Clinic. Host why did you write this piece . Guest the Opioid Epidemic is an epidemic. That strikes some people is a little histrionic but i think its fair to say. Atan average, 15 people a 1000 overdose on opioids. It used to be 1. 5. We can go on about statistics but it is clearly a major problem. I wrote about it because we have to think clearly about what to do. I think people with Clinical Experience have a great contribution to make. I wanted to do that. Host you mentioned unconditional ideas for opioid treatment. Tells about some of them. Lets start with the Harm Reduction philosophy. Guest people think there are three axes about drug policy. Supply reduction, demand reduction supplied means less available and demand means getting people to one and less. And Harm Reduction for people you know are going to use. Either they dont want to stop or they cant stop. You want to make it safer for them to do with they do. In this epidemic, this drug crisis, we are really thinking of things that were kind of inconceivable before. From programs where police can tell citizens to bring in their drugs and we will not charge you. We will try to get you in the treatment. All the way to something that is rather radical for the united states, not for british colombia or europe which is called consumption sites. Some call them supervise injection facilities. That is when people bring their own drugs they have obtained illicitly, heroin sentinel fentanyl, which is very powerful. They bring it to a site that is staffed with nurses. They consume the drugs usually by needle. Nurses are there with an antidote call narcan and oxygen if needed. It is on the front lines to save lives. I consider it an emergency kind of intervention. Sites try to get people to pursue a more traditional recovery route but at least they keep people alive. Host in canada, they urge patrons to go in the treatment but they also distribute clean needles to reduce the spread of viruses such as hiv and hepatitis c. One study found opening the site has reduced overdose death in the area. One analysis showed reduced injection of places like public bathrooms were summit can overdose undiscovered and i. Die. What is the biggest pushback in the states to adopting this idea . Guest i believe seattle will have two injection sites by the end of the year. New york city is at least trying to pursue them. There is a bill in california to establish one. Burlington, vermont. Boston, philadelphia. It is declining. It is certainly controversial, but i think sentinel has fentanyl has changed it. Is much more potent than heroine, about 50 times more. Its a synthetic opioid. There are other synthetic opioids. Many come from china and a little from mexico as well. They are so powerful. There is one that is literally 1000 times to 5000 times more potent than heroin. You had no chance with these drugs. Is a Public Health emergency. Host we are inviting you to weigh in. If you have been affected by the Opioid Epidemic, call 202 7488000. If youre a medical professional, call 202 7488001. Everybody else call 202 7488002. Of more unconditional ideas. One is the idea of a drug court. Guest that is not a conventional. The first one was in 1989 in miami. Former attorney general janet reno established it. That was during the crack epidemic. That has since multiplied. Now we have about 3000 in the country and i think we need more. Gets a diversion program. The point is not to arrest people and put them in jail. The point is to arrest them so they can stand still. So many people involved with drugs need structure in a neat supervision and leverage. These drug courts defer people the treatment. They collect urine regularly. If they are negative, there is a consequence. The big reward however is at the end if one completes the program, 1218 months long, and many courts the charges are erased. That is a huge benefit to people who have gone off track but have the potential to Reenter Society and do well. Host you mentioned the swift, certain and fair approach. Guest it is one way to look at it is its drug Court Without the mandated treatment. Whererted in hawaii theres a huge methamphetamine problem. The idea is to use the sanctions and incentives. A person is sometime somehow not in compliance with the program, that is their responsibility. You do what we expect and we will not force you to do any kind of treatment. We will not impose anything on you. If you cant meet those expectations, we will send you to treatment. Swift refers to the consequences are immediate. They are certain. And they are fair. Everyone is treated the same. When you think about that, that is behavior 101. If you want to train someone, change their behavior, shape their behavior, that is how you do it. Through incentives and sanctions. They have to happen quickly, not severely, but they have to happen everyone else. A lot of the majority of people in the Hawaii Program do not even need to get a treatment. The structure was sufficient for them. Guest lets start with a call from North Carolina on the other line. Good morning. Caller can you hear me . Host go ahead. Caller usually i say my comments for something more political. But this sparked my interest. Its a little too late. Ago. Looking back 20 years i think the methadone treatment does work for those that really want to get off. For those that dont, it wont work. I dont understand why 90 have all these programs, but back then you put black folks in jail. I dont get that. He threw a bunch of black people in prison. The same is going on now with white people but they are treated totally differently. They understand the concerns and needs. When i was growing up in baltimore city, he did not care about black people. You just threw them in prison. The solution was prison. That was the solution back then. , but i know the answer think the solution should be a job package. Thats the reason why black folks went to jail and used heroin. They were desperate and there was disparity. Host he raises a point that weve heard before. How we feel about addiction is how we feel about the addicted. Guest he raised four good points. The first was about when this started. If youre living in different areas, it did start in the 1990s. Why it took so long to Pay Attention is an interesting question. My colleague has two theories. Unlike previous drug echo things epidemics, this did not start and a major area where there was media markets so it was hidden for a while. And it is not that associated with violence. A mother passed at a walmart parking lot with kids in the back seat. Its a different epidemic in many ways. It did take a while to come to the national attention. He mentioned methadone. Will it work . It does work and hes right. It works when people are motivated. Then he mentioned the racial it seemshich is undeniable. A combination of society being drug war weary, incarceration fatigue. I do think there was an element to racialization. The emphasis is more on seeing as a Public Health problem. President trump said that many times, rather than a criminal justice problem. Although i mentioned there is a role for criminal justice in the diversion programs. The last point was i cant read my notes. He had a lot of good points to make. Host some a ghostly article you wrote. This is about reducing opioid deaths. Most dont realize they are taking. They are driving the rate of 33,091e a total of deaths. Of philosophy known as Harm Reduction, the goal of reducing opioid related deaths and disease. But good to krista from cocoa, florida. She is affected by all of this. Caller in many ways. I would first like to mention that i have been prescribed opioids by a doctor. I would like to preface that. I am a drug in a call abuse prevention specialist and alcohol abuse prevention specialist, for i was. I dont think this started in the 1990s. In the 1980s we were already going to the homes of fiveyearolds and teaching them how to set alarm clocks and how to get themselves to school because of the crack going on. It was not considered a radical position to advocate for 24 hour day schools where i lived in the lehigh valley. When i became ill with severe migraines and chronic time they really liked to give up the pills. Get out the pills. I could not believe some of the things my girlfriends were on. My doctor was judicious. He would take me off opioids every so often, but he said youre not getting rebound. You need this. I didnt it addicted to it because even now i went off it because i dont want to be on it. And i just went off it. Into the five days. It was not it took me five days. It was not bad. I knowe people that are prescribed that. The one lady was taking it with morphine. She was a nurse. What is the treatment plan here . I think might personal experience is if you want to become addicted, dont do it. Especially down here. Of north you have to take breaks. It down here they will give you but down here they will give you any kind of opium pill to take three times a day. That is just too much. You should be able to go on and off it when you really need it. If youre having a surgery or something. Then try take down. That was my experience. Guest the color mentioned she took opioids for quite a while but did not become addicted. The truth is that is the most typical experience. Most people who received opioids, especially for shortterm problems, do not become addicted. If a person really needs them and they are managing them well, it would be irresponsible to take them off in my opinion. However it is also true that physicians have been too liberal and their prescribing, especially for chronic pain. There may be other kinds of therapies and medications that would be effective. Insurance should be more generous and covering those and doctors are becoming more aware of that. Who is at risks for misusing these drugs. When you look at the history, most people who do get in some trouble with them the average person is not a patient, and thats a really a problem with totors being promiscuous with prescribing. Unless the patient has a previous history of drug or alcohol problems or mental illness. Is the fact they give you a months worth. You put it in the medicine chest and someone comes along and takes it. That is how these drugs these medications get into circulation. Percocet, oxycontin. Things like that. Host john is a medical professional. Good morning. Caller yes, im 70 years old. Im a respiratory therapist in the emergency room dealing with overdoses for 40 years. Withther worked in chicago jim jones. Not the jim jones in california. They called him the program priest. The hoodlum ive been following draws on my life. I think the consumption concept is very good, but using narcan. If an individual was to graduate intentionally or unintentionally, i say allow them to graduate. I think its more humane than going to the battle. The primary problem i find his money. It is a business. An individual it, has to, if you want to say, put bread on the table. There areey do no jobs. It sounds rather ridiculous but it is true. It is just like any other business. Mattel toys or whatever. I think we have to hit the source from that aspect of it. When it comes to shaping behavior, shaping behavior is very good for the individuals that want to do it. If not, allow the individual to graduate on their own. Thats about all i have to say. Thank you. Guest i think you make a good point about what you might call the upstream causes of addiction. You mentioned jobs. By thent report princeton economists, they call these deaths of despair. They are now causing an increase in mortality in middleaged white people, which is the first time in history that mortality rates and whites are actually going down i should say up, excuse me. Middleaged whites have a higher mortality rate now than they ever had. Higher the minorities. These are white folks who dont have good educations so they dont have good job prospects. They are in communities where they are manufacturing jobs and mining had gone away. Have gone away. Its a desolate situation. They are literally hemorrhaging hopes and jobs. Use is very high and overdoses from opioids is very high. That is very much an environmental or social cause. It gets filtered through one psychology. Individuals feel despair and communities feel despair. But people appear to have everything the world and yet they have their own psychological pain. Quiteo find opioids soothing and compelling. They are very in double about giving up very ambivalent about giving them up. Host lets listen to new jersey governor chris christie, taps toledo White House Commission on drug addiction. [video clip] the president and i both agree that addiction is a disease. Its a disease that can be treated. When you make sure we let people know. The president talks about how folks dont talk about it. We talk about cancer and Heart Disease and diabetes. People are afraid and shamed to talk about drug addiction. Probably dont talk about it we lose lives. Addiction. And why they dont talk about it we lose lives lives of good people. The president ended by talking about prolife. The president and i are prolife. We are prolife for the whole life, not just the nine months in the room, but the whole life. Gift life is an individual from god, and no life is irredeemable. People make mistakes we all have. Mistake. A we cannot throw their life away. Host what is something the administration has signaled about how they might handle the Public Health search for this or how the Justice Department might handle drug crime . Guest President Trump has said all the right things, thanks ple i like to hear which is the emphasis on the Public Health dimension, the emphasis on treatment. It mirrors what governor christie just said. On the other hand, folks are heartened by that, but they are worried at the same time that the republican repeal of obamacare goes through, that will fall very hard on people who rely on medicaid for their Substance Abuse problems, and they are also concerned about attorney general sessions, not so much in terms of dealing harshly with people who are trafficking i do not think there is any debate about that but will they put an effort on incarceration for people who commit minor drug crimes . So kind of mixed messages. Host lets go back to the phones. Ann is calling in from louisville, kentucky. She has been affected by the opioid crisis. How so, ann . Caller first of all, i want to disagree with two things governor christie said. He used the word disease. I do not agree it is a disease. He also use the word mistake, that,do not agree with either for your i think using those words takes response ability off of the individual as far as their own personal circumstances. Those words are important the disease, that is connotation that they cannot help it. That isall in mistakes, a connotation that they did not mean to use the drug. I prefer the word choice they chose to use it. My nephew is in prison right now because of using heroin, also selling heroin, and the way this all started was he was in the air force he was not even in there for 15 months before he was declared disabled. He was diagnosed with schizophrenia. , ands honorably discharged he was given a check for over 2500 every month. This money was from the air force, he was considered a veteran, even though he never saw combat, and he was also declared disabled. He was using this money every month he did not get a job when he got out he was using this money to go out into buy heroin for he and his girlfriend. My sister called in, she called the v. A. , she tried every way to get them to test him to see that they were on drugs and to stop them from getting this money, so what i would like to see happen, i would like to see anyone who is getting a government check in any form or government assistance to be drug tested areuse if these people using drugs, then there is no way that they are going to be able to go out and get a job because most places now drug test. So if they cant get a job and they are sitting around and getting money from the government and they are using this money to buy drugs and im not saying that all people who are getting money from the government are doing this but if people have to take a drug test in order to did a job, why should they not have to take a drug test in order to get money from the government . Guest i think the caller makes a lot of very considered points. One of my very first papers when i was an assistant professor at yale before i came here was actually on veteran to use their checks and disability recipients who use their checks to buy drugs, and what can we do to basically use the money, if they are disabled and they do need that money, that is fine, but how can we distribute that those benefits to them in a way that helps them rather than reinforces the drug use . ,o we came up with some ideas and actually Social Security does this, it is called representative payees, where the check goes to somebody else. That actually is a problem. It you do not want to deprive people of support if they needed, but you want to make sure they are not using it to make themselves worse. Another point she makes, which is a good one, which is the word disease, and i do think it is problematic. This puts me probably at odds with others in my field. What i am referring to is the fact that when most people hear the word disease, they think something is involuntary, that a person has absolutely no choice at all. And while it is certainly true that no one wants to as they say, no one wants to become an addict, i agree with that, but that is what they want. They want to feel better in the short term. A craving foreel drugs, and that is a very real biologicallye driven, if you will, but that craving pushes them. But it does not commandeer them. They also want to feel better in the short term, and when you read addiction memoirs, when you talk to individuals with this problem, you can understand why they want to feel better in the short term. From next we have a call denton, texas, jim, calling in only all others line. Good morning, jim. Caller actually, i was involved in the development of the transdermal delivery system, the fentanyl product that was working with the transdermal delivery system. What i want to say is these Overdose Deaths are directly a product of governments ervention in patients particularly chronic pain patients. These people have found their costs go from 700,000 a year to treat their law chronic pain, probably spinal, back pain, and notice tends to tens of thousands of dollars a year. Especially those without good insurance, the they no longer have access to a health care system, so they go out side into the illicit market. And sentinelnyl, ntanyl analogues, deathstrack the overdose of these drugs, you will see a direct correlation, a cause and effect, of government then thesen and drugs coming into the illicit market and people, whether they are self treating actual pain that they used to be able to afford to have treated by Trained Medical professionals, and they can no longer afford it. Is all selfinflicted, driven by our change in policy, because politicians would rather go after these simple things than address more serious concerns. That is where i wanted to say. Thank you. Guest you do bring up an interesting paradox, which is that the more doctors become alert to generous prescribing, the more we enforce Prescription Monitoring Program so doctors can see who has gotten prescriptions, if they have gotten them from several places, if they are dr. Shopping , these kinds of things the state of new jersey is considering passing a law that would determine how big of a prescription a doctor can give in an initia visit. I think there should be surveillance, however, there are legitimate pain patients who do need these medications and take them responsibly, and they are very nervous that something is going to happen to make it more difficult for them to get their medication, and already we are seeing examples of adware thatcians who of where physicians who have treated a patient for years, now the physicians are pulling back. Now is that the average patient going to a drug dealer for heroin . There is a high bar for that. But then you have somebody in more pain, and that is a bad outcome as well. Host the last call for this segment comes from david. He is in missouri and has been affected by all of this. House so, david . Caller hello. A youngeri was man, i was into major accidents together. Crushed him and then eight month later, i had my hammer, and ith a lost my left doctors. Ive been on opiates. On 300 milligrams at least of oxycontin a day. If scared right now because this happened to be taken away from me, there is only one alternative to that, and that because i am in very serious pain constantly. That is my concern. I have never used street drugs in my life. I never even knew of a pain pill before i got hurt. This started coming up, it is really scary because if i lose my doctor, which he is an elderly doctor, i dont know what my options would be except death. Guest wow. What we haveechoes been talking about, that there is fear among people who take these medications legitimately. That is one of many lessons of what is going on now is that the pendulum should not swing too far to the other side. Arguably in the early 1990s, doctors were becoming more aware of treating nonmalignant pain, that is noncancer pain. I think there was something to that. There is a movement to be more attentive to patients with different kind of pain. That ended up contribute into the problem that we have now, and i worry that we might go too far in the other direction and end up compromising people who really do need this medication. A resident satel is scholar at the american institute. Thank you for being here today. Guest thank you. Host up next is open phones. We want to hear your views this morning, your take of the week in politics. Ets see here republicans, call 202 7488001. Democrats, call 202 7488000. And independents, 202 7488002. As always, you can reach us on twitter cspanwj, and on facebook, facebook. Com cspan. Give us a call. This weekend, cspan cities tour along with our Comcast Cable partners will explore the literacy and history of charlottesville, virginia. Today at noon eastern on booktv, we visit the university of virginia to see their exhibit on william faulkner, novell rise winner and uvas first writer and resident. We have a lot of wonderful artifacts, of course, from time at uva. We have the typewriter he was issued by the university, even with the University Property staff on the back. E have a jacket that he wore as you can see, when you look at the jacket, it is pretty torn up and ratty. He likes to keep his clothes for a long time. He left this jacket hanging in his office when he went on his last trip to oxford, mississippi when he passed away. 2 00 p. M. Eastern on American History tv, we will travel to Thomas Jeffersons monticello. If you have visited monticello, say, 20 years ago, you would have just seen jeffersons beautiful new classical villa, but what we wanted to do to change that, we remnants restore the of slavery, because if you come up this mountaintop and jeffersons time, the first thing you wouldve seen most likely would have been his slave people. No placeld have been on this mountaintop that slavery was not visible, and we wanted to restore that, make that known to visitors who come here today. We will also visit the Miller Center at the university of virginia to learn about their first year project, which explores challenges u. S. President s face in their first year on the job. Lyndon johnson said when he became president , no matter how big your majority, you get one year before they, the congress, stop thinking about you, the president , and starts thinking about themselves, their own reelection. And in about january of your second year, after you have done your second year, all of the members of congress of thinking about numbers of midterm election, and they are really cautious about taking any risks to help you get your mandate in your agenda through. Tourtch cspan cities and sunday afternoon at 2 00 p. M. On American History tv on cspan3, working with our cable affiliates and visiting cities across the country. Washington journal continues. Host welcome back. We are taking your calls during the segment. Im going to go to the phone lines will more time because we get the numbers sorted out. Republicans, call 202 7488001. Democrats chemical 202 7488000 democrats, call 202 7488000. Independents, call 202 7488002. Earlier this morning, we were talking that the rising tensions between u. S. And north korea, but there is another story that broke yesterday, also on the front page of the new york times. Headline white house Wont Disclose list of visitors. It is written by julie hirschfeld