we want to show you his author talk now. sam is a journalist and author of the 2015 the true story of america's opiate epidemic. before we get to the book i want to ask about something you wrote on your log. you said writing about hera one is another way about -- of writing about america who we are and what we have become. can you explain that? >> guest: this occurred to me as i began in the middle of this project and i began to wonder why it was that this problem is affecting appalachia but also why was affecting charlotte and salt lake in indianapolis and places that did very well over the last 20 or 30 years. what was the common denominator and understand the common

denominator with their own isolation that you weren't really writing about much bigger topics than simply drug trafficking. i thought i was writing a book about drug trafficking from mexico and marketing. all of that is certainly part of the story but i think beyond that it gets into who we have become. we have become so isolated and fragmented. we have done enormous amounts to destroy community in this country. the dreamland title comes from a swimming pool in the town of portsmouth ohio in southern ohio on the ohio river that once was the thing that held the town together. that's where you grew up. it was a place where gwen came together and formed a community. after slate was jobs and goods downtown but once all that one

away like they savaging of the societal immune system. it left people very vulnerable. that took place in the rust belt area but in the wealthier areas and suburban areas. everyone is so isolated. our suburban communities architecture is almost designed for that. technology while it connects us superficially really does a lot to separate us. i thought writing about heroin was like writing about who we become as a country. >> host: if you've been affected by opiate addiction we want to hear your story. you can call in our send us a tweet as well 2027488000 to one to colin or tweet at c-span. if you're a medical professional 2027488001 and all others to want to join the conversation.

you mentioned "dreamland" and portsmouth ohio. what should viewers know about mexico? >> part of my book deals with the guys who first figured out the heroin traffickers who first figured out that there's a very aggressive push to promote a pain pill prescribing among doctors and doctors buying into that idea. it would conventionally lead to a fast new heroin market. the guys at iraq about in my book figure that out and saw that first emerging and column this ohio and areas around their and around cincinnati west virginia and places like that. it developed a system, developed in the west coast where all the market that they broke into eventually had a static number of addicts and they were all

from the same town. it was this one town in particular. it played a very important role. these guys figured out a retail model of selling heroin by the tenth of a-gram very much similar to pizza delivery. he would call and order. they then the driver to deliver heroin. these guys with their model initially developed -- were the number of addicts with was static. they became master marketers. they were all from the same town and they knew where each other's mothers lift. they could really eliminate the competition the way people in the underworld traditionally had really so they had to become marketers. that's what they became and it was a way of discounting giving

doughboy for methadone clinics and two guys who just got out of jail. five new customers brings five kilos of heroin. one guy in particular i talk about in the book landed in columbus just as a massive new push is underway by pharmaceutical companies and pain specialist particularly in the area of southern ohio and virginia and kentucky to promote narcotic painkillers vicodin percocet and oxycontin. this creates a whole new number, huge number of addicts and to service those addicts once they can no longer afford those bills and are looking for something cheaper. plus it tells a i portsmouth ohio and you have the drug traffickers. what should viewers know about the purdue farmer? >> guest: perdu farmer,

oxycontin was crucial. it was crucial. for two reasons. one was purdue pharma use the daria gress is form of marketing to doctors very similar to the marketing tech makes to sell their heroin to convince doctors that these pills were no longer take if particularly oxycontin was no longer addictive and they began to prescribe it to their patients. they don't do this anymore but for seven years they gave away a little cd called swing in the right direction with oxycontin where when you have a swing band he was a very aggressive constant marketing.

and then also oxycontin was a crucial part of it it is oxycontin was not an abuse deterrent. people would get addicted take their tolerance of two high levels and then they would be looking for a cheap potent alternative and heroin prove to be back. particularly the hera went initially proved to be the crucial alternative and all that. >> host: and the drug overdose death rising to somewhere between 59,000 in the united states in 2016. what is the story talk about in this book taking place? what year's? >> guest: i would say the mid-90s to 2014 and those ears i would say where you are saying , then of course what's interesting when i was writing the book i'm a long-time crime reporter the new the most

innovative and fast-changing part of our economy is the underworld. it's always morphing into something new. i kind of knew part of the story would just continue as after the book came out and that's also what has happened with the emergence of fentanyl as an additive to the drugs before using. >> host: the book is sam quinones the true tale of the opiate epidemic. sam quinones is with us in davis up next in denver colorado who has been affected by opioids. good morning. >> caller: this is dave from denver colorado. i hear every day treating my granddaughter is an epidemic and it's heartbreaking. every day we talk about solutions putting her on this drug and that jacket on c-span they talk about how they are

getting all the states with marijuana legal. overdoses that dropped 30%. you never hear mention of that. marijuana secure and they don't want to admit it. >> guest: i'm sorry to hear about your granddaughter. i know this is a story that's going on across the country and its crushing torture to so many families across the country. i think there are early signs that maybe this is one way of transitioning people off of medical marijuana. i think we have rushed through to medical marijuana a little bit and i think we need to be a little bit more humble about the potential use of this and in fact the potential, what might

happen should the legalize marijuana. certainly all kinds of marijuana nationwide. marijuana varies widely nowadays very different from when i was a kid in california. marijuana was very mild back then. now it's extraordinarily intense. there's also a big question of what kind of marijuana is good for medical purposes. the marijuana that makes you the most high with thc in high levels of thc is what makes you high and marijuana. for my reading it's not always the one that contains all the medical benefits. it's the -- elements of marijuana that have the medical effects so i would be cautious. given what i wrote about here which is that a massive amount of legal drugs was unleashed on the country to die or a nightmarish consequences.

it's worth keeping that in mind as well as far as marijuana is concerned. >> host: a medical professional, good morning. >> caller: good morning. i have a question i want to ask the gentleman and i would like him to address three areas for me. the first area is -- can you please explain how poverty plays a role especially when it comes to rural areas and urban areas. i live in baltimore but that would work in washington d.c. and they work in this population. the other area thank you to address is the easy accessibility of prescription drugs. you walk through the streets of the washington d.c. area can get a prescription for $5, $10. it's everywhere.

and three the big one is our justice system. this one needs to be addressed because a lot of people -- for different things. whatever they accumulate in whatever situation keeps following them and as a result agrees the population where we cannot find jobs. they go back and do using drugs because they get frustrated. we have to deal with the situations every day. is there a way we can address this? >> host: before he addresses your question what kind of medical profession are you? [inaudible] >> guest: those are huge questions and i thank you for bringing them up. it's a first of all this certainly started in the rust belt in poverty-stricken areas and rural areas primarily zero

ohio, kentucky and west virginia, virginia eastern tennessee and western pennsylvania. that would be like ground zero if you like and yes i think those were areas that were ripe for this. there were a lot of places where doctors found solutions not just to people's physical pain but their economic pain as well. doctors were the people he had to go to if you wanted to give workers comp or ssdi, supplemental disability insurance. ssi is another one that you needed a doctor to sign off on and these were areas where the doctors were acutely aware of the pain and suffering physically but as well economically. i think i was one of the reasons why pharmaceutical companies went to those areas. first because they promoted in those areas and they saw doctors robert e-prescribing a lot of pills and already amenable to this approach. they were acutely aware of how

bad things were in this area. i would say however it's important to understand today that that's not always the case. mostly i would say it's in well-to-do suburbs where you're finding the problem. this is not only rust belt areas of appalachia. this is charlotte north carolina, salt lake minneapolis indianapolis all over the country. the common denominator is not economics. it is i believe the common denominator. while it's jrue to say drugs do not discriminate this is almost entirely of white persons problem. it's very rarely that you find a large number -- now baltimore being an exception to that rule but across the country you are finding mostly white people and native americans as well.

i would say in answer to your other question, yes, this is a supply generated problem. i used to believe when i lived in mexico that demand was the problem. our demand here created the motivation for people to sell drugs from mexico. i now believe something very different that i really believe that's a crucial detonator of this problem is supply, excess supply and that is what we had when doctors across the country came to believe the i.d. of that first evolved these pills were not addictive and therefore didn't matter how many of these pills they prescribed and for 20 years plus now all kinds of surgery, chronic pain etc. mainly acute pain after surgery has been massively overprescribed. these pills now are circulating everywhere. there are a lot of ways in which

these pills have leaked out into the black market but what you were seeing in baltimore and other places are a result of that. >> host: the book is "dreamland" the true tale of america's opiate epidemic and sam quinones why are you in d.c. today? >> guest: i'm here to speak at the invitation of the faith and politics institute. and speaking privately with some congressional staffers and at 7:00 p.m. tonight in the capitol visitor center at 7:00 p.m. i think is the time a public panel with a couple of congressmen and senators just on the very issue which is so important nationwide now. >> host: a busy day, thank you for taking the time. margaret is in cherryville texas go ahead. >> caller: okay, i am coming towards us in a different way. i'm in 89-year-old and i see

that so much in our lives now we are projected with the image that any discomfort whether physical or mental is a natural. we need to take something to get rid of that. i used to be a competitive runner for example and i know the difference between discomfort and pain. a lot of people dealt. they seem to think every little discomfort in their life is so unnatural you've got to take something to get rid of it. i seldom watch tv and i was watching the program. every intimation where they had ads there were three or four ads that gave the image of happiness without pain, without discomfort and if you have either of those you had better take something to get rid of it. you go to the doctor and you

asked the doctor for a certain kind of medicine so you will not feel discomfort. i could go on and on with this and i'm not going to put this to me is one of the big things in our lives. >> guest: you were asking earlier about how this is reflective of a larger issue, cultural issue in our country and i think what margaret brings up is exactly one of those points. we as a culture have room to fear pain. you know you can see this in all parts of life. we are afraid of letting your kids go outside and skin their knees. afraid that they might feel some emotional pain from not being chosen to play on the team so we give away trophies to everybody. it's part of our culture now. we treat our bodies frequently like cars. doctors who use them as -- you

go to the doctor and say fix me infrequently i think you can hear doctors very vividly on this point. frequently the doctor says the problem is you need to workout you need to be better you need to quit smoking, walk more swim or whatever. we need to be responsible on our own and we need to look at our own wellness. they are approaching it that way our response is that's not my job, that's your job, fix me. all across our culture today you are seeing this way of no one is outside. there's a certain anxiety parents have about letting their kids go outside alone and there is a child molester behind every tree they are imagining. we fear, we have hyperprotected our kids to the point in our effort to get them to avoid

pain. i think really we have deformed the kids in a lot of ways. they are not prepared to maybe work hard at something and deal with common ordinary pain that they might feel just their living life. >> host: ventura california melody has been impacted by the opioid abuse. go ahead. >> caller: i live in ventura california and i have chronic pain. i depend on my medication has it's not just a little bit of pain, it's a huge amount of pain. i don't abuse my go to my doctor regularly. i understand there is a drug addiction problem but why us, the ones that are in critical care are being cut off? that's my question. number two how come nobody is

addressing the methamphetamine problem that we have? that seem to be more outrageous than the opioid addiction. gezdah with regard to the your first comment yes i mean one of the reactions and again we seem to have trouble letting the pendulum ease into the middle somewhere. there are people who need like you who need these pills and who need these drugs and therefore should not he cut off from them. this is unfortunate what has been happening in some areas. it seems like we go from one extreme to the other. be there massively prescribed these things or we want to cut them off entirely. i would say there's a role for nuance medicine here. and back to again that community care, the way the doctor and the

patient worked together to find a solution to each patient's pain. they are very important to practice medicine that way it seems. >> host: to her second the meth addiction in this country is worse. >> guest: it's true there is a serious problem with meth addiction and matthews in america. i don't think methamphetamine is to blame for 59,000 deaths annually. that is not possible. it's a gruesome drug and it's an unfortunate drug and i wish it on nobody but i don't know that it is at this point the preeminent threat. >> host: 's back from minneapolis affected by opioid abuse. go ahead sac. >> caller: everybody that i know the pieces starts from the doctor abe vigoda the doctor and they have a back pain or shoulder pain and they get

oxycodone and before you know it they need more and it's really a gateway to heroin abuse because heroin is cheaper. i noticed you mentioned marijuana earlier in the conversation. nobody is ever overdosed on marijuana. no one is ever stolen to get marijuana and no one has ever sold their body. marijuana is not a gateway to opioid abuse. >> guest: i would agree with that. i think doctors have overprescribed and very aggressively prescribed for 20 plus years now and that has created a lot of people, doctors and dentists i would say. and as for example prescribe huge amounts of these drugs with

a tooth extraction for example. that to me is bizarre honestly. i would say absolutely right. what you are talking about is one reason why i think football is a gateway to heroin addiction because folk wall is one of those sports that creates the most injury i think. when you deal with injury through firing pills at it eventually lots of kids and lots of football players will get addicted. i think that's what you have seen all across the country. it's a serious problem. i would say the only difference today is in the last couple of years it has gotten the attention it deserves. we have been watching this for 20 years now and in the last two years it's become a big deal. >> host: on that point i want to come to the story that you are about in your book from avon lake, ohio, his obituary and his

parents mentioned his son's battle with opioid addiction. while noting their sons charismatic personality and appearance of the 24-year-old and his five-year battle with addiction took over into eventually beat him. he spoke often before he died. it takes a community to battle addiction. the parents talking about how that change. >> guest: absolutely. when i was writing the book was stunned me was the lack of enormous willingness to talk about it. i had grown up during the years. that was my first job where i was covering crack-cocaine in the town of california, stopping california. back then it really was not hard people would come and say write a better neighborhood rates under siege and there are traffickers there.

with this story i was stunned because i could not -- it was very difficult to find parents who wanted to talk about this. this was not so long ago, 2013, 2014 when i was in middle of all of this. i would go to them and they would tell me off the record please don't print that, don't write anything. this is one of the reasons it spread because people who would ignite interest which would be parents on the poignant lacerating story to tell that only they really can't tell did not want to and were actively trying to hide it. in their bid to raise they would die of a heart attack or died suddenly. he reminded me of the aids epidemic where people would make up lies for the obituary. what has changed in the last two years that is ignited interest

in this topic i believe is that parents now have found common cause. they are coming out of the shadows to talk about this in a very open way and tell the story in a way only a grieving parent can. i've been in the media for 30 years now. i know the power of that and that is what has changed i would say. now you are seeing that kind of obituary, put them up on my facebook account all the time because i want to encourage that. i think it's healthy for them not to sit in her room crying and being all alone but it's happening all over the country. >> host: bob is a medical professional. good morning. >> caller: good morning. the question i have. [inaudible] that much could kill two or

three people if that was fentanyl so you can get a rough idea on how small a dose of fentanyl can be distracted. that is what they are putting in heroin. it is 50 to 100 times more addictive than regular heroin. the ones who make that fentanyl and it's coming from mexico, mix it with the heroin. it is more addictive, you know buy more from us. if they are selling it then be responsible. if they have made money on it, take everything away. they can never own anything in the united states.

>> guest: getting to the point of fentanyl this is absolutely true. fentanyl is a whole new wrinkle that is extraordinarily scary. scary for users. scary for family members of course because the death toll is largely due to the of fentanyl now i think that it's also very dangerous for law enforcement and ems who have to deal with folks who are overdosing. they don't know what is and what isn't fentanyl and it's a very dangerous for those folks as well. i think about them a lot. but you think of fentanyl in terms of the last wrinkle in the latest wrinkle in the underworld as it has adapted to our overprescribing of these pills. first it was the black market in these pills that you could sell for 1 dollar-milligram and sell 40 or 80 milligrams.

then of course not long after that heroin from mexico, all of this heroin comes from mexico now. >> host: afghanistan? >> guest: that's a myth great afghanistan is too far away. think of it in terms of the business. you cannot ring huge amounts of heroin from afghanistan 8000 miles away or something like that and have it compete with heroin brought by very efficient traffickers from mexico, very good at their job and very good at production from 200 or couple thousand miles away. they cannot compete. mexico is right there so all of our heroin, 90% comes from mexico. fentanyl is simply the latest wrinkle in a group from an underworld that does not care basically.

fentanyl is an opiate without a plan. you don't have to have a group of laborers that know how to harvest and cook it in the heroin. it's very quick and easy and very cheap and extraordinarily profitable. that's why fentanyl is down the scene. >> host: ben has been impacted by this. go ahead. >> caller: the people that need these and use them i'm in my 70s and i had to retire earlier than i would have liked to. i did heavy labor all of my life and had back injuries. they took them and you can't do that anymore. you have to take a test in the blood test and if you aren't the right level they will cut you off. there are too many people that need these and i got a letter from my doctor. all the back trouble that i've had i've been dealing with colon cancer now for five years. i'm a major caretaker for

grandchildren and now my doctor set me a letter that i've been cut off. i will have to go to a pain center. that's a 100 something mile trip that i will have to make and stay all day. they will put me through the ropes. they want to stick needles in your back and do mris and all that. i can't understand how an opioid epidemic, most of the people you see are young people with a needle hanging out of their arm. why go after the people in their 70s that worked all their lives and need this stuff to function? i'm not stoned. i would never do that. i've never had a problem in my life with drugs but now i need the drugs to survive. >> guest: i think this is part of the problem that we face. we have a distorted medical world where we have, where drugs

have been the answer used so when they create a problem, severe problem i'm quite certain you know lots of people in your area clip grown addicted to these pills and from there they got addicted to heroin. that doesn't change your problem i understand that the problem is medicine has become used -- it's got to learn, doctors have to learn how to find that nuance, how to find that it'll wrote so that they can work with you personally over period of time to find the proper roach to your pain and maybe those pills are big part of it. i don't know but i think we have gotten away from that. many years ago medicine was practiced in a more personal way. individual background was taken into consideration and we were

treated as a production line of patients. >> host: the house is expected to come in 20 minutes and we'll take out the words they are. a lot of pictures today in the wake of republicans in the senate abandoning their health care bill. we will certainly be watching for that but until the house comes in taking your calls with the author of "dreamland" the -- christian is in lexington, go ahead. >> host: hey sam great discussion today. a couple of questions for you. i live next door to a notorious pill mill dealer. his name is aliso wasp and i know you've talked about him but you can check them out. how many pill mills are there in america today? i don't know the number and i can't wait to read your book but i can tell you having something

like him in my neighborhood and we live in a very nice neighborhood and did a full city the police had told me this is a -- neighborhood in america. as you were saying it's not just poor. this is a million-dollar home neighborhood and the police say unless you see him carrying 20 pounds of heroin there's nothing they can do. >> guest: i would say the pill mill thing began with our overprescribing of pain pills. the pill mills are essentially pain management clinics in which the doctor has abandoned any reasonable diagnosis as a matter of selling prescriptions for cash. again and the ground zero area i was talking about in no high wind west virginia, kentucky. i write a lot in the book about

the guy who invented the business model in ohio. that spread to other areas. florida was varied egg invested them in 2000. now what you are seeing i think is not so many of the most outrageous pill mills were you would have long lines of people from out of state and people just in pajamas to get their prescription and move on. i think what you are finding is a lot of doctors would succumb. this is the problem. this will take care of your greatest problem which is pain patients who take a lot of your time. turned out really to be a curse. a lot doctors saw the scruples withered away over time. they got used to the cache. what we got used to her doctors popping up across the country.

i think there are fairly isolated case but nevertheless problems where they were way over prescribing and in a lot of cases dying. gone are the days of the wild west of pill mills in appalachia i think that they still exist and they pop up occasionally all across the country. doc jars have lost their way honestly with this and become addicted to the test. >> host: a question on twitter where was the concern for the epidemic besides locking users up? >> guest: a good question. i was a crime record -- crime reporter during the epidemic. .. epidemic right now. whites are the

dominant racial group in this politicalhat affected discourse, a lot of people are contacting state legislators, mayors, congressmen. political ing a effect and they have power frankly, speaking bluntly, that do not have. that has created, i would say specially interestingly in red areas, radical change in how this is being approached. longer throw away the key, lock them up forever, that kind of thing. addiction proach to that involves treatment. we need to treat the folks, court, they don't have a felony record, none of the crack oposed in epidemic 25 or 30 years ago there is one big difference epidemic and that one, well, two. then most of ck the dealers that i saw were black.

were of every race, stockton, california, crack race.of every but this one is almost entirely people, so intensely public violence, drive-by shootings and there was recorddr homicideiv levels every year tht i was in stockton during this problem. so it was very intent on getting these dealers that were all over heir neighborhoods. therein was no focus i could w remember on expanding theover tr capacity and any of that. fast forward to today we have on buildingpublic find is associated.ny it would be hard to imagine this

problem. if there is the same violence we saw during the years the crime problem was awful and. ers. >> caller: this is about 15 years ago i was told by a docto that they were refusing to writ5 prescrip ytions for powerful painkillers the reason being they would be a concern for the health and well-being of the patients who were nfl playersin and a lot of it has to do withth playing through injury during

the game and i remember it concentrated on the running backs are particularly beaten up n. tremendous amounts of painkillers.were bea >> what struck me one of the stories is the university ofyou, akron that disintegrated undera the pressure of needing to win a and alllso the first string ewtting hurt if they were not up for the jobs there was a lot of pressure to get them back on so deal with pills toto pain and getting people back peocally destroyed the team.

they got addicted, a quarterbaci eventually died of a caravan ac overdose. >> caller: i've suffered from chronic pain due to work-relatem injuries infected and with the loss of a family member. it's a complicated problem as a

chronic pain sufferer i want to ask if he's ever personally suffered or experienced a ruptured disc. from >> guest: i >> guest: i have a hernia when i was in and did the. yourost: finish your comment. i know there are dot or south herself there doing this that's obvious but it's not been mylle, personal experience just to echo what the are doccaller called in to say. they will not prescribe controlled substances anymore.aa

if you suffer from degenerative practi disc disease or have a history of back surgery and nerve damagr and suffer from another event, you are out of luck.r from a >> guest: this is part of the problem thatt event, yo we face. the system has this production d line quality. they are saying i'm not going t prescribe these. sayingust how you use them. the other flipside of that is when you go in for an operation

and when you leave you are given 30 days worth of painkiller. those days may be coming to an r end slowly. come that's when the earlier caller said that that's what's is th happeninge other as well.think s we will try to get to as many calls as we can. rea as a registered nurse there was prhuge impact and there was a

huge focus making sure [inaudible] they started and take advantage of these type of things. there were enormous pressures to is actly, t this way and one of them was the idea that it's now to be called the fifth vitalf ts pagn.sign. to get the doctors to look at pain and attack the pain of ardr

patient always ask about this idea along with some others and there was this idea if you were a doctor you were failing inotr your mission and if you've got a bad evaluation, too many of thee could be affected economically. this took a long time but in the end marketing worked so this ist where, we are. over thp, we pushed the pendulum from we g should never use these for any reason which i didn't think was a good idea to use them for pai

that has ceased to exist. exist >> host: catherine has been in the by this. the t go ahead. >> caller: ii just wanted to touch on a couple things quickl. iust wantt was made that parents and family members need on a c get involved. my mother committed suicide andt when a the police chief called me upe that and said she was gin lice chi extremely high doses ofy antidepressants and it's like ds the doctor puts a bullet in the gun.s i was so shocked.

weere more drugs to control her pain l because she wouldn't allow us im the doctor visits, we were not told what she was taking or why she was taking it.e if you can touch on on the non- medicaic painkillers and why wee were not told about these and what they are if the police and the courts could get involved to help the families when they know that there is abuses, why we got ty know thanks for sharing your story. and i'll lien

>> guest: we have a culture m nowot using pills for every mea, problem and not to say that somo of them were not necessary, perhaps they were but it doesedn wet to me that we have focusedd so much on the use of pills at the exclusion of other usproaches more under the on wellnesse rubric. t i stopped buying all the food they advertise on tv and weary began to work out for and i know that this is kind of part

of one of the lessons i take from this experience. looking at the labels and making sure we don't get too much sugar and that kinddowners of thing. s the easiest way is to go to the chiropractor and get your back eeve b fixed and if you miss that andn, get addicted acupuncture works better but the real situation is almost any condition because itr

is all about the immune systemcl condityou wat and you don't have any of the programs on tv all d we time and we can do it in a very cause and effective mannern and there's all kinds of seminal ight, you do for example. i'm not an expert in chiropractic medicine but it does seem to me the overall point is many ways of treating pain. we were working towards thatt: o kind of a more holistic way to treat individuals with a mystern of human pain.

role ihe doctor was alluding to is that there were a lot of approaches and insurance what companies ought to beo was that reimbursing for them all and we ought to be making use of them all as we pay very close be in attention to our own wellness and what we put in our bodies tg after this.lness and a little bit about how weant gues.nto this we put and why. i'm not an advocate.but is there a follow-up to this? >> guest: possibly. wemight go will see.

the author of the book dreamland and