 Welcome everybody. I want to talk about a very serious problem that Pennsylvania has. It's a drug overdose problem. Actually it's an epidemic. Last year 3,300 Pennsylvanians that we know of died of a drug overdose and that's up from 2,500 that we know of the year before. It's a terrible, terrible problem and it affects people all across the Commonwealth, young and old, rich and poor, Republicans and Democrats. Too many families are affected by it. Too many parents lose their children. Too many children lose their parents and too many Pennsylvanians lose friends, neighbors, loved ones and all of us, all of us lose fellow citizens who could do so many things to make our communities, our lives, our economy stronger. The point is we cannot afford to delay any longer dealing with this epidemic. So what are we doing about it? Well, the budget that was just passed appropriated $15 million to address this issue and we can leverage with that $15 million and additional $5.4 million from the federal government. So that's over $20 million that will be used to create centers of excellence. These 20 centers of excellence that we have established were identified by a group led by Ted Dallas at DHS and Gary Tennis. Over 100 organizations, I think 116 organizations actually applied to serve as centers of excellence and from this group only 20 were chosen. They will work with victims of opioid use disorder to make sure that they get the treatment they need. Now the point of these centers is not that they're going to be giving the treatment but they will help citizens affected by opioid use and addiction, that they will help those citizens navigate the health care system. They will be the first stop for people looking for treatment. Today we're here to talk about another initiative aimed at defeating this disease, prescribing guidelines. The Departments of Health Drug and Alcohol programs have convened a task force to recommend prescribing guidelines. In addition to state agency executives these task forces have included representatives from medical associations, provider advocates, community members and so forth. This task force has come up with guidelines for a number of specialties on the safe and effective use of opioids for the treatment of pain. Recently Dr. Levine presented these guidelines to the State Board of Medicine, the State Board of Pharmacy and along with the State Board of Dentistry these professional groups are putting their own stamp of approval on these guidelines. The goal for all of us is to reduce the pattern of over prescription. I am proud of the work my administration has done to create these guidelines and I look forward to working with our legislature on these issues as we move forward. There is still much to do. By the end of August we will have completed the ABC MAP system that will serve as a central database for opioid prescribers letting them know what has been prescribed to whom and by whom. We have submitted an amendment to a state Senate bill sponsored by Senator Jean Yaw that will require doctors to check the ABC MAP database before they prescribe an opioid based drug to a patient. The state will also work with surrounding states to make sure that this information is as comprehensive from a geographical point of view as can be. We must also work within our prison systems. Our prison system state and county will do a more and they must do a more complete job of getting OUD opioid use disorder suffers leaving the prison system to make them give them a more seamless handoff to the Medicaid program. We call this a warm handoff so that there's no longer that 30 to 60 day waiting period between the time that prisoners leave the prison system and the time they can become once again to get onto the Medicaid system. The point is that we all have a problem here in Pennsylvania. This is exactly what the Commonwealth is trying to do to address this problem and the problem affects people again all across Pennsylvania. We have a bipartisan approach to this. Republicans and Democrats are committed to doing something about this. What we've done so far is just to start. I'm really pleased to turn this now over to Dr. Levine, the physician general of the Commonwealth of Pennsylvania to talk more about prescription guidelines. Dr. Levine, thank you. Good afternoon. I am so pleased to be here today to discuss the opioid prescribing guidelines for the Commonwealth of Pennsylvania. And thank you, Governor will, for your strong and progressive leadership on this important issue. I would also like to thank my colleagues, Secretary Murphy, Secretary Tennis and Secretary Cortez. This crisis involves an interagency effort, interagency collaboration, really an all hands on deck response to address it. The overuse and abuse of prescription opioids and heroin is the most significant public health crisis in the Commonwealth. As the governor had mentioned in 2014, we lost over 2,400 individuals, that's at least seven a day to this crisis. The preliminary data from 2015 indicates that there were over 3,300 overdose deaths and that's a 24% increase. In 2016, in the first quarter, we're on track to increase those numbers still. As a physician general, I've been very pleased to work with all of my colleagues on the comprehensive response that the governor has spearheaded that includes prevention, treatment and support for those in recovery. Now, healthcare providers in 2012 wrote 259 million prescriptions in the United States for opioid pain treatment. That's enough prescriptions for every American adult to have a bottle. The reduction of opioid prescriptions is absolutely essential to curb this crisis. Four out of every five new users of heroin actually has started out using prescription painkillers. Many have been misusing painkillers that were prescribed to them by healthcare providers that they got addicted to, but others use medication that they received from from friends and family that they took from medicine cabinets or that they obtained illegally on the street. In response to this rise of prescription opioids, the departments of health and the Department of Drug and Alcohol programs with Secretary tennis have partnered with medical stakeholders and other stakeholders throughout the state to publish these evidence based specialty specific prescribing guidelines. The guidelines were developed by the safe and effective prescribing practice Task Force, which is an interagency group of physicians, nurses, state agency leadership and community advocates. These guidelines encourage the judicious prescribing of opioid pain medications, and they also call for other clinical interventions prior to the initiation of opioids. Really, opioids should be one of the last treatments for for acute pain or chronic pain as opposed to the first treatment that's prescribed. The Pennsylvania opioid guidelines outline key practices for the care of patients, including guidelines for chronic non cancer pain for the emergency department for geriatric patients, OBGYN patients as well as dental patients and then for dispensers pharmacists guidelines. The most recent guideline that we published yesterday is treatment of substance abuse disorder in pregnant patients. And again, this has been done with stakeholders throughout the state who specialize in that treatment. This new guideline advocates the use of medication assisted treatment during pregnancy. And this has been shown to reduce newborn morbidity and mortality and support and sustain the mother's recovery. We have additional guidelines in development, including for medicines called Benzodiazepines, which are anti anxiety medicines that if used on top of an opioid can lead to overdose. Then we're developing guidelines for orthopedics and sports medicine and guidelines for pediatrics and there are further guidelines in the pipeline. All of this work has been done in partnership with the Pennsylvania Medical Society, the Pennsylvania Dental Society, the Pennsylvania Pharmacists Association and other important stakeholders. And they're all available on the Department of Health website and the Department of Drug and Alcohol Programs website. Now today, the State Board of Medicine affirmed the guidelines for chronic non-cancer pain and for emergency departments. Additionally, the Board of Medicine will hold a special session in August to review the other guidelines, the ones for geriatrics, obstetrics and gynecology and treatment of opioid use disorder in pregnant women. In addition, this morning, the Board of Pharmacy affirmed the pharmacy guidelines. And on Friday, last Friday, the dental board affirmed the dental guidelines. I would like to thank the Department of State and the boards for their leadership and partnership in response to this crisis. Now, there was a recent national study and actually some Pennsylvania data as well that showed that health care providers are just starting to prescribe less opioid pain medication. We are bending the curve, but we can't stop there. We have to continue this process. Now, we have other preventative measures, including continuing education, working with medical school deans and lots of other initiatives. And we will begin to turn the tide of this public health crisis. It is now my pleasure to introduce the Secretary of the Department of Health, Secretary Karen Murphy, who I know is passionate about this issue. Thank you, Dr. Levine. As Dr. Levine shared, and I know you all are aware of the work that is led by the governor and I can assure you that we are all laser focused on this public health crisis. So today, I'd like to briefly share some of the initiatives in addition to what we talked about thus far and what the Department of Health is doing in conjunction with all of the cabinet members because we all have a part to play in the largest public health crisis that we have known. In addition to the guidelines that Dr. Levine has outlined, and I commend her and Secretary Tennis and Secretary Cortez for their work. This is an extremely heavy lift to implement guidelines and to get the buy-in of all the health care professionals. So we certainly applaud their work and appreciate their efforts on this front. In addition to developing the guidelines, we are working with medical school deans to implement changes in their curriculum that educates medical students on opioid prescribing and heroin addiction. This is a critical part of addressing this crisis because we not only have to look at treatment, but we have to look at prevention and we feel that starting with the next generation of physicians that we will begin to prevent the disease from occurring. We also have worked as Dr. Levine said with continuing education efforts for existing providers through all health care professionals actually that have prescribing authority. The department now maintains the Pennsylvania Drug Monitoring Program called ABCMAP. As many of you were at the board meeting this morning, we continue to emphasize that the purpose of ABCMAP and our success measure will be how many people we get into treatment. So the prescription drug monitoring program is not only used to identify those that need help, but more importantly to be sure that they get the help they need as quickly as they possibly can. We have also worked on expanding naloxone to prevent overdose death and with one in four families in the Commonwealth are suffering with this disease of addiction. All of these life saving measures are imperative. We will continue to advocate for those trying to save lives as we know they are not alone. It is with partnerships, clear communications and empathetic understanding that we build a world where drug overdoses become rare and are not the sad part of everyday life. The Department of Health is proud to be a part of this administration's effort to curb the opioid abuse in the Commonwealth and we will continue as I share to be laser focused on our efforts. It is now my pleasure to introduce Secretary Tennis who is also very passionate about this topic and is doing a magnificent job of doing this for the Commonwealth. Thank you. It is a real honor to be here with this team. I want to particularly thank Governor Wolf who has clearly, there can't be any question that this isn't a very, very top priority for this administration. This has been a team effort. This has been something that we've been involved heavily with the Department of Health and with the Physician General. We've had a number of other departments at the table. We've had federal, state, local stakeholders involved in pulling these together. The Department of State has played a critical role as well to pull these prescribing guidelines together. But the team has got to be more than just state government. It has to be more than certain meetings. This is the team really has to be all of Pennsylvania. So I just want to take the opportunity to call on all healthcare providers, anybody involved in prescribing, anybody involved in dispensing to please take the free CMEs that we've put online with the Pennsylvania Medical Society, take them, they're free for one hour continuing medical education credits and one hour of those is how to use these guidelines. It could not be more critical. I want to call on our healthcare systems. We have many great healthcare systems in this state to please take those and incorporate those prescribing guidelines and incorporate the effective use and the regular use of the monitoring program to make sure that the over prescribing stops, that we really, as Dr. Levine said, we really only use this as a last resort. And to our health insurers, they also have a key role not only in identifying those that have really become egregious over prescribers, but also in incentivizing the more responsible pain prescribing or pain treatment practices. We have many ways of treating training. There are electronic pain, electronic stimulation units, physical therapy, sometimes even cognitive behavioral therapy to learn that you can function and be happy with some low degree of pain. There are many other chiropractic, there are many ways to approach pain. Our health insurance compensation system needs to reflect that and really needs to drive our healthcare providers toward using some of these less dangerous mechanisms to alleviate pain and to go to opioids only when appropriate and only for so long as appropriate. As we move forward with this, this is going to have a positive effect. It's going to keep new people, people from becoming newly addicted that are not now as we get that, as we have that happen. But we also know based on the experience of other states that as we get these prescribing controls or in another example, our department has worked with a number of other agencies to do take back programs and to put the take back boxes, we've collected over 100,000 pounds of prescription drugs over the past two years. As we do that, those who are currently addicted to prescription opioids are at risk of switching to heroin, so we need to expand our access to treatment. And again, Governor Wolf has really reversed about 10 years of cuts to treatment through Medicaid expansion, through the Centers of Excellence. And we have in my department 80 applications since January alone, 80 applications for new facilities or expansions of facilities to try to meet these new resources and to meet this terrible demand. We need to make sure that as we get those who are currently addicted to opioids that we don't let them go to the street for heroin, that we wrap our arms around them and get them to treatment. It is absolutely critical. I'm going to close my remarks and I just want to say how proud I am to work with Secretary Pedro Cortez, the Department of State, with their medical boards and in a number of other areas we have collaborations going along with the Department of State. This is a team effort and Secretary Cortez has been a critical member, so it's my honor to introduce Secretary Cortez. Thank you, Gary. And the Department of State is extremely grateful then to be part of this team effort and I want to again commend the leadership of Governor Wolf as well as Physician General Levin, Secretary Murphy, Secretary Tennis for what they have done and they have gone into detail about the efforts that this administration has taken to curb what is clearly the number one public epidemic that we have here in Pennsylvania and tragically in the United States. We find it served in a very tough spot and what is so sad about it is that nobody's immune from the possibilities of getting hooked into a go down a path that may lead to death and that oftentimes as he was stated begins with the prescription of opioids. The Department of State's our role in in this particular initiative is working very closely with our licensing boards. As you may be aware the Pennsylvania Department of State houses 29 licensing boards, 15 of them are health-related boards which include the Board of Medicine, Osteopathic Medicine, the Board of Dental Board as well as the Board of Pharmacy and we're very happy to restate that the boards of medicine, pharmacy, dentistry have adopted for the most part or almost all the prescription guidelines that have been submitted thus far and he was noted that there's other meetings that will come about to complete that work. I have I'm extremely grateful and must point out the leadership and great work of Commissioner Ian Harlow. Commissioner Harlow is the Commissioner of the Bureau of Professional and Occupational Affairs. He sits on the boards that I mentioned and many others and he has been a positive instrument to maintain that dialogue with the health community. Please be mindful that most physicians and pharmacists and dentists and others that are licensed in Pennsylvania are very caring, competent individuals that by and large do a pretty good job at making sure that they protect the health and safety of the public but this guidelines, the prescription, the opioid guidelines are going to take that to a next level because there are still areas in which our medical providers and others could use the benefit of additional information. They are compassionate, they want to help those in pain and that's why those painkillers are often prescribed but they do necessarily don't end up in the right hands or their abuse as you know. So the Department of State is committed through our licensing boards to maintain our strong partnership with the Departments of Drug and Alcohol Programs, Department of Health, Department of Human Services and all others and certainly the stakeholder community, the medical society and others to ensure that the good message is out and I am extremely proud to be part of an administration and a group of individuals that care deeply about something that affects so many of us and by the way this is not an strange comes it when we're talking about opioid and heroin, the death and everything that is so sad related to it. We're talking about our own family members, our neighbors, those we worship with folks that we know and care deeply about and others that we don't know but we similarly need to be engaged in a positive outlook to make sure that we do whatever we can and this administration is doing that, that the Department of State is grateful for the opportunity to do its part.