>> hell oh, welcome to power house, an independent book store so we thank you for your support and attendance' hope you purchase the back. we have many done by the cash strengthster. very excited to host chris mcgreal. he'll be reading and then talking with our moderator, after wears taking questions and chris mcgreal now writes from across the united states. he has won several awards including for their recording of the genocide in rue wantda, coverage of israel and palestine, and writing on the

impact of economic recession in modern america. reef the prize for working a a journalist that has come boundaried moral expression professional swelling gist. the prize for report that told the truth. and phillip is a longtime staff writer for the numberer, the new yorker, and cold case and we wish to inform you that tomorrow we'll be kill with our family's stores from rwanda, which won a number of prizes. his book, short fiction, essays and reportage have been translated into a dozen languages, work on a new book, you hide that you hate me and i hide that i know. please jean me now in welcoming chris mcgreal and phillip

gourveitch. >> this is an honor -- >> i don't think your mick is on. >> is my mirk on? what am i supposed to do? >> so well, that's mic works. we meat long time ago. covering other things, and that was at the -- i think we met -- at the rwanda congo boredder in 1996 or earlier than that. and chris was doing some of the really truly essential and outstanding reporting from there as he has from wherever he reported and guess he want to just start tonight, you have

written a book about american overdose, that i can say is just a terrific book. it's terrific report, terrific writing, an exceptional read, an urgent story. how did you get into it? you have been in this country while reporting now. how did you settle in on this and get into williams and west virginia? >> i think this whole thing will work fine. good evening. how did i get into this? i was washington correspondent for five years and after that it decided i didn't want to be washington correspondent anymore because i spend far too much time writing but sarah palin, and so i then started wandering around the country, and really placeses that didn't get written about. marginalized communities, particularly a lot about poverty

and that drew me down the path toward this epidemic, because once you travel through appalachia or the midwest you can't constantly confront this epidemic and its impact on society. out of the news reports came these big questions that you don't really answer in daily journalism, and the two questions that haunted me were, you kept hearing from people that had become hooked on these pills 20 years ago and say how is that an epidemic can run 20 years and we're only here talking about this now because i would imagine most of you five years ago probably had no idea of the scale of this thing. in these communities they did. they were living with it. and it was invisible to large parts of the states and how was that possible? and the other question was, when you look to the statistics, this

was pretty much uniquely american phenomenon. the u.s. consumes somewhere around 8-0 85% of the world's prescription opioids and they're 5% of the world's population. i thought there's obviously something very american going on here. something about either the people her to system or the place or whatever it might be, and that really is what drew me interest trying to answer that question. that's what drew me into this book. williams and west virginia is this small town that i end up focusing on quite a lot. in a place called mingo county, the very southwest of the state. you look at a map the cdc has online of opioid overdoses back to 1995 there's a little red dot and begins in that part of west virginia, and you watch it expand year after year, grows

through west virginia, through eastern kentucky, into southern ohio, new dots pop up in different places, particularly in places like maine and new england, and these are places that share quite lot in common with appalachia. they're poor, working class communities, often where employment is very labor intensive but all begins down there in southern west virginia, and williamson is this town of 3-point three and a half thousand people where a decade into the epidemic, you have a roughly 20 million pills a year going through this one town of three and a half thousand people. they're being prescribed in -- by pill mills, but also dispensed by pharmacies that are all part of a -- what becomes a

very widespread operation to deliver opioids on behalf of the drug companies across all of central appalachia and into ohio and bits of iowa. >> so there's so many questions that come out of that, too, which are, for instance, why is it that we're only hearing about it now? one of the questions that you address and raise but don't totally buy, but obviously see a lot in, i is that this is a group of people who are dismissed as hill billies. they up a off. that's a population whose well-being, health, condition, i presumed to be wretched and they're prey to the drug companies and don't have

advocates. is that the issue, they written off as disposable or how did it get to be that a single place could be that kind of an epicenter and also be that epicenter for under the radar no so long. >> a couple of things that were at work. the whole mass prescribing in this country, which didn't happen anywhere else, comes out of a -- if you go back to immediately after the civil war in this country, a lot of soldiers are very badly wounded and they -- morphine is more and more come means of dealing with pain. it comes along with a hypodermic needle so much easier to use, and as the morphine use munns soldiers spread so doctors start using is for pain, becomes extremely common in this country. and it leads -- gets rise to

america's first morphine epidemic, alongside particularly in the west coast, the rise of opium, and for the first time you have a president, teddy roosevelt, who appoints a drug czar, and he is the commissioner for opium and opioids. and he describes america that the world's worst drug fiends, and new laws are used to come bait opium and there is a recity is dance within the medical community to -- any kind of use of morphine or opioids of any form for treating pain. and that pretty much stays the situation until around the 19th centuries and then out of the uk comes the hospice movement. a doctor decided after watch her husband die in immense pain

without any treatment, that there has to be a better way of dying and that the fathers about addiction are irrelevant if you have -- if you become hook on the drugs. so the hospice movement emerges in britain and it comes across the atlantic. as it comes across the atlantic, it coincides with the rise of a group of doctors in the 1980s here who think that actually opioids can be used on a much wider scale than just end of life care. they start to push the idea that you can use them to treat chronic pain, and cute pain. so post-surgery, you can actually take -- post-injury you can take opioids for quite a long time until your pain goes away, or if you're living with chronic pain, resume tim, bad

knees, that you could -- these could be life enhancing drugs and you understand where that comes from doctors see people come to the with chronic pain and there's very little they can do for them. they give them drugs, ibuprofen is a good example but it's quite damaging to your live and all the rest. there weren't many answers out there. so, a group of doctors, led by a -- called russell portnoy decides to start pushing this idea but fight the stigma and in order to fight the stigma they start to in essence fabricate evidence, and they they take studies at portnoy admits to use his phase, weak, weak, weak, and inflate them. one study suggested that there was a 1% risk of addiction with

opioids. and that came out of the study that actually, when you look more closely at it, what it turn out to be was a group of patients in a hospital, in very controlled circumstances, who were given opioids by nurses who then withdrew them if they showed signs of addiction, therefore it's very unlikely that large number offered them would develop addiction. another example was a doctor called hod county who had a theory of pseudo addiction and he said that what looks like addiction isn't addiction, just your body reacting to the pain and needing more drugs to treat the pain, not to feed addiction. and when you go back and look at that study, it's based a single cancer patient. what these group of doctors did was took the studies, ininflated them, trusted nobody would look closely and then wend out there with the idea that these drugs

were completely safe there was an unreasonable stigma around them and you wouldn't need to worry about mass prescribing of opioids. that idea was woo have floated around for a while if drug companies, never short -- never slow to spot an opportunity, had not latched ton that idea and suddenly thought, here is a great opportunity to make a very large amount of money. and they start mass producing opioids, and get them on to the market, and then they look at who is already using pain killers and it's places like west virginia, where -- >> down in the mines and they -- >> down in the mines. >> get it up for another shift and so forth. these doctors, portnoy and so forth, they see -- start, as you say, putting out weak evidence that they acknowledge is weak. they weren't themselves, like, in on the take at the outset. they weren't setting out to be

snake oil salesmen but it did take some serious snake ole sales men to get this going and hustlers and hucksters. it's an american addiction. every country obviously has corrupt scammers and so forth but sure seems like you find quite a cast in west virginia of people who were very distively distinctively american hustlers, former undertaker and gay escort on capitol hill who run his pharmacy. you have so many corrupt doctors who seem to just flock to this particular epidemic, corrupt fire chief family whose family are up drug dealers who see the opportunity to do legal drug dealing. a kind of nose out there from the very top, from the fackler family and purdue pharmacy down to ground and one thief wonderful things about the book is how much it connected the dots between the two and shows what is happening up high and

down low are connected. they're quite comfortable watching a great massacre take place as they pocket the money. >> yeah. think one of the reasons that happened was that they persuaded themselves that they were doing good. at least some of them did. obviously there were doctors who were mass prescribing who understand fool fully they were make midnight but the drug companies persuaded themselves with the idea there was an epidemic of untreated pain out there and this becomes their justification in the early 2000s, one answer why it went went on for -- when you go back and look and think didn't nobody ring the alarm bells and you discover in the early 2000s, a lot of people were ringing the alarm bells and there was -- there's a doctor -- several heros in this book, one of the real heroes as i doctor called

jane ballennine the head of pain at harvard university and its associated hospital, massachusetts general, and she buys into this whole idea, the port now idea and all i have to do it guess my patient these drugs. but she starts to notice that the patients just aren't doing well. she starts to see that actually they're in more pain than they were after a few months. she starts to see their personalities have changed. their relatives are saying, what are the drugs you're giving my husband or children because they're not doing well on them. but it was hard to get them off the drugs because they had become depend depth and one thing about opiode is they replicate your pain in order to force you to feed the addiction. so you have the illusion that it's because the pain is because you're not taking the drug but it's not because of writhing

pain. it's because of the effect of dependency or addiction. so, balentine looks at what is really going on, and what she does is, she puts together over a couple of years a really comprehensive study which appears in the new england journal of medicine and says, we need to pause these drugs are actually not really working long-term, maybe short-term they relieve pain but you end up in -- end up worse off. >> this is what year? >> 2003. and that comes out and she thinks this is going to cause everybody to pause and take stock of what is going on here. we're going to stop spreading these drugs as rapidly, going to stop the mass -- the push for mass prescribing and in fact what happens is the industry reacts to balentine and others who are ringing the alarm bell by going for distraction. it creates the idea that america

is suffering and epidemic of untreated pain. 100 million americans have untreated chronic pain that needs these drugs which is one in three americans which is ludicrous because although we may ail suffer pain, we don't need opioids to treat it. and they fund it as a moral contradiction between those people who become addicted and those people who are legitimate what they call legitimate pain patients. what they says that the who became addicted are abusers. they stigmatize them and they say, those people should not be allowed to take away the drugs from the people who legitimately need them, and the fact that one group, the people who become addicted -- who are addicted, often are abusing the drugs they

become so addicted they find drugs hope to black market, were the same people who originally had prescriptions and they followed them legitimately, they obscure create this -- obscure and create this good and bad scenario, and they run with it and it's quite effective for quite long time because they simply cast anybody -- cast the actual genuine victims, people who are taked and dying, as actually the criminals in this and they keep the floodgates open that way. >> in this town in williamson, you have this man, henry vinson who start the pharmacy becomes the pharmacy through which these vast quantities of just -- disproportionately vast quantities go through. heels not somebody who is really get a theory about this. just in o the main chance, run like shell companies and his

parents run it. >> run it exactly as he ran his gay escort service in washington, dc, until he got arrested and thrown in jail, and various people commit suicide in the reagan administration and then he comes out and sees a new opportunity. >> so he is not interested in pain. he's interested in the main chance and the money and take and he has a remarkable cast of supporting characters who are also quite comfortable with that, who are able to smith anything that comes and up don't pay attention to it and are watching this dealing going on in his parking lot, people come in with three, four prescriptions, getting them filled, selling photo are twice as much in the parking lot him doesn't care and has an approved pharmacy and doctors who say we can only prescribe to this family and he prescribing to people they barely met. how does that get ginned up and get going and why do you think there were so little resistance

you say there were alarms going off but there were people who smelled something going on that was ugly but sucked people into it more than people who said this has to stop. >> because everybody was making money and the end ends up infecting the politics. you have henry vinson, who comes out of prison, sees this opportunity, and in a warehouse that his mother happens to own, he sets up a medical clinic and sets about just recruiting doctors who he happens to know are pretty dodgy. founds a door who lost her medical license in florida, for amongst other things, she manages to persuade or try to persuade one of her teenaged patients to have sex with her teenaged son because he is in need of sex, apparently. this gets reported to medical

board. apart from the issues around her prescribing down there, she comes to west virginia, she is called katherine hoover and starts working in this clinic, and the way it works is that somebody will come who wants these pills and they come from far and wide, from hundreds of miles once word get out and pay $150 to see her or 250 it went up to, and she will write them a prescription for a month's worth of pills and then she never see hes them again and never wants to see them again but they can come back every month and collect a prescription from $150 cash from her and -- that is ready and waiting. just writes mass writes blank prescriptions for anybody that comes in and puts the money down, and within a period of eight years, she prescribed -- on average she prescribed more

pills than west virginia's largest hospital. and she is not the only one doing this. another doctor, diane schaeffer who lost her license in receives -- sorry -- in kentucky and moves across the boredder in into west virginia and starts all of this. and you end up with several doctors -- >> a guy -- >> a guy -- henry vinson recruits him because likeman was the doctor in the prison, the federal prison he was in, so after he comp us out he calls up the doctor and says wouldn't you like to earn a bit more money working for me and that's what he does. all these doctors injures writing prescriptions for anybody and taking cash so much so that when the police -- the fbi eventually raid the clinic, they find hundreds of thousands of dollars in cash just lying around and stuffed under beds and rescueman was taking a million dollars a month into just a single bank account.

the clinic itself, the profit on top of what the doctors were doing they were making by $20,014.5 million a year in cash. this is the kind of money being spent. >> the town of 3500 people. >> a town of 3500 people. but those people that come in to buy disease these drags from despair wide, they need go to a pharmacy to get dispensed and what happens is the doctors work out that you don't want to go at the walmart because that's will range too many alarm bells so the come to an agreement with a handle of pharmacies that they will dispense the prescription has to go to these pharmacies which they'll dispense and the police observation reports on the pharmacies are interesting. they are so many people going in that actually to have all the pills prepackaged in 30, 6090 and they describe the stock behind the counter literally throwing them over the bar as

people just march up, push the prescription in over the tone, catch it, off you go and just going through the thousands every day. the family is open at 8:00 in the morning and people line up out 5:00 or 6:00 in the morning and goes all day and that money begins to in fact -- by the end you have -- essentially the judge -- 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, and some of them end up in jail and some end up dead, but it takes over this entire town. becomes -- essentially becomes a kind of financial structure of the town. >> at what point do families -- people start to watch -- i know you tell some stories of fathers and sons who work together, the

father's accepted in the mines as a bit of people come in and give each other pills just to help them get through the shift but at one point does the sense, this is destroying us, and a few people who aren't totally involved from it, having it happening in their family, start to -- why there is no voice to that? why is the -- you say it's a political structure but why is there no ability for people to start to say, this is outrageous, this is killing us? if our local person can't deal with it, our congressman should, senator should. it takes a long time. you mentioned how much money 4.35 million bucks they're making. oxycontin is introduced in '96. >> yes. >> by 2000, fackler, family, purdue, is making a billion dollars a year. by 2004 they doubled that. >> yes. >> so the four and a half million is a drop in the bucket. gives you a sense of the

national scale on that and keeps going up from there. but why is there -- why is so the hard for those people to be heard are they trying or just to shellshocked and grappling with valley the day to day. you were down there a long time. >> in that part of the country there's a sense of powerlessness, historically they felt that corporations are coming, coal companies in particular, are coming and plundered and they did fine while they were making money, but when the left think left nothing but destruction behind, and they don't feel they're heard in washington, and there's a real sense of powerlessness. what there is also a sense of -- and it's why it wasn't difficult to get people to talk about this -- is anger. so, there's a miner i talked to who becomes hooked by accident because he has an accident on the mines, called willis duncan

and starts to taking low level pills and then as the pain gets worse, because he is dependent, think it's the pain of the injury -- the doses go up and he just -- the doctors say, take more. he takes more. this will he gets to the point he's going to clinics, the pill mills just to get whatever can feed his addiction. a couple of years of him becoming addicted his wildfire as hit recollect my and his prescribed oxycontin and is addicted. and hisseddest son who works in the mine is addicted and it's not immediately clear where the oldest son began taking his dad's supply or he was getting it on prescriptions but he ends up addicted, and i won't tell you what happens to this family but but is a here horror here store of the years. when you speak to willis about

this, the thing he is full of this incredible anger at doctors and at the medical profession because he said, nobody in this -- all those. >> ever said to us this might be dangerous, just said keep taking this stuff. you're in pain, take more of it. which is the pseudo addiction idea, philosophy, and it was still pushed by doctors and still is by some doctors. and he feels his life -- as he said in the past 20 years, there's only been two years he wasn't taking opioids opioids au meet a lot of people like this. the sense of powerlessness because they simply did what their doctor said and then led down a route that has destroyed their lives. what changed, of course, is that there are people in this country who don't feel powerless, who understand how systems work and

you -- first begin to see the wired awareness once it starts to feed into middle class communities, places like california, where when kid start dying through experimentation, the parents start to sea what the hell is going herein and they know they can be heard. even they have to break through stigma and all of the usual judgments about people who end up addicted but they do know how to do and that do feel confident, and that's when you begin to start to see the rise of awareness, never really comes out of appalachia and those poorer communities. >> so, it really is this moment -- that's happening when? this moment when it does break through a little bit, and the

drug companies are caught on the back foot nor first time and suddenly on the defense, and yet it keeps going. i mean, the epidemic numbers -- the death toll continues to rise. the statistics keep all going up in a bad direction. and yet we're in more and more aware of it. how do you account for that? how do you explain that? that is it just an inevitable arc that the momentum is so great that the addictive hook of these things -- then they replace one thing with another. guess oxycontin and then the solution is fentanyl and that becomes terrible, too. so where are we in that arc and how did that get to that point? >> one thing i do in the book is i look at where were the people who are supposed to look after the interests of americans the regulators. this country is full of federal

institutions that have responsibility for drug abuse. there is the national institute for drug base, the white house drug czar, the office of national dug policy. owl of these institutions and the food and drug administration which licenses the drugs and approves them, have to institutions, one way or the other, failed americans, and that is what essentially permits this thing to good on growing, even though there's this greater awareness. on digging into that, looking at what went wrong, what you begin to realize after a while is that the drug companies not -- were not only very effective at marketing their drugs to doctors but they effect deliver market it to the system to the medical authorities of this country and get them onboard. they end up co-opting the

institutions that are essentially supposed to regulate and monitor and protect americans from this kinds of abuse if religion give you -- i'll give you an example which had a big effect of push through the mass prescribing. the joint commission and the joint commission's responsible for licensing hospitals, and if you don't meet the joint commission's standards as a private hospital, you don't get federal money. don't get medicare and made okayed money and all of that chits 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 they used -- the fund a number of organizations, one called the american pain society, and they -- through the american pain society they led a campaign to have pain recognized as the fifth vital sign, you have your

heart rate, your bulb, all of that, which can be measured, but they said hospitals now have to measure pain as a fifth vital sign which is why when wow grow into a clinic you see the smiley faces and you have to say, how bad your pain is or isn't. and this became a kind of tyranny for doctors. they were obliged to do this and if people said they were five out of ten or higher, they then had to be referred for pain management and pain management meant an opioid prescription. very frequently. the joint commission pushed this through america's 40,000 hospitals so that you ends up with a system very quickly in which doctors were obliged to not only monitor pain but essentially fall back on opioids as the default position for treating pain and you watch the prescriptions for opioids escalate and that was just one

element of what they were able to do. they influenced state medical boards to do the same thing. so you start to see states regulate that you have to -- doctors must monitor pain and it creates the idea that there's this enormous pain issue out there, and the only way to deal with it is prescribing of opioids and any resistance to that is met actually with -- well, there's a doctor called charles lucas, a surgeon that detroit general, and i write about him because he has ban a surgeon since the 1960s and started to observe his patients who were given high levels of opioids post surgery were dying, and so he stopped giving them high levels. went back to what he was doing and finds himself hauled up but the ethics board, one of his colleague is taken to the state medical board and he said to me -- he was hauled up a number of times and able to resist it

because our his experience. he said if you're a junior doctor, what are you going do? you're just going to do what they want, which is prescribe these pills, and he said, it became a tyranny where you just followed the advice and there were a number of other pressures the insurance companies saw this as an easy way to deal with pain, didn't cost money. wasn't like physiotherapy. so they said, yes, the defall has to be opioids. and you saw one institution after another co-opted by the industry, and then also get most importantly the food and drug administration onboard. >> i should draw attention to the fact this is one to the thing but you book, not the first become written but this but it draws together all these different elements. this very. on the ground experience and also the history of the epidemic

over time, how it unfold and the policy side of it and knitting those together in a way. i think you can correct me emi've wrong, one thing that distinguishes what you project was and the fda thing is amazing. a man at the fda who you'll remember his name, don't off the top-my head but who starts out basically as being in charge of looking into oxycontin and kind of seven nagle not gettingty kind of tested done and avoiding any clinical evaluation and then works for purdue within a year and unleashing the vast marketing campaign and the blitzkrieg to escalate this thing, and the fda seems deeply compromised if not corrupted at least during their phases of this. >> one reason that purdue pharmacy was able to take oxycontin and market it to doctors as less addictive and more effective than other opioids was because the fda

allowed that to good on what they call the label, which defined what the drug was but the only fda on only allowed that on because that what purdue pharma told them, and the fda did no checks itself. it simply endorsed what the company told it. then what the company does is says this is the fda approval, what the fda is saying. it is a real turn-around nor fda because by that point it's become deeply compromised and deeply complicit in the promotion of opioids with the drug companies, but the fda in the 1960s had set a global standard. it was drug called thalidomide which was very widely prescribed in europe to pregnant women as a -- to treat morning sickness and my mother was offered it in

1959 and she turned it down. and it led to thousands of babies being born with very serious deformities, and before that was known, the drug came to the states and it went to the fda for approval, and there whereas a scientist, a woman at the fda, who looked at the data and said, there's not enough here. we need more information. and she kept saying, there's something missing from this. and she kept asking for more. and because she was a woman, she was disparaged by the drug company think went around her to the senior officials in the fda and said, listen she's just being awkward and duck and holding things up. just approve it. it's being used in europe, and she resisted and resisted and resisted, a year later the in europe everybody connects this -- these vary large numbers of babies being born with

deformities to thalidomide and that kills the drug being marketed here and saves american women and children from the same thing. she is awarded medals by college and jfk and hailed as a hero. what that lead ises to new i laws that's give the fda great powers to control drugs and that mole thing exists for 20 years, they fda set the standard the drug drug company thieves do what they're development then along comes aids and ronald reagan and because of the aids epidemic, understandably, peep or hiv positive say we don't have long enough for you to wait around and test drugs. you can experiment on us basically. so the regulations were weak enbud not just for drugs to treat hiv and aids but all drugs, along with that went essentially the idea that the fda could stop to pay its own

way and the drug companies start to essentially pay the fda to license their drugs. >> the drug companies are piggybacking on the hiv -- >> they use the hiv agency to essentially break down the regulation us. once they kind of broken down the regular layings, they march forward -- regulations, they match forward through congress to get approval time speeded up but they're given able to do this by the fact that what happens is that the fda -- the clinton administration introduces licensing of drugs that the fda -- the drug companies have to pay for, and the fees go up and up in order to fund the fda until at this point 60% of the fda's income comes from drug companies, and you watch the relationship evolve from regulator and

regulated to essentially a business relationship where the drug companies become the clients and they have leverage and that leverage is not only through the money going the fda but of course, they can go to congress where they spent $2.5 billion a year lobbying and saying we're paying there is money, the fda is not delivering and you see pressures build up in the fda and what evolves gradually is a situation you end up with by the time to opioids come on to the market where actually the fda and the drug companies are essentially working hand in hand, and that opens the door for the drug companies to co-opt the fda into approving these drugs in way they should never have been approved. >> so, you started out this evening a little bit by saying, well, one of of the questions that got you into this is why this country, america, has 80%,

85% of the world's opioid addiction and five percent of the world's population or opioid use, prescription, and a way you're giving us an answer. some complicated mixture of american structures, high and low. what do you think it is? why are we susceptible to this? the way our medical system is structured as a business rather than a social welfare enterprise, that it's not a public good, it's private for-profit industry? is it a kind of set of attitudes we have that would allow something like there is to take place? where the fda, in order to fix one thing, just turns a blind spot to something that just turns out to be flat out deadly, and why do it take so long? because seems like a very

bipartisan failure to contain this thing to recognize this thing to deal with it, and we haven't dealt with it. >> yeah. >> i know that was a lot of questions in one. >> there are very uniquely american things at work i guess the short answer is, it's because medicine in this country is an industry. it is not a health service. all driven -- driven by the interests of the drug companies, be thes into the insurance companies, driven by the interests of the hospitals, often it is not driven by at least primarily by the interests of the patient. that is on the whole for awe the problems with public health systems in other countries where they have financial problem but there's a different sense of priorities and also driven by patients themselves to some degree. the evolution over the past 20

years of partly because of rising cost of insurance, but the idea that patients think of themselves as clients. they go into the doctor, tell the doctor what they want. they -- doctors tell you this, they're far less likely to listen to the dar than they were 25 or 30 years ago. that in concern is partly driven by the rise in medical advertising, the only other country other than north dakota, strangely, which permits direct consumer advertising ol' of drugs and that began 1997, interestingly, when opioids first came on the market. but doctors will tell you there's this inexorable rise in just the pills people take and it's partly because of this meant mentality that hays taken hold of a pill for every ill because those are the answers of the television. that's what the see in the advertising between news bulletins, particularly old

people, and doctors say people come in complain offering conditions they never knew exist evidence but then they've seen it on the television want a pill and doctors say they are prescribing pills to offset the effects of pills but always going be a pill. that is in part reinforcers by the interests -- the financial interests of the insurance company which is not interested in your doctor, sitting there spending half an hour telling you, actually, your real problem is you need to deal with being overweight. this is your life. how to reduce stress. they want you in and out in ten minutes and prescribing a cheap generic pel. so you have that at work. but in term of the fda relationship, the fda prioritizes the business interests of the drug companies and it's specifically does that because that -- it believes that's part of its map --

mandate and in the middle of the epidemic the fda has approved 5 opioids through this epidemic and one in 2012, came on to the market -- came up for approval, and it was year after the centers for disease control said there was an opioid epidemic so nobody what in any doubt. you have probably at that point 50,000 people a year dying. everybody knew at least who should know, what was going on. and so what the fda does is appoints recommendation committees are scientists and doctors to consider whether a drug should be approved. there will 13 people on the committee, and the epidemic was at the forefront of their minds so they start asking all the weigh right questions like do he wi need another drug on the market? what is the chances this is going to end up being used by

people who shouldn't use it? it was a it was ten times the power of your average opioid so it was going to be very open and attractive on the black market. and the senior fda official on this committee interrupts them and he is head of the department that deals with opioid approvals and the says, that is not your business. your business is to decide whether this drug is any less safe than a drug already on the market. and if it is no worse then you have to approve it because -- this is the phrase he used -- has to be a level playing field for industry and what that meant was that if one company was making a drug that was out there, killing lots of people, provide that drug was legal, every other company had the right to do that. the committee, there -- you had

doctors saying, but surely we have the trying put the public health first. surely we don't need another high powered drug on the market that's going to end up in the wrong hands, feeding this epidemic, the committee voted 11-2 to reject approval of the drug. and the fda approved it anyway because it has the right to override the committee. and that for me was real indicator of what the fda's priorities were and what its thick can was about. and then you later discover that the same doctor who was the head of the approval division, he had spent the previous decade in secret meetings that had been taking place between the fda and the drug industry at which the drug industry had been paying $40,000 a time to be at the table and decide the procedures

for the approval of opioids and that all came out later in these e-mails that were leaked, but it is an indication of where the fda's head was at, i think. and the role it played. >> you have been a foreign correspondent for your last couple of decades. you have worked in central africa and south africa and the middle east, here. how is it different here and how is covering this story as a foreign correspondent do you think gives you what kind of advantages or so do you think you have looking at this from the outside, not seeing it with maybe some of the american presumptions or the way that one might nod one's head and also, i wonder a little bit about americans like to think we don't have corruption the way one might in the third world or somewhere else, right? we have -- sometime we'll say that's corrupt we ticket like that an anomaly where it always

seems to me that in fact we have a lot of structural corruption but not a pay as you go don't have to bribe a cop or pay your school teacher to, like, give your kid a grade, rather than just flunk them, but you do have to put up with this kind of institutional corruption and this very high level of money. i wonder if that's something that being a foreign correspondent you think makes a difference even just working in west virginia. they know that you don't sound like them. and i wonder if that is an advantage in many ways? because the way it is, when you're talking about a doctor in rwanda who committed genocide -- you covered a lot of these things in different forms where people suffer and the policy is out there, does that ring a bell? does that feel like it's different than it would be for the rest of to us cover? >> its certainly helps to be an outsider.

if you go in with this accent -- first you they assume you don't know anything, which will be true -- >> almost an advantage. >> exactly. i guess what it does is it lifts the idea that they have any judgment about who you and are whether you're judging them. i think there's a real sense, particularly in parted of, say, appalachia and things, of being judged by other americans, and there's a particularly by people from the east coast, i have to say, the idea that what they regard as -- they feel so badly let down by politicians and institutions, but also how they regard they're talked about by people they regard as elites in this country so i go from the outside and i'm not any part of that so that helps and also true to be montz in dealing with law enforcement as well. think people think you don't have an agenda and i didn't have an agenda other than to write this book and fine out what was

going on. i think you don't come politically loaded, let's say. so, that definitely makes it easier. but, yes, hey have been struck by the institutionalized corruption in america over the years. i didn't really understand until i worked in washington, just how the money affects the policy in congress, and you see this here. one reason that congress really didn't act on this for so long was because where does the money -- so much money comes from drug companies towards campaign contributions and wasn't they bought a particular policy. what the bought was inaction. that's what way wanted. didn't want anything to happen. just wants the drugs to go on being prescribed, and -- but it is also interesting to me how many people recognize that. so, if you're dealing with law enforcement guys or prosecutors, or in the case of west virginia,

i spoke a lot to the former attorney general, they're all pretty conservative guys, often republicans, certainly not anticorporate, but the turns in which they -- the terms in which they talk but what happened. he talked but the drug companies as drug trafficking organizations, talk but the institutions that enabled them, and these include some federal institutions, as corrupted. they talk about -- testify commitly talk about congress as corrupt. former healed of the dea division responsible for preventing drugs from diverted, regards congress as completely corrupted by money and this is a man who -- a form are pharmacist, trained as a pharmacist and a lawyer, but he is not anti-establishment, and i heard this time and time again. and i was really struck by it. they see the system as structure

hill compromised and it it's true. i do think there was so much money involved in this, what the drug industry was able to do in a much more sophisticated way than you would have seen in africa, is if they co-opted, co-opted through money institutions into going along with this policy and it gets dressed up but in the way that's what it is. none of these federal institutions that has a responsibility for drug abuse weighed in until the cdc weighs in. >> right now pablo escobar is on trial here. does its seem right he is on trial and at the facklers volunteer? >> so. >> of course, being they're purdue oxycontin family. >> i don't know but the facklers themselves, however individual family members knew.

the two fackler brothers that set this who up died in the past five or six years, undoubtedly knew what was go on and one of their sons who heads the -- the rest hover fackler family became billionaires. i don't know how much they did or didn't know. what i do think and you larry time and time again from quite conservative people including elect mayor of these counsels, republicans, in these towns and cities that's have been just devastated by this epidemic, and including people like hall rogers, the republican congressman for eastern kentucky, who was very early and loud on this epidemic, they think the executives are the people in these drug companies that once they were warned, shown the evidence, and they just kept going, and there's sense that corporations and executives have spent the past 15 years, buying their way out of a accountability.

pay massive civil sentimented without admitting liability, but no -- >> the cost of doing business. >> the cost of doing business. >> like a tax. >> exactly. they want to -- they say this kind of thing won't stop or won't be prescreened again until the individuals who make these decisions start to go to jail and that's now quite a lot of pressure building for that. be interesting to see with got if you have a federal prosecutor wanting to make their name for election in parts of this country. i can see something starts to go after these guys. >> i'd therefor take some questions from everybody here but i wanted also 0 just quickly get on that one question which is where are we with this, like, with the policy level? president trump has said we have an opioid epidemic and we'll deal and if it that was a while ago. then was another news cycle five

minutes later. so i wonder, is an end in sight? ... i talk about these parents in this book who have been very courageous and have gone a long way to break down the stigma around drug addiction. >> parents from sort of suburban and middle-class, not apalachee but people whose kids died at college somewhere or something. >> right. i also think as things have changed you're now seeing that translate to larger parts of

the country. using a resistance the old idea that they are to blame for their addiction and that was a huge part of resisting the drug company narrative. it's become a political issue. congress finally is doing things, the biggest change was in the absence of any federal action, the cdc stepped up. and the centers for disease control. and it came to -- who in the mid-2000, was responsible for looking at all forms of accidental deaths in the country except car accidents. and he thought it would be interesting to go and see whether they were going up or down. so he got to get the statistics as he noticed every form of accidental death in the country had been falling with the exception of drugs. and when he dug into it it was opioids and he makes noise inside the cdc and nobody wants

to hear it. until obama points to the head of the cdc and he looks at this and he said -- in an interview with me, he said, the numbers were reminiscent of an epidemic. the kind of thing ec with aids in africa or uc with influenza epidemic after the first world war. and nothing else creates this kind of numbers. and so, he stood up a year later and said, this is an epidemic and it was the first time anybody took any notice and of that being applied. other people had used it but because of his position they took notice. and the cdc really became -- he got himself into a lot of trouble for this but it really they became the pacesetters forgetting other institutions

to move. and they met little resistance until last year, the issue guidelines recommended doctors cut their prescribing. and they were told this isn't your business, why is that is cdc weighing into this? it is medicine. other people are responsible for this. and if i am not misrepresenting what you said to me, i am essentially, it was that nobody else is doing it and this is an epidemic so it is our business. and we have a duty to do this. and their objections within the fda and elsewhere, but it had a huge impact because ordinary doctors took notice. finally, doctors are being told by someone sensible the problem here is the scale of the prescribing. and you don't need these drugs they are unsafe, they don't, they shouldn't be your default means of prescribing.

it shouldn't be a first stop and more important, there is no evidence, no studies to say that they are effective long term.which is what every dr. has been in told and there is no evidence for it. that led to a shift in thinking amongst the doctors and also prompted a number of states to limit how many days a prescribing of opioids there can be. i think actually, the prescribing has fallen, although not you know as dramatically as we probably need to in the sense the u.s. still prescribed three or four times the rate of your average european country. and 60 times the rate of japan. but injected into the conversation, a consciousness about the levels of prescribing. they appointed an opiate commission which i think was a very good report on the origins of this epidemic. all of the factors which i just touched in that fed into it and also came up with some good solutions.

you now have $8 billion spending bill on it, some quite good. to find alternative treatments, nonaddictive type of treatments. some of it goes toward treatment of people who are addicted but it is a fraction of what's needed. when we consider that the white house committee concluded that probably by the time this epidemic has run its course, it will cost the country $1 trillion. 8 billion seems really a small amount to pay and it is rising. >> it is not a administration known for this. you could not regulate guns are just too many out there. obviously, people don't consume guns in then they are gone and so, is a little bit of a

different analogy but there is the idea sometimes that it is just out there, you cannot stop people, they're going to be in pain and they will want drugs. all the alternatives there? i know with heroin addiction on the street, methadone, although it is argued against it as a substitute addiction, that had people can live on and it is less destructive. is there anything like that that is just waiting in the wings and that the drug companies themselves or others are resisting? >> no. there's no magic bullet. probably because of the nature of addiction and different people need different things. there are drugs that help some people that do not help others. and very large amount of people have been to the process tell you that you did with the two, three, five or six times before you merge and are finally able to live post addiction but you never kind of completely passed

it. but, you know, there are two elements to this. one of them is back to the reducing of prescribing because it is all very well providing the treatments to the people who -- there two or 3 million people dependent on drugs. which is a huge number of people. we get locked into the fact that 2000 people died last year of drug overdoses. that has a huge impact on families. and if you're drug dependent and seriously drug dependent, you're not looking after children. that puts pressure on the family, social services, it was so bad they took so many people into care that they have to ship them to other states. some of us in central africa in the 1990s, you go to villages in uganda and you would see a missing generation where the grandparents are looking after the grandchildren. there are places in west virginia where you need more children in the care of grandparents than the parents.

because of this. and the parents are either dead or just not functional. but the second thing you have to do, you have to stop another wave -- if you go on prescribing at this level, then you will continue to create this you know, another generation. there is an awareness but there will always be, if the pills are out there and people are using them at the level to which they have been prescribed in the past, the cdc guidelines, i had my acl replaced last year and i came home with 15 days worth of hydrocodone. and you need that. and when you go to the pharmacy and say, when i going to do with these? devices, grind them up in the coffee grinder and bury them in the back garden. andy said that is how you are dealing with very powerful drugs actually have quite high value on the street, you know, you're not taking this sensibly so you need to be sure there is not another wave coming on the

road that then, they turned to heroin and fentanyl as well as dealing with those already poked. no, this is a big task. >> you have your hand up. should i make sure that everybody gets a microphone? >> can you talk about the underground drug market for this? and also, how much is in the heroin addiction also prevalent in the states? >> and never quite know. you see statistics and you never know how reliable they are but the statistic that has been floated around that seems to be the most credible, 70 percent of people who overdosed on heroin began on the prescription drugs. now, some of those will have begun through prescriptions for

injuries, or chronic pain. some of them have begun because they are sitting in the medicine cabinet home and there was such a lack of awareness, of the dangers of them that in some cases, they got passed around as regular painkillers. having headache, have a pill. i think the cdc study which they suggested that you can become addicted to these pills in as little as five days. so you do not to be taking them for very long. not everybody, but those that are vulnerable. and the stronger the drug more vulnerable. you have a black market because of two things. one is, people need to conquer enough drugs to bring home to fit in addiction. and those three experimentation.

there is a market for many years that was fed by these pill mills. shutting down the pill mills in west virginia there were no ends going in -- new ones going in florida. and florida has an unusual law that allows doctors to dispense peer normally had to take a prescription to a pharmacy but florida allows the dr. to give the pills straightaway. and so, these pill mills were packed with doctors to hand the post-anyone that walked in. i mean the biggest was run by two brothers. who hired -- because the pills were in the pill mills, they became so doctors at the doctors were actually carrying guns to protect themselves. and people cannot afford $150. both of the brothers now are doing 30 years in prison.

but at one point the pill mills were prescribing more than any other place. and those pills end up on the black market and you had a situation where the dealers could make thousands of dollars a month and parts of the country with had difficulty finding them would recruit all of the people and particularly, people that didn't have a lot of money like in west virginia. they would take them to the drugstore, and people would use that to pay their rent. and it can became an economy. and a lot of these smaller places. where people are making more money from dealing in drugs. including people who would not normally have dealt drugs but had a prescription. they need the money. and they became a primary economic source in these towns. and then they just flitted across the country with these

pills. >> what actually is the law that is supposed to control a dr. from doing this? obviously it is wrong for someone to be prescribing 200,000 pills in the course of a week or a month. but they are practicing medicine in theory. and if the cdc is not able to regulate that, and they are not facing the civil charge of malpractice, what is a crime and who is responsible for enforcing the crime? [inaudbile] >> they got them mostly, i love doctors were prosecuted because they were not following medical practice or procedure. particularly, -- >> what is the law? i mean what is the actual --

>> the loss is a dr. who fills out a prescription has to see the patient and must fill the entire prescription at that time. you cannot fill it out and date it later. what they were doing was mass writing prescriptions and leaving them at the front desk for people to come and pick up every month and return for a cash payment. these are the doctors that been criminally prosecuted. it was that kind of thing. the dea will go after them because and the fbi, because of the way they handled prescriptions. there was often the armor. if they can walk into a pill mill and discover, which it did in west virginia, that they were all of these prescriptions prewritten, that is illegal. if they could show as it did with catherine -- who was allegedly seeing 300 patients a day which is just impossible. she was always not treating the it's illegal. so they are not following the

procedure by which you prescribed pills. and those legal obligations -- the family, the fbi manages to get into the pill mill because the make an error and the error is that one of the prescriptions goes out to walmart. gets taken, the patient takes it to walmart and walmart pharmacist noticed that the date is written with the different colored ink and different handwriting. he calls the dea and unravels from there. they've got reason and they go in. but that is in the end, how -- one of the reasons doctors went over for so long as the federal prosecutors were reluctant to go after them because of the practice of medicine. how do you prove that this

person wasn't genuinely in pain? what they have to show, what they did with most of these is to show that they knew they were prescribing to people and circumstances that were not legitimate. the dr. in california serving 30 years, she was the first dr. convicted of murder for prescribing opioids. and they got her on the regulations. and it showed that her breach of regulations led to five deaths. that she was not following medical practice or regulations of how you rate prescriptions. but it is technical. [inaudbile] >> there was a charge of murder. >> can i ask a quick question about, one of the things -- a prescription in general, pain is a perfect indicate appreciate became the fifth vital statistic.

but heart rate and blood pressure and other things, that there is a metric for, pain is sort of this smiley faces or you know the dr. says you know, is it a nine of 10 or 7/10? can you say i don't know. what you got? and there is also obviously, a huge explosion for antidepressants and other things. they may or not be addictive but you can argue that maybe people become dependent on them but they are not like destroying the peoples lives. but they are very loosely prescribed. they are often prescribed to people who have like you know you're supposed to check in with them once a year. you go when it's a few questions and get another prescription. there is an attitude that goes with the pill fixes everything. it is not strictly born of the opioids. i wonder if there is a correlation between the two. you try to correlate the explosion and that there are to be an idea of fixing things.

and some of these are a godsend and some of these are a nightmare. >> when it goes back to that, patients going to doctor singh have these problems, the doctors face the choice of saying it's because you are really badly overweight, you don't to any exercise, that's what your knees hurt. or you can have a pill. and often, walking into these appointments they expect the pill, not to get electric. in the dr. will tell you you know, it's a really hard conversation to have with patient after patient when you're supposed to, the insurance want you to put them through 10 minutes at a time. but let's talk away lifestyle and they don't want to hear about their lifestyle. they want the pills. so there's a mentality, absolutely. that the pain contributed to was that people who were genuinely dependent learned to gain the system. because there is no dr. judging on the whole, you're pointing 8/10, particularly with

emergency departments, they learned to walk into the emergency department and say i am in terrible pain, i need pills. and depending on the hospital, you would get the pills. and it became a very common way. there was a point at which i think one third of all pills being dispensed were coming through hospital emergency departments. and they learn that that is where they could get the pills. but i mean, undoubtedly, the broader idea that this was all part of it. >> yes. >> i understand what you're saying about the black market. but how does a worker who has become dependent on these pills, continue -- or someone that becomes poor and unemployed, managed to keep taking these pills, having them dispensed to him for 20 years. and i mean, that as i

understood from what you are saying, that was not a person who was involved in the black market or wasn't doing anything illegal, they were as i thought i understood it, legally dispensed to him. >> it wasn't legal in the sense he was going to pill mills and getting them from there. he knew phil well that no time he is getting prescription after prescription which wasn't legitimate. >> what does the money come from if he is out of work? >> i think that's one of the things, quite a large number of people who are dependent or addicted on these pills, go on more or less functioning. and so, he was still often working but at one point he spent $1000 a week on getting pills from different places. there is a phenomenon as dr. shopping. where you just go from one dr. to another because there was no monitoring. there is now but no monitoring of different prescriptions and

so you could literally go to three doctors in the same hospital and get three opioid prescriptions. particularly in places like west virginia. a lot of the workers that initially it came through workers compensation schemes. for a while you are funded. it is when -- >> 20 years? >> no, it is when you need more than is prescribed in debt, he describes how the money that should have gone to his children and to other things, just went to pay for drugs. but it also, you know it contributes -- there plenty of crimes because of this and there are no, small towns in eastern kentucky where people tell you, 20 years ago we never lock their door. 20 years ago you know everything was safer in here.

we all knew each other and now, we don't even trust our own relatives. and then he comes home one day and he's been robbed. and he's lost everything. including because he'd been collecting, hit a knife and gun collection for his son. and he discovers eventually, it is a son that robbed him. and the levels of distress to go up in these communities because people are so desperate for drugs, they basically will do anything. the other thing is huge rise in prostitution and eastern kentucky and women in prostitution at younger and younger. and none of these towns talk about that. and then of course you start dealing. if you want a source of cash, you do. so you need, you know, another thing you need 20 pills a day. you buy 50 and you take them to

ohio and sell them there. there were a group of guys who were opioid users in boston. and they fund the entire thing by going to one county in florida bringing pills back and selling them twice the price. then when heroin enters the market, and it pops up in florida a lot cheaper, and until, like many people actually become so addicted it takes over their lives in the can no longer properly function but you can you know, a lot of people for many years to actually function. and it's why when you hear people say i don't know anyone addicted, it may not necessarily be true. in west virginia they told me a couple of years we had to -- punch them in the nose, throw them in jail, tell them to

clean up their act. he discovered there were eight people on the staff who were using pills. and then he stopped and said okay we need to think differently about this. and actually he'd been very successful to change the mindset of both institutions like the police but also, ordinary people in huntington breaking down stigma and hate think about it. partly because it had to pay for the process himself. >> great to see you. thank you for doing the book. i look forward to reading it. if we think about structurally, what's happening, we don't deal well with pain. we don't deal well with addiction. and those two things are overlaid on an economy that's very difficult for increasing portion of people. what we tried to do was, it was easy to say there's an epidemic. that the data was crystal clear. it was much harder to say and this is what needs to be done.

usually we say what we do infection control or vaccination. with opiates it's really difficult. and i think you made a very important point here that we are to think differently about the two or 3 million people who are addicted today and everybody else. because they need different approaches to reduce the risk and when we release the guidelines you mentioned, we did get a lot of pushback. we got threatened with a lawsuit by a the ended up being industry funded. we were forced to delay a few months for additional emaciated procedures. we had to respond to 4000 comments but what we learned through the process was not only is there not good evidence that these medicines help in the medium all long-term, there's pretty good evidence they make it worse. if you take opiates, become kind of acclimated to pain relief and they feel more pain. with the same stimuli in the future and they are less able to go on with their lives. so almost no role ever for

these medicines in chronic pain and way too often used in acute pain. for addiction, you see the change, frankly, from when it was black and hispanic people. it was the family and white people is a disease. it's always been a disease. it changes the way your brain works. and it does that long term. one of the things that really, that we've started when i was at cdc. it would take a few years to come out as, what works in terms of treatment? i am an infectious disease physician by training. we look at what is the long-term success rate per treatment? is there been done an actual living world for all of the different modalities of treatment of opiate addiction and so cdc has begun the study to look at that rigorously over 2 to 5 years. many of us expect many of the drugs programs have very low success rates. not nail, but that most people

who have the changes in their brain are going to need something to help them. short maybe even indefinitely. with it is methadone and buprenorphine or another drug. one question for you. one of the things that always was frustrating as the cdc director with the role of what is called samsa. they actively oppose efforts to make it easier for doctors to prescribe you been offering. they said that most of their resources to program for their unlikely to be helping people who are addicted. in the event surveillance. that wasn't commercial interest. there was definitely commercial interest involved in there but over regulating buprenorphine, and not looking at some of the treatment outcomes, that maybe the treatment industry as it is but did you have a sense of what the role they could and should have played? were the functions of that how

it could have been better done in the federal government? >> my sense of all the federal institutions to be honest, except for the cdc, was that they weren't -- there was plenty of studies, nothing was ever acted on his far as you can make out. but from a dr. that was on the presence opiate commission said, when she looked at all of these federal institutions and what they could have done, she said, they spend a lot of time looking at what they could do. and then never did anything. and she had the sense that that was partly a failure of political leadership. that there really wasn't any national, there was a lack of national leadership and it was not an interest and because of that, really these institutions on the whole, weren't going to take it up. she thought they weren't

motivated because nobody was motivating them and they had their own, the national institute for drug abuse is a good example of this. it took the attitude that it was going to only deal with treatment rather than any other role. that is fine, but there was a point at which it could have played an important role in prevention as well and they decided it was too much trouble. i think part of it my impression from talking to some about this was part of it was they didn't want to go up against the drug companies and the prevailing mood in congress. they were doing whatever track they were on. as i said, that was a failure of national leadership. interesting what you had to say about the cdc and how these

things don't work. i was talking about jim valentine's paper in 2003 and that is what she was saying in 2003. and then finally it is recognized for what it is, exactly right. to pick that up again and get it out of legitimacy, you talk about cdc wanting to do studies, there were never studies. the industry resisted studies that would show how these drugs work to. they must have had their suspicions. the studies were never done. the fda could have required them, had the mechanism, people in the fda, doctor peter e, a senior person said we could

have done these studies, to force the drug companies to do them and nobody ever did. one thing that blinded the whole thing is lack of real information. we've seen the outcomes. it seems obvious, it created an epidemic. from what jane ballantyne said it you are saying, drugs don't work. through all of this nobody has ever done studies and that to my mind resisted it. >> the american medical association, have they taken a line on this and to do people listen to what they're lying is? >> for quite a long time the american medical association took the line they don't want to do anything that inconvenienced doctors, that was it. and in eastern kentucky,

rogers, a lone voice for quite a long time, and congresswoman mary bono whose son became hooked. they pushed through the ryan creedon act. what that law would have done would have required doctors who wanted to provide opioids to have training in comprehensive treatment and addiction. one of the shocking things which you don't expect to hear, after four years of medical training they got a day or two of training on pain so doctors know little about pain. and so susceptible to the drug company, the salesman appeared to know more than they did. they pushed this law and

leading the fight against it, they would inconvenience doctors. there is a close relationship with the industry as well. they put into the line that we mustn't deny the $100 million, indeed of opioids, denying access because of these abuses. and the objections, about compulsory training. this is on the face of political reality. they want to talk about the future. >> looking forward to reading this book and they said thank you for doing the work to tell these stories. i grew up in a community not as

severe as you spend your time in but i have seen what these drugs do and to borrow your phrase it does sound like a very american epidemic that will continue to present itself. what i curious about thinking about those seniors, we see the devastation and how egregious it is but staggering amounts of money, very small amount people are collecting. i'm always curious, where is that money going? what is the vision or site or motivation? is it to pass it onto a generation or an issue the country has that it continues to struggle with? >> are you talking about -- >> the institutional correction.

that influence politics -- >> people get more money and feel they need more. the family made $50 billion. they stamp their names on a lot of institutions. it is a tiny fraction of the money. the 10th richest family in the country, and not short on rich families. that is the kind of money that has been made at the top. by 2009, putting in $3.4 billion a year. there were lower-level opioids which were in the system and the hydrocodone pill made $1 billion a year so i think at

the height of it the opioid industry was worth $8 billion a year. then everybody take their cut off. i don't really know how to explain the money working its way through the system and work its way through the political system in the sense that that is how congress is funded through campaign donations and the rest. the lobbyist for the industry, for the pharmaceutical trade industry on capitol hill had been a congressman. he goes over in the late 2000s over to represent the drug companies, specifically on opioids and became the highest-paid lobbyist in washington dc which tells you a lot about the power of drug

companies but money distorts everything and people pocket it, cops pocket it, doctors pocket it. when the clinic in the safe-deposit box they found $400,000 in cash, what she was worth. the former prison doctor, they lock -- looked at her four bank accounts and he had $1 million in cash and told the police he didn't know who it belonged to 2. he had never set it up which is probably true until his staff set it up. so much money that the receptionist at the williamson center when they rated her house they found $480,000 in cash in her house. that is how much she was making as a receptionist and her

husband was a state policeman. when the fbi said where did the money come from? i do a lot of overtime. >> the housework? >> they tried to seize the house, they could prove they bought the house before the money but they had a collection of 600 guns because the fbi agent that rated the house said to me he built an area above his garage where he stored his guns and they couldn't believe it and 600 guns in there. the fbi agent said when you have that money would you do with it? he seems to like buying guns. so yeah. >> thank you. many more.

[applause] >> for sale downstairs and you do that and thank you for coming up. >> here are the best-selling nonfiction books according to amazon. topping the list is becoming.

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