director of the honest elections project, jason snead, talks about securityelection laws. c-span's "washington journal," join the conversation live at 720 start wednesday morning on c-span, c-span now, our free mobile app, or online at c-span.org. >> if you haven't missed any of c-span's coverage you can find it anytime online at c-span.org. videos of debates and other events feature markers that guide you to interesting and newsworthy highlights. these points of interest markers appear onsb the right-hand side of your screen when you hit play on videos. this makes it easy to quickly get an idea of what was debated and decided in washington. scroll through and spend a few minutes on c-span's point of interest. joining us from new york, correspondent here to talk about his new series, the war on recoverystatnews.com.

guest: thank you for having me, to c-span. host: thank you very much. how do you describe stat to people and how you are supported? caller: guest: -- guest: we are a health news website under the boston globe umbrella, but if folks are interested in premium health content, we are do a lot of general news coverage for much broader audiences as well. host: you write a lot about addiction in the unith a look at recovery. the war on recovery is how you title it. how did you get interested in this topic? guest: i wanted to drill down on what's going on in the united states. we are obviously not handling our drug crisis well.

10,000 people dying each year of drug overdoses. 80,000 are drug -- opioid overdoses. the premise of the series is that essentially we have two really effective medications know overdose by about half. instead of doing everything we can to get these medications into the hands of the people that need them, in many cases we do the opposite, we make it difficult to access and place a lot of restrictions on use. people may know it by the brand name suboxone. that's the premise of the series. at many different levels we are restricting access to medications known to prevent overdose death and, of course, with over 80,000 people dying of overdose, it's something that needs to happen urgently. host: let's start with the drugs themselves. how do they work? guest: they

are weak opioids. gum for someone trying to not smoke cigarettes. essentially, if you try to stop using illicit opioids like heroin, fentanyl, or even a prescription painkiller, if you just stop cold turkey you will experience agonizing debilitating withdrawal symptoms. so severe that almost no one successfully does it. was already true in the age of heroin. now that the drugs on the street are almost entirely this ultra potent fentanyl, it's doubly true. it's all but impossible to just quit cold turkey. the medications essentially come in and bind of the receptors in your brain, the same as heroin fentanyl. but they don't get people high if administered properly. for someone with addiction tryingo stop using illicit substances, the idea is that the medication leaves them clearheaded, free of withdrawal symptolife as family members

students employees, anything else. host: you said if they are administered properly. typically, how are they administered? guest: methadone is very effectiveaddiction. it's only available at a special methadone clinic. in many cases they require patients to come in every day to get a single dose. you are essentially structuring her life around the ability to be at these clinics and in recent years more have grown lenient with take-home towing -- doses. giving you three days, week, two weeks to take-home, keeping your fridge in little liquid bottles. but for the most part, people that go to methadone clinics have with logistics in a way that a lot of public health experts believe is harmful to their recovery. because obviously you want to be able to have a source of income stable living situation, stable family situation.

any of us who wake work every morning can only imagine how difficult it would be if we added the requirement of going to a medical clinic every day at 6 a.m., 7:00> a.m.. that's methadone. bucher nor frame is much simpler. you can essentially get it prescribed by most doctors and you can get it from a doctor. our guest is with us here through -- if you want to give them a cal eastern and central time zones, (202) 748-8001 for mountain and pacific. if you are a caregiver or medical professional, give us a call at (202) 748-8002, and you cat (202) 748-8003. the first part of the war on recovery is found online and you said it is conscious choices that are being made to keep these drugs from people. can you elaborate?

guest: there are many different levels of american society that in some ways work harder to deny the medications to people that need them than to provide access to them. a few examples. until recently doctors required a special license to prescribe it. even though any doctor who is a licensed p could of course provide patients highly addictive painkillers like oxycontin or any other opioid painkillers. even though there was a much safer, weaker medication used to treat addiction, those painkillers can cause the addiction themselves, so doctors had to jump through hoops to get a special license just to prescribed the medication treatment. . i already mentioned the prescriptions around methadone clinics and how difficult it can be to receive care and nuanced example is that of narcotics anonymous, the 12 step program modeled largely after alcoholics

anonymous. i don't want to paint with too broad of a brush, there has been an evolution, different chapters are different the next, but in many cases these meetings, the organizational literature at a national medications, even though they are essentially the best tool that we have to help people stop using illicit opioids em from dying of opioid overdoses. there is a view that people that use the medications are not clean, fully abstinent or in true recovery, but addiction doctors and many who use the recovery would essentially tell you that they have given them their life back and they are happy and thriving thanks to these medications. stigma to this day that people that take the medications face. host: the groupicco but it raises the s to encourage the addicts still using to listen and speak

with members after the meetings or is not meant to alienate or embarrass, but to preserve atmospheres of recovery. there is more on thet i saw that one part and you did say it was a nuanced approach. can you elaborate in light of that? guest: i didn't want to cast every meeting in the same light, many are increasingly supportive of this approach, known as medicated assisted treatment. but in the language you just cited, i heard the phrase still using, i believe. i think th the phenomenon we are discussing because of course there is a huge difference between, you know, smoking fentanyl you buy on the street or injecting it. and, you know, waking up in the morning and taking, you know, a pill or a sublingual film that is approved by the fda and manufactured under tight regulations by a pharmaceutical co know exactly what's in it.

those things are clearly just not the same and one is, d one is likely to help enable your recovery and enable you to go about life as anybody else can. that's not just narcotics anonymous. it's more broadly true. people view these medications as just another form of addiction sometimes. tom price, president donald trump's first health secretary infamously kind of refe as substituting one opioid for another, which in a technical and medical sense is true, but at the same time, again, taking an fda of fda medication safer and allows you to live a happier, healthier life than, you know, using fentanyl several times a attitude that remains pervasive throughout american society. host: lev facher, who reports on

addiction in the united states for stat news, you can find it online. (202) 748-8000he eastern and central time zones, (202) 748-8001 mountain and pacific. for those of you with a special interest on the topic, (202) 748-8002. paul, you are on with our guest go ahead. caller: thank you for take my call. i had a couple of questions. i currently take opioids and i have for quite a few years. i've got five major third test had five major surgeries arthritis. you have kindquestion. is there a government formula that says x amount of milligrams is safe for a person that currently takes opioids? guest: yeah, i figured we would get some calls from patients

with pain, it's a huge subplot in my opinion. for those who may not know, you know, inp the mid to thousands and, you know, about a decade ago, there was of course a huge prescription opioid oversupply problem large part by companies like purdue pharma and the medication oxycontin. of course, the government restrict opioid prescribing and really encourage a change in the medical culture to prescribe fewer good. i remember how many vicodin i got when i got my wisdom teeth out, it was probably 20 but there are also a lot of pain patients who have been taking oil -- opioids for years and haven't overdosed or had adverse effects and suddenly those folks have found access to their medication restricted by doctors who are worried about crackdowns from the drug enforcement administration or patients

overdosing. taking prescription opioids who lost access to those medications and because they had become physiologically depended on them had wound up using heroin, now fentanyl. there is a convincing argument that severe restrictions in the wake of theer drugs crisis, it surely exacerbated the overdosed problem. but yes, there are prescribing guidelines from the centers for disease control that specified amount they believe is safe but they stress that it is not one-size-fits-all and that doctors and clinicians should use discretion. and i'm not a medical professional, so i don't want to quote amount of opioids, but there is government guidance on that, yes. host: john is in tennessee. go good morning thank you. according to what i see on cnbc there is a pharmaceutical company called vertex that is working on a non-opioid

painkiller and has shown partial results. evidently, it is not addictive that it is an effective painkiller. i'm curious about it. it sounds -- promising and i was wondering if you know anything about it. guest: there has been a big effort to develop non-opioid painkillers. i will admit, i don't know the specifics of this particular drug candidate. i will say that we are essentially talking about two separate issues. one, how do we treat pain, how do we treat it in ways that are not going to give people access to huge quantities of potentially addictive medications? of course, there is this welcome effort to develop non-opioid painkillers to avoid another oxycontin situation in the future. however, there already is a huge population of people taking

either prescription opioids for pain or illicit opioids because they have grown dependent or addicted to those drugs. so, there is the pain question butler is also the russian of what we do with the huge need opioids day to day or are addicted to illicit substances and, the latter category, if people want to stop using, their best bets are these two medications, methadone and buprenorphine. b has there been an official position taken on these drugs? guest: the director of the nora -- national institute of drug abuse is a huge opponent of their use. -- proponent of their use. buprenorphine, 40% less likely to die, 59 percent less likely if you're taking methadone. the agency position is that

these are effective medications. when i spoke to the agency director for the first piece series war on recovery, she told me that she believes if we made access universal essentially if we provided it to everyone in the country who needed it, we would see opioid overdose deaths fall by 50% and she stressed that was a conservative estimate, saying essentially that if we universal access, 40,000 fewer people, at least, would die every single year of opioid overdose in this country. host: there was an announcement earlier this year that hhs expanded some of that access to methadone through telehealth means. can you elaborate on if hhs has taken a position on granting more access? host: -- guest: hhs has gone back and forth on access to

buprenorphine through telehealth. they in the drug enforcement administrationand the drug enforcement administration don't always see eye to eye, another thing we will cover in the role of law enforcement, jails, prisons, the court systems, and restricting access, but there has been a debate over how doctors should be able to prescribe buprenorphine by telehealth. as of now you can get a prescription without ever visiting a doctor in person. you can see them over video chat and they could write you a prescription and they could pick it upthere is no access to methadone by telehealth. for the most part people need to go to the clinics in person just to get a single dose. certainly, there have been efforts by the biden administration to expand access to the medications. early in his presidency, the white house set one goal was

that by the end of his first term would be to make access for methadone and buprenorphine. here we are in 2 it's obviously not going to happen, but yes, hhs and the bite administration have taken steps to increase access. public health experts tell you that for the most part they have not fast enough. host: this is lev facher joining us from statin news, looking at opioid addiction and recovery. kevin, your next, michigan. caller: thanks for taking my call. i'm a guy with permanent nerve damage done by a doctor. the war on opioids is re b because it doesn't take into of account a guy who -- people who rely on opioids. i had a buddy who lost a leg. a year ago they cut off his

opioids. he had a quality of life, taking one opas now passed. when you have a war on opioids and all doctors are scared to give them out, you know, it leaves us people in pain, which we shouldn't have to do and we should have to fight. whenever there is a hearing on opioid have never seen anybody there who is a pain, has to deal with the pain, because they have taken their opioids away. there has got to be a middle there. 2% of people who are chronic opioid users od and some of them are probably just sick of being in pain. nerve damage never 24/7 you are hurting ok? but can you get a doctor to help you out? no, they are scared of the government. that's not good. i would like to hear your response. thank you very much. host: thank you, kevin. guest: we just mentioned this,

there's a huge population of chronic pain patients in this country who rely on opioids to treat theirn. in some cases they are also physiologically dependent on those opioids in a way that hasn't crossed the threshold into addiction. these are different concepts. there is the physiological dependence and then there is addiction, a psychiatric diagnosis about yourance use. yes, there are tons of people in this country who regularly take prescription opioids who are not addicted in a medical and psychiatric sense to opioids. it is a huge problem that people are increasingly being cut off from pain medications they have relied on for years. there is anecdotal evidence, yes, that it has led to increase in. certainly, there is thought that restricting pain medication for people who have used it for a overdose. when people regularly use opioid painkillers and are suddenly cut

off,y is usually not a practical ask to make of someone. a lot of people end up using heroin instead. now that the drugies fentanyl, they use fentanyl. as you can imagine you are way more likely to od on fentanyl then a prescridioncatiabsolutely, that is a huge issue and i agree, probably one that esn't get enough attention from policymakers. host: las vegas, go ahead. caller: my question goes to an article that you posted recently about private sectors overtaking methadone clinics. i was just wondering if the people manufacturing it are actually infected and those -- invested in those private sectors, in overtaking the methadone clinics. caller: he's referring to an art he's referring to an article i published this morning

about the increase of private equity in methadone spaces. one third of them are owned by private equity firms, two thirds are run as for-profits. that is a big shift from a couple of decades ago when the majority of clinics were run by government agencies or local nonprofits. as far as i am awaree medication, is not a huge moneymaker because it is a very common, generic medication. there is noparticularly specialized about manufacturing or selling methadone. i think the bigger financial implications are in the way that the clinics operate and the fact that they build to dispense the medication and hire patients to participate ining, drug testing, and sometimes other services as well. they bill for those. it has turned into quite a large for-prit industry. in that story we reported that acadia health care, only about 17% of their revenue is from.c

methadone clinics. they call it a comprehensive treatment center. i believe that even that 17% accounted for half of a year. yes, in some senses methadone clinics have become big busine them getting reimbursement for the services they provide as opposed to a huge profit margin on the physical medication itself. host: that was part three introduced today. in part two you introduce us to rebecca smith, who goes to her clinic every morning to get her treatment. you also describe why she has to go physicaate? guest: right. we were in detroit, michigan, and as you say we spent time with asmith, who really was the model of what you would want recovery from opioid addiction to look like. she had beenovery for five or six years. she was active in her church.

had great relationships with her kids and, working a steady job. she credits this with helping her put heroin. she had been going into the clinic. she met every week and met weekly with counselors, picking up medications to take home. she deliver life. she attended she had a small amount of white wine as a part of a toast they were making. she mentioned it to her counselor. a small amount of alcohol showed up on her drug screen. i shouldsomeone who has ever had a problem with alcohol. the clinic has never been worried about her alcohol use. but the clinic this stripped her the take-home

privileges, which they call them , making her come in every single morning. en s had to come in every single morning, this woman doesn't own a car, has had a knee replacement, needs another she was not able to show up at the clinic every morning and then also make it to her day job and she essentially told the clinic that if you need me here every rning, i have to quit my job. they were not swayed. filet, she has a great support system and she made it through. you know, she's doing well even today. but i do think her story is illustrative of a very restrictive and punitive culture at methadone clinics that makes people who use drugs afraid to even seek care or once they are enrolled in treatment it can pose obstacles to them saying in stable recovery. host: that is part two of the series. you can find it at statnews.com.

pennsylvania, you are next up. hello. caller: unfortunately, i have had a ton of experience with these problems of addiction. ñé13 people that i know personally have done this. my stepdaughter used methadone, which was a disaster for her because like you said, in your last story, running back and worth, determining how much you take, and if you're good about it you can do what you want and take it ho.me suboxone is the same thing. addicts have a problem with the on-off switch in their brai want more of it. my experience shows that when addicts go to a recovery a recovery center, get through the detox part, the most difficult and dangerous part for them, when they go toy get a sponsor they work the program with a family of people doing the exact same thing that is t

giving them more drugs is not the solution to the problem. it might stop them temporarily and they do abuse those substances. i have seen thousands of addicts in recovery and not a single one of them said they did it with methadone or suboxone. i know it is a treatment plan, like you suggested, for some people, but it is not a panacea. it's basically replacing one drug use for another drug use and if you really want to solve the problem the 12 steps changing mind, body, and soul, because they cannot deal with life on lrms, once they learn how to do that, that's how they get clean. everyone in my life who used drugs an program. i wish they would do that more instead of people into more drug use. host: we will let our guest respond to that. guest: i am happy that your kids

are doing better. there are different approaches that work for different people. certainly, there are a lot of people happy and in stable recovery thanks to narcotics anonymous. i would doubt a couple of things . the drug supply being what it is today, fentanyl being so prevalent, asking people who want to stop using to just detox and go through a week or more of total agony as the -- they experience this, it is not always a practical yes, people have achieved really successful happy lives in recovery thanks to 12 step pam and thanks to other abstinence-based approaches, that's certainly true. i want to stress that a prett shows that abstinence based opioid treatments, essentially cold turkey detox, 12-step, and cetera, is a lot less effective than medication treatments. simply put, people who take methadone more buprenorphine are

far less likely to die. of course, in a drug crisis like this country has, not dying is i think, the most rtdown the road people can choose whether they want to remain on the medications. doctors have mixed views about tapering folks off, if it's safe or if there is a reason to. yeah, i want to stress that. studies show that people who take the medications are far less likely to die than people who receive abstinence-based treatment. host: what's the costs of the treatment? guest: it really varies. one big issue is that historically insurance coverage for these medications has not been good. as well as the fact that as you can imagine, people with particularly severe addiction many people who are experiencing homelessness, are not actively enrolled in insurance, don't have good idrds.

pain is an issue. it varies so much from place to place, from medication to medication, one provider to the next, but some people pay very little for these medications and there are people who pay thousands and thousands of dollars year just to stay enrolled at the methadone clinic. host: new jersey, good morning. caller: thank you for doing this topic, today, i really appreciate it. i never was an opioid addict. i used because of the spine injury at a neurological disease. back in january, the fda announced that buprenorphine was causing people to lose their teeth. this was on the heels of that other lawsuit where they were lying to people about the pills nond trying to force them to take the film. i'm starting to wonder, because of what's happening with people losing their teeth is that why doctors are not prescribing buprenorphine instead of the other opioid pain medicines?

guest: i'm not aware of active change in prescriber behavior. it's true that one side effect of some forms of buprenorphine are dental decay. that is certainly something to of. while we are on the topic methadone is also a serious medication with potential side effects. first of does cause overdose. in much smaller numbers than fentanyl or a more powerful, licit opioid. but methadone can also cause heavy sweating, weight sexual dysfunction. these medications are, like a previous caller said, not a panacea. they are medications like any other with because it is, gatives, side effects and benefits. the bottom line is that people who take them are less likely to die, but there are side effectsnue their use. it's a good question about prescriber behavior in the wake of that warning aboutl issues and something i will be

tracking moving forward. host: you used of the term filmic. to get the medications, then? guest: it's like a sublingual film, almost like a listerine strip that you can put under your tongue and it dissolves and that is how you ingest it. it's not a liquid or a pill. it's a little film that you put on or under your tongue and that is how you take your medication every day. host: ron is in tennessee. thanks for calling. caller: thank you for calling -- taking my call. i have experience with don't oppress the mental obsession. actual drug addicts live with this mental obsession until they can get a psychic change. you are not addressing that. you are just putting a band-aid on something that is always going to be there until they go

through this change. i don't see taking drugs it doesn't make sense to me. i mean, there's always, there's different ways people do it, but if you don't go through that psychic change, the mental obsession will always be there. i've seen people be sober for years and go ba back after -- i went back after 16 years, now i'm coming up on 10 again. it's jugot. thanks for taking my call. guest: sure. i don't want to invalidate anyone's lived experience with addiction. i don't have lived experience with addiction. i know what the research says. i know what leading medical ouient groups say about the use of these medications. i don't there are too many people arguing, though, that people should use these medications in do absolutely nothing else in the worst of their addiction treatment or recovery. most people believe that therapy

or some formal counseling can be helpful. other structures, activities related to recovery and the underlying reasons they may have been driven to drug use in the first place, those are important and i don't mean to downplay their importance at all. there are doctors who will tell you, though, that you cannot treat dead. which is to say you cannot give someone access to therapy if they have already passed away from a drug overdose. so, there is a lot of stigma, a lot o as we are hearing, in some of these calls that the medications don't constitute true recovery. i gu know is that these medications enable people to stop using illicit substances. they are associated with just terrific health outcomes across the board in terms of being less likely to get hepatitis c, hiv, endocarditis or any other

disease associated with injection drug use. not a panacea. nor are they necessarily the sole component of high-quality addiction treatment. countries that have made access to these medications easier have had great public health outcomes associatproblems. the united states has kept these medications quite strict it and we know what the public health outcomes have been here. 80,000 people dying every year. host: how do we compare with other countries? are there countries that do a good job? guest: absolutely. i should say that we do better than some countries. in russia, i believe that methadone treatment is largely illegal. however in other parts of europe like switzerland germany, the netherlands, even to a degree in france in the u.k., access to these medications is far, far better and they have far opioid overdoses and drug-related deaths with far

fewer adverse health events like the infectious diseases that i mentioned associated with drug use. i will admit it's not a totally apples to apples comparison. we have fentanyl here, it's the dominant illicit opioid in the drug supply. thankfully, for europe fentanyl doesn't have a huge presence. yet. that said, everything i have set on this segment was true prior to fentanyl entering the american drug supply. had more restriction on access to these medications with worse public health outcomes likely as a result. host: let's hear from ed, in new jersey. for lev facher, e good morning. d. caller: happy anniversary. i worked in the 80's at a drug have program at turnout is marijuana and how that influences gateway drugs to

higher use. guest: i will admit that i don't know for size numbers on recent studies about marijuana is a gateway drug. there are some concerns certainly, associated with the legalization ofthat it has been made available. generally speaking, speaking to addiction medicine, it's not high on their list of we know that opioids are killing people. we know that stimulants like cocaine and meth are killing people. marijuana is not. i'm sure that there are concerns associated with marijuana legalization and use among young people. but in terms of the scope of the public health crisis, it's frankly just not a high priority topic in a lot of my conversations with peopling dying

of drug overdoses. host: one more call from danny, washington state. caller: yeah, hello? host: go ahead. caller: i've just been sitting here watching this show and i wanted to add in, i'm a 35 year functioning addict, i go to work , i got addicted, but i got addicted to mee, got on got on the merry-go-round. did all that stuff. finally got clean. the one thing he's talking about is the psyche. one caller called in and said no matter what, people who have been clean thousands of times went to jail, got out. if you take them to jail and get them clean, before you release them, you give them the shot, they won't even think about it anymore. it's on. the craving, the idea you can get past the next fix, it's

essentially gone. then you can dl with your personal issues. host: did you want to comment? guest: as we are hearing, it's a common sentiment. again, the medications are not a panacea or the sole component necessarily, of high-quality addiction treatment. i will close by saying, again research shows people who take the medications are far less likely to than people who pursue abstinence based courses of treatment. methadone and buprenorphine make you less likely to die,. , which is what the research shows conclusively. host: we talked about the tangents of far. what other avenues did you want to ask for? guest: folks can expect to hear more about the recovery community. we have touched aron nymous. we are also writing about sober living homes. we are going to talk about law

enforcement settings. that's jails and prisons. as well as drug courts and the role of those systems in denying to these medications. we will write about the health care system itself, which even though doctors buy a march support the use of these medications, access at hospitals and pharmacies is not always good. we are also going to talk about the discriminationonal discrimination, that people who take these medications so often face. much more to come on the war on recovery at statnews.com. host: that is where our guest >> washington journal. our live form involving you to discuss the latest issues and government politics, and public policy from washington and across the country. wednesdayng, the state of negotiations to find the government ahead of the weekend

got deadline and the latest on foreign aid for israel and with christa case bryant. and then peter welch. the executive director of the honest elections progress -- project talks about a report on election security and improving state election laws. washington journal. join the conversation at 7:00 eastern wednesday morning on c-span, c-span now and c-span.org. >> c-span has been delivering unfiltered congressional coverage for 45 years. here is a highlight from a key moment two weeks ago in the midst of a terrible tragedy on the potomac, we saw theican heroism at its finest. we saw the heroism of o of our

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