, but is focused on punishment. that leaves us, the states, to right the wrongs of a war on drugs has done nothing to address the issues that drives this public health crisis while our prisons and our foster care systems are filled to capacity with its victims. i have seen it firsthand. prior to becoming governor, i worked as a lawyer representing parents and children in the foster care system. i watched children come in and out of foster care as their parents struggle with substance abuse disorders.

as children struggled with the foster family they barely knew, their parents struggle with addictions that overwhelmed our treatment systems. in oregon, 60% of foster children have at least one parent with a substance abuse issue, including opioids. if we can make meaningful change and prevention, treatment, recovery and substance abuse, we can create better lives for our families. we can see more success for our students in school. we would lift a burden off of our hospitals and our law enforcement and our prisons. in my phone -- in my own family, access to comprehensive behavioral health treatment changed the trajectory of addiction. my stepchild started abusing drugs in high school. my husband and i watched him change and felt powerless to do anything about it. eventually, a teacher caught him

using at school, and instead of kicking them out, she called us. we knew that just trying to stop using would not work. his daily routine had become centered around getting hot. he needed -- high. he needed an immersive program, but our insurance policy stood in the way. he had to go through two separate outpatient and inpatient treatments and relapses for insurance cover the residential program he desperately needed. fortunately, for us, our family's story turned out very differently than that pinskys, but it turned -- taught me how different recovery could look for every individual. we need to think about it as a process that needs to be tailored to a person's unique circumstances and environment, turning away from a failed first model. that is something we are working on in oregon. we're also getting more lifesaving overdose drugs into

the hands of first responders and implementing creative programs to provide a warm handoff from emergency room to treatment and recovery. in addition to increasing treatment resources, we need to make sure we are focusing on decreasing stigma as well. we must break through the barriers of shame to provide the best treatments possible first and the most effective assistance now. we need to let people know it is ok to come out of the shadows and ask for help and there is help available for them. at the federal level there is so much that can and must be done. improving data sharing from the federal to the state level, making affordable, generic overdose drugs more available, rejecting a punitive approach to addiction. who knows? aybe this could have saved max's life.

we know it can save millions of others. thank you. >> thank you, governor brown. thank you especially for your personal story. we'll now begin a five-minute round of questions. senator isaacson? >> thank you both for being here today. we appreciate it very much. governor hogan, in my state it is estimated by professionals there are 541 million doses, particularly in my state right now, of opioids, in georgia. last year in june we had an epidemic run where in two weeks there were eight deaths of overdoses, 40 hospitalizations, through middle georgia where a number of percocet pills laced with fentanyl had gotten loose in the public. you testified on fentanyl in your testimony and i understand your state has been dealing with similar problems because it is a growing -- fentanyl is a growing magnification of the opioid problem. what are you all doing in maryland that's working and what can you share that will help us to work to reduce the

fentanyl effect? >> thank you, senator. we first started with prescription opioids and we did a -- we put in a regional, in fact, we worked together with the district of columbia and virginia and did a regional prescription drug monitoring program. we put in legislation to limit the number of pills you can prescribe. we were focused on that part of the issue and done pretty well. we were squeezing that down. and then, unfortunately, more people were doing heroin because they couldn't get access to the prescription opioids. then we started to clamp down on the heroin distribution and we got this new fentanyl and carfentanyl which is 50 to a hundred times more deadly than anything else. now as we have been working on the crisis it evolves into something else so we have to constantly be shifting. and they're lacing not just

heroin. they're stealing fentanyl directly but also lacing now cocaine and marijuana. people don't know that they're getting fentanyl. some people are seeking it out and some people are unaware. but it is killing people every day in our streets. we had seven people die in one of our wealthiest counties in one day. and i know that you and i share -- i know your story with your back surgeries and i'm sure they prescribed opioids to you. i went through 18 months of battling cancer my first two years as governor and i had four or five surgeries. i know at one time three different doctors within a matter of weeks prescribed me 30 day supplies of three different opioids. that can't happen anymore in our state. but the fentanyl, we are really trying to crack down, but it's coming a lot of it through the u.s. postal service. it seems like nobody uses the postal service anymore but the drug dealers from china are

because they aren't checking the packages the way the other delivery services are. we have to put some federal funding in that. it's now being manufactured or transported and smuggled in across the border in mexico. this is actually -- we've got to do what we can on the local level in interdiction, but the federal government has to step up, keeping it from coming into the country. >> would you agree with me it's also not totally an addiction problem but a one-time problem, too? fentanyl is so powerful. a person could get one pill. they're not an addict, never were one, but the one pill could kill them alone. >> there is no question people that are addicts are killing themselves and people that don't even know are doing it once and killing themselves. it is a deadly, deadly thing and 50 to a hundred times worse than heroin. >> governor brown, i appreciate your testimony and i enjoyed our conversation earlier before your testimony. >> thank you. >> as i told you or shared with you i lost my oldest grandchild

to an overdose the day before he was to receive his diploma from georgia southern university in mathematics. it was a one-time occurrence in terms of that. he had had a problem but it had been years ago. he had been clean. he'd done everything he needed to do. he rehabilitated and then one exposure took his life. the reason i am so big on this is prevention is as important as enforcing the law to arrest people and put them in jail. you just got -- education is the key in this. i got a first class education myself because of back surgery and the pain management. i knew a lot of things to do and not to do because of the things going on up here. tylenol worked pretty darned well and the other can kill you. so what are you doing from the education process to get not only those who are circulating the stuff but prevent people from thinking about taking it in the first place?

>> thank you, senator isakson. i am terribly sorry for your loss. this is one issue that unites all of us regardless of where we live or what party we're with. we've had family, friends, relatives, impacted by substance abuse. i think because it is an issue that unites us we can all work together to tackle it. for us, education and prevention are key. we want to make sure that our students throughout our schools -- oregon is big but we're small in terms of the number of population -- we're only 4 million -- we want to make sure our students have access to mental health services, comprehensive mental health services, behavioral health services in every single school across the entire state of oregon. we think that's key that students be able to access therapy and treatment if they

need it from an early age. we also need to make sure we are working hard to educate students about the impacts of sexual abuse in schools throughout the state of oregon. i think the challenge is these drugs are coming on so quickly and they're so dangerous it's hard to get the word out. certainly partnering with us at the state level providing resources around education and prevention would be extremely useful for us at the state level. >> thank you very much. i know my time is up, mr. chairman. i point out, though, the methamphetamine program now in place about four years to try and stop people from getting exposed has paid some dividends. so educating people against ever getting into it in the first place can be as big a help from stopping somebody from selling it to somebody who got it. >> thank you, senator isaacson. senator murray? >> thank you very much. i want to follow up on senator ice ackson's first question. there is a decrease in

prescribing opioids but opioid use is rising as you both talked about. there is new data that shows a 30% increase in the emergency department visits associated with opioid overdose. we do know illicit drugs, fentanyl is part of that. mr. chairman, i hope to work with you on clarifying some of fda authority at our international mail facilities where fentanyl is entering this country. i think we need to focus on resources through our appropriations process to deal with this. either of you have any other ideas and want to submit them to us this is one we really have to start getting a handle on. appreciate both of you commenting on that. governor brown, i understand oregon doesn't allow law enforcement access to its state prescription drug monitoring program. can you tell us why that decision was made and what the implications are for sharing that data with other states? >> we're just beginning our work with our pdmp, and i just introduced legislation and

passed the legislature. i haven't signed it yet. as a result of the work from the opioid task force that will require our physicians to register with the p.d.m.p. the opioid task force is looking at the law enforcement issue. the goal for us is to make sure that we have physician registry and that just got done this last couple weeks. >> so it's not that you're not doing it with law enforcement. you want to look at it before you start doing it. >> absolutely. >> ok. governor, did you want to add anything to that? >> well, i would just add that we're trying to look at it from both directions. people that are addicted need treatment and they need help. we're trying to get them the help they need rather than go after them on the law enforcement side. but the folks that are bringing in these large quantities of deadly drugs knowing that they're going to kill our citizens, we're cracking down and getting tougher on those folks that are doing much of

the, not only the drug dealing that is killing people, but the shootings in baltimore city where we had 343 people killed last year by gunshot. nearly all of that was opioid elated as well with gangs. so it's a comprehensive approach. it's the early education and the prevention and then it's the treatment for the folks who need it. but, also, cracking down on the people that are profiting from death. >> ok. over the past couple years, through the actions this of committee actually we have increased the caps on the number of patients, a health care provider can prescribe and the types of providers who can do so. can you both talk a little bit about some of the benefits from increasing the caps on that and providers and is there more you think you we can do to increase hose caps?

>> thank you, senator murray, yes. we think having access to evidence based treatments is the most effective approach. my understanding a medically assisted treatment can be extremely effective. one challenge we face in this arena is that the data in terms of the physicians that are able to prescribe medically assisted treatment, that's not available to the states. it would be extremely useful if we could access that .nformation tveragets is not available because? >> it is my understanding we can't access which physicians are providing the treatment. it is a challenge particularly in our rural communities where we have limited access to treatment and we cannot . . they need. >> governor hogan? >> yeah, i would agree with governor brown that we do need help from the federal government on expanding

medically assisted treatment. that is the only way you can get people off of these drugs. it is the most effective way to break these addictions. the narcan front, we have opened them up to, you no longer need a prescription. they are available in every pharmacy and drug store across our state. we've tried to provide them to every single first responders, police officers, fire department, people in the emergency rooms, and it is saving lives temporarily. but the same folks are showing up over and over again in the emergency rooms. >> the side of it that we aren't getting access to. >> go ahead. >> senator murray, thank you. the other thing i would add in terms of treatment, one of the things that, one of the new, innovative policies that we are moving forward on, it was legislation that i just passed at the request of my opioid

task force, and that is making sure that there is a warm hand off. and so folks go into emergency rooms having overdosed. e've just saved their lives. what i've heard is they go to the next room, the next bathroom, and use right away. one of the innovative pilot programs we just funded as program to ensure a warm handoff that we can have a peer mentor in the emergency rooms to help people get directly into treatment and recovery. we think that will be a creative approach to enable folks to access treatment immediately. >> thank you very much. my time is up. >> thank you, senator murray. senator young? i'm sorry. senator collins. >> thank you, mr. chairman. i know we look a lot alike.

[laughter] in all seriousness, thank you very much for holding this series of really important hearings. it as public health crisis and a crisis for families all across this country. as governor brown pointed out, there is no place that is immune. governor hogan, i want to start with you. this month as we've been tallying up the numbers from 2017, we've been hit by a series of heart breaking statistics. just a few weeks ago we learned that last year drug over doses killed a record 418 people in the state of maine. that's an 11% increase. so we're going in the wrong direction. then this week the c.d.c. announced that in maine emergency visits for opioid

overdoses jumped by 34%. last year. in the past three years, the number of people in maine who died by drug overdose has doubled. t the same time, we at the federal level have increased funding and federal efforts year after year to combat this crisis. so my question to you is what are we not doing right? you talked about the multi-pronged approach that i totally agree with of the education, prevention, treatment, and enforcement. we, due to the leadership of this committee, have poured a lot of money into all four of those categories. so what is it that we're not doing right? >> well, senator collins, thank you. we ask ourselves that same

question nearly every day. i mentioned in my testimony at the beginning that we were sort of ahead of the curve on focusing on this issue going back to 2014 and we immediately took every action that anyone could think of from every direction and we put $500 million into it in our little state, in state money. then we created the first state of emergency where we stood up our emergency operation center to coordinate every single state and federal and local agency to provide real time assistance on all of these different directions. and as i said, we made slight improvements in prescription opioids and heroin but because of the new sin thetics, fentanyl and carfentanil, we still had more than 2,000 people die and more people died in our state and a 70% spike in the new drug nobody knew anything about. i mentioned a few things, but i

think more coordination. more cooperation from the federal government with the state and local. so we are all knowing what can e each do? collectively to start -- we need funding with more flexibility with each state how they can utilize these funds depending how the issue is shifting and where they are at that point in talking with governor brown, fentanyl is not yet, i guess, a big issue in oregon. ut i believe it will be. i talked to the other governor. we had all the nation's governors together last week and there were people talking about chrystal meth is now reviving in their states and they're lacing that with fentanyl. they don't even have opioids and heroin. i think it is going to take all of us working together, you're right, the federal government, and your committee has been on top of this issue. it's been a focus and i know there was a task force put together with a lot of smart

people and lots of recommendations but it is going to need federal funding. i think the stop act on fentanyl so we can interdict is important. the opioid response enhancement act, you know, comprehensive addiction and recovery act, synthetic overdose prevention act, there are many good pieces of legislation in the house and the senate that should be passed, and they are coming from both sides of the aisle in both houses and all ought to be considered because we have to look at this from every direction. >> thank you. my time is nearly expired so, governor brown, i will submit a uestion to you for the record. just so you know what it is going to be about you mentioned at life saving drugs such as nelaxafone have seen exorbitant price" ceases in the past three years in some cases as much as

487%. for the record i'm going to ask you to explain what your state is doing to try to combat those huge pricing increases, which limits the availability to first responders. thank you, mr. chairman. >> thank you, senator collins. senator warren? >> thank you, mr. chairman. thank you both for being here today. far too many families in massachusetts and all across the country have had to bury swn they love because of this opioid crisis. more deaths, more funerals. this crisis didn't happen overnight and it didn't happen on its own. and a big reason it happened is because the biggest drug -- a billion he dollars doing it. i think it is time to start talking about holding these companies accountable and holding their executives accountable for the crisis they

helped create. in massachusetts attorney general healy is helping lead a bipartisan coalition of 41 states investigating drug manufacturing distributors for their role in the opioid epidemic. cities and towns in massachusetts have already filed lawsuits and a number of native tribes including the cherokee nation have also seen in both tribal and federal court. so let me ask this. governor hogan, maryland is also part of this investigation. baltimore and several county governments in maryland have filed lawsuits against manufacturers and distributors. you agree that part of tackling this crisis is holding these companies accountable? >> there is no question about that. we have directed our attorney general to sue some of these

manufacturing companies. there is liability, some of them knowingly pushing the sale of some of these drugs, knowing they had these addictive capabilities and did not disclose it. you can't paint all of the people trying to help people with pain with a broad brush but those doing these things should definitely be held accountable. i agree with you absolutely. unfortunately we can take those actions and we should but it is not going to stop the people dying on the streets. >> i understand. i understand. the investigation is ongoing and we should let the attorneys general do their work on this. if it turned out the drug companies broke the law, lied about it, and hurt people to rake in profits it won't be the first time on this. oo few years ago a corporation made a spray out of fentanyl, powerful opioid. the fda told the company that

its spray was approved only for use in cancer patients who were in such pain that other drugs like morphine just weren't enough to control that pain. but it turns out there just weren't enough of these cancer patients for the company to make buckets of money. and so it started illegally marketing the drug to people with milder forms of pain and bribing doctors to over prescribe it. a lot of states sued the company including massachusetts. oregon was the first state in the country to reach a settlement and it forced the company to pay up. so, governor brown, that settlement occurred a few months after you took office in 2015. has the money that oregon recovered from the company helped the state fight the opioid epidemic? >> absolutely. thank you for the question, senator warren. we received a little over a million dollars. over half of it went directly

to opioid, substance abuse, treatment, and recovery. a portion went to oregon health sciences university. they're well renowned, a research medical university. they're doing incredible work. i was very pleased with how the dollars were targeted. >> good. ' glad to hear it. here's the thing. -- i'm glad to hear it. here's the thing. when a company breaks the law it is because the people running the country broke the law. a short time ago the department of justice announced the founder and owner of the company along with six top executives had been indicted for fraud and racketeering because of their actions. let me ask you this, governor brown. do you agree that c.e.o.'s deserve to be held personally accountable when the companies they run break the law and hurt people? >> senator warren, in egregious cases loo ick this, absolutely. but obviously these cases need to be taken on a case by case

approach. this was a particularly egregious case and people should be held personally accountable. >> i agree on this one. this is not a democratic or republican issue and neither is holding drug companies accountable. the department of justice announced last week they are forming a task force to target opioid manufacturers and distributors that contributed to the epidemic and i am glad to see it. families and communities have already paid an enormous price for this crisis and it is time to start holding companies and their c.e.o.'s available. thank you both. >> thank you, senator warren. senator cassidy? >> i thank the chair and ranking member for holding these series of meetings highlighting both statistics but also individual families. and that's what we're here for. governors, thank you all for being here. thanks for being front line and finding solutions. i want to agree with using the p.d.m.p. data.

we have a bill included that would encourage states to proactively share this with law enforcement. governor brown, you've mentioned that i think you said that is your goal. but, governor hogan, don't i know that maryland does not proactively share with law enforcement? i say that not to accuse but rather to ask why not and what can we learn from the difficulties of implementing this program? >> i think we've got to be careful about the sharing of information. we want to protect the folks that are actually having drug addictions and not treat them just as law enforcement cases. that's what we're talking about with all the treatment and other education and prevention. >> if i may, the way i see this, is not so much that you would attract -- track down people who are addicts but rather pill mill doctors and pharmacies which are knowingly over prescribing and are pharmacies which are not aware that a patient is going from pharmacy to pharmacy to pharmacy and doctor, doctor,

doctor in order to aggregate. >> we are doing exactly that actually. i was just talking with our czar who is heading up the entire emergency operation that we've declared and we are shutting down pill mills all across the state and certainly would be happy to talk with sharing that information. >> let me ask again, not to interrupt but i have such limited time. what are the lag times between, in each of your states, between someone getting a prescription filled and it showing up on your p.d.m.p.? i say that because i spoke yesterday to walgreens and they said most states at least five days at which point a doctor-shopping patient can go to five different pharmacies. >> i don't know the exact time. we'll get back to you with that information. we did boost the enforcement capabilities and we're trying to go after it as fast as possible. >> i have to ask a question. if your czar were a woman would she be a czarina? just had to ask that. now let me also ask, because senator murray and i have both

discussed the indifferent settings. the limitation. because apparently there is a huge lag time as walgreens reports. would you agree the ideal system would have real time upload of prescriptions being written capturing people from all states and capturing people who are paying cash? >> i think that's exactly what we're doing with virginia, d.c., and maryland. >> my only concern is your p.d.m.p. probably has a lag time according to the pharmacies it can be five days to two weeks. >> in terms of oregon the legislation just passed two weeks ago. i haven't signed it into law yet. in terms of requiring physician registration with the p.d.m.p. our time frames, we'll get that to you as soon as we have any available evidence. and in terms of connecting with law enforcement, that is something we want to take a look at. i think it's going to be critically important. one of the tools that we think is going to be extremely effective in terms of p.d.m.p.

is that we now have a good electronic records health system. we are able to connect the p.d.m.p. with electronic health records in our emergency rooms. >> are vendors cooperating with that? >> yes, so far. but like i said, the law was just signed two weeks ago. the chair and ranking member have intense interest as do i so if you can give us feedback on whether that is collaborating we would like that. can i mo some very effective and some high-rate recidivism. >> senator cassidy i will be

signing plan concerning state-wide program. 74% of people are in abuse plan. some of the challenges is making sure everyone has southwest access to health care. one challenge is making sure everyone has access to health care and we have comprehensive --. >> let me ask. when i speak to providers and say this their heads nod. some are merely combing jails finding cassidy, we'll use evidence base in terms of that is why we think it is so effective because if there is evidence it works. >> i am out of time. much to ask but no more time. i yield back. thank you. >> thank you. >> if you want to stick around, a second ground like to do that. senator? >> well, thank you, mr. chair

and ranking member, murray. thank you, governors lo gn and brown for being here. brown, andgovernor, senator isaacson, too, for being personaltack the stories as they connect to this epidemic. other americans have been speaking up being brave sharing too, so i would like unanimous consent to enter photosrrative and some from this week's "time" magazine called the opioid diaries. compelling. and i think the pictures in particular capture what is country because of this epidemic, so with u would like tont i enter those fot hes into the record. >> order. to return to the issue of's sestedn-aye treatment in a minute but i wap to touch on something that we have not talked about that much .et i believe that strategies to

address the opioid epidemic need thoughtful. they need to be long sighted and multi facetted while we talk as crisis, we now and the impact of this health epidemic. this is not something we can fix overnight. the $6 billion be secured in the bipartisan agreement is a start. ultimately need far more funding beyond this to truly address this crisis. keep fighting to make that happen. i know a lot of people leering that as well. governornal association federal action to crisis nation's opioid recognizes the need to increase federal in vestments and during of new as governor jersey new hampshire. i worked with governor baker to first recommendation on the epidemic which noted the need for additional resource. consensus among governors on the need for in

crease resource highlight just epidemic is.his i have made this point in our opioid marings and mack it again to make sure we're making robust sustained invest presidents to stop this epidemic. investments to support those on the front lines of this crisis, and investments in prevention, recovery.and to that end, governor, what would additional funding mean for your efforts on the ground and governor brown, why don't i start with you? senator has sand. in terms of additional resource they would be key for make sure have affordable, generic overdose drugs available to all of the first responders, that is is an issue for us. and having additional resource would be key. that we have access behaviorialsive health treat and effective abusence and alcohol treatment. those is where, that is how the dollars would be focused. you, governor, hogan.

>> well, senator hassan, i agree that we need more federal funding and not to, not not a that $6 billion is lot of money. it is. to the tax pay evers about it is compared the bucket toed what we actually need in a mentioned earlier, our small marry listen, we spent a half billion dollars in state funds. >> yeah. >> and $6 billion stretched across the countries not going far. very we need it from different places. >> right. >> and for different reasons. , you know, medically assisted treatment we talked about. long term, you mentioned it is the immediate crisis, but its the long term recovery services that we're going to a way to pay for it. example. for >> exactly. so it may be additional funding in multiple different department's budgets, not just the health issue yeah. orre just education issue just a crime prescription issue. it is across almost everything

you are funding. >> ok. well, i you a appreciate that i. the cost to new hampshire ekcally was $2 billion. our country in 2015 was $504 billion from this impact of this crisis. so i agray $6 billion is not do the trick. just quickly, on the medication assisted treatment and if i am ofund far second round it more., will go into locatore a practitioner on the website, and by zip code ash even, sob this may be of assistance, and i have a bill, and i will, i will provide it to that would help, would fight topes to medical schools develop cur ruck cue lum around medication assisted treatment, that asized that so people are learning about prescribing opioids, they can also learn about addiction and treating addiction and if we can

standardizes the and agree on basic credential for it that allow them to get the kind of waiver they need to become pracs ners in the field wherever they decide to go practice, and i am hopeful that will help with of practitioners base in new hampshire shall where it is a great need. it is.ing from you, >> i awould agri with that completely, senator. both.nk you, >> thank you, senator hassan. >> more mckowski. >> thank you. importantthis very hearing, thank you governors for today, butance here also participating with the broader group of governors controy focus on the issue. senator cassidy has raised isatment not all treatment equally effective, and in far cases, weolices and simply don't have the treatment facilities that are available. alaska is pretty sad canes

point, unfortunately. are, while we're getting more treatment beds, eight detoxwe have beds, in the state, in the for detox for opioids. we have more detox beds for our realities he is dow and bess dest operate for youbody who is addicted and are ready for treatment and have , ow do you get the service. in eitheron for you and your jailland programs for addiction within your facilities? >> yes. part of themnt because people addicted, they addicted, we're hitting that from a number of

different directions, first of corruption inme our prison system where jail guards were. buy rooting out that corruption but we also increased the dollars of the funding and the beds and treatment option prisoners because getting them the help they need while makes a bigprison difference. we have a problem, though. thatve the 8507 beds judges can accepted treatment to a treatment bed rather than jail. thee are supposed to be for nonviolent offenders who really need help. judges now, a huge front page in the baltimore sun sendingy about judges hardened repeat violent criminals. and so the people that really need the treatment are getting them and see, what i should be long time are getting out and they are sentenced to a 16 or 20-year or getting out in a year two after they reside of

this treatment so ge we got to direction.from all >> but it is a program that from havingte's perspective those individuals who need that tream, they are there. you dop need to build a stand alone fa cecily continued they treatmentg the program within the jail itself. >> it is effective. >> yeah. brown.rnor senator, yes we're. i cannot say that every one of in custody has access to the substance and the alcohol abuse treatment that they need. we simply don't have the resources to provide it. have 14733 adults in custody right now, the vast bulk them, as you are aware, suffering from some type of substance and alcohol disorder as well as some type of mental health issues. focus in tackling it at the fronted in terms of stimes.enforcement the number of state courts have

drug courts that have been recentlyd we also reduced production of a controlled substance, small ams felony to a miss did he meaner because of their, the significant impact particularly and lacan-american continue know men in our state. but certainly, we would like to substance abutte are buse treatment available to everyone that is in custody. you, governork hogan, you just mentioned that, in about half billion dollar the state of maryland has put forward for treatment, prevention, and enforcement, you break that i always think that, the more that we can put in prevention, the less we have but then treatment, purposes of your spending, how does that break out? >> well, most of the funding , probablytreatment less on education but we also into crime fighting because you have to do both. we have a situation in our largest city where as i

mentioned 343 people are shot, know, 1,000 people were killed buy overdose, we brought gotwe brought in, we tougher, i passed the biggest criminal justice reform bill in maryland in a generation which lowers sentences for certain thems but also, toughps for people who committed a crime with a gun, people who are toest violent person because we got to get them off the street. we had a successful kind of a where we sentmore in 500 state and federal officers and arrested 500 people including 289 of the most violent repet offenders throws to folks we want to get off jail so they all require funding but most of the money goes into treatment and we are spreading wherever the need is. no mart how much be spen, it doesn't seem to be enough. >> thank, mr. chairman. am out of time. appreciate the response than the ship. >> thank you senator mckowski. >> senator smith. andhank you, mr. chair ranking member, mr ry, governor

hogan, governor brown, it is won develop you have here. governor brown is from min set to originally, signed am very to see you happy here today. governor brown, you mentioned in thistestimony about how opioid epidemic touches every one of us in one way or another, doesn't matter whether you are rich, poor, you live in rural come tins or urban communities. certainly know that is true in machine seat to. we see in our tribal communities in minnesota, a challenge. know this is true in many states including alaska as well. i was lieutenant governor, i helped to convene a we couldioid summit so benefit from the learning and the understanding and the culturaland the resources of tribal communities, november,air, this the indian affairs committee, held a roundtable with witnesses including representative interests the wide earth mom's

program in minnesota talking of carpe challenges coordinate with travel come continuities in a would like to to u incomous consent subknit transcript for the record. >> thank you. >> governor brown, could you talk a little bit about what you are seeing in oregon and what you are hearing from tribes in issue?about this >> , thank you, senator smith. we have nine federally recognized tribes in or gore oregon. our tribe feel the impact of historical trauma on a regular basis and the consequence reason substance and of alcohol abuse on our tribal communities on the reservations and we have on some of the resser vases very high unemployment rates. springs for example. over 50% and the substance and alcohol abuse is very, very high. i think what is really important noto make sure that we are doing a one size fitz all approach so we work close tribes in a number of levels and have good working

relationship with the tribal chairs and with the health policy advisers. governmentually in a to government summit but we also have cluster meetings and quarterly basis regain make sure that we are work hard to collaborate around this issue. of the most successful programs has been the native rehabilitation association a long time cultural topetent program designed meet the needs of our tribal communities and they have very effective results, but i think it is really important it, ae look at comprehensive way, that we provide wrap around services for strugglings that are shall we cannot treat the underlying substance abuse shall shaw. we need to treat the other issues that foe foul three, the homelessness, the lack of employment, those other issues as well. so we're finding in our tribal come that is in a wrap-around

approach can fyke. >> thank you. thank you. thank you very much. sounds like is great model and very important way of thinking about this. of time ilittle bit would have left. i would like to touch a little bit also on this connection substance abuse and behavior health. and how we need to do, how we to make connection more itmly and you know, i think also relates to the tendency we have to sort of move from, you focus on one cray sis while another crisis developing, and you spoke about this comments.ogan in your well, so i am wondering if, anticipate of you in a little i have couldhat just talk a little bit about what we can do to, at the level, you know, avoid that, and, and try to have more term sustainable tramming day this address all of disease of depair as the friends in the public health community call them. well, senator smith, i agree with that. think the federal level we got

to focus on mental health and abuse issues together. because in many cases, they, throwse overlapping and two issues that almost everyone has mentalon system health or substance abuse issues that is response for a lot of the crime we're dealing with and apart families and we shouldn't look at it them separately. problems, butrent we need more coordination and funding for both. >> thank you. >> governor brown? >> thank you. i be a absolutely agree. think we need reduce the stigma related to substance and alcohol treatment and i appreciate isaacson coming forward and sharing his family's story. criticallyis also important that we expaned access to comprehension behavior health only way you the can do that is to make sure everyone has access to health share, i just want to again, 74 percent of those diagnosed with opioid disorder the oregon health plan

for treatment. we couldn't be providing the oregonithout health plan. and it is a come planessive approach. and i know i am out of time. i also have to add we have, we have laws about mental health pair ty, yet we know that not living up to the promise of those, of that legislation. >> thank you. you, senator smith. let me ask you a couple of questions. we often have good ideas presented us to. then we have a spirited discussion here. sometimes differences of opinion about whether the federal do the goodaught idea or whether the state government ought to do the good idea. a biaser governor, i got in that respect, but i want to for us aboutce some good ideas we have heard and to what extend the federal should do it or to what extent the state should it

did or how we should do it together. example. and you have mentioned this curriculum. dropped it by the governor's meeting with heads of trainedutions that doctors, and they were talking curriculum fornt each of those medical institutions so the doctors understandingter about how the prescribed opioids that be done from washington or should that be done in the state? example would be monitoring, drug the senator cassidy has questions about that. 46 states have a prescription monitoring system and we had variety of suggests about how to make those more effective. proposal is we have a federal prescription drug outfit in addition to state organizations and housed department of justice and another that is we help states

connecting inb of operatability. another that is we establish standards about about how states should set up their systems so what should we do about prescription drug monitoring from here? >> another example is e prescribing. many witnesses have suggested that that is very, that is a do. good thing to seven of eight states have already taken steps to do that, some in different ways. is that something we should do from here? states something that should continue to explore and do? then, finally, limits on prescriptions. we had a lot of, in an effort to try to, to try to avoid overprescribing, about half of the states have in different limited the doses of opioids that a doctor may prescribe. three.y some say seven. some say ten pills it has been ought to have federal

rules about that. what is your advice about the division between the federal and what states ought to do. >> governor hogan? mr. chairman those are all really difficult and important questions. typically i agree with you on ie states rights guy and believe that much of the innovation is happening out in the states and i like the flexibility of states being able to do what they feel is right state,ir own individual thinkme of these things i the federal government needs to are arole in because we small state some issues we may be trying to address in maryland really help if someone goes into washington, d.c. to overeroin or they cross the border in virginia. >> do you which we need federal, we need federal into it has been work in our state it? has been working in the region.

don't know why it would not work some, at least, some standard from the federal level. >> what about e prescribing. a look at,rth taking too. the state cannot control what is happening across the internet. >> and, and, what is the other one you mentioned a couple of others? >> well curriculum, limiting the doses. >> on the limits the dose, i know, massachusetts just recently passed a three-day we pushed for a seven day limit in maryland, and i think limiting the dose is important. but many of the states are already take those action. >> governor zon. >> senator alexander, i don't know if i disagree anticipate governor hogan said. we should take that down. that i think the federal government can be fekive and that is we're doing some with the state of washington around reducing drug costs and to the extent that, canfederal government assist us with making sure that

generic overdose drugs available and affordable, that thed be absolutley key, other area of where i think that the federal government can around a more come the prensive approach to pain management. obviously,spective, the opioid crisis part of it our challenge in this country in dealing with effective pain management and , worknly, we have happening at the research arena,tions around this but for us, to able toll see what is happening across the key, and ild be recently appointed easter to vern from oregon health sciences university to cannabis commission and we are just beginning to take a look at the data there, it is the reresearch. buy think we need to, we would, we could sure use the support of the federal government around

comprehensive pain management people.s for our thank you, governor brown. >> well, go to senator cane, encouraged this committee dr. collins at the national uninstitutes of health to accelerate research on nonaddictive pain medicine and management strategies. and senator mr ry in a to allowd legislation him to move money around in a way to accelerate that. will, that is helpful. senator cane? >> thank you, mr. chairman. witnesses, inhe 2018 in virginia. 1460 people overdosed. 80% was opioid based overdose. is really tragic about that. odt was 38% increase in the dea interests one year before 2015 evening to we have been paying attention it to. i was increasing because we were paying attention to the contrary our governor governor mccullough has opioid task force we were debating and

passing carve. were having endless hearings, books are being written, dream eyes on others with all it. the od deaths still went up by 38 percent largely because of poency of fentanyl. so this details the magnitude our challenge. we have a wonderful journalist macy, we heardth from sam, recently who wrote a that is a great journalist who is writing a book about in apa latch sha. the work is entitled "dope sick" points out something that winded my thought about the magnitude of challenge she was interviewing somebody who was working as a summer councilor at decade andhas for says when he started working as councilor camp, the campers ap some would have medicationest from supposed to take during the week. may be mass or it was handful f. now we take about the kids

and 12 yearsare 11 old. so many are bringing medications adhd, all kinds of other medication. this was observation not a but theic study individuals asking whether we're pills notrmalizing just as pain management strategy but normalizing at younger, that just pills are what you pay. to your summer camp or pills dumbed into into a around as apassed party or pills described for pain management this demonstrates the magnitude of we're dealing with. i want to thank you for the work you have done and especially governor brown. brotherrer and sister-in-law live in or gn and involved in preventionbuse activity in the state and big fans of yours. talked aboutn, foster care. and i want to ask each of you about that. seeing aia, we're tremendous increase up the

number of kids who come to the foster care system because their are either disabled or in jail or die because of opioid overdoses. talk a little bit about what you are seeing in foster in your own are from things we could do to be helpful in foster policies as you dealing with this challenge? >> thank you, senator, cain. represented children and parents the foster care system. the havoc that substance and alcohol abuse wreaked on our families. we have 60% of our children in foster care have one parent the substanceh abuse issue. i have to say a shout out, i mentioned the foster families that are caring for the fostern, a lot of families are grandparent and i want to say thank you to the grand par reasons who are doing an extraordinary job taking care of the grandchildren across the country. the other thing that we're doing and i just met on monday at our

residence with we call it the three branches of judicial ranch, the executive branch and the legislative branch there to tackle shores that we are facing foster care system. because of the growing numbers placed inn being foster care due to the substance abuse issues. and i think it is so crit call that wework together work collaboratively and some of created one family court so if there is a drug issue, a domestic violence issue, and juvenile court issue, that one judge is dealing with the whole family one, one judge at a time, one family at time, veryhas been a and we hope to share it with the rest of the country. >> governor hogan, how about foster care issues in your state? >> thank you, senator, kaine.

we both had increases. the just rating part that we just imagine had we not taken steps wee had taken, how many deaths we would have had. the child welfare and foster is important part of the issue. most of the kids that we are dealing with that are going intr foster care have some relation to the parents being involved in substance abuse of some kind and much of that is opioids and in many case it is grandparents are actually taking care because the parents of the kids are addicted and have issues but in many cases they don't have someone directly-family related that can take care of them and they are going to foster homes and it's a growing, growing problem. in addition to that, we are getting a big issue on the neo natal, many of the babies being bornin to hospitals are addicte, starts before they get to the foster air level. >> great, thank you. mr. chair, thank you very much. >> thank you, senator kaine.

senator murray, do you have any more questions? >> i believe senator wanted to askth one more question, i belie senator baldwin is hope to go return. >> why don't we go to senator cassidy. >> governors, i actually have questions from a father who son died and as i read testimony it's veryy moving so excuse me s i feel his pain. he says if your son 17 year's old, treatment options are limited and in your state what is available for someone who is a less than 18-year-old person as his was? >> thank you, senator cassidy, and i'm terribly sorry for this man's loss. in oregon we are working hard to

make sure that our young people have access to treatment. i mentioned earlier focused on comprehensive behavioral health. we unfortunately are struggling with some of the barriers through insurance policy and requiringce failure first before rsgetting the best possible treatment and we want to change that dynamic in the legislation that just passed two weeks ago it's going to to be taking a look at insurance barriers. >> let me come back to that. >> okay. >> somebody less than 18 year's old, do they have same access to treatment as someone who is over 18?? >> yes, i believe so. >> governor. >> yes, i don't think we discriminate based on age. >> these questions are based on his suggestion, he suggested and one of you thought that you decriminalize possession, if you will, you decriminalize addiction because a 17-year-old could end up being forever from normal society if that's on his record, have your states

decriminalized addiction, if you will? >> we haven't decriminalized drug use but we have lowered penalties and changed things from felonies and misdemeanors. >> a 17-year-old was found with fentanyl. he was not a distributor but user? >> it would depend on the circumstances of case. our preference to get him on treatment but every case is dealt different in drug courts. >> are there penalties associated with dealers associated with addict's death? >> i will have to get back to you on that specific question, i will get that information to you. in terms of decriminalization, lowering of penalty from felony esto misdemeanor. i'm not sure what the sentencing is for juveniles. again, particularly with regard to juveniles we obviously want to take treatment first

inapproach. >> we increased the penalties for people who knowingly deal fentanyl knowing that it can cause the death of another individual. >> would they get also a secondary manslaughter charge? >> yeah, a primary manslaughter charge on top of anything else. in fact, we just passed the law that i introduced in -- and state of maryland passed legislature, my daughter is a prosecutor in st. mary's county, second-degree depraved murder, which is higher than manslaughter. >> wonderful. you mentioned the obstacles and mentalal health parity. doeses it cost money or what are the obstacles? >> we passed mental health legislation in the mid-2000's in

oregon. i spent years passing that legislation. in terms of coverage, i don't know from specific plan to specific plan, i will tell you through the oregon health plan we now have 100% of children covered and we treat our substance abuse -- >> now publicly-funded in some cases but seems to be the private insurance, i'm told that you said you have to fail or there has to be preauthorization and other obstacles that seem to inhibit the in fact if not in the law, is that also an impression in your state? >> i think if you are using the federal programs, i think you're covered but on different individual health plans -- >> how the law could be changed so it's, in fact, as opposed on paper? >> sorry, governor hogan, we need to provide the best possible treatments first and

most effective assistance immediately and the legislation that just passed that i haven't signed yet into law will take a look at insurance barriers that are present that my own family had to deal with. >> senator -- >> whatever. >> governor hogan. [laughter] >> something that the federal government and all of you to take a look at. >> i think if would be interested in understanding that. >> thank you. >> thank you, senator cassidy. senator hasen. >> thank you for having the second round of questions, and thank you both for persistence andd stamina. look, i think one of the things that's important as we talk about all of the challenge that is this epidemic brings is for as to focus on the fact that recovery is possible. in my state i have been just honored to know people who suffered from this disorder and

gotten better and turned their lives around and are in the field working for people every day. i'm reminded of a grandmother, i didn't know it at the time, annual eggn' roll hunt at the state house, the day before easter a few years ago when a woman came up to me with a baby in her arms and i admired the baby, we tookd the picture, you both know how it works, she then pulled me aside, the woman, she said, i'm not this child's mother, i'm his grandmother, the mother died of overdoes a month ago. that grandmother was there with her grand baby to ask me for help on the weekend that we celebrate renewal and resilience as christians and i keep her in mind all of the time because, in fact, this is an illness that can be treated and people can have productive lives afterwards and so, we have talked a little

bit about the importance of medication-assisted treatment here, we have talked about the barriers of insurance and one of the things i'd like you both to address is whether there is action we can take from here that, you know, generally regulate insurance both state and federal level, should we be federal regulations to make sure that insurance coverage gets that best treatment to thera person first and how can we increase our capacity for treatment and recovery services. so why don't i start with those kind of two general themes? whichever one of you wants to start. >> thank you, senator hassen, one of the key pieces is making sure that alcohol and abuse programs are effective and folks have access to the best treatment first and most effective assistance

immediately. and i would welcome -- normally as governor i don't always welcome federal engagement in this issue but to the extent of federal conversation about what utcomprehensive behavioral healh looks like and making sure that everyone needs to have access to it i think are absolutely key and we know that we are seeing challenges in our kindergarten and early prek with children that are really struggling and we need to be able to make sure have access to therapy and support and wrap-around services they need so they can be successful and we don't end up 20 years from now having to address substance and alcohol abuse treatment issues. >> thank you. governor. >> senator, thank you for sharing the story. i think everyone has been touched by personally or had the

same kinds of conversations from people that moved us. i didn't mention it earlier and don't talk about it much but i had first cousin that went through three years of treatment and became clean and got married and had a kid and was happy and turned his life around and had good job and then one time went out and died of heroin overdoes. so while it'sed great to see the people who have gone through treatment and been successful and many of them are the best folks to talk to other people in treatment and counseling centers, but there are sad cases, unfortunately the majority of people the treatment doesn't work. >> let me interrupt and move onto another quick issue. i think the treatment over time can work but this is a chronic illness. >> yes. >> when a diabetic happens to have, you know, insulin level go wrong, we don't say, gee, no treatment will ever work for that person again, we understand

that it is a chronic disease that it is and we are just learning about how to treat this disease especially with the onslaughtci with incredibly powerful fentanyl which raised to a different level. ly ask for the record because my time is almost up, one of the things we are doing in new hampshire with federal funds is bringing mental health andl substance abuse professionals into school systems to deal with trauma that kids are facing who areth coming from situations whe addiction has really turned their lives upside down and created trauma and i would love to know whether you have similar programs in your state and -- and how -- if and now federal funds could help you do more of that. >> thank you. >> thank you,, senator, we just recently beefed up our program after the school shootings in florida. i put 125 million more dollars into schools for school safety issues and $50 million more per year and part of that was

specifically geared toward mental health counselors in the school to make sure that every single school had the capacity so that they could catch troubled youth at earlier stage before tragedy happens. >> thank you. >> thank you, senator scott, senator baldwin, first senator scott and then senator baldwin and then we will conclude the hearing. >> thank you, mr. chairman. thank you for be willing to share stories and senator hogan, certainly good to see you healthy and before us. >> thank you. >> we know that, in south carolina we have seen 9% increase in opioid-related deaths, about 615 in 2016, i think nationwide that number seems to be heading towards 70,000, the crisis is absolutely an epidemic but when you think about the crisis of the opioid and the crisis, perhaps the larger -- more time to discuss

crisis around mental health, my understanding while focusing attention of gun violence, we have 33,000 gun-related deaths last year, about 20,000 plus of those deaths were suicides. >> yeah. >> so my question is, how are you in your state using medicine as means of addressing some of the shortage that is we are all experiencing, south carolina is a fairly rural state, our medical university of south carolina is spending some resources towards the challenges that we see in some of our areas where it's harder to get mcworkers much less mental health care workers as opposed to specific programs that we have been the state, can you talk about a willingness to use telemedicine and/or its

application in parts of the state that may have mental health from folks that could help treat folks who are suffering because it does appear to be a major challenge that is growing? >> well, thank you, senator scott, we just mentioned a moment ago, we are trying to put more money into mental health counseling. i'm not sure that we are taking advantage of that using tela health for mental health issues, but i would love to hear how it's working in sk and maybe reach out and talk with folks there and get input, sounds like you're right, you can't hire enough people to be everywhere. we would love to take a look at it. >> thank you, senator scott, i know that we are using tele medicine very effectively particularly under unique and emergency situations in rural oregon but not aware of mental

health but iha will certainly ak experts and get back with information on that. i will tell you that suicide is a huge challenge, drugs contribconstitute that and we were able to pass red flag legislation that enables courts to take away guns from folks that are a danger to themselves and others and i was pleased to sign that into law. >> thank you, mr. chairman, i will note that my answer really started in conversation with my brother who is now retired and they were experiencing a suicide a day. and the importance of resources for those who need desperately seems to be urgent opportunity

for us and i hope as we look for ways to deal with the challenge that is we face as a nation rather than military folks or civilians, the reality is that wewe simply do not have enough people who are experts to help other people who are suffering and if there's a new way to help them through tele medicine, i hope that we have more time and more information on the success of tele medicine not simply from mental health perspective but overall but uniquely with 20,000 plus suicides from gun-related perspective would beit helpful. >> senator scott, if i may, one of the challenge that is we face in rural oregon is lack of pediatric specialists in children's mental health care. i'm hoping your suggestion could be a useful but we literally lak

specialists in children's special health care outsides of metropolitan areas and it's dire need and our children are desperate. >> thank you so much, ma'am. thank you, mr. chairman. >> thank you, senator scott and senator baldwin. >> thank you, mr. chairman and ranking member, thank you to our witnesses for being here, you are on the front lines and your perspective is very, very helpful to us, i have had an opportunity now for several years to meet with some of the workers on the front line and in wisconsin as well families impacted by the opioid epidemic and the lion share of work is done on the ground. but i recently introduced a bill, governor hogan, i understand that you referenced it earlier before i arrived that would increase extend fundingg for state-targeted response opioid that we included in

cure's act and the funding expires at the end of the year, esso we ask -- we have to act to maintain it. my bill would also give states flexibility to use some of the funding for other substance abuse issues such as methamphetamine. wisconsin meth abuse has drastically increased by more than 300% in parts of our state while we continue to see a record number of fentanyl deaths and heroin deaths in other parts of the state particularly, almost eastern part of the state, western part of the state division if you travel around and listen to what people are struggling with, so this is further straining our local resources and forcing our leaders to look for other ways to adapt to this crisis. governor hogan, how would additional funding and that sort of flexibility through the

cure's opioid grant help you in your fight against this ever-evolving epidemic. >> thank you, senator baldwin, it would help tremendously. i mentioned your legislation earlier, i think it needs to get passed and can't have it run out, it would be a critical situation that happened and i agree with you on creating more flexibility for the states to be able to utilize and focus on the problems that they are having. you mentioned in your state and governor walker brought this up in the governor's association, we don'tca really have a methamphetamine problem but we are have a fentanyl problem. a couple ofal states did mention that this was coming back again, making a comeback, so i think providing the funding and giving us the flexibility at the state level to use it as we see fit in critical fight, we need the help, thank you.

>> thank you. >> i understand that senator kaine had questions about foster care earlier. i want to follow on that, the rise, the dramatic rise in opioid addiction has proliferated a cycle of trauma that has significantly impacted wisconsin children number of kids in foster care has grown 20% due in large part for parental substance usead addiction, the last time we convened for a hearing on the opioid epidemic, i shared with the committee a little bit -- they heard me for years talk about the fact that i was raised by my grandparents but revealing that part of the reason was my struggle with addiction due to prescribed narcotics for chronic pain that she suffered throughout her

life. i have bipartisan legislation called the family care act and this focuses on their -- therapeutic foster care and providing foster care for children with needs and would help access through services with medicaid, provides special training to foster parents and kinship families for youth with major mental health challenges where children receive in-home clinical trauma informed services who help keep them in the community. governor brown, you note that oregon's foster care system is similarly struggling with the simpacts of childhood trauma fm addiction. can you discuss what your state is doing to address this and why it's important to strengthen federal programs like medicaid and foster care services to prevent our struggling kids from

growing up to be struggling parents? >> thank you, senator baldwin and thank you for your leadership in this arena. we are struggling, our faster care system, we have one and a half times children in the national average and 60% of our children that are in foster care system, one of their parents is struggling with substance abuse. a good portion of them obviously being opioid abuse. i think more resources is key for us, as you know, intensive comprehensiveco foster care programsms like the ones you mentioned are extremely expensive, but i will tell you investing those dollars at early age we will prevent significant expenses to state government in the future, so i applaud your efforts more resources would be key for us. we are struggling trying to get

the appropriate number of case workers and the appropriate number of trained foster families to deal with these children's specialh needs, these trauma impacts that they are seeing from their families. so resources would be the absolutely crucial to state like oregon. >> thank you. >> thank you, senator baldwin. senator murray do you have concluding remarks? >> i want to thank the governors for being here today. incredibly helpful part of conversation as we move forward on bipartisan legislation, so thank you. >> thank you, this is our sixth hearing, very, very helpful and we are working on drafts of legislation we hope to recommend to full senate shortly, so staff works on that, we heard senator murray's comment and my interest also with the witnesses, suggestions that commissioners made about fentanyl from china

through u.s. postal service and more authority to seize fentanyl sent through u.s. postal service and stop act that senator portman and others have introduced. also comments about public service television, i wish there was a way that we could have the testimony of becky savage whom ysenator murray mentioned who said that when she showed the picture of her two sons who took occasional overdoes that died from that mixing, graduation party at her own home. when she put their picture up and told stories, high school studentsth listened. it made me think if we could find some way that could find something that could go viral on the internet or television that many young people simply don't know that if they mix a pill with a drink they may be death

in their basement the next morning. .. very and even, and it's hard for us to regulate that from here but obviously that maybe something where the federal and states could work together but states could take the lead on. thank you again for coming. the hearing record will remain open for ten ten days. members may submit additional information for the record within that time if they would like. our committee will meet again thursday, march 15 at 10 a.m. for on the 343b program. thank you for being here. the committee will stand adjourned. >> thank you [inaudible

conversations] [inaudiblenc conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> here's a look at the legislative agenda this week for congress.

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