readers. here's tonight's prime time lineup. first up, journalist chris mcgreel. at 8:45 p.m. eastern, former guardian editor-in-chief alan rusbridgeer. and on "after words" at 10 p.m., economist stephen moore discusses the economic policies of the trump administration. we wrap up our prime time programming at 11 with pulitzer prize-winning author jack miles discussing the god of islam, the world's second largest religion. that all happens tonight on c-span2's booktv. it's four days of nonfiction authors and books on this holiday weekend. television for serious readers. ..

. >> he has won several awards coverage of israel and palestine in his economic impacts on modern america he was the prize as work as a journalist for national integrity and the award for

her penetrative establishment of events a long time staff writer and the author of standard operating procedure and we wish you inform you we are here to inform you which has won a national book critic awarded guardian award and his sharp fiction and essays have been translated into a dozen languages please join me to welcome chris mcgreal. [applause]

. >> good evening. is my microphone on? . >> i think we met in rwanda in 1996 or maybe earlier and chris is doing those truly outstanding reporting from everywhere he has reported and it has a pleasure to read but you have written a book about american overdose is a terrific book, writing, and urgent story, how did you get

into it? how did you settle in on this and how did you get into west virginia? . >>. >> how did i get into this? was a washington correspondent for five years then i decided i didn't want to anymore writing about sarah palin. and what did not get written about. and about poverty that drew me down the path towards this rocket one - - epidemic want

to travel you constantly confront this impact on society. then came the question the two questions that haunted me that how is it an epidemic that yet we are only really here talking about it now? because most of you five years ago had no idea of the scale of this but in these communities they did ever living with it it was as invisible to many parts of the state and the other question it was uniquely american and 5 percent of the world's

population there is something early american going on whatever it might be that is what drew me to try to answer that question. williamson west virginia is a small town i ended up focusing on quite a lot and the very southwest part of the state if you look at the cdc has a line of opioid overdoses going back to 1995 little red dots in west virginia you watch it expand year after year through kentucky into southern ohio dots pop up in different places like maine and they

shared a lot in common with appalachia where it is labor-intensive but it begins in with those three and a half thousand people where a decade into the epidemic you have roughly 20 million pills per year going through this one town of three and half thousand people. being prescribed nose but also disposed by pharmacies that what becomes a very widespread operation to deliver opioids on behalf of the drug companies across all appalachia.

>> there are so many questions that come out of that which is why is it we only hear about it now? what questions do you address that you see a lot that this is a group of people dismissed as have been one - - hillbillies? they have not been stigmatized but they are written off it is a population whose health or condition is presumed to be wretched. and they don't have advocates is it because they are written off as disposable or how does it get to be a single place could be that kind of

epicenter though whole describing in this country that didn't happen anywhere else a lot of soldiers are very badly wounded to be, more and more common name to with the name it comes with a hypodermic needle so it's much easier to use. so doctors start using it for all kinds of pain it is extremely common in this country and it gives rise to the first morphine epidemic alongside the life of opium and for the first time i have

a president roosevelt who appoints a drug czar and as a commissioner of opium and opioids and describes america as the world's worst drug fiend and to combat the use of opioids in any form which leads to a real resistance within the medical community any kind of use of morphine and that is the situation through the sixties then the uk comes the hostage movement after watching her husband die in immense plate on - - immense pain there has to be a better way of dying. so the fears of addiction are

irrelevant if you are dying if they relieve your pain especially for cancer patients in the last months or years of your life. then it comes across the atlantic and it coincides with the rise of a group of doctors in the 1980s who think that they could be used in a much wider scale and they start to push the idea you could use them to treat chronic pain and acute pain so post surgery you can take them for quite a long time until the pain goes away or with the chronic pain bad knees or rheumatoid or rheumatism because doctors see people with chronic pain all the time and there is very

little they can do for them. they give them drugs but actually it is damaging to your liver. group of doctors decide that we need to fight the stigma and in order to do that they bifurcate the evidence so they have to overcome the idea of addiction so they take studies week week week and there were a couple of key studies and one suggested 1 percent risk of addiction with opioids. that came out of a study that actually when you look more closely, it was a group of patients in the hospital very

controlled circumstances given opioids so therefore it is very unlikely large numbers would have addiction. and as a pseudo- addiction what looks like addiction it isn't it is just a body's reaction to the pain and eating more drugs to feed the pay not to feed the addiction but what we did nobody would look closely and then that these were completely safe and there was no stigma around them and you wouldn't need to worry about opioids.

the idea floated around a while and then to latch onto that idea here is an opportunity to make a very large amount of money and they start mass-producing to the market they look at who is already using painkillers like west virginia. >>. >> so they have weak evidence. but they want themselves in on the take at the outset they were not setting out to be snake oil salesman but they did take it to get this whole thing going and to talk about this addiction everybody has

corrupt scammers it does seem like you found quite the cast in west virginia that are distinctly american hustlers and as an undertaker on capitol hill who pops up running the pharmacy who seem to just fire chief family there is from the very top from the family of the pharmacy and connects the dots and to be beyond the world for

a massacre to take place like a big pot of money. >> one of the reasons that happened is that they were doing good, at least some of them in those doctors that were mass describing but the drug companies persuaded themselves of the idea and that becomes the justification so we go back and look did nobody reading the alarm bills? but you discover a lot of people were. there are several heroes one is jake valentine the head of pain and it's from massachusetts general.

and then to buy into this whole idea. >> that they just are not doing well. and that pain after a few months it with those personalities change. and to get these drugs for my husband or children because they are not getting well. and then to replicate your pain. because the pain is because you're not taking the drug because of the rising pain of the effect of dependency or addiction. and what she does is and may

be a short term there is no pain but then you are not worse off. this was 2003. so this would cause anybody to pause. does a push. and then to ring the alarm bell by going for a distraction. to find an epidemic 100 million americans that is

ludicrous but they frame it as a moral those who get addicted if they are abusers. they should not be able to take away the drugs from those that need them. of those who are addicted but then they are so addicted to find the drug on the black market or the people who originally had prescriptions and now they have to steal

them so they create this good and bad scenario and it is quite effective for quite a long time because those who are addicted and dying and then they keep the floodgates open that way. >> but henry who starts the pharmacy becomes the pharmacy through which these fast quantities disproportionately quantities come through. he is not somebody who has a theory about this he's just in their like a shell companies of his parents running at this one and that one. >> he is running it as he ran the service in washington d.c. until he was arrested and thrown in jail and then people

were committing suicide in the reagan administration then he comes out and sees a new opportunity. >> he's not in maine pain but he has a remarkable cast of supporting characters who are also comfortable with that and are able to dismiss anything that comes up and don't even pay attention and watch this going on people are coming in with three or four prescriptions selling it for twice as much and don't care he has doctors and pharmacies we can only prescribe to this pharmacy and prescribing to those they barely met so how does that get going? and why was there so little resistance within the communities so there was alarm bells like at the medical school but there were people in the communities who smelled something ugly but it sucked

them in more than those who said this has to stop quick. >> yes because everybody was making money in the end it was the politics but henry comes out of prison to see this opportunity and in a warehouse that his mother happen to own he sets up a medical clinic to recruit doctors that our pretty dodgy and finds a doctor who lost a medical license in florida amongst other things she manages to persuade one of her teenage patients to have with her son because he needed sex apparently and this is apart from the issues and comes to west virginia and she starts

working in this clinic and somebody will come who will want to be fell they come from far and wide hundreds of miles and they will pay 152 c hurt one up at 250 and she will write them a prescription and then she doesn't see them again and she doesn't want to see them again they collected for $150 cash from her as a lady in waiting just mass rights blank prescription for anybody who comes in and puts the money down. and within a period of eight years on average she prescribed more pills than west virginia's largest hospital and one who lost her license in west virginia i'm

sorry kentucky then moves across the border to west virginia and starts you end up with several doctors. because henry vincent recruits him because as the doctor in the federal prison and says what you like to earn more money working for me and that's what he does so they are just writing prescriptions to anybody and taking cash so much so that when the fbi eventually raid the clinic , they find hundreds of thousands of dollars in cash lying around stuffed in the beds and at 1.1 was taking $1 million a month into a bank account and the clinic itself on top of what the doctors are

doing in 2094 and a half million dollars per year in cash. this is the kind of money in a town of 3500 people. but those people were coming to buy these drugs from far and wide and what happens they could not bring too many alarm bells so they just had a handful of pharmacies that they will dispense of the prescriptions so the police observation reports there are so many people going in that have the pills prepackaged in 30 and 60 and 90 they are literally throwing them over the counter over the bar as people just march up and then they throw it over the top they catch it and then there you go people are lined up at

five or six in the morning and it goes all day and that money also begins to infected by the end of that essentially the county judge, the sheriff, the county magistrate, members of the council and various other officials are all on the payroll of this whole system some of them end up in jail summit takes over the entire town essentially it is the financial structure of the town. >> at what point do people start to watch i know you tell some stories as people come in to give them their pills but at what point the people that

are not totally involved? why is there no voice to that? you say there is a political structure but why is there no ability for people to say this is outrageous? this is killing us so it takes a long time and then oxycontin if i remember correctly and then to make $1 billion per year so far and a half million is just a bucket and it's just a national scale going up from there so why is it so hard for us to be heard?

why do they shellshocked that reality? . >> that there's a sense of powerlessness. they felt corporations are coming and coal companies in particular and while they were making money but they left nothing but destruction behind they hurt and a sense of powerlessness but why wasn't it difficult to get people to talk about this? it was anger so one becomes hooked by accident because he starts taking low-level pills and then as the pain gets worse he becomes dependent but the pain as an injury and

doctor say take more so he takes more until he gets to that point where he's going to those clinics just to get whatever to feed his addiction and within a couple of years of him becoming addicted his wife gets a hysterectomy she gets prescribed oxycontin then she is addicted within another couple of years the eldest son who works in the mine is addicted and is not immediately clear if he was taking his dad supply or getting his own prescription but he ended up i won't tell you what happens to this family but it is a horror story over the years and speaking to this they are full of this incredible anger the medical profession and says all those years nobody ever

said it's dangerous they just said keep taking it if you're in pain then take more which is that addiction philosophy and and is still used by some doctors and he built his life over the past 20 years is only been two years he was not taking opioids and you meet a lot of people like that that sense of power they simply did what their doctors said that it has destroyed their lives but what changed of course, that people understand how systems work and then they began to see the awareness to

those middle-class communities faced by california when kids are dying and they wonder what's going on so even they have to break through the stigma and go through those usual judgments of people who end up addicted but they do know how to do that and that's when you beget to see a rise but it never really comes out of support. >> so it really is and this happens when? it does break through a little bit and the drug companies are caught for the first time in several are on the defense but yet it just keeps going the

death toll continues to rise the statistics keep going up in a bad direction but yet we are more and more aware of that so how do you explain that is it the inevitable arc that the addictive book of these replace one another than oxycontin and then fentanyl and that's trouble to? so where are we in that arc and how does it get to that point? . >> in the book i look after where they were supposed to be watching americans this is full of institutions that have responsibility for drug abuse like the national institute for drug abuse or the first

the white house drug czar for national drug policy. so through these institutions or organizations one way or the other failed americans and that is what permits this to keep growing even though there is a greater awareness. so looking at what went wrong the drug companies were not very effective at marketing their drugs to doctors that they marketed to the medical authorities of this country to get them on board they were co-opting the institutions that were supposed to regulate and protect americans from this kind of abuse and one

example pushing through the mass prescribing the general commission was responsible for licensing hospitals if you don't get federal money without medicaid or medicare many which is obviously a big part of their income so they want to meet those standards. and the drug companies pushed the idea that pain needed to be better monitored and a number of organizations one was called the american pain society and through them they led a campaign to have pain recognized as a fixed vital sign heart rate and pressure that could all be measured in hospitals now have to measure pain as a vital sign which is why when you go to the clinic these days you will see smiley

faces and you have to say how bad your pain is or is not. this that doctors were obliged to do this so five out of ten or higher they had to be referred for pain management which meant opioid prescription the joint commission essentially push this through the 40000 hospitals so that you ended up with the system very quickly and which doctors were obliged not even monitor pain but essentially fall back on the opioid positions for treating pain and watch those prescriptions escalate and that was just one element and the fake medical boards and the state board start to regulate to monitor pain and

it creates the idea of this pain issue the only way to deal with it is prescribing opioids and any resistance to that actually there is a doctor who was a surgeon at detroit general had been serving since 1960 and he was observing patients would do a high amount of opioids post surgery then they stopped giving them high levels and he finds himself up before the ethics board and going to the state medical board he was able to resist it because of his experience but said what are you going to do if you are a young doctor you will do what they want which is prescribed these pills and said it is a tyranny.

and there were a number of other pressures this is an easy way to deal with pain it didn't cost money it wasn't like therapy so it has to be opioids so one institution after another bought into the industry and then most importantly the fda comes on board. >> i should draw attention to the fact the first book that is not written about this but it draws together all the elements this underground experience but also the history over time and how it unfolded but also policy and knitting those together in a way that is what really distinguishes your project and

the fda themselves this man at the fda who starts off basically to be in charge of looking into oxycontin and then financial goals no kind of tests done to avoid clinical evaluation that works for purdue within one year and part of that marketing campaign was part of the blitzkrieg to escalate this and the fda is deeply compromised if not corrupted during this. >> one of the reasons they could take oxycontin out and marketed to doctors as less addictive and more effective than other opioids because the fda allowed that to go on the label which defined what the drug was that that is what purdue pharma told them and

the fda did no checks itself adjusted with the company told that but then it says this is the fda has approval this is what the fda says. it is a real turnaround for the fda because by that point it is deeply compromised and deeply complicit in the promotion of opioids but the fpa on - - the fda in the sixties setting the global standard was a drug called for little my which was widely prescribed in europe to pregnant women to treat morning sickness in 1959 my mom was offered it but she turned it down that led to thousands of babies being born

with very serious deformities. before that was none - - before that was known seeking approval from the fda there was a scientist at the fda a woman who said there isn't enough here we need more information and she kept saying there is something missing from this she kept asking for more and because she's a woman she was disparaged they went around her to the senior officials she's just making things difficult just approve it is being used in europe everything is fine. she resisted and one year later everybody in europe connects this very large number of babies born to the drug and that kills it being marketed here in the states

from american children being the same thing she was awarded a medal by congress and jfk and hailed as a hero but that gives the fda great power to control drugs and that lasted 25 years they just set the standard and drug companies have to do is they are told then comes aids and ronald reagan and the aids epidemic understandably those were hib positive one - - hiv-positive we can test drugs you can experiment on us basically so the regulations were weakened but not just for drugs to treat hiv aids but all drugs and along with that essentially the idea the fda could pave its own way and the drug companies start to essentially allows them to license their drugs to break

down the regulations as more forward through congress to get approval time speeded up but they are given the ability to do this because what happens the clinton administration introduces licensing of drugs that the drug companies have to pay for and the fees go up to find the fda 60 percent of the income comes from drug companies watch that relationship evolve from regulator and regulating to a business relationship where the drug companies are the clients in that language

of course, they could go to congress with two.$5 billion per year to lobby to say the fda is not delivering so you see all this pressure build up on the fda so in time with the situation by the time the opioids come onto the market actually the fda the drug companies are working hand in hand which opens the door for the drug companies to co-op the fda to approve these drugs that never should have been approved. >> so you started off by saying one of the questions that got you into this why if we have 85 percent of the worlds addiction or use and in

a way you are giving us an answer it's a complicated mix of america structure high and low but what do you think it is? why are we susceptible? is at the way the medical system is structured as a business rather than social welfare? is not public good but private or a for-profit industry? is it our attitudes that allow this to take place in order to fix one thing some of that just turns out to be flat-out deadly? and why did it take so long because it seems like a very bipartisan failure to recognize that they failed. >>

[laughter] . >> they are all very uniquely american things at work the short answer is because it's not a health service it is all driven by the interest of the drug companies and the insurance companies and the hospitals. often it is not driven primarily by the interest of the patient and that on the whole are the problems of the health care systems of other countries the financial problems is also driven by the patient's themselves over the past 20 years because of the cost of insurance but the idea that patients think of themselves as clients they go

to the doctor they tell them what they want the doctors will tell you they were less likely to listen to the doctor than they were 25 years ago and part of that is medical advertising in this country so this permits direct to consumer advertising and after 1997 when opioids first came on the market the dock doors will tell you just the rise of the pills that people are taking in this country because of the mentality pill for every ill that's what they feared with the advertising and doctors will tell you people come in complaining of conditions they never knew existed but they see it on the television and it's gotten to

a point where they are prescribing pills to offset the side effects of the pill. and part that is the financial interest of the insurance companies because your doctor is spending you half an hour to tell you really your problem is you are overweight this is your lifestyle to reduce stress now they just want to come in to ten minutes to prescribe a pill. so certainly you have that at work but with the fda relationship it prioritizes business interest of the drug companies because it believes the mandate so in the middle of this epidemic the fda has approved more than 50 opioids right through this epidemic

but then coming onto the market coming up for approval it was one year after the cdc said there is an epidemic sweat that point there is no question what is going on but at that .50000 per year are dying everybody knew or should have known what was going on. so the fda makes a recommendation committee if the drug should be approved and the 13 people on this committee they are asking the right questions like do we need another drug on the market or what are the chances this will used by people that has ten times the power of your average opioid and to be

effective on the black market senior fda official on this committee interrupts them and says to the department that deals in opioids that's not your business. your business is to decide if 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 that meant if one company makes a drug that is out there if providing that was legal than every other company has the right to do that. the committee where you had the doctor say but surely we have the right to put the public health first we don't need another high-powered drug on the market ill and up and

more hands feeding this epidemic so the committee voted 11 / two to reject the drug and the fda approved it anyway and for me that shows where their priorities are and then you learn to discover that same doctor who was head of the drug approval division in the previous decade had secret meetings that was taking place between the fda and the industry which they were paying $40000 to be at the table to decide those procedures and that all came out in these e-mails so it is

an indication where the fda's head was at and the role that it played. >> to be a foreign correspondent over the last couple of decades through south africa and the middle east, how is it different as a foreign correspondent what kind of advantages looking at this from the outside may be not seeing it with those american presumptions and also i wonder americans like to think we don't have corruption may be in the third world or somewhere else we say that's corrupt but that's the anomaly or we have structural corruption but you don't have to bribe every cop or pay your

schoolteacher rather than just flunk them but you do have to put up with institutional corruption is that something being a foreign correspondent makes a difference even just working in west virginia? even though you don't sound like them is that an advantage in many ways when you talk about a doctor in rwanda committing genocide you have covered a lot of these in different forms where people suffer and the policy is out there does that ring a bell or feel it's different for the rest of us quick. >> it certainly helps to be the outsider. >> but the idea that there is

a sense of appalachia to be judged by americans particularly those from the east coast and with those police of the doctorate. that definitely helps. and then to have the agenda so yes i have been struck of that

institutionalized corruption. and affecting that policy in congress. and so much money comes from the drug companies and campaign contributions they didn't buy a policy that in action they didn't want anything to happen. and so to dealing with law enforcement and in the case of west virginia and with

anticorporate. and to talk about the institutions and through the dea division and those distributors very vigorously this is a man who is a pharmacist and a lawyer. and i was struck by it that they see the system structurally compromised and it's true.

with much more sophisticated way and if they co-opted those institutions but in the end that's what it is. with those federal institutions to have that responsibility. >> right now pablo escobar is on trial here does that seem right he is on trial and they aren't and for those individual family members that set this up and those that have died over the five or six years how much they did or did

not know and time and time again including the elected mayor for republicans and the republican congressman for eastern kentucky that once they were worn and show the evidence and corporations and executives over the past 16 years to buy their way out of accountability. without liability.

>> and it will not be prevented again and now there is corporate pressure building for that. and for election of parts of this country so where are we with that policy level funding? we have an opioid epidemic then there was another new cycle five minutes later and then not getting enacted and

what is being done and why? . >> and the fact we are sitting here talking about this shows there is an interest in the book there is an awareness and it's a big part of it. that have a courageous campaign with that stigma around drug addiction not appellation but those who are in college somewhere quick. >> also absence of change you can now see that translate to large parts of the country and that is huge parts of the drug company narrative.

but the absence of any federal action the cdc stepped up. . . . . with the exception of drugs. when he got into it, he makes noise in front of the cdc. the head of the cdc and looks at this and then he said, that's later. he said in the interview with

me, the numbers will reminiscence. it's the kind of thing you see. the epidemic after the first world war. nothing else creates this kind of numbers. he stood up a year later and said, this is an epidemic. it was the first time that anybody took notice of that word being in play. a lot of people abused it because of his position. the cdc really became, got themselves a lot of trouble but they came the setters for getting the other issues. they met a lot of resistance until last year, the guidelines that recommended they cut their subscribing. the life of cdc winning for this, it's practice, other people are responsible for that

and ripped misrepresenting essentially was nobody else is doing it. it's an epidemic so it is our business. we have duty to do this. there are objections within the fda but had a huge impact because ordinary doctors took notice. doctors were being told by somebody sensible to actually the problem was prescribing. you don't need to use drugs that are safe, they shouldn't be the fault of prescribing shouldn't be your first stop. more important, there's no evidence or studies to say they are effective long term. which is what every doctor were told and there's no evidence for it. that led to a shifting and thinking amongst doctors and also prompted a number of states

to limit how many days were prescribing opioids that could be. i think the prescribing was not, as automatically as it probably needs to and that sense. the u.s. still prescribes three or four times the rate of the average european country. sixty times the rate of japan. injected into the conversation, the consciousness about prescribing. we turned out with a very good report on the origins of this epidemic. also good solutions, you now have this 8 billion-dollar spending bill on, some was quite good, alternative treatment,

paint treatment. some of the goats towards treatments of people who are addicted but it's a fraction of what is needed. when you consider that the white house committee concluded that probably by the time this epidemic on its cost, it will cost $1 trillion. a billion in the small amount to pay. the deaths are rising. >> is not that the administration knows they are effective for regulation. how do you dial this back? the argument about guns is why you couldn't regulate guns. there's too many out there. obviously people don't consume guns and then they are gone and so, that's a different analogy but there is that idea sometimes that well, it's out there. you can't stop it. people are going to be in pain, people want drugs. the alternatives there, i know heroin addiction on the street, methadone although it's argued

against as a substitute addiction. people can live on it. it's less destructive. is anything like that that is waiting in the wings that the drug companies themselves are resisting? >> no. there's no magic bullet because of the addiction, the put people need different things. there are drugs that help some people that don't help others. a very large number of people have been through the process, they will tell you that they have to go through it two, three, four, 56 times. when they are finally able to limit post addiction. you're not going to find a completely answer. there are two elements to this. one is back to the reducing prescribing. it's all very well providing treatments to the people who are addicted. there are two to 3 million people dependent on drugs.

the huge number of people. we walked into the fact that 72000 people droid over year to drug overdoses. they have a huge impact on the families. seriously drug dependence, not looking after the children, pressures on their families, social services, west virginia is so bad, they took children in the care. you have to ship them to other states. several of us were in africa in the 1990s and go to villages and in uganda, you'd see i missing generations. the grand parents were looking after the grand children. there are places in west virginia where you meet more children in the care of the grandparents. because of this. the parents are either dead or nonfunctional. the second thing you have to do is you have to stall another wave of people becoming addicted. if you go prescribing at this

level, you will continue to create another generation. there will always be, if the pills are up there, people are using them at the level to which they have been prescribed in the past, and for all the cdc guidelines, but they replaced last year i came home with 16 days worth of hydrocodone. you need about two. when you go to the pharmacy, which we do with these refills? trying, grinding them and bearing them in the backyard. if that is how you deal with powerful drugs, the quite high value on the street. not taking this -- you need to ensure there is not another way coming down the road, so many drugs they turn to heroin. dealing with those already, this is a big task.

>> 's name make sure everything, everyone gets a microphone? >> can you talk about the underground drug market for this? also, how much of it plays into the heroin addiction now? >> we never quite know. you see to statistics and you never know, the statistics that have closed around that seems to be the most, 70% of people who overdosed on heroin began on a prescription drug. some of those will have begun through prescriptions or chronic pain. some of them have begun because they are sitting in a medicine cabinet at home and they, there was a such of a lack of

awareness of them that in some cases, they simply got popped around as a regular pain pill. headache, have a pill. the cdc study, they essentially said that you can be taking these pills, in a matter of five days. those who are funneled to it can be. you have a black market because of two things. one is, people who can't get enough drugs to feed an addiction by prescribing and those who experimentation. for many years, they set by these pill mills. they started setting them down in west virginia, new ones coming in and for. they eventually became that.

ford has an unusual way to dispense. normally you have six prescription but florida allows the doctors to give them straightaway. they were packed with doctors, for anybody who worked in. the biggest was around by two brothers. they hired them on this list and because the pills were in the pill mills, it became so dangerous, the doctors were carrying guns to protect themselves. people who couldn't afford the $1150. those pill mills were prescribing them. you had a situation where the dealers who worked out that they can make thousands of dollars a month, selling them in part of

the country where they had difficulty finding them would recruit all the people in particularly people who didn't have a lot of money like west virginia, they took them to the drugstore in people would use that to pay the rent. it became an economy and a lot of these smaller places. people were making more money from dealing drugs including people who wouldn't normally deal drugs but had a prescription and they became a primary economic force in these towns. they just floated across the country. these pills. what is the law that is supposed to control a doctor from doing that? it is wrong for somebody ascribing 200,000 pills in the

course of a week or a month, but there practicing medicine in theory so if the cdc is not able to regulate that, and they are not facing civil charge of now practice, it is a crime? who is responsible for enforcing that? >> is illegal to prescribe that? >> it was mostly a lot of doctors who persecuted because of evidence they were following medical practice and procedure. particularly -- >> what is the law? >> a doctor who filled the prescription, one sees the patient, they must build the entire prescription at that time. you can't fill it out and take it later. what they were doing was mass

writing prescriptions at the front desk but they would come and pick up every month in return for a cash payment. these are the doctors that have been criminally prosecuted. that was kind of thing that the da would go after them in the fbi because of the way they handled the prescriptions. that's often the change in the armor. if they can walk in to a pill mill and like they did in west virginia, there were all of these prescriptions rewritten. that's illegal. if a show as a kid with uber, who was seen 300 pages a day which was impossible, she hadn't seen a patient, she wasn't treating them. that's illegal. they are not following the procedure by which you prescribe the pills. there is a legal obligation that finally the fbi manages to get

into the pill mill because they make an error and the error is one of the prescriptions goes out to walmart, takes them to warmer and warmer pharmacist noted that the date is written with different handwriting. he calls da and it unravels from there. they got the reason for the want in the going. that's how they demand, one of the reasons that doctors were able to get away with it for so long, federal prosecutors are reluctant to go after them because of the practice of medicine. how do you prove that the doctor didn't notice, this person wasn't generally in pain. they have to show what they did, so they knew they were prescribing to people in circumstances. there's a doctor in california who is serving 30 years, she was

the first doctor convicted of murder for prescribing opioids. they got her on relation. her breach of the regulations left, led to five debts. she wasn't following medical practice. regulations of how you write the prescription. it's technical. they got hurt on a state charge of murder. >> can i ask a question -- one of the things i wanted to know, there's a loosening of prescription in general. pain is a perfect indicator. the fifth vital statistics. the heart rate and blood pressure and other things, there's a metric for. pain is sort of this smiley faces or the doctor says, nine out of ten or is this seven? like, i don't know. is a huge explosion of the

prescription of data presence, also is of other drugs. they aren't necessarily, they may or may not be addictive. but they are disruptive in the same way. maybe people become dependent on them but they are not destroying those people's lives. they are loosely prescribed, often prescribed to people who have, you had to check in once a year, they get another prescription. there's an attitude that goes with the pill, fixes everything. i wonder if there's a correlation between those two. if anybody has tried to correlate the explosion in the idea there are pills to fix things. these are a godsend. some of them are a nightmare. >> goes back to that, pill for every l. patients go to doctors, about this problem, the doctor faces a choice. you don't do any exercise,

that's why your knees hurt. or, you can have a pill. after you walk into these appointments, expecting the pills, not to get electron. sorry a hard conversation to have with patient after patient when you're supposed to go through, the insurance wants to go through ten minutes at a time. let's talk about your lifestyle, they don't want to hear about the lifestyle, they want the pills. there's a mentality, absolutely. the pain drops into rated to people who were genuinely dependent, became the system. there is no need that the doctor judging on the whole, you're pointing at eight out of ten, particularly with emergency department, they learned to walk in to the er, say i'm in terrible pain, any pills. the hospital, you would get the pills. that became a very common thing. a third of all pills be expensed

were from hospital emergency departments. they learned that's what they could get the pills. undoubtedly, the broader idea that you pop pills, was all part of it. >> i understand what you say about the black market and how does a worker who has become dependent on these pills, who becomes bore and unemployed, manage to keep taking the pills, having dispensed to him for 20 years, and i mean, that is, as understood from what you are saying, that wasn't a person who is involved in the black market or wasn't doing anything illegal, they were as i thought understood it, legally expensed to him.

>> it wasn't legal in the sense he was going to pill mills and getting them from their and being used for that, he was getting prescription after prescription what wasn't legitimate. >> what is the money come from? >> he wasn't necessarily out of work. quite a large number of people depending on these pills go on more or less functioning. so he was often working but i won point he spent $1000 a week on getting pills from different places. he was dr. shopping where he would go from one dr. to another because there was no monitoring. no monitoring of different prescriptions and so you could literally go to three doctors in the same hospital and get three up your prescriptions places like west virginia, a lot of the

work come through worker compensation. that's a day pay. for a while, you are funded. it's when -- >> twenty years? >> no. that's when you become dependent anymore. yet it takes your life. he prescribed the money that should have gone to his children and other things, went to pay for drugs. it also, it contributes to that. there are plenty of crimes because of this. there are small places in kentucky what people will tell you, 20 years ago we didn't want to endorse. everything was safe around here. we all knew each other and now, we don't even trust our own relatives. when someone comes home wednesday after you've been robbed and you've lost everything including, collecting

knives and guns for his son and he discovered eventually his son did this. the levels of distress in his community is because people are so desperate for grasping they would do anything. is a huge right and prostitution in part of eastern kentucky and prostitution got younger and younger. the other thing that happened is he stopped building. if you want a start source of cash, you deal. let's say he needs 20 pills a day, by 50 and take them off to a higher and sell them better. a group of guys i talked to, opioid uses in boston and they funded the entire thing by

bringing pills back and filling them twice the price. then when heroine entered the market and it pops cheaper, they stopped bringing heroine. until like many people become so addicted, it takes their life and they can never function. a lot of people for many years, do actually function. it's why, when you hear people say, you don't know he there were addicted, that may not necessarily be true. i was told couple of years ago, the way is to punch them on the nose, throat them into, tell them to clean up their act. he discovered eight people who were using pills. then he started to think, we need to think differently about this. he's been very successful. to change the mindset of both

institutions like the police, also ordinary people in huntington. wrecking down stigma and how you think about it. he went through the process himself. >> things for doing the book. look forward to reading it. if we think about the structurally what is happening, we don't deal well with pain. we don't deal well with addiction. those two things are overlaid on an economy that is very difficult for the increasing of this. what we try to do is, it was easy to say there's an epidemic. the data was clear. was much harder to say, this is one, what needs to be done. infection control of vaccination, with buicks, it's difficult. i think you made an important point. we have to think different about the people who are addicted today and everybody else.

any different approach reduces the risk. when we release the guidelines that you mention, we did get a lot of pushback. we got hit with a lawsuit that ended up being industry funded. we were forced to delay for a few months for additional sieges. we had to respond to 4000 comments. or we learned, not only is it not good evidence that these medicines help in long-term, there's evidence to make it worse. people would take opiates and become acclimated to pain relief and they feel more pain with the same stimuli in the future. they are less able to go on with their lives. almost no role ever with these medicines and chronic pain. way too often used for acute pain. for addiction, you see the change from when it was back in the those people, when there was

more white people it was this. it changes the way your brain works. it does not long-term. one of the things that we've started at the cdc, it will take a few years to, as what works in terms of treatment. i'm an infectious disease, we look at what is the long-term success rate of any treatment. that's never been done in the actual living world for all of the distant what ologies of trip treatment of opiates. it's begun a study to look at that previously over two to five years. many of us suspect many of the drugs program have very low success rate. not milk, most people who have those changes in the brain are going to need something to help them. short or maybe even indefinitely. one of the things that was

always frustrating as the director was the role of sam, mental health administration. they actively opposed efforts to make it easier for doctors to prescribe for pain. they sent out most of their resources to programs unlikely to help people who are addicted. they ran their surveillance system. that wasn't interest. there was commercial interest involved in here but over regulating, not rigorously looking at treatment outcomes, that maybe the treatment industry as it is. did you have a sense of what the role the could and should have played or the functions of that and how that could have been better done. >> my sense of all the federal institutions was that they weren't infested. there were plenty of studies and

he did his own studies. a doctor on the president's opioid commission. when she looked to all of these federal institutions and with the could have done, she said they spent a lot of time looking up they could do. they never did anything. she had the sense that was partly because of leadership but there really wasn't any nationaf national leadership and there wasn't a political interest. it's really the institution on hold, that won't take it. she felt they were motivated because nobody was motivating them. they had their own, the masculine abuse is -- it took the attitude that was only going to deal with treatments rather than any other role.

that's fine but there was a point in which they could have played an important role for veterans as well. they decided it was too much trouble. i think part of it, my impression, was part of it was didn't want to go up against the drug companies and the prevailing congress. it was influenced by the drug companies. to politically dodgers. they are doing fine, whatever they were on. i think that was a failure of leadership. what you have to say about the cdc and how these drugs don't work long-term, before you got here, i was talking about valentine in 2003, that's exactly what she said in 2003. fifteen years later, finally, it's recognized for what it is.

which was exactly right. it took the cdc to pick that up again and get it. one of the reasons i think was, the cdc wanting to do a study. there were never the settles. the industry insisted setting that would show me think of event with these drugs work. he must've had their suspicions. the studies were never done. the industry wasn't born to do them, the fda which could have required it, had the mechanism, people who were in the fda who said, we could have done the studies. we had the authority to force the companies do them and recovered it. one of the things that blinded this, was a lack of the information. we've seen outcomes, it seems obvious that this created epidemic.

it seems from what valentine said, these drugs don't work. but actually, nobody ever did the study. that's because the industry of this. >> the medical association, have they taken line on this? do people listen to what their line is? >> the american medical association took the line back. they didn't want to do anything that inconvenienced doctors. there was basically it. there are two men in congress, the guy in kentucky, rogers who was a lone voice for a long time. then a congresswoman, mary whose son became hooked in much later, she came to this. they pushed through this act.

what the law would have done would have required doctors wanted to prescribe rights, to have training in pain treatment and addiction. one of the shocking things that you don't expect to hear, dr. after dr. was four years of medical training, the got a day or two of training on pain. doctors know very little about pain. which is why the drug company salesman because salesman appeared to know more than they did. they pushed through this law and leading the fight against it was the american medical association because it would inconvenienced doctors. but the ama had the relationship with the industry as well. they brought in that we must not does my people who need these

drugs, 100 million who were in chronic need of opioids, denied them access because of these abusers. to this day, they retreated from their objections. it looks like there will be training for doctors but it's reality, they won't discuss their past. they'll want to only talk about their future. >> looking forward to reading this book and people have said thank you so much for doing the work to tell these stories. i grew up in a community, not as severe as what you spend your time in but i've seen the abuse of drugs. i hear you talk, it does sound like a very american epidemic and something that's probably

presenting itself as awful feeling. i'm curious about, we've seen this devastation and how egregious it is but these staggering amounts of money that ever small group of money people collecting, where is that money going or was the decision our site or motivation for collecting? is it to pass it on to generation, an issue our country has and continues to struggle with? >> are you talking about -- >> the institutional corruption. >> and then influence our politics. you a lot of people get more and more money. they feel they need more and more. it's addictive. they have made $15 billion.

they stepped their names on a lot of institutions. they money they've given, the money that they made. it made them the tenth richest family in the country in a country not short on rich families. that's the kind of money that was being made. i think by 2009, $3.4 billion a year. there were these opioids which were also in the system and the pill hydrocodone pills, there was a billion dollars a year. i think at the height of it, opioid history was $8 billion a year. everybody takes their cut of it. i don't really know how to explain the money worked its way

through the system. the political system in a sense that it was funded through campaigns, campaign donations and the rest. it was obvious for the industry, for the pharmaceutical train industry on capitol hill had actually been accomplished. it goes over in the late two thousands, over to represent the drug companies on opioids. it became the highest paying lobbyist in washington d.c. which tells you quite a lot. one sue and distorts everything. doctors pocketing. when they went to the clinic,

parker box, they found $400,000 in cash. it's what she was worth. the former present doctor, they looked up her bank account in one of the accounts, he had $1 million in cash sitting. then he told police, he didn't know who it belonged to, it might have had his name on it but he hadn't set it up. it was so much money, sections that the williamsons sent. when they rated her house, they found $480,000 in cash in her house. that's how much she was making at the receptionist. her husband was a policeman in the fbi said where is this money coming from? he tried to say, i do overtime. [laughter] they tried to seize the house but they could prove about the

house before the money. he had a collection of guns because the fbi agent rated the house said to me, he built an area above his garage where he stored all of his guns and they couldn't believe it. he had 600 guns in there. when you got the money, what you do with it? he liked buying guns. they kept the house, so you. [applause] >> thanks for coming out.

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