No epidemic can be stopped by one corner of our country, or one state government, or one part of HHS. This [opioid] crisis demands our common devotion, and an uncommon level of cooperation.
As Prepared for Delivery
Good morning! Thank you Kana [Enomoto] for that kind introduction and for joining us here today.
It is such an honor and a privilege to be here today to address you all and to discuss an issue that is a top priority for President Trump and the Department of Health and Human Services.
What a remarkable gathering this is: the first interagency collaboration of its kind, bringing experts from three key operating divisions of HHS together with state and local leaders and grantees.
This kind of collaboration, and the leadership you all represent, is what is going to help turn the tide against the opioid crisis that now seems all-consuming.
I want to offer special thanks to everyone from the states for coming here to Baltimore for this meeting.
Everyone here is playing a vital role in this fight—from the staff we have here from SAMHSA [Substance Abuse and Mental Health Services Administration], CDC [Centers for Disease Control and Prevention], CMS [Centers for Medicare & Medicaid Services], and the rest of HHS to state Medicaid officials, state mental health officials, and grantees. Allow me to applaud you—give yourselves a round of applause for the vital work you do.
Because it’s so critical to understand what’s going on out in the states, we’ve been traveling across the country to see for ourselves and, most important, to listen. As of last week, we’ve now been to eight states to hear from the folks on the front lines of this epidemic: not just state and local officials, but community leaders and Americans who have been swept up in this epidemic, either because of their own struggle with addiction or that of a family member. So many folks have been moved to join this fight by the devastating experience of losing a son or daughter.
We’ve heard of real tragedy in these places. One first responder in Charleston, West Virginia, recounted to us the countless times he has revived people around the east side of Charleston with naloxone—sometimes only to be called in to revive them again later the same day. As we stood in the vehicle bay of the fire station, a call came over their radio about an unconscious man found under a bridge. The folks we were visiting knew what that probably meant: another overdose. And off they went.
We saw the same caliber of dedication from first responders we visited in Quincy, Illinois, and that same sense of unbreakable community when we visited a gym in Colorado Springs that offers free workouts to anyone who has stayed sober for 48 hours.
So many individuals making a difference in their communities ought to make us all proud and grateful to live in such a compassionate nation.
They’re not giving up on their neighbors—and I know you’re not either.
Our travel has been part of an ongoing commitment HHS made as soon as this administration took office in January, to make the opioid crisis one of our top priorities.
Immediately after we arrived at HHS in February, we designated the opioids crisis one of our top three clinical priorities. Like the other two—serious mental illness and childhood obesity—we knew that as a society we were losing this battle badly.
That’s why we unveiled a new strategy for the crisis in April, at the Rx Summit in Atlanta.
We outlined five key elements to the new strategy:
- Improving access to prevention, treatment and recovery services, including the full range of medication-assisted treatment;
- Targeting availability and distribution of overdose-reversing drugs;
- Strengthening surveillance activities through timely public health data and reporting;
- Supporting cutting-edge research on pain and addiction; and
- Advancing better practices for pain management.
As you all know, at the Rx Summit, we also announced the first round of State Targeted Response grants, from the 21st Century Cures Act: nearly half a billion dollars’ worth of support for prevention, treatment and recovery. Many of you here today are beneficiaries of those grants.
HHS action on this crisis has gone far beyond the scope of 21st Century Cures. There are other grants programs, from SAMHSA and CDC, including two programs for preventing drug overdose and improving public health reporting, that we were able to expand, thanks to increased funding in the government-spending bill President Trump signed in May.
There is the public-private partnership NIH has announced to chart a new course on pain and addiction, and bring new treatments for both to market as fast as we can.
A recent funding opportunity from the Office of Minority Health, Empowering Communities for a Healthier Nation, focused on addressing the opioid crisis—and childhood obesity and serious mental illness—in minority communities.
At FDA, Commissioner Scott Gottlieb has taken rapid action to examine whether our current regulatory approach to opioid pain relievers makes sense, whether we are properly taking into account the costs and benefits, and the real risks, of opioids.
We’ve been supporting the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which released its interim report last week.
But as I said, the real battle to defeat this scourge has to happen not in the halls of HHS headquarters, or the campuses of NIH or SAMHSA—as important as the work there is—but in our streets, churches and homes from Colorado Springs to Quincy, and beyond.
That is why the State Targeted Response grants are organized the way they are: We want to see how states use the grants to address the particular problems they face from opioid addiction and overdose, in the particular ways that work for them. Moreover, we want to learn lessons from this year to inform next year’s round of grants, so we can do the most good with the resources we have. We have been heartened by what we’ve seen so far: states rapidly implementing a wide range of evidence-based prevention, treatment and recovery interventions that make sense for their communities.
But we need to go beyond the scope of the grants programs we have and leverage our existing healthcare programs to tackle this fight. One way to do that is through Medicaid’s Section 1115 waivers for Substance Use Disorder, an option a number of states have already taken.
Four states have already secured Section 1115 waivers for substance abuse: California, Massachusetts, Maryland and Virginia. We believe in the ability of states to come up with ways to address this crisis, but we know the process of receiving a Medicaid waiver can be onerous. That is why we are committed to streamlining the process for these substance abuse waivers, to make it as straightforward as possible for states to stand up their own programs and get federal approval and support.
We urge all of you to think expansively—especially while you are gathered together here over the next couple days—about what we can do to expand access to treatment and recovery services to all the Americans who need it. That is one of the key challenges in this epidemic, and making it happen is going to require a healthy dose of creativity and cooperation. It can take any variety of forms, sometimes at a lower cost than you might expect. At the gym in Colorado Springs last week, it was such a heartening, inspiring experience to meet with folks in recovery who are benefiting from a community-driven, sustainable intervention.
Our Department is in the midst of a process we’re calling ReImagine HHS, an effort to examine, from the bottom up, how we accomplish our mission and how we can be doing it better. It is especially timely when we have this crisis to confront, because we ought to be thinking about how our current structure might be impeding our efforts.
Everyone here already embodies the spirit we want to invigorate at HHS: the spirit of cooperation that can occasionally be hard to come by in sprawling government agencies. You are defying that stereotype and coming together with such wonderful results.
At the Rx Summit in April, I mentioned a Scripture verse that speaks so powerfully to many who struggle with addiction. The Apostle Paul wrote to the Corinthians: “No temptation has overtaken you except what is common to mankind.”
After six months engaged in this fight at HHS, one particular aspect of that line stands out to me even more than it did at first: The key phrase is “common to mankind.”
This epidemic has struck such broad swaths of our country, devastating people from all walks of life—it is a struggle that is now common to us all, that must be borne by us all.
No epidemic can be stopped by one corner of our country, or one state government, or one part of HHS. This crisis demands our common devotion, and an uncommon level of cooperation. That is why it is such an honor to be here today, to recognize the work you do and exhort you to continue your cooperative efforts.
So go forth and do your good work. There is so much that needs to be done – but you are making a difference. Let’s continue working together in common with each other, and we will succeed.
