panel is included as assistant u.s. attorney who has prosecuted doctors and drug rings. also the author of the book dreamland, the two true tale of america's opioid epidemic. this is just over an hour. >> now it is my great pleasure to introduce tonight's moderator lisa geary and is a top news editor for the americas at riders. as a former investigative reporter at the l.a. times, she works in a series of stories that connected drug-related death to the doctors who wrote prescriptions and the pharmacies that filled them. her team also reported on oxycontin producer which failed to disclose risk factors for addiction as well as evidence for illegal drug trafficking.

she has won awards on human rights abuse exposes and on health insurers who rescinded coverage for sick members. please give a warm welcome to ms. lisa. [applause] >> i want to introduce the rest of our panel. we are really lucky to have a diverse group that can speak to many aspects of this problem. chill is a legal scholar at ucla who has done a lot of research in the opioid epidemic and efforts to fix it. this is a fabulous journalist and reporter who i worked with

at the paper and has written many books. she has written an amazing chronicle of this epidemic called dreamland. if you haven't read it, i highly recommend it. it's fabulous and touching and tragic. dr. larissa muni runs and addiction clinic at ucla and helps doctors learn how to cope with victims of this epidemic and she has done research into medication responses. this is a federal prosecutor down here in the courthouse in l.a. and as an assistant u.s. attorney, he has prosecuted doctors and drug rings and gangs that move drugs and he has seen quite a bit of the risky and

dangerous sides of this problem and has endeavored to try to attack it from that end. i first began looking at the opioid epidemic as a prescription drug epidemic in 202010. i joined some colleagues and began looking at the problem. over the past 15 years, more than 2000 people have died of drug deaths. most of them are in prescription opioids but increasingly on heroin and they are closely linked. there are 20 million people currently addicted in this country to both legal and illegal drugs and only about 10% of them managed to get treatment it is underfunded and just not been available.

i wanted to start the conversation by hearing from each of you, your perspective on what is really the biggest part of the problem or what is driving this problem. there have been a lot of people who have been touched by this. >> i think what's going on with this problem is two things, one is oxycontin, we would not have a problem in this country without oxycontin. it was promoted as nonaddictive and it was prescribed in the '90s as a cure all for a lot of pain. the difference between oxycontin and the opioids that have been used before was that there was no use deterrent with it. like bike it in and percocet, they have acetaminophen and

tylenol secant really develop a healthy, an unhealthy bad habit without destroying your internal organs. oxycontin had none of that so what oxycontin did was, because it was so widely prescribed all across the country, it had the effect of raising people's, raising their tolerance to a very high level that was unsustainable, because because on the street after people had to turn to the street, these pills ended up costing a dollar a milligram :

>> >> because it was not a problem in the 80s or 90s bed only we recognize how bigoted deal with said geographic strict ones which and basically get out competed the heroin from the far east when we created new opiate addicts with pills for every kind of pain for a wisdom tooth extraction but

60 by did offer new box the content -- oxycontin or vicodn looking for the heroin coming from mexico provides that alternative it is potent and it is cheap and very deadly that is what we are seeing all across the country with uh culmination of those to historic changes that created a year when issue that we have today it's the white families that were not used to this sort prepared for this believe me they did not deserve this it

is in the heartland and the suburbs and in the rural areas did is very different and also deadlier than we have never had. >> i think the pills and heroin what law enforcement is doing about this and how you try to attack this will answer the first question how law-enforcement was involved but one of the reasons it is so hard to tackle it is the multifaceted issue the issue of corruption, medical practitioners, negligent, ig norance come over prescribing like oxycodone

and the issue you can stop them from prescribing these drugs on the black market from heroin addicts with the abuse of the prescription drugs to be even more powerful when like the tranquilizers that our views. in the massive death we are seeing like and west region yang and hampshire. we obviously have a lot of different people where

law-enforcement comes into play to deter corruption with a prescription pad can sell as much heroin it is a massive part of the problem of the seamier involved in the interdiction and the importation and fentanyl in we cooperate very closely with regulators involved for the medical practitioners antiquing licenses or disciplining one that needs to happen. >> i want to follow-up on what sam was saying that i started off to say to madrid password -- to render thousand death but the

genesis of all of this was to the changes of madison in new drugs like ochs the content -- oxycontin coming off into the market there were proximate 4,000 deaths every year. now is north of 36,000. in 2009 drug negative actually surpassed crack as a source of mortality in this country. won the huge goals is to drive down a preventable death that is why we have childproof bill caps and it is unusual from a public

health perspective to like of mortality charts to see everything going down. cancer. heart disease. everything we can do everything about now we see going up sharply in very clearly a byproduct of medicine and therapies. most of the drug deaths are actually involved with prescription medication but increasingly they involve heroin. this a be a good time to talk to jill. p.s. steady their responses to this crisis was for the state's two said the.

prescription drug monitoring programs with the idea if you are a doctor writing these prescriptions recovering from surgery or a car accident you want to make sure they're not getting the same prescription from three different doctors or selling them and contributing to a public health problem. jill can tell us more but the pharmacy cents a record of the prescription that is dispensed to a state agency and the doctor has access to that in through the of the interface and jill will tell us of the is working. >> one of the things that is

interesting is there was a ton of activity mike colleagues published the paper on this last summer it sounds like the beginning of a joke that we wanted to cover all the facets in the period that we studied there were 81 separate state law as passed in the one that gets all of the attention like timber resistant prescription pad used to be easy to steal a pad and now they save for a did they get to heat or pre-printed your check for signatures there

was a lot of hope they would make a difference so we studied a very tough population of people permanently disabled and don medicare even though under 65 because they were disabled and could no longer work. among that population play counted about 50% so it was very hard hit looking at the passage of these laws we thought we would find something then look at the trend of prescription abuse what you find is a slight slowdown in 2010. but when they pass the law compared to the states there

is no defect with any intervention at all. so maybe the lesson is a tough population but we will be careful how much money be throw at interventions. they need to take the bad news we will again different populations this is not good news. >> with the regulators from taking extremely bad actors. >> we don't know every

instance they sell drugs but every single time a doctor has prescribed a drug we know the dosages with the same dosage we know they are living miles away with the danger is cocktail is essential but not just for prosecution but the medical board in pharmacy board regulators every time we get a conviction that sends a message someone to emphasize how important they operate very differently the mandate

across the border and that makes the big difference in places where they had the biggest problems like new england it is not so hard as i learned in growing up in massachusetts to go to new hampshire as the states are right next to each other berger it could work in some places and not others. >> with the topic of imperfect solutions is a good opportunity to talk about treatment options. i know i have spoken to wait too many families looking at a retirement funds or mortgaging their homes to get family members treatment numerous times only to have them relapse or overdose or

recover or finally died. so how well is that working quite. >> in terms of treatment i view the most important element is prevention of overdose death because nobody can be engaged with rehabilitation and recovery with that treatment is medication treatment. it is very beneficial to have different types of treatment and behavioral therapies but those of our available to treat zero pla

dictionary the gold standard aikido little bit into those differences but essentially working with methadone are opioid aids. is a partial activity more than what we were talking about but they are long acting opioid substitution therapies so you get the medication that to be intoxication and withdraw all it is a vicious cycle of addiction and really could

be a lifesaver to allow individuals to improve functioning and quality of life and get their life back. now myth tracks so is a one opioid blocker this seems to be a better option but if you use that the effects are blocked. these are the of medications that our important other medications that can rapidly reverse the opioid overdose used in the year setting and for the people to have

access. so physicians are encouraged so a family member or a loved one could use that with day overdose. >> have the question for you , sam versed what i found interesting with death of mortalities what is interesting is of the greatest risk of death it is the kids issue could imagine the people in their 40's and '50's the mortality in terms of will be rates -- opioid.

one of these solutions people hot talk about lately in the presidential campaign is interdicting the flow of heroin into the country from mexico. so tell us if you could explain what affected think the wall could have on them? >> and the fact that most of the heroin comes from mexico in key to the victory ohio

one in pennsylvania and other. and that played a big part in that but heroin is a great traffickers' drug because it is very easy to conceal not like cocaine or marijuana that is balky you don't need a lot of space to traffic carolyn. -- opioid see you don't really need a wall one that starts 50 yards into the ocean going 15 miles. but we have a lot of walls along the border.

but a particularly with the size of what we have created but what will stop the flow of heroin is a the stops in in mexico from fundamental ways. and this seems to me what we really need to do is not alienate it, but being conversation with mexico and relating to that but we need to push them to what will make that country a place where they are dying that is literally the case.

only when mexico begins to change without law enforcement capacity that canada has can b.c. a moderate partner but the way that we get there believe is not by alienating or insulting to allowed the elites of mexico to use the inflammatory rhetoric with that bilateral relationship with us the better law enforcement so that the cops can call down to areas it is a perfect example because it

is so condensable and so small it could be smuggled across the border very easily and stepped john five times and it was still be very potent. we need to understand for that to change we need to treat them as neighbors and not treat mexico was the dysfunctional family and hasn't done anything positive in that regard. >> i talked to a lot of doctors obviously in the reporting of this issue and many doctors who were trained recently all told me they were trained in medical

school really careful prescribing opioid they are addictive and have to weigh the risk of addiction with what your patients are facing. and through the mid nineties the resident to prescribe opioid for anybody with terminal pain or cancer if they would die so addiction is not a problem ohrid is not humane. but the humanity a dia was expanded with the much broader range of pain and the doctors prescribing tendencies shifted. but it got to the point where doctors were prescribing opioid frequently for all kinds of pain including extraction or

short-term pain, all kinds of pain. day you have an idea how that transformation went to get your patient addictive so stay away or you will have a tooth pulled why would give you a prescription for the opioid? >> p.s.. i am not scheerer of all of the historical reasons. but i do recall in medical school exactly what met transformation occurred now if it is of vital sign they are under treating pain we need to be more aggressive i am not a pain management dr.

dr. so hearing exactly what was supposed to be done. so the potential swung the other way now unfortunate -- fortunately this swinging back we were told that opioid for paying are effective in minimal risk of addiction we are learning that is not true in much of the research is showing that 91 to make a point they are a valuable medication we need these if you have a surgery, injury, acute pain they are highly effective but the efficacy for chronic pain and long term use is no question to in the risk is

clear now there are new guidelines shifting that we need a new approach so pleased consider non opioid therapy medication even cognitive behavioral therapy to cope with pain so hopefully we will see a return of more pain clinics to manage these problems. >> i think it has to do with the spread what data was writing a book about drug-trafficking but it became a book about american and who we have become. at the end of the cold war a country that loves to read salt the private-sector work people are applauded for

making lots of money. be savaged government been became a country band wanted convenience with the lack of pain. we have a padded playground so the kids doeskin their knees. trophies for everybody in case somebody feels left out. now in college they asked for a trigger warnings so the professor bill deals with an issue that could be painful. billing from the physical pain to me emotional pain and i believe that doctors saw this in the 1990's the patients would say i just

cannot have any pain people began to believe that we really could not suffer any pain add also that his plan we began not just to prescribe the pills not just 40 ailment the massive doses to think that they were not addictive even after the acute pain of my appendix out it was three-- public gets 60-- worth then we isolated ourselves inside there is a story of isolation the end of community in america. the hallmark of the crack epidemic the hallmark to this epidemic is the sign of

our great prosperity where every mother says don't go outside there are child molesters. stay inside in the bedrooms where they hide the dope or they are shooting up and dying. so doctors began to see this when they wanted no pain at all. bumblebee what started this is americans believing we had won the cold war and halloween candy have you seen that?

i think it is all part of the story and why they are getting a pain specialist to tell them that we now know that the opiates we noted drugs are not addictive so they went right ahead solis to be not accountable for our own choices that would push that in that way. that is well lead us to where we are today with the story of lee r. as a country and what will lead us to happiness we have to let get

the insurance system and with the slow careful intervention in shown to be quite effective the insurance system says to write the prescription furthermore to write that for a lot of pills because you don't do so well if they come back that takes a lot of time so there is of six to set up the system with a certain number of pills if you call in to get a certain number more but there are system exchanges we could make.

i am not sure i grieve about the candy bar but i do agree that a practice patterns in madison that is really different bubbles of prescription and treatments and ironically the problem of white america with the prescriptions to people of color. and the cultural causes need to be looked at from the community and into think of

a culture what happens in our society to make the 18 year-old take her grandmother's spills from the medicine cabinet but is happening when somebody does that wexler large part of the problem when people are addictive they are treated but what about all of these young people? what makes people so desperate? >> one element is a lack of perceived threats. there was a perception that medicine prescribed by a doctor not history drug must we safer battle lot of

experimenting with of pills people to experiment with drugs but certainly high-school students what do opioid do they block pain there the analgesic so to talk about the only person in an immediate relief with

instant gratification that is very powerful memory and a cross addictions a big component they are reinforcing the next time you feel stress repressed to obliterate the feeling. >> donald lots of school campuses football has driven this as a gateway addiction because that is how we have learned to treat pain.

like the cool guy is and people watch football players with rustling or baseball with the enormous number of football players being addicted there is pressure to get back on the field with a lot of spillover. then pretty soon there in four or five other guys lockers and football players being bought popular leaders on campus. is a hunch idol have any evidence but iran into that lot.

>> akin completely corroborates. i was usually in the homes that people have lost someone to an addiction to and overdose in their teens or early 20s almost every case they had a football injury or wrestling injury car accident in skiing injury 6917 put:opioid was the right response in the hospital immediately after bed then there was no follow-up you go from the surgeon and a the hospital to the family practitioner and nobody pays attention to their refill. >> been those terms let's go

easy on this. but nobody got that talk that i talk to any way. >> i spent quite a bit of time with alcoholism at the betty ford center. and by the early part then all of the sudden opioid with hydro coda owned or purpose set to --. said silas in the office said he said the practice

culture i had an emergency to pulled for 30 days of vicodin were you doing you know, what they do for a living and they said i know. you don't have to move one fell met or take it but i don't want to move have you call in the middle of the night you are in pain. >> backed explains the enormous supply story. the new live did mexico that this is a supply story. so the guy who gave me 60 vicodin worth of three days of appendix operation pain. and if you multiplied that

by millions of doctor visits that is what creates a massive supply that transitions to to 2220. >> how easy is it to obtain and thankfully not to say we don't have the drug problem and that data is relatively new although we start to see that spread to see those

overdoses on fentanyl in a couple of weeks with of fraction of the penny to be imported then you go to a party and take whatever you get to did is vicodin id is sent producer by perdue but drug dealer in the basement steven know we were taking or how strong or how safe. so that ignorance of the drugs that you are taking when somebody will hand you one. that is an interesting point '01 to make but that insurance industry was brought up not because of anything medicare or

medicaid does wrong but the black market and that is the outrage. not because they do many things wrong but the industry of people in mossy angeles that are so involved with the medicare and medicaid patients to steal the identities of the ldp paul so normally these are drug addicts with the number

one cause of building by more than double so you should be outraged because this is your tax payer money ended isolde tragic to create other issues and for so many of the drugs that are spread. >> whenever started to lick the problem there was and that many prosecutions that was the long law on the book has that changed? >> so i tell people remind be afraid the telling the doctor because a paper trail

exist you literally can see every drug prescribed doctors who are drug traffickers who has the cash business? then a very narrow range of conduct of a legitimate pact -- practice and within dangerous combinations why are they only doing the examinations? sabine had incredible tools

and regulators as well one big area is the area that is more difficult so it is a fungible business in half to be licensed the willing to commit a crime so there are fewer and fewer doctors now we have to turn our attentions to the pharmacies of there is a doctor in los angeles convicted of murder despite the rampant death

and was a righteous result it was 25 years sentences for those that need to be treated as such we have a lot of tools we just need to use them. >> we will take questions from all of you please say your first and last name. >> there is a trend going on denies suspect on drug testing so that it is a two-part question does this

ketch prescription drugs doesn't highlight this epidemic? >> it would be hard to distinguish between morphine and heroin i am not type of fish and sure what type of test and then goes to the point of like it's down to the chemical level. >> but those are people with a win for public assistance

so those were not dependent on public assistance. this affects white people just white people that is appellations of but in my book and was also and suburban charlotte portland portland, lakes city, indianapolis the best of the of run-up of the of mid-90s. the bigger question party

that has to do with what doctors are prescribing the many black people have prescribe these drugs. part of that may have to do with cultural memory. celerity is a cultural memory. i don't know abut they say addiction is colorblind it is all over where every find a white person. >> people with medicare and medicaid cards to maybe homeless to be easily

manipulated, if you have a government card and you are valuable to drug dealers view are driven in a van taken to a corrupt dr. a prescription is written in your name you turn that over to the person who drives around $100 sounds like a lot think they do that all lot that is the way i have seen public assistance play out. >> q paid for drug dealers

to get their source of the supply. >> i am writing my dissertation about the opioid epidemic is to very helpful. i would love it if you could speak to the gray area that exist the high deregulated markets for prescription drugs in the market for heroin but what bridges that dividing research like suburban charlotte? >> so why is there a market in suburban charlotte blacks

with this transition for prescription opioid for those who need that type of assistance. >> back gets back to doctors except teen media that was the fundamental change with a pain specialist to convince entire generation the drug said every by the new was addictive. so we now know massive prescribing of these bills in many parts of america. medicaid medicare is a big

part of what happened and in various parts of the country but scandalous doctors were not the reason why this happened it was an entire generation to buy the idea that they could be prescribed with no press the world supply of hydro codon was 3 tons n reason that 43 tons 99 percent of that was used in our country is a revolution through marketing that is why charlotte or mexico over the country from you have the supply and that

has been exacerbated but overall they general change of mind on the part of hundreds of thousands of doctors. >> digest one to add to that that there are bad apples out there but but this unwitting participation where we don't like regulation we will see that increasing with public health experts like me talk about regulation did is called a death panel instead of evidence based medicine

said to have that culture that does not like to take that systematic evidence into account then we will end up with a lot of prescriptions ended is important we have law-enforcement dealing with those bad apples because that is the way we have them to practice and to get the right incentives in place. indict think. >> and pat attention when it

is a problem in the light communities. >> and with the statistics of racial demographics so here and los angeles limited to white people may be that is just from my perspective. with every age group bent can class it is not the

people of color cannot get hurt or are immune from this. they are but what has got the attention is that we have seen for the first-time in 75 years a turnaround of life expectancy for white people caused by this. and what should this for the first time and that its white people in a particular way. but this is something very dramatic going on. >> i have a question on the left.

i am mainers practitioner talking about the doctor patient relationship and the nurses are pivotal. to be the number wind population of health care none of you have mentioned vendors. >> earlier this month there was a report dropped on the opioid problem and what the responses should be and he

worked in the same hospital and when he became surgeon general of the united states the nurses said they gave them one request per go do something about the opioid epidemic. absolutely there on the front lines. and to work for doctors and also contributing to the solution and dealing so they are on the front lines and a lot of them are looking for a resolution. >> thanks to ucla for making this event possible this evening also thank you do

that wonderful panelist. [applause] [inaudible conversations] and [inaudible conversations]

[inaudible conversation] [inaudible conversation] >> will have a lot more from the conservative political action conference later today. mike pence will be speaking at the sea packed dinner. he is expected to speak at 730. you can see that on c-span. there is more tomorrow when president trump will be speaking to the conference. you can can watch live coverage at 1010 eastern, also on c-span.

>> watch c-span as donald trump delivers his first address to a joint session of congress. >> this is going to be the busiest congress we have had in decades. >> live tuesday at nine pm eastern on c-span and c-span.org. listen live on the radio app. this weekend on american history tv on c-span three, this saturday morning at 930 eastern, we are live from the library of virginia in richmond for a symposium on civil war monuments, the history of their construction in the north and south and how it has changed. then at eight, on lectures in history, and in college professor john tunes on how the rise of tobacco consolidated the wealthy virginia planters and london merchants in the 17th century. >> instead of accepting price that this ship captain offers

me, i will send it to england on my own account and pay a commission to someone to market it for me. this developing consignment trade ties them to the english merchant. >> we will continue with our coverage of black women. she received a presidential medal of freedom and congressional gold metal. >> i grew up, and even in my religious experience, working with people of different religious backgrounds, with a feeling of importance and openness, and how much each one of them contributes to the other. there's no superior or inferior.

>> at eight on the presidency, historian catherine clinton talks about what happens to president lincoln's family after his assassination. >> the morning of may 19, convinced that his mother might do herself harm and prodded by a team of experts, robert lincoln filed an affidavit to have his mother tried on mental incompetence spreadsheet could be held against her will due to insanity. >> for our complete american tv schedule go to cspan.org. >> white house counselor kellyanne conway talks about her role in the 2016 presidential campaign and working in the administration of president donald trump. this took place at today's session of the conservative political action conference. it is 20 minutes. ladies and gentlemen, this is an interview. please welcome the honorable