in his favor and established equal protection under the 14th amendment applied to immigrants as well as citizens. examine this case with the professor of asian-american studies and history at columbia university and author of "the lucky ones." josh blackman also, associate law professor of the texas college of law and houston, and president of the harlan institute. watch live on monday at 9:00 eastern on c-span, c-span.org or listen with the free c-span radio app. order your copy of the landmark cases companion book available for $8.95 less shipping and handling at c-span.org/landmark cases. ♪ announcer: on capitol hill this

week, maryland governor larry hogan and oregon governor kate brown, testified on how their states are dealing with the opioid epidemic. they talked about prescription drug monitoring programs and other options for helping people suffering from addiction. the hearing was by the senate house labor and education community -- committee. it is just two hours. 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 giving us the opportunity to provide testimony here today 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 traveled 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. one of 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 focused on a four-pronged approach of education, prevention, treatment, and enforcement. i was the first governor in 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 half $1 billion towards fighting the heroin, opioid, and substance abuse epidemic from all directions. yet in spite of our efforts, we had nearly 200,000 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 heroin, but a new and even more deadly drug is growing out of control across america, and that is fentanyl. overdose deaths from fentanyl were up a staggering 70% and our state last year. the majority of this fentanyl is being shipped in from china or it is crossing the order, being smuggled in from mexico. we simply cannot stop it without

federal government stepping up. this crisis is going to take an all hands on deck approach from federal, state and local governments, along with community organizations and faith-based organizations and others in the communities. we all need to be working together on this issue. i urge you and your colleagues to make increased funding for the opioid crisis a top 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, and 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 opioids through initiatives like the synthetic trafficking and opioid prevention, or stop act. as this crisis evolves, so does our response it. i agree with senator murray, 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. it will take a collaborative, holistic, and bipartisan approach to accomplish 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? welcome. governor brown: chairman alexander, ranking member murray, committee members, thank you for having me here today.

i am honored to be sharing the dais with my colleague governor larry hogan. by providing our states' perspectives, i hope we can underscore the urgency of tackling the opioid 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. abuse can begin as easily as reaching into the average family medicine cabinet. that is what happened to max pinsky of southern oregon. he was a poet and a chef. when he was 17 years old he got into a car accident and was prescribed opioid painkillers. what started as therapy became self-medication and spiraled into abuse. from prescription pills, he moved on to heroin. his mother, julia, was devastated as she watched the grip of opioids consume his life.

he died of an overdose at age 25. it is hard to look back on max's story and wonder what could have been. what if we lived in a society where he was not ashamed 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 blind to circumstance, but the high cost of addiction is borne by 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, that has done nothing to address the issues that drive 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 struggled with substance abuse disorders. as children struggled with the foster family they barely knew, their parents struggled 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, and recovery from 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 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 him out, she called us. we knew that just trying to stop using would not work. his daily routine had become centered around getting high. he needed an immersive treatment program, but our insurance policy stood in the way. he had to go through two separate outpatient and inpatient treatments and relapses before our insurance would cover the residential program he desperately needed. fortunately, for us, our family's story turned out very differently than the pinskys, but it 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? maybe this could have saved max's life. i we know it can save millions of others. thank you. sen. alexander: thank you, governor brown. thank you especially for your personal story. we'll now begin a five-minute without round of questions. senator isakson? senator isakson: 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, circulating 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? governor hogan: thank you, senator. very we first started with prescription opioids and 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 100 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 but postal service anymore but the drug dealers from china are because they aren't checking the packages the way the other delivery services are. on we have to put some federal funding in that. now 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 a up, keeping it from coming into the country. darrell: would you agree with me it is also not totally an a addiction problem but a a 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. gov. hogan: there is no a 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

it is 50 to 100 times worse than heroin. darrell: governor brown, i appreciate your testimony and i enjoyed our conversation earlier before your testimony. your a as i told you or shared long 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 one terms of that. he had had a problem, but it had been years ago. a he had been clean. he'd done everything he needed to do to be rehabilitated and then one exposure took his life. one the reason i am so big on a 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. as governor hogan said, i got a you first-class education myself because of my back surgery and the pain management. i knew a lot of things to do and and not to do. you not to do. are a tylenol worked pretty a well, and hydrocodone can kill you.

a 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? gov. brown: thank you, senator isakson. i am terribly sorry for your loss. a 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 a 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 a students throughout our schools -- oregon is big but we're small in terms of the number number of population -- we're only 4 million -- we want to make sure our students have one and access to mental health services, comprehensive mental health services, behavioral a health services in every

you 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. are 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. around throughout the state of oregon. i think the challenge is these and 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. a 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. one-out chairman. and 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 you it to somebody who got it. >> thank you, senator isaacson. senator murray?

>> thank you very much. i want to follow up on senator first question. don't there is a decrease in prescribing opioids but opioid use is rising as you both talked run about. in there is new data that shows a 30% increase in the emergency and department visits associated with opioid overdose. we do know illicit drugs, fentanyl is part of that. mr. chairman, i hope to work inmr. 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 andi 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 a prescription drug monitoring program. can you tell us why that

a a 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. andi haven't signed it yet. 90 and work 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 >> well, i would just add in >> 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. a you you 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 youbut the folks that are bringing in these large you 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 are people, but the shootings in baltimore city where we had 343 people killed last year by gunshot. you a nearly all of that was you will opioid related as well with gangs. so it's a comprehensive approach. a it's the early education and you 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. a >> ok. over the past couple years, through the actions this of committee actually we have and increased the caps on the number of patients, a health care provider can prescribe and the types of providers who can do so. i 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 provided think you we can do to increase those caps? >> thank you, senator murray, in yes. an we think having access to evidence based treatments is the most effective approach. my understanding a medically as ismy 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 information. 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 access that information for rural oregon and make sure folks get the treatment that 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 a lotit is the most effective way to break these addictions. on the narcan front, we have opened them up to, you no longer a need a prescription. they are available in every you pharmacy and drug store across our state. a we've triedou you are we've tried to provide them to every single first in an emergency room 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 and that at the request of my you are opioid task force, and that you that is making sure that there is a warm hand off. are a you and so folks go into emergency rooms having overdosed. we've just saved their lives. you and 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 memory 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. and senator young? i'm sorry. senator collins.

>> thank you, mr. chairman. i know we look a lot alike. may even you must [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. at 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 we 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. but 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 question to you for the record. just so you know what it is going to be about you mentioned that 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 companies in the -- a billion 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.

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. im' 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. -- accountable. 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 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. [laughter] [laughter] [laughter] [applause] 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 move on not to be rude but just because there is too much to ask you. you all are implementing treatment programs. not all of treatment programs are equal. some very effective, some high rates of recidivism. how do you decide which to use and monitor whether they are good program or if there is a

high rate not of recidivism but rather relapse? >> i will be signing an order asking for a comprehensive, strategic plan regarding our treatment program statewide. 74% of the people in treatment for substance abuse are on the oregon health plan. 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 people on medicaid to bring them out and put them into treatment without followup. and there are others who do it right. if he says you a provider, they not their heads. how do you sort those? >> we are going to use evidence based in terms of our treatments and that is why we think medically assessed treatment is so affected because if there --

there is evidence. >> i am out of time. much to ask, but no time. >> thank you senator. thank you chair and ranking member murray as well as governors hogan and brown. thank you governor brown and senator isakson for being brave to speak about your personal stories as they relate to this epidemic. other americans have been speaking up. being brave and sharing their stories. i would just like unanimous consent to answer some narrative timehotos from this week's magazine called "the opioid diaries." it is compelling and i feel the pictures capture what happens. with unanimous consent, i would like to enter these photos and narrative into the record.

i want to return to the issue of medical assisted treatment in a minute. but i want to touch on something we have not talked about much yet. i believe strategies need to be thoughtful, long cited, and multifaceted. while we talk about this as a crisis, we now have a generations work of work -- generations worth of work to do before we can turn around the impact. it is not something we can fix overnight. the $6 billion we secured in the bipartisan budget agreement is a start, we know we need more funding beyond this to truly address this crisis. makel keep fighting to that happen and i know lots of people will do that as well. fornational recommendations the action to end the nations opioid rices recognizes the need to increase federal investments.

during my time as governor of new hampshire, i worked with governor baker to determine the first recommendations which noted the need for additional resources. the bipartisan consensus on the need for increased resources highlights just how serious this epidemic is. i made this point in our other hearings and i will make it again, we have to make sure we are making robust, sustained investments to stop this epidemic. to support those on the front lines in treatment and recovery. to that end, what would additional funding mean for your efforts on the ground. >> thank you, senator. in terms of additional resources, it would be key in making sure we have affordable and generic overdose drugs available to our first responders. that is an issue for us. having additional resources would be key. making sure we have access to

comprehensive cave girl and help treatment and affected substance and alcohol abuse treatments. that is how our dollars would be focused. senator, i agree with you that we need more federal funding. not to say that $6 billion is not a lot of money, it is to the taxpayers, but it is a drop in the bucket compared to what we actually need. i mentioned earlier that are small state of maryland has artie spent half $1 billion in state funds. stress across the country is not going to go very far. but we need it from different places and for different reasons. a medically assisted treatment we talked about. long-term, it is not just the immediate crisis but the long-term recovery services we will need a way to pay for.

it might be additional funding and -- in multiple different departments, but not just a health issue, and education issue, or a crime issue. >> i appreciate that. the cost of new hampshire in 2014 economically was $2 billion. 504cost to our country was billion dollars. that is the economic impact of this crisis. $6 billion not going to do the trick. just a quick question. have a practitioner locator on its website in my state and by zip code even. so that may be of assistance. i have a bill, i will provide you to do that would provide grants to medical schools to

around curriculum medical treatment and standardize that curriculum so as people are learning about prescribing opioids, they can also learn about addiction and treating addiction. if we can standardize those particulars and agree on a basic credential, that would allow them to automatically get the kind of waiver they need to become practitioners in this field, wherever they decide to go practice. i am hopeful that will help us with the volume of practitioners. i would agree with that completely. >> i would to. thank you chairman, and thank you for this very important hearing. thank you governors for your sharing here today, but also in participating with the broader group of governors around the country.

senator cassidy raised to the fact that not all treatment is equally affective. and in far too many places and cases, we simply do not have the facilities that are available. it is a sad case unfortunately. while we are getting more treatment beds, our reality is we had eight detox beds in the state. for detox and opioids. we have more beds for alcohol, but our reality is it is pretty dire and desperate for somebody who is addicted and decide that they are ready. that they are ready for treatment. where did i go, and have you get the services? a question for you. in oregon or maryland, in your jails, are there any treatment

programs for addiction within your facilities? >> yes. that is an important part of the program. people entered jail addicted and they would leave jail addicted. we are getting that from a number of different directions. first of all, we had some corruption in our prison system where jail guards were smuggling drugs in and we indicted on hundred people in that scandal. thewe have also increased dollars of funding and number of treatment beds and options for because getting them the help they need makes a big difference. we have a big problem. we have these 8507 beds for judges can send people to a treatment bed rather than jail. these are supposed to be for the nonviolent offenders who really need help. we have our judges now. have judges the hardened, repeat violent criminals to

these 507 beds. people who need the treatment are getting, and people who should be in jail for a long time are getting out and are sentenced in a year or two after they have received the treatment. so we have got to look at it from all directions. >> but it is a program that, from the states perspective, having those individuals who need that treat. you don't need to build a stand-alone facility on the treatment side. you are getting that treatment within the jail itself. >> i can't say that every one of our adults in custody has access to the alcohol and treatment facilities they need. we simply don't have the resources. we have thousands of adults in custody right now, the vast bulk of them are suffering from some type of substance and alcohol

disorder as well as of mental health issue. we are really focused on tackling it on the front and in terms of our law enforcement. a number of our state courts have drug courts which have been effective. recently reduced possession of a controlled substance from a felony to a misdemeanor, because of the significant impacts on african-american and latino men. certainly, we would like to have treatment available to everyone. >> let me ask you, governor hogan, you had spent half $1 billion for treatment, education, prevention, and enforcement. down?u break that i always think that the more we can put in prevention, the less we haven't treatment.

most of the funding goes into treatment. we have also put it into addiction and crime fighting, because you have to do both. situation, i moved to 343 people were shot and thousands were killed by overdose. i passed the biggest criminal justice reform bill in maryland in a generation, which lowers sentences for certain crimes, but also conference sentences for people who commit crimes with a gun or repeat violent offenders. we just had a very successful surge in baltimore where we sent in 500 state and federal officers and arrested 289 of the most violent repeat offenders. all of these things require funding. those of our money goes into treatment, and we are spreading that out.

or how much, it never seems to be enough. >> thank you mr. chair and ranking member murray. governors, it is lovely to have you here. governor brown is from minnesota originally, so it is nice to see you here today. governor brown, you mentioned how this epidemic such as one of us in one way or another other you are rich or poor or live in rural communities or urban community. i certainly know that is true in minnesota, and we can also see in our tribal communities a particular challenge. i know this is true in many of our states. governor, lieutenant i helped to convene a tribal opioids summit so we can benefit from the learning and the

understanding and strengthen the cultural resources of tribal communities. mr. chair, this november the indian affairs committee held a roundtable with witnesses and talking abouts the challenges of coordinating with tribal communities and i would like to ask unanimous consent to submit this transcript for the record. >> so ordered. >> thank you. could you talk about what you are hearing in oregon about this issue? smith --you, governor senator smith. our tries to feel the impacts of historical trauma on a regular and the high rates of substance and alcohol abuse on our reservations. have on some reservations, very high unemployment.

and the substance and alcohol abuse is very, very high. think what is important is to make sure we are not doing a "one-size-fits-all." i have good working relationships with our tribal chairs and with their health policy advisors. we meet annually in a government --,overnment summit comment but we also have meetings on a quarterly basis to make sure we are working hard to collaborate. of the most successful programs has been the native american rehabilitation association. a long time, culturally competent organization designed to meet the needs of our tribal community. they have very good and effective result. i think it is important that we look at it comprehensively and provide services for the families that are struggling. we can't just treat the

underlying substance abuse issue , we have to treat the issues that follow that: the homelessness, lack of employment. we are finding in our communities that a wrap around approach can be extremely effective. >> thank you very much. that sounds like a great model and an important way of thinking about this. timejust the little bit of i have left, i would like to touch also on this connection between substance abuse and behavioral health. and how we need to make that connection more firmly. think it also relates to this tendency we have to sort of move from one crisis while another is developing. you spoke about this governor hogan in your comments. i am wondering if each of you, in just a bit of time i have, could talk about what we can do at the federal level to avoid that and try to have more of a

long-term sustainable strategy that addresses all of these diseases of despair as some of our friends call them. senator, i think we need to focus on mental health and substance abuse is together. in many cases, they are overlapping. those are the two issues. everyone in our risen systems has either mental health or substance of bruce issues -- substance abuse issues. we should not look at them separately. a are different problems, but we need more coordination for both. you, i absolutely agree. i think we need to reduce these stigma related to substance and alcohol abuse treatment and i appreciate senator issa coming forward and sharing his story. think it is important that we

expand access to comprehensive health treatment, and the only way to do that is to make sure everyone has access to health care. 74% of those diagnosed with opioid disorder rely on the oregon health plan for treatment. we could not be providing treatment without the help let. it -- the health plan. i just have to add that we have laws about mental health parity, yet we know we are not living up to the promise of that legislation. >> thank you senator. , let me ask a couple of questions. we often have good ideas presented to us and that we have a spirited discussion, and sometimes differences of opinion about whether the federal government ought to do the good idea or if the state government should.

as a former governor, i have a bias in that respect, what i want to hear your advice for us about some good ideas we have heard and to what extent the federal government should do it or how the states should do it, or together. for example, you mentioned this curriculum. i mentioned i dropped by a reading with tears of institutions that train doctors and were talking about a different curriculum for those medical institutions so that better would have understanding about how to prescribe opioids. should that be done from washington or the states? another example would be prescription drug monitoring centers. 49 states have a prescription drug monitoring system, and we have had a variety of

suggestion. one proposal is a federal monitoring outfits, in addition to the states organizations. another is that we help states do a better job of connecting interoperability. another is to establish federal standards about how the states set up their system. another example is e prescribing. many witnesses have described that is a very good thing to do. seven or eight states have artie taken steps to do that. ,s that something we should do or something that states should continue to explore? finally, limits on prescription. efforts to a lot of avoid overprescribing. about half the states have, in

different ways, limited the doses a doctor may prescribe. it has been suggested we ought to have federal rules. curriculums, e prescribing, limits on opioids, what is your advice on provisions and what ought states to do? well, those are all difficult and important questions. typically, i agree with you. i am a states rights guy and i agree that most of the innovation is happening out at the state. statesthe flexibility of being able to do what they feel is right for their individual state. , i some of these things think the federal government needs to play a role. we are a small border state. -- the the additions

issues we are trying to address don't really help if someone crosses the border into virginia. >> what about prescription drug monitoring? >> it has been working in our state and the region, and i don't know why it would not work if there were at least federal standards. it is worthribing, taking a look at because the states cannot control what is happening across the internet. well, curriculums and limiting the doses. on limiting the doses, i know massachusetts recently just passed a three day limit. i think limiting the doses is important. but many of the states are already taking those actions. >> senator alexander, i don't know if i disagree with anything governor hogan said.

areas where i think the federal government can be most affected. that is we are doing some pooling about reducing drug costs to the extent that the federal government can assist us in making sure that we have generic overdose drugs available and affordable. that would be absolutely key. the other area where i think the federal government could assist is on a comprehensive approach to pain management. the opioidspective, crisis, part of it results in our challenge in this country in dealing with effective pain management. , we have worked happening at our resource -- research institutions. for us to see what is happening would be absolutely key. master -- appointed

someone to head our cannabis commission. we are beginning to take a look at the data and beginning couldch, but i think we sure use the support of the federal government around comprehensive pain management strategies. >> we have encouraged this committee to accelerate research on not the two pain medicine and management strategies. senator murray and i have introduced legislation to allow money to move around to accelerate that. that's very helpful. >> thank you to the witnesses. in virginia, 1400 and 60 people overdosed. 80% was opioid-based. the thing that's really tragic about that is it was a 38%

increase in the od deaths from one year before even though we been paying attention. it wasn't increasing because we weren't paying attention. to the contrary. we had an opioid tax force. we were having endless hearings. books were being written. with all eyes on it, the od deaths still went up by 38% largely because of the potency of fentanyl. this details the magnitude of our challenge. we have a wonderful journalist in virginia, beth macy. beth is a great journalist. she is writing a book about opioids in appalachia. the working title is dope sick. thatoints out something widened my thoughts about the magnitude of the challenge. she was interviewing a teacher who works as a summer counselor.

started, the they campers would come in and somewhat have medications they were supposed to take during the week. it was just a handful. now they talk about the kid to come who are 11 or 12 years old and so many of them are bringing medications. all kinds of medications. this was an observation, not a scientific study. the individual was asking if we have normalizing pills. normalizing at a younger and younger life. pills are what you take. whether it's to summer camp or pills dumped into a hat and passed around at a party. this demonstrates the magnitude and the complexity of what we are dealing with. i want to thank both of you for the work that you've done. sister-in-law live in oregon and both are

involved in substance abuse prevention. they are big fans of yours. you talked about foster care. i want to ask each of you about that. we are seeing a tremendous increase of kids who come into the system. disabled, or in jail, or died because of opioids. can you talk about foster care in your own states? are the things we can do to be helpful? lawyer, i represented children and parents in the foster care system. that substance and alcohol abuse wreaked on our families. we have 60% of our children in foster care having one parent struggling with a substance abuse issue. i mention the foster families that are caring for these children.

a lot of these families are grandparents. i want to say thank you to the grandparents who are doing an extraordinary job taking care of their grandchildren across the country. what we are doing, and i just met on monday at the governor's residence, we called the three branches of government. tohad our branches there tackle the issues that we are facing in our foster care system. because of the growing numbers of children placed in foster care care due to substance abuse issues. i think it's so critical that we work collaboratively. some of our courts have created one family court so that if there is a drug issue, investing domestic violence issue, a juvenile court issue, that one judge is dealing with the whole family. one judge at a time, one family out of time. very successful model and we hope to share it with the rest of the country.

>> governor hogan, how about foster care issues in your. where will, thank you senator and your opening comments about virginia we have been doing. with governoring mccullough we had great ideaance both increase. the frustrating part. had we not taken the steps we taken, how many deaths we would have? ischild welfare and foster really important part of the issue. we are dealings with that are going in fost care now have some relation to the andnts being involved substance abuse of some dined and much of that is opioids and are cases, the grandparents actually taking care of because the par reasons of the kids are addicted and/shoes but in many cases they don't have someone directly family related that could take care of them and they are going to foster home and it is a growing, growing problem addition to that. we're getting big issue on the

our babiesny of being born into the hospitals are addicted, so it starts get to the foster level. >> great wherever thank you. mr. chair, thank you very much. you, senator kaine. senators weuple of would like ask additional questions. senator murray, do you have any other questions? >> i don't. i believe senator hassan wanted to ask another question. else?ne i believe senator baldwin is hoping to return. >> ok. to senator cass think? governors, i have questions from a father whose who died as i read his testimony, it is moving so excuse me as i feel his pain. he surface is his son is 17 year options are limit ap what is available for someone 18-year-olds than

person as his was. >> thank you, senator cassidy in a am terribly sorry for this loss. in oregon, we with r working hard to make sure that our young have access to treatment, i mentioned earlier, focused on behavior health, we, unfortunately, are struggling with some of the barriers through insurance policy and requiring failure best before getting the possible treatment and we want to change that dynamic and the that just passed two weeks ago is going to be taking a look at the insurance barriers throughout. >> let me come back to that. >> ok. is less than 18 years old do they have the same access to treatment as someone believever 11238 eye so. >> governor. >> yes. i done think we discriminate. >> let economy. questionsgest, these are made on suggestion. he suggested one of you thought.

i thought i believe this. 17-year-old could end up being forever from normal society if record.on the have your states decriminalized addiction if you will? >> well, we have not decriminalized drug use but we have lowered penalties and felonies togs from misdemeanors and increased the amount. senator cassidy: if he was a jail?would he end up in governor hogan: each cases separate. cassidy: are

there increased penalties for someone who has died? governor brown: i will get the information to you. in terms of art the criminal is a, it was a lowing a penalty from a penalty to a -- from a felony to a misdemeanor. --ticularly with regard to we want to take a treatment for suppression. cassidy: and a manslaughter charge -- governor hogan: they would get a primary manslaughter charge. we just passed a law in maryland. my daughter is prosecuting eight cases where we are charging them with second-degree depraved heart murder. senator cassidy: you mentioned the obstacles in mental health parity.

do your state group plans offer mental health parity for addiction and mental health services? what are the obstacles? governor brown: we passed mental health parity legislation in the mid-2000's. i worked 10 years to pass that legislation. in terms of coverage, i do not know from specific land to specific land. plan, weegon health have 100% of our children covered, and we treat our substance abuse -- senator cassidy: be private insurance, i am told there can fail or there has to be a preauthorization and other obstacles that seem to -- if note in fact the law. is that impression in your state? if you are using the federal program, i think you're covered

by different individual health plans. senator cassidy: you have suggestions how the law can be changed? governor brown: sorry, governor hogan. we need to provide the most effective assistance immediately, and the legislation that just passed will take a look at this insurance barrier that is present, that my own family had to deal with. senator cassidy: governor hogan? governor hogan: i think it is something that the federal government and you ought to take a look at. you haveassidy: if stress and, we would be interested. senator alexander: thank you. senator hassan? i thank you both for your persistence and stamina. the things that is important as we talk about all the challenges that this

epidemic brings is for us to focus on the fact that recovery is possible. in my state, i have been honored to know people who have suffered from this disorder and gotten better and turned their lives around, and then are in the field working for people every day. i am reminded of a grandmother -- i didn't know it at the time -- it was the annual egg roll the state house a few days before easter a few's go, and a woman came up to me with her baby in her arms. she then pulled me aside, and she said, i am not this child's mother. i am his grandmother. his mother died of an overdose of month ago. that's grandmother was there with her grandbaby to ask me for help on the weekend that we celebrate renewal and resilience as christians.

and i keep her in mind all the time because in fact this is an andess that can be treated people can have productive lives afterwards. and so we had talked about the importance of medication -assisted treatment here. we have talked about the barriers of insurance. and one of the things i would like you both to address is whether there is action we can that generally we regulate insurance, both the state and federal levels. should we be looking at federal regulations make sure insurance coverage gets that best treatment to the person first? and how can we increase our capacity for treatment and recovery services? why don't i start with those two general things -- themes. governor brown: thank you, senator hassan. y think one of the kee

pieces is making our substance and out all treatment programs are effective and folks have access to the best treatment first and the most effective assistance immediately. normally,d welcome -- as a governor i do not welcome federal engagement in this issue, but to the extent of a federal conversation about what comprehensive behavioral health sure weke and making understand everyone needs to have access to it i think are absolutely key. and we know we are seeing challenges in our kindergartens and early pre-k with children that are really struggling, and we need to be able to make sure they have access to therapy, to support, and the wraparound services they need so they can be successful and we do not end up 20 years from now having to

address substance and alcohol abuse treatment issues. governor hogan: senator, thank you for sharing that story. i think every one of us has been touched by personally or have ame kind of conversations with those who have moved us. i have a cut first cousin who went through three years of treatment and became clean and got married and had a kid and was happy and turned his life around, had a good job, and then one time went out and died of a heroin overdose. while it is great to see the people who have gone to treat meant and been successful, and many of them are the best folks -- treatment and been successful, and many of them are the best. who have worked in treatment and counseling centers, but unfortunately the majority of treatment does not work. governor brown: let me interrupt and move on -- senator hassan: let me introductor -- introduced --

israel. a treatment can work, but this is a chronic illness. when a diabetic has an insulin level go wrong, we do not go, gee, no treatment will work for that person. we understand it is a chronic disease, and we are learning about how to treat this disease especially with the onslaught of these competitive -- these powerful drugs like fentanyl. i would ask the record because my times. that's my time is almost up. one of the things we are doing with new hampshire with federal funds is bringing mental health and substance abuse precious into our school systems to deal with the trauma that kids are facing who are coming from sister rations where addiction has really turned their lives upside down and created trauma. i would love to know whether you have similar programs in your state and if and how federal funds could help you do more of that. governor hogan: thank you,

senator. we recently beefed up our program. after the shootings in florida, i put more money into our schools for safety issues, and part of that was geared toward mental health counselors in the school to make sure everything, every school have the capacity so they could catch some of these troubled youth at an earlier stage before we have a tragedy. he willalexander: go first to senator scott and then sen. baldwin: will conclude the harry. senator scott? senator scott: it is good to be here this point. governor hogan, it is good to see you healthy for us. we know that at least in south carolina we have seen about a 9% increase in opioid-related 616 in 2016.

nationwide, that number seems to be heading toward 70,000. the crisis is epidemic, but when you think about the crisis of the opioids and the crisis, we need more time to discuss the crisis around mental health. my understanding is wall folks need some attention on gun violence him and i think we should, we had 33,000 gun-related that's last year. about 20,000-plus of those deaths were suicide. my question is, how are you and your state using telemedicine as a means of addressing some of the shortage that we -- shortages that we are experiencing? south carolina is a rural state. resourcesnding some toward the challenges that we see in some of our areas where it is harder to get health care workers much less total health

care workers. so as opposed to specific programs you have within your states, can you talk about a willingness to use telemedicine and or its application in parts a your state that may have folks thatth -- from could help treat folks who are suffering because it does appear to be a major challenges -- a major challenge that is growing. governor hogan: thank you. i just mentioned a moment ago, we are trying to put more money into metal health counseling. i am much or we are taking usingage of that, but telehealth for mental health issues, but i would love to hear how it is working in south carolina and talk with folks there and get input, because it sounds like, you are right, you cannot have people be everywhere. we would love to take a look at it.

thank you,san: senator scott. i know we are using -- governor brown: thank you, senator scott. i know we are using -- i will ask my experts and get back to you with information on that. i will tell you use suicide is a huge challenge for my state. obviously, drugs contribute to that and guns also contributes to that as well. we were able to pass red flag legislation last year that enables courts take away guns from folks who are a danger to themselves and others, and i was pleased to sign that into law. : i will note that my answer started in conversation with my brother, in thea retired sergeant military, and they were experiencing a suicide today -- a day.

and the importance of focusing our resources for those folks who need the help desperately seems to be an urgent opportunity for us, and i hope as we look for ways to deal with the challenges that we face as a nation, whether it is our military folks were our civilians, the reality is simply do not have enough people who are experts to help other people who are suffering, and if there is a new way to help them through telemedicine, i hope that we have more time and more information on the success of alemedicine, not simply from mental health perspective, but just overall, but uniquely with 20,000-plus suicides, from that perspective, it would be helpful. governor brown: if i make him one of the challenges we face in

rural oregon is a lack of pediatric specialists and children's mental health care. i've believe your suggestion around telehealth, telemedicine can be a useful told. but we -- tool. but we lack specialists in children's metal health care outside of our metropolitan areas, and is is a dire need. our children are desperate. alexander: sen. baldwin: sen. baldwin: -- senator alexander: senator baldwin? i have had the opportunity now for several years to meet with some of the workers on the front line in wisconsin as well as families .mpacted by the opioid epidemic and the lion's share of work is done on the ground. but i recently introduced a bill

-- governor hogan, i understand you referenced it earlier before i arrived -- that would extend funding for the state-targeted response opioid grant that we included in the 21st century cures act. this funding expires at the end of this year. itwe have to act to maintain . my bill would also give states flexibility to use some of the funding for other substance abuse issues such as methamphetamine. ethwisconsin, net abuse -- m abuse has drastically increased by more than 300% parts of our state, while we consider -- continue to see a record number of fentanyl and heroin deaths in other parts of the state, particularly the eastern part of the state, the western part of the state. the division as you travel around and listen to what people

are struggling with. this is further straining our ourl resources and forcing leaders to look for other ways to adapt to this crisis. governor hogan, how would additional funding and that sort of flex ability through the cures opioid grant help you in your fight against ever-evolving epidemic? governor hogan: thank you. it would help tremendously, and i mentioned your legislation earlier. and wes to get passed need to reauthorize the bill. we cannot have it run out in a critical situation. i agree with you on creating or flexibility, for the states to be able to utilize and focus on the problems they are having. you mentioned in your state -- and governor walker brought this up -- it surprised me because we do not have a methamphetamine problem. we have a fentanyl problem. most of the other governors were dealing with heroin, and a couple states mentioned this was

coming back again, making a comeback. i think providing the funding and giving us flexibility at the state level to use it as we see fit in this critical fight, we need the help. thank you. senator baldwin: i understand that senator kaine had some questions about foster care earlier. i want to follow on that. the rise, the dramatic rise in opioid addiction has prolifically did a cycle of trauma -- proliferated a cycle of trauma that has significantly impacted wisconsin children. the number of children in foster care has grown 20% in the last five years due in part to parental substance abuse addiction. last time we convene for a hearing on the opioid epidemic, i shared with the committee a little bit about -- they had heard me for years talk about the fact that i was raised on my grandparents -- by my

grandparents, but revealing the reason was my own mother's struggle with attention due to prescribe narcotics and chronic pain that she suffered with throughout her life. i have a bipartisan station called the family-based care services act, and this focuses on therapeutic foster care. care that providing foster for a child with significant medical or mental health needs. what it would do is help enhance access to services through medicaid. it provides special training to foster parents and kinship families for use with major mental health challenges, where children receive in-home clinical trauma-informed services to help keep them in the community. governor brown, do you note that oregon's foster care system is

similarly struggling with the impact of trauma from addiction, and will you address what your state is doing to address this to strengthen federal programs like medicaid and foster care services to prevent our struggling kids from growing up to be struggling parents? andrnor brown: thank you, thank you for your leadership in this arena. we're struggling. our foster care system -- we times the children in the national average, and 60% of the children in our system among one of their parents is struggling with substance abuse. a good portion of them being opioid abuse. i think more resources is key for us. as you know, intensive comprehensive foster care programs like the one you just mentioned are extremely expensive. but i will tell you that by investing those dollars at the early age, we will prevent

significant expenses to state governments 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 special needs, these trauma impacts they are seeing from their families. so resources be absolutely crucial to a state like oregon. alexander: senator murray, do you have concluding remarks? senator murray: i want to thank the governors for being here today. so thank you. senator lysander: this is a -- alexander: this is our sixth hearing. hope to recommend the senate shortly. we heard senator murray's

comment, and my interest also and the witnesses', and the common made about interdicting fentanyl from china through the u.s. postal service and more authority to seize fentanyl in different ways through the u.s. postal service. there is the stop act that others have introduced. also your comment about public service television. i wish there was a way we could have been tested -- testimony of becky savage, who senator murray mentioned, who said when she should the picture of her two sons who took an occasional overdose, that the children she was talking to listened, and mixing at aat, graduation party at her own home, that when she put their picture up and told their stories, high school students listen. and if we can find some way to

find something that would go viral on internet or be on television, that many young people do not know if they make a pill with a drink -- mix a couple with a drink, they might be dead in the basement the next morning. i heard your comment on makingnal funding, overdose drugs available to everybody, and then treatment. and in the comment on the unevenness of treat programs. as his and area we need to be careful about because we are ofng to have a large number new treatment programs. they are very expensive. and they are very uneven. and it is hard to regulate that from here, but obviously that may he something where the federal government and the states good work and the states could take a lead on. thank you again for coming. the record will remain open for 10 days. never spaceman additional information within that time if they would like. a committee will meet again

thursday, march 15, at 10:00 for the hearing on the 340-b program. thank you for being here. the committee will stand adjourned. governor brown: thank you. [captions copyright national cable satellite corp. 2018] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]

>> we will review the latest job numbers and trade policy with a wake forest numbers economics essar. our guests will discuss the

success of the me too movement. the role and perspective of women in the gun violence space with a huffington post reporter. be sure to watch washington journal every sunday. we have a special series. we will look back to a turbulent time including a vietnam war in a fractious presidential election. >> lets this bill all about? this is called the stop school violence act and it's significant because it something everyone can agree on. makes schools