>>. >> welcome to powerhouse thank you for your support tonight. we are very excited to be hosting tonight with the author american and overdose. and then we will take questions.

chris was a reporter for the guardian and former journalist of the bbc and a correspondent in jerusalem and washington dc and across the united states covering genocide in rwanda and palestine and economic recessions receiving the prize a professional integrity and awarded the prize for journalism that told the unpalatable truth of events and former editor of the author in 2008 and we wish to inform you and stories from rwanda. the national book critics circle award and the guardian first book award those have

been translated into a dozen languages you hide that you hate me. please welcome chris. [applause] >>. >> good evening it is an honor this one works. [laughter] a long time ago we met before

1996 and chris was doing truly outstanding reporting some of the best reporting i ever had the pleasure to read. so you have written about american overdose that i can say is a terrific book with an exceptional read and an urgent story how did you get into it? you have been in this country for a while how did you settle on this to focus and how did you get into west virginia? >>. >> how did i get into this? as a washington correspondent for five years that i didn't

want to be a correspondent anymore because i spent far too much time writing about sarah palin so i started to go around the country with those patent places of the marginalized community that that threw me down the path toward this epidemic because once you travel through appellation are parts of the midwest you constantly confront this epidemic. so out of the news reports came the questions that you don't really answer the questions that haunted me to say how is that an epidemic that really we are only here?

i would imagine most of you five years ago had no idea that in these communities they did. so how is that possible? so when you look to the statistics it is a uniquely american phenomenon. with 88 percent of the worlds population, i thought there is something very american going on here. so whatever it might be that is what drew me to try to answer that question. so there was a small town i was focusing on quite a lot so in the southwest of the estate

if you look at a map of the cdc of the opioid overdose going back to 1995 this begins in parts of west virginia to watch that expand year after year, through eastern kentucky and southern ohio particularly in places like maine and new england so where the employment is very labor intensive. so this is a town of three and a half thousand people where a decade into the epidemic you have roughly 20 million pills

per year going to this one town of three to half thousand peopl people. that is prescribed but also dispensed by pharmacies of what becomes a widespread operation to deliver opioids on behalf of the drug companies across appellation and up into ohio and bits of iowa. >> there are so many questions that come out of that so why is it that we only hear about that now? but that you see a lot that this is a group of people that are dismissed as hill abilities they are the

inner-city population to be stigmatized but they are written off at this is the population his well-being were health or condition is presumed to be wretched. so they are prey to the drug companies and they don't have advocates to look out for them is that the issue that they are written off as disposable or how does it get to be a single place could be that at the center to be under the radar for so long? >> that we are describing in this country if you go back to the civil war in this country those that were very badly wounded morphine is more common to be dealing with pain with a hypodermic needle so it

is much easier to use. so doctor start to use that which is extremely common in this country so that gives rise to the first morphine epidemic and for the first time you have a president teddy roosevelt who appoints a drug czar and a commissioner for opium opioids. and he describes america as the drugs worst one - - the world's worst drug fiends and then then that leads to a real resistance after that within the medical community with any type of opioids of any form.

that pretty much is the situation through the sixties and then from the uk after watching her husband die in immense pain without any treatment there has to be a better way to die. so the fears of addiction are irrelevant if you are dying if you are hooked on the drugs if they relieve the pain in particular for cancer patients in the last months or years of your life. so this movement is in britain and comes across the atlantic and as it comes across, it coincides with the rise of the group of doctors that opioids could be a much wider scale so they start to push the idea

you can use them to treat chronic pain and take them for quite a long time or rheumatoid they could be life enhancing drugs so there is actually very little they can do for chronic pain they give them drugs but actually it is damaging to your liver. so a group of doctors decide to fight the stigma and in order to do that in essence they start to fabricate evidence the big thing to

overcome is the idea of addiction so they take studies and there were a couple of key studies that suggested there is a 1 percent read - - risk of addiction that if you look more closely it turned out a group of patients in a hospital very controlled circumstances given opioids by nurses so there it is very unlikely it would develop the addiction and another example coming up with the theory of pseudo- addiction that it looks like addiction is not addiction your body reacting to the pain and when you go

back and look at that study based on the cancer patient but they took these studies and inflated them didn't think anybody would look closely then said they were completely safe there was no stigma and you don't need to worry so that would have floated around for a while but if they had not latched on to that idea they started to mass produce opioids to get them onto the market at a place like west virginia. >> they go down into the minds and so forth.

>> but they start to put out weak evidence they were not setting out to be snake oil salesman but it did take that to get it going and when you talk about the american addiction so it seems like you have a cast in west virginia that are american hustlers. with a former undertaker on capitol hill with so many corrupt authors that flock to this epidemic. in the fire chief whose family are all drug dealers.

but from the very top down to the ground of how much that connects the dots it's is sinister in that sense they are quite comfortable watching a massacre take place. >> and one of the reasons that happens is that we persuaded ourselves we were doing good at least some of them did the doctors understood they were just making money that the drug companies with the idea there was an epidemic of pain out there and that is the justification in the early to

set one - - 2000 if you go back and look nobody would ring the alarm bells and then you discover a lot of people were ringing the alarm bells and there are several heroes one is jane valentine who is the head of pain and of massachusetts general. she buys into this whole idea all i have to do is give me patience these drugs but they just are not doing well. they are in more pain than they were and their personalities have changed what are these drugs you are giving my husband or children because they are not doing well. it's hard to get them off the drug because they have become

dependent and then they replicate your paid to force you to feed the pains you have the illusion the pain is because you're not taking the drug not because of actual pain. so that sets out to look at what is really going on so what she does she puts together a comprehensive study that says we need to pull these drugs but this is worse off. so that comes out and now they

look at what is going on with the push of mass prescribing so as they react to valentine and others ringing the alarm bell so it creates the idea that america is suffering an epidemic of pain may have treated chronic pain one out of three americans. which is ludicrous so they frame it as a moral contradiction between those people who are addicted and those are legitimate pain patients those who became

addicted and they should not be allowed to take away those that legitimately need them and then to find the drugs but one of the same people that followed those legitimately to create a good and bad scenario and run with it and it's quite effective because those that are actually addicted and dying so they keep the floodgates open that way. >> so you have this man who starts the pharmacy that

becomes the pharmacy through which vast quantities that are disproportionately he's not someone who really has a theory from this one and that one. >> and with the reagan administration. and then with a remarkable cast that are all quite comfortable with that. who are able to dismiss anything that comes up those that are coming in with three or four subscriptions.

then he has pharmacies and doctors that we can only subscribe and then how do you get going? why do you think. >> and with harvard medical school? but i didn't get those communities that would smell something ugly then to meet up with people. because everybody was making money but then it affects the politics. that in the warehouse he sets up a medical clinic and finds a doctor who lost their

medical license and then to try to persuade the teenage patients to have sex with her teenage son and this is reported to the medical board along her issues of prescribing down there. coming to west virginia and then starts working in this clinic but somebody who will, who once these pills. and they will pay $250 to see her and will write a month worth subscription of pills but she doesn't want to see them again they will collect

at $150 cash ready and waiting. mass rights blank prescriptions for anybody that comes in with money down. within a period of eight years she prescribed on average each year more pills than west virginia's largest hospital. and diane shaver lost her license in west virginia i'm sorry kentucky so she lives across the border into west virginia and starts. so you end up with several doctors because one is recruited with the federal prison so then says you can make more money waking for me one - - working for me but actually he doesn't.

and then to find hundreds of thousands of cash lying around. and at one point and that itself on top of what the doctors are doing with four and a half million dollars a year in cash and a town of 3500 people. and then to buy these drugs they need to go to a pharmacy to get to spend so now you don't want to go to walmart so they come to a handful of pharmacies where they could

dispense and then that is interesting to take the pills prepackaged and then literally throw them over the bar. at eight in the morning people are just lined up and it goes all day. then that money begins to infect because essentially the judge the county magistrate, members of the council and various others are all on the payroll of this whole system that so many end up dead.

it takes over this entire town. and it is the structure of the town. >> and then to work together and then they just to get through the shift. and those that are totally involved why is there no voice to that with that political structure why is there no need to say this is outrageous that they cannot deal with their congressman? it takes a long time oxycontin

introduced in 1996 that the family is making $1 billion per year and then they double that. so for the half-million is a drop in the bucket and then it goes up from there. why is it so hard for those people to be heard? and to be shellshocked so there is a sense of powerlessness historically with those coal companies in particular while they were making many and there is a

real sense of powerlessness. why wasn't it difficult to get people to talk about this is anger. so to become hooked has an accident on the minds and starts to take low-level pills and then you take more and then he takes more and then to get whatever he can to feed his addiction and within a couple of years and then to prescribe oxycontin and she is addicted. and it isn't immediately clear

if that supply to get its own prescriptions but it is a horror story over the years. but to be full of incredible anger and the medical profession who said nobody in all these years ever said this might be dangerous. just keep taking this. if you are in pain take more. and is the pseudo- addiction idea philosophy. is still pushed by doctors and still is some. and of the past 20 years and to meet a lot of people like that.

and then to be led down a route to be destroyed. and then to begin to see with the wide awareness once it feeds into the middle-class communities and when they start to die to experimentation. but that they have to be through more of the usual judgments about people. but they do know how to do that. and to come out of those poor

communities. >>. >> bad is happening when? so those that are caught for the first time and those numbers are the death toll continues to rise. and the statistics go in all directions and how do you account for that or explain that? is that the ark that the hook and then they replace one with another. if it is oxycontin then it is fentanyl which is terrible.

so when do we get to that point? and then to see how the regulators. but first with those standards like the national drug policy. and those institutions and that is what permits this to go on.

but you still look at what went wrong after a while that they were not only very effective but they effectively market that to the system to the medical authorities. and to regulate to protect americans from this type of abuse. and to have that big effect that was responsible for licensing hospitals. and then to get medicaid or medicare money which is a good part of no income. but the drug companies push the idea that in those number

of organizations. and truly the campaign that the pain recognizes the fifth vital sign with heart rate and blood pressure but hospitals have to measure pain as a vital sign which is why you see how bad your pain is or isn't. so when people said five or higher they don't have to be referred to pain management which meant an opioid prescription. so they push this through the hospitals see you end up in the system very quickly and

then to fall back on and then watch the prescriptions for opioids escalate. and for those medical boards and that the states start to regulate and it creates the idea and the only way to deal with that. so that surgeon at detroit general of those that were

dying post surgery they stopped giving them high levels that one of the colleagues of the medical board and said for the number of times so what will you do you just do what they want? and with that of vice there were a number of pressures with the insurance companies and it didn't cost money for physiotherapy and most importantly the fda on board.

>> this it isn't the first book but it draws together the different elements and over time and then to knit those together and correct me if i am wrong but the fda i don't off of the top of my head to be in charge of looking into oxycontin and do not get any kind of tests done. and with the blitzkrieg and to escalate this.

and to be deeply compromised. >> and then to take oxycontin out as less addictive and more effective than other opioids because fda allows that to go on the label. and they did no checks itself to endorse what the company told that that when it does and it's a real turnaround. and with those opioids.

and with that global standard what was prescribed in europe but like my mother in 1959 she turned it down. for thousands of those being born before that was known with the fda for approval before that there was a scientist that looks at the data to say we need more information and he kept saying there is something missing from this. and kept asking for more that she was disparaged by the drug company that go around her and

then to hold things up. and then one year later everybody connects with very large numbers of being born with deformities so that saves american women and children from the same thing she has awarded medals by congress and jfk and hailed as a hero but that means that gave the fda great power to control drugs. that whole thing lasted 25 years just sets the standard for companies to do as they are told. then along comes of the aids epidemic we don't have long

enough for you to wait to test drugs you can experiment on us so the regulations for weaker not just to treat hiv and aids but all drugs. and that they could stop to pay its own way. >> so they use that to essentially break down the regulations. and congress. and with that ability to do this the clinton

administration and that this but 60 percent of their income comes from the drug companies. and watch that relationship evolve. it with the business relationship. and that leverage and then to go to congress and then to say they are not delivering but then gradually in time to come onto the market for the fda and the drug company will work hand in hand they never should

have been approved. >> we started off this evening by saying why is it this country has 85 percent of opioid addiction and you are giving us an answer because it is a complicated mixture of high and low but why is it? why are we susceptible is that a business it isn't public good that private? is it that set of attitudes?

and then that turns to be flat out deadly and why did it take so long? >> so that is very unique so the short answer is because it isn't a health service so it's all driven by the interest of drug companies and insurance companies and often it is not driven primarily by the interest of the patient so

that is the problems with public assistance and other countries where they have financial problems but it is a different sense of priorities. also to some degree the evolution of the past 20 years of the rising cost of insurance but that patients think of themselves going to the doctor what they want the doctor is far less likely than they were 25 or 30 years ago but in no other country other than new zealand permits the right to conceal advertising of drugs and then in 1997 when opioids came on the market the doctors will tell you there is a rise just the pills people

take in this country partly because of this mentality there is a pill for every ill because they see what's on television in the advertising particularly older people and those are telling of conditions they never knew existed but actually now they are prescribing pills to counter the effects but now with the insurance company with your doctor standing there spending half an hour that you need to do this and this is your lifestyle now they want to go for ten minutes and to be prescribed a generic pill.

so you certainly have that at work but with the fda relationship it prioritizes those business interest of the drug companies because that is part of the mandate so the fda has approved through this epidemic but then they came into the market and came up for approval and it was one year after sweat that point nobody was in doubt what was going on you have about 50000 per year dying and everybody knew or at least should know what was going on.

so at that point the recommendation committees concerted if every drug should be approved and then the epidemic so then they weren't asking all the right questions what is the chance this will be used? if it was ten times the power of your average opioid so it was very open and attractive on the black market and one fda official on this committee interrupts them and says the department says this is not your business your business is to decide whether this drug is any less safe than the drug already on the market.

if it is no worse than you have to approve it because there has to be a level playing field for industry so what that meant was if they were making drug if that was legal than everybody else had a license to do that then there was an uproar where the doctor said we have the right to put the public health first surely we don't need another high-powered drug on the market just ending up on the wrong hands so the committee voted 11 / two to reject approval of the drug but the fda approved it anyway so that was a real indicator and then we discover that same doctor that had the drug approved the

previous decade was in secret meetings that was taking place between the fda and the drug industry paying $40000 to be at the table to decide those procedures for opioids and that came out later in the e-mails that were leaked. but it is an indication of where the fda's head was at and the role that it played. >> you have been a foreign correspondent the last couple of decades working in south africa. how is it different here so covering the story as a foreign correspondent what type of advantages do you think you hav have?

not seeing it with those american presumptions? and i wonder that americans like to think we don't have problems like in the third world that we act like it's an anomaly but it seems to me we have structural corruption but not a lot of pay-as-you-go you don't have to bribe every cop or pay the schoolteacher to get a good grade but you do have to put up with institutional corruption and very high level of money is that something as a foreign correspondent makes a difference just even working in west virginia? is that an advantage or like talking about genocide because

you have written about all of these in different forms does that ring a bell that is different? mimic yes. it certainly helps to be an outsider people assume you don't know anything which could be true but but you make that judgment about who you are particularly in parts to be judged by other americans and people by the east coast with the idea because they feel so badly let down so they also have the regard that they

are talked about as if they are elites so i come from the outside and i'm not a part of that so that definitely helps also law enforcement as well i think people think you don't have an agenda and i don't other than to write the book but you don't come politically loaded. that definitely makes it easier. but yes i have been struck by the institutionalized corruption in america. i did not really understand until i worked in washington just how money affects the policy in congress. one of the reasons congress really did not act on this for so long was because so much money comes from the drug companies are campaign contributions in action is

what they wanted so they wanted the drugs to go on being prescribed but also how many people recognize that? if you are loss one - - law enforcement or prosecutors or west virginia speaking to the former attorney general not republicans or anticorporate that the returns in which they talk with the drug trafficking organizations and institutions that enable them and they definitely talk about congress to be corrupt for preventing this stuff and the dog - - the drug distributors to be

completely corrupted by money and this is a man who is a former pharmacist and trained as a pharmacist he is not antiestablishment but time and time again that they see the system structurally compromised. and it's true. i do think that there is so much money involved that the drug industry could do much more sophisticated way than if they co-opted institutions into going along with this policy. but in the end that's what it is none of these federal institutions have that responsibility.

>> so right now pablo escobar is on trial here. with that perdue oxycontin family? >> i don't know themselves how much individual family members knew because they died over the past five or six years and one of their sons got very very ric rich. i don't know how much they did or did not know but what i do think you hear time and time again from quite conservative people including the elected mayor from these towns and cities that were devastated by the epidemic including the congressman from eastern kentucky that was very loud on

this with those executives and drug companies once they were warned and they just kept going so there is a sense of corporations spending the past 15 years to buy their way out of accountability they pass my - - pay massive civil settlements without admitting liability. so basically this is the kind of thing that it won't happen again until the individuals making these decisions go to jail so now there is a lot of pressure building for that it'll be interesting to see where it goes especially a federal prosecutor trying to make his name i can see that happening. >> i would love to take questions but i also want to

quickly get on the one question is where are we with the policy level? trump said we have an opioid epidemic and we will deal with it so is an and insight are policies waiting to be approved are there good policies that are just not enacted? what is and is not being done and why? >> there is progress the fact that we sit here and talk about it suggests or a book like this suggest there is an awareness which is a big part of it and i talk about these parents in the book who have been very courageous on their campaign with that stigma.

>> these other parents from suburban and middle-class not up last year but have gone to college somewhere? >> also other large parts of the country to see that resistance. that was huge parts of the drug company and with that political issue that the biggest change was in the absence of any federal action the cdcs stepped up and in the mid to thousands was responsible for licking all forms of accidental death except car accidents he thought it would be interesting so he starts to

gather statistics and notices every single accidental death in this country in a year with the exception of drugs and then he got into it it was opioids and then he makes noise inside the cdc and nobody wants to hear it until the head of cdc and looks at this. >> other people have used it but because of his position they took notice and the cdc really

became -- got into a lot of trouble for this but it became really the pay setters for getting of institutions to move, and they met a lot of resistance until last year, the the issue guidelines recommended to cut their prescribing and they were told this isn't your business why is cdc weighing into this. this is practice of medicine other people are responsible or this and if i'm not just remember -- misrepresenting what you said to me, i'm essentially it was nobody else is doing it, and this is an epidemic for the business and we have a duty to do this. and the objections within the fd airings and elsewhere, but it had a huge impact because ordinary doctors took notice finally doctors were told by somebody sensible actually problem here is scale of a prescribing, and you don't need to be unsafe.

they don't -- they shouldn't be your default means of prescribing shouldn't be a first stop. and more importantly, they have no evidence there are no studies to say they are effective long-term which is what every doctor i've been tolding and there's no evidence for it and so -- that led to a shoift shift in thinking against doctor and promoted a number of states to limit how many day of prescribing of opioids there can be, and i think -- actually the prescribing has fallen although not dramatically as they probably need to in the sense that u.s. prescribes it three or four times rate of your average european company and 50 times rate of japan strangely. but -- it injected into the confers a consciousness about level that prescribing and appointed opioid

commission came out with a very good report on the origins of this epidemic of all of the factors which we have only touched on that fell into it also came out with good solutions. you now have this -- 8 billion dollar spending bill on some of it is quite good to fund alternative treatment and pain treatment some goes to treatment to those addicted that is a fraction of what is needed, and when you consider that the white house -- committee concluded that probably by time this epidemic has run its course it will cost the country a trillion dollars, 8 billion is a really small amount to pay, and the rising. >> not known for regulation. you sort of thing how do you dial all of this back right, in

other words, the argument if gun is why you couldn't regulate guns too many of them out there. obviously, people don't consume guns and then they're gone and -- so -- so that's a little bit of a different analogy but there's that idea sometimes well it just there you can't stop people are in pain and they want drug or atties there -- i know heroin addiction on the street methadone although argue against a substitute addiction on the other hand people can live on it and it's less destructive. is there anything like that that just waiting in the wings and that the drug companies themselves or others are resisting? >> no. there's no imagine pick bullet partly because of the nature of addiction. is people need different things. there are -- there are drugs that help some people. they don't help others, and very large number of people who have been been through process tell you you have to go through two, three, six times before you

merge other side finally able to live post addiction but you never completely past it. but you know, there are two elements to this. one of them is to reduce the prescribing because it is all very well providing the treatment. to the people who already addicted two or three million people out there dependent on drugs which is a huge number of people. you know, we get locked into the fact that 72,000 people died last year of drug overdoses. if you look 2 or 3 million people have a huge impact on their families if you're drug dependent and seriously drug dependent you're not log a ever your children that puts pressure on social services and state you're in and they took so many children in care they have to ship them other states, and you know, several of us were in -- in central africa in 1990s and you go to uganda and see a missing generation with the grandparents are looking after

the grandchildren. but there are places in west virginia where you meet more children in care of their grandparents than parents because of this, and parents are either dead or just not functional as parents. but second thing you have to do is you have to -- find another wave of people becoming addicted if you go to prescribing -- at the level then you will continue to create this -- this, you know, another generation. there is the awareness but always will be if those are out there and people are using them at the level to which they have been prescribed it in the past, and for all of the cdc guidelines and acl replaced last year i came home with 15 days worth of hydrocodone and you need about two, and when you go to the pharmacy and say i don't need all of these their advice is grind them in coffee grinder

and bury them and those are high value on streets, you know, you're not taking this sensibly so you need to be sure there's not another wave coming down the road that then -- needs so many drugs they turn to heroin and fentanyl as well as dealing with those already. hooked, this is a big, big task. [inaudible conversations] >> you have your hand up. [inaudible conversations] make sure everybody gets a mic. >> can you talk about the underground drug market for this? and also how much of it plays into the heroin addiction now that is so prevalent in the states? >> you never really -- i never really quite know you see statistics, and you never know how reliable they are. but statistic that has been floated around -- that seems to be the most

credible at the moment says that 70% of the people who overdose on heroin began on the prescription drugs now some of those will have begun through prescriptions for injuries or chronic pain. some of them began because they are sitting in a medicine cabinet at home and they -- such a likable awareness of the dangers of them that in some cases they simply got passed around as your regular painkiller got a headache have a pill. i think the cdc study which they essentially said that, you can become addicted to pills in as little as five days so you don't have to be taking them for very long but those vulnerable to it and stronger the drug more vulnerable. and then you have a black market because of two things. one is, the people that can't

get enough drugs to feed on addiction bought on by prescribing and then those who -- accommodate through experimentation. and the -- black market for many years was fed by pill mill when it started shutting down pill mills in west virginia new ones were going in in florida and they actually eventually became a biggest in the country, and florida has an unusual law that allows doctors to dispense normally you have to take a prescription to a pharmacy but florida -- allows you doctors to give you pills straight away -- and so these -- pill mills packed with doctors just handing pills to anybody who walked many and, and it was run by two brothers -- who hired and because the pill were in the pill mills, place became so dangerous that doctors carrying guns to protect

themselves. from people who couldn't actually afford 150 dollars. both of brothers are doing now 30 years in prison but at one point pill mill were prescribed more than any other place and those pills entered the black market, and you had a situation where the dealers who worked out they could make thousands of dollars a month selling them in a country where they have difficulty finding them, which would recruit all of the people in particularly people who have a lot of money in places like west virginia, they take them to the drugstore they buy drugs off them, and people would use that to pay their rent and it became an economy in a lot of these -- these smaller places. where -- people were making more money from dealing in drugs including -- including people who wouldn't normally dealt drugs but they

have a prescription it shall they needed money. and they became a primary economic force in these towns. and then they just flooded across the country these pills. >> what -- sorry. what actually is the law that supposed to control a doctor from doing that, obviously, it is wrong for somebody to be prescribing 200,000 pills in course of a week or month. but -- they're practicing medicine in theory, so if cdc is not able to regulate that, and they're not facing a civil charge of malpractice what's the crime and who is responsible for enforcing that crime? [inaudible conversations] >> is it legal to prescribe pills -- for that period of time? >> got them on mostly --

was a lot of doctors were prosecuted because of the evidence they weren't following medical practice and procedure particularly -- >> what's the law? [inaudible conversations] >> the law said -- doctor who fills out prescription one has to see a patient and two must fill the entire prescription at that time. you can't fill it out date it later and what they were doing was mass writing prescriptions and leaving them at the front desk for people to come to pick up every month in return are for a cash payment. so these are doctors that have been criminally prosecuted that kind of thing that dea would go after them because and fbi because of the way they handled a prescription that was often the armor if they could walk in to a pill mill and discovery which they did in west virginia. that there were all of these prescriptions prewritten that's illegal. you think it could show as they

did with katherine hoover who was seeing 300 patients a day which is -- just impossible she hasn't seen a patient she wasn't treating them. that is illegal so they get them on the procedure they're not follow the procedure by which you prescribe pills. and there was a legal obligation that finally the fbien manages to get into the pill mill because make an error and the error is that one of the prescriptions goes out to wal-mart. gets taken -- patient take it is to wal-mart and the wal-mart pharmacist notices that the gate is written with a different colored ink and different handwriting he calls da and it unravels from there. they've got no reason for their warrant when they go in. but -- that's how they in the end because one of the reasons that

doctors were able to get away it for so long is that federal prosecutors were reluctant to go after them because of the practice of medicine. how do you prove that doctor didn't know this person wasn't genuinely in pain so they have to show what they did was most of these is to show they knew they were prescribing to people in the circumstances that weren't legitimate but a doctor in california who is serving -- 30 years plea is a she was the first doctor convicted of murder for prescribing opioids and they got her on the regulations and showed that she -- her breach of those regulations left led to five deaths. that she wasn't following medical practice or regulation of how you write prescriptions. >> murder is same charge. >> her on state charge of murder. yes. >> ask a quick question about -- one of the things that i've

wondered about a loosening of prescription in general and it is perfect indicator it was the fifth -- vital statistic, right so -- heart rate and blood pressure and other things things there's a metric for, and pain is sort of this, you know, smiley faces or you know doctor says you know, a nine out of ten or a 7 out of ten you're like i don't know. what you got -- and there's also, obviously, a huge explosion of the prescription of anti-depressants all sorts of other drugs which aren't necessarily -- well they may or may not be destructive but you can argue they maybe people become dependent on them but not destroying those people's live bus they're loosely prescribed they're often prescribed by people who have like a you're supposed to check in with them once a year and it is a few questions they get another prescription. there's an attitude that goes with fill fixes everything that isn't born of the opioids now i wound per there's a correlation between two or anybody tried

that you have comed across to try to correlate the explosion in just the idea that there ought to be a pill to fix things and that some of these are a god send. right, obviously, and some of them are a nightmare. so patient is going to doctor saying i have these problems -- but doctor faces a choice saying well actually it is because you're badly overweight you don't do any -- you don't do any that's why your knees hurt or you can have a pill. and the -- often walking into these -- into these appointments expecting the pill not to get a lecture and doctor will tell you it is a hard conversation to have with patient after patient when you supposed to get them and insurance wants to get them through ten minutes at at time let's talk your lifestyle and they don't want to hear they want the pills. so there's a border mentality absolutely and you know, but the pain contributed to was people

who were genuinely dependent learn the system because there's no doctor judging on whole you're pointing at 8 out of ten, particularly with emergency department they learned to walk into the emergency department say i'm in terrible pain i need the pills and depending on the hospital you would get the pill and that became a common way i think there was a point at which i think a third of all pills dispensed were through emergency departments to learn to get the pills but yeah, undoubtedly border idea that you bought pills it was all part of it. >> i'm unction -- understand what you're say about black market but how does a worker -- who has become dependent on these pills report one who is

poor and unemployed manage to keep taking these pills have them dispensed to him for 20 years? and i mean, that is -- as i understood from what you were saying, that was a person who was involved in the black market or wasn't doing anything illegal. they were as if i -- thought i understood it legally dispensed to him. >> well it was illegal in sense that it was going to pill mill and getting them from there and he knew full well that, you know, he was getting prescription after a prescription which wasn't legitimate. >> where does money come from if he was out of work? >> he wasn't that quite a large number of people who are dependent or addicted on pills go on more or less functioning it shall -- so he was still often working but spent a thousand a week on getting pills from different places.

look i noticed doctor shopping where you would go from one doctor are to another because there was no -- monitoring there is now. but no monitor of different prescription and so you could -- you could literally go to three doctors in the same hospital and get three opioid prescriptions. a lot of -- particularly in place like west virginia, a lot of workers initially came at ohm yoidz come through worker compensation scheme that's a they pay for it so for a while you're funded. it's when 20 years -- >> not for 20 years but when you become dependent and needing more than they're prepared to prescribe yes it takes over your life. you describe how the the money that should have gone to his children and to other things -- just went to pay for drug. but it also -- you know it contradicts to crime boot. there's plenty of crime because

of this, and there are -- you know, small towns in eastern kentucky where people will tell you 20 years ago we never locked our door 20 years ago, you know everything was safe around here. we all knew each other and now -- we with don't trust our relatives what if did you know comes home and lost everything including -- because he was collecting had a knife and gun collection for his son and he discovered eventually his son robbed him. and the -- the level of distress that grew up in community because they people are so desperate for drugs they basically will do anything. other thing is that huge rise in prostitution -- in possibly eastern kentucky and it -- women in prosecution got younger and younger mayors talk about

impact of that on their towns. and then other thing that happens is, of course, you start dealing. you know, if you want to have a source of cash you deal. [laughter] so -- you need, you know, i know how many let's say he needs 20 pills day you buy 50 and take them off to higher and sell them there. one -- i talk to a group of guys who were -- opioid users in boston, and they found their entire thing by doing one in florida bringing pills become and telling them twice the price. and then when heroin enters the majority and it pops up in florida or a lot cheaper they start bringing it back. until -- like many people actually they become so addicted it takes over their life and they can no long. but you can, you know, a lot of people for many years do actually function. and it's why when you hear people say i don't know but he's

addicted but that may not necessarily be true. mayor of huntington, west virginia told me couple of years head-to-head attitude the way to do it was to punch him on the nose throw him in jail tell him to -- clean up their act and then he discovered there were eight people on mayor's staff that were using pills. and then he started okay question need to think differently about this and he's been successful at leading effort to change the mind effect of both institutions like the police, but also ordinary people in huntington in stigma how you think about because he's had to go through that process himself. yeah. >> great to see you thanks for doing the book i look forward to reading it. if we think about the structural what's happening we don't deal well with with pain. we with don't deal well with addiction and two things are overlaid on an economy that is very difficult for increasing

portion of people. but until you see what we've done easy to say it was epidemic that data was crystal clear it was much harder to say and this is what needs to be done where usually you know do infection control over vaccination with opioids it is really difficult, and i think you've made a really important point here to think differently about the two or three million people who are addicted today and everybody else because any different approaches reduce the risk and one is to improve prescribing when we release the guidelines that you mentioned, we did get a lot of pushback we got with with a lawsuit that group ended up being industry funded. we are forcedded to delay it for a few months for additional ministry procedures to respond to 4,000 public comments but what we learned through that process was not only is there not good evidence that medicines helped in the medium or long-term there's pretty good evidence that they make it worse and take opioids become kind of

acclimated to feign relief and they feel more pain. with the same stimuli in future and they're less able to go on with their lives. so almost no role ever for these medicines in chronic pain and way too often used and used in acute pain for addiction you see -- the change frankly from when it was black and hispanic people it was moral family when it was white people with a it has. it is always been a disease it changes way your brain works. and it does that long-term. one of the things that really -- and we've started when i was at cdc take a few years to -- to come out is -- what works in materials terms of treatment i'm infectious disease by training what is long-term success rate of any treatment? that's never been done in the actual, living world for all of the different modality so cdc

has a study over two to five years many of us suspect that many of the drug freed programs have low success rates. not narrow -- not that they're -- but that most people who have those changes in their brain are going to need something to help them short or maybe independently methadone or another drug so one question for you. one of the things that always was frustrating as cdc director was role of the what's called sam, substance abuse mental health administration. they actively opposed efforts to make it easier for doctors to prescribe. they sent out resources to programs unlikely to be helping people who are addicted and they ran surveillance system so that wasn't commercial interest. they were disefl commercial interest involved in here. but overregulating -- not rigorously looking at some

of the treatment outcomes now that may be treatment industries, as it is. but -- did you have a sense of what the role they could and should have played with functions of that you don't and how that could have been better done in the federal government? >> my sense of all of the federal institutions to be honest for the cdc was that they weren't entrusted. they were -- plenty of studies and to his own studies nothing ever angted on as far as you can make out. a doctor who is on president's opioid commission said that when she looks at all of these federal institutions on what they could have done, she said, they spend a lot of time looking up what they could do, and then never did anything and she had, she had the sense that that was partly a failure of political leadership so there really wasn't --

any national -- there was a lack of national leadership and there wasn't a political interest and because of that -- really these institutions on the whole weren't going to take it up she felt they weren't motivated because nobody was motivating them and they have their own -- the national institute for drug abuse is a good example of this. it took attitude that it was going to only deal with treatments rather than any other role, and you -- that is fine. but there was a point of impact at which they could have played important role in prevention as well, and they just decided it was too much trouble. i think part of it my impression talking to some people about this was they didn't want to go up against drug company and prevailing mood in congress which was influenced by drug companies this too politically n contentious didn't need to federal and doing fine with whatever track they were on. and you know, as i've said i

think that was a failure of -- national leadership. but it was interesting here what you have to say about cdc and how these don't work long-term and all of that. before you got here i was talking about john's paper in nulled journal of medicine in 2003 that was saying in 2003 and 15 years later finally, it's recognized -- for what it is. which was exactly right. but it took the cdc to kind of pick that up again and get it. and one of the reason ares i think it was, you know, you talk about cdc wantings to do studies there were never studies. the industry resisted study that would show anything other than what these drugs were. they must have had their suspiciouses. but the studies were never done industry wasn't going to do them, the fda which could have

required them had the mechanism, there are people who were in the fda called peter who was a person who said yeah we with could have done these study. we had authority to force drug companies nobody ever did, but one of the things that's blinded this is lack of real information we've seen outcomes. it seems pretty obvious that mass describing created an epidemic it seems from jane said and what you're saying that these drugs don't work and for all of this nobody is ever really done studies and that's to my mind because industry resisted it. >> to associate the american medical association have they tin a line on this and do people listen to what their line is? [laughter] >> the time american medical

situation didn't want to inconveniences doctors that was basically it. so -- two members of congress, the guide i talked about from eastern kentucky rodgers who was a voice for quite a long time, and then a congresswoman mary bono who's son became hooked and much later she came to this and they pushed through something called wine and kreegen act and kid became addicted and died and what that law would have done would have required doctors who wanted to prescribe opioids to have training in comprehensive training in pain treatment and addiction. ...

>> and leading the fight against it was the american medical association. but they have a close relationship with the industry as well so you cannot deny the people that these need these drugs the 100 million that are in chronic need you must not deny them access because of the abusers. and to this day really they have retreated from their objections from that compulsory training of doctors but it is really in the fate of the political reality that

they will not discuss the past they only want to talk about the future. >> i'm looking forward to reading this book and thank you so much for your work to tell the stories. i grew up in a community not as severe but i have seen the devastation of what these drugs do and sitting here listening to you talk it does sound like a very american epidemic. but what i'm curious about is we see the devastation and how egregious but the staggering amount of money with very small group of people so where is that money going or what is the motivation?

>> so the institutional corruption? >> if they are influencing the politics? >> after they get the money they need more it is a human trait. >> that the family makes $15 billion from this. so now actually they money they give to the institutions is a tiny fraction compared to what they have made at one point it made them the tenth richest family in the country. that is the kind of money that is being made at the top. oxycontin was pulling in

three.$4 billion per year in 2009 that was no effort but also in the system and that was making $1 billion per year. so that the height the opioid industry was worth $8 billion per year. so i don't really know how to explain how it works its way through the system it works its way through the political system in the sense through campaigns and campaign donations and all of that. but the lobbyist for the pharmaceutical trade industry on capitol hill as a congressman goes over in the late 2000's specifically on

opioids and became the highest paid lobbyist in washington dc which tells you quite a lot about the power of the drug companies but then it destroys everything but in diane shafer's clinic they found $400,000 in cash just in the petty cash box and that was just a fraction of what she was worth and the doctor looked at the four bank accounts and one he had $1 million in cash sitting he told the police it was his name on it but he never said it up but that was probably true.

the receptionist they rated her house and found $480,000 in cash in her house. that is how much she was making as a receptionist and her husband was a state police man so when the fbi said where did this come from he tried to say i do a lot of overtime. [laughter] so they seized the house that they did prove that that as the fbi agent that rated the house said he built it in an area where he stored all of his guns and they cannot believe it the fbi agent said when you have that kind of money you have to buy something and he likes to buy guns so they had to get a u-haul van to take it all away.

>> yes. think you. [applause] [inaudible conversations]

>> i grew up as a neighborhood became more black you could feel the deterioration people taking money out of the schools and the attitudes of the teachers towards us and i could see it as a young child. i was that kid who came home from second grade and i was all disgusted we were not learning in second grade. i would come home and say we did not get homework again. [laughter] i don't know how we're going to prepare for third grade this is outrageous. i was that kid. my mother wonderfully said i wasn't raising children i was raising adults so she taught us to express ourselves and to speak our minds.

so in kindergarten you can see there are kids of all backgrounds we played together and add each other's homes and little did i know people were whispering in their ear the realtors were saying get out it is turning into a ghetto you better run. by the time i was in eighth grade as you can see in this picture the neighborhood was all black. so that sociological phenomenon of white flight has been going on in communities all over the country and i stopped here because they want us to understand that in that time people were afraid of us. just hold that thought because we are going through that right now where we tell ourselves are being told we need to be afraid of people who don't look like us or don't speak the same language because somehow we are to be feared. there were white folks who were afraid of michelle and

fraser and southside and i want us to hold on to that because that still goes on with the notion that people look at the color of your skin and make assumptions of who you are. they didn't know we were kids striving to be good at our father was hard-working. they didn't care but they were running from our race and we still do that. >> - - just a portion of her talk in new york city watch for more in-depth coverage saturday december 1:58 o'clock p.m. and sunday december 16 on book tv. [inaudible conversations] >> good morning. we will get our program started now.