>> r "washington journal" author series concluded with chris. his new book is american overdose. the opioid tragedy. good morning. you open this story in williamson west virginia in the mid- 1990s. why there, why then? >> when i was researching the book one thing that was most striking to me and the book came out to my reporting for the guardian. i'm talking to people in west virginia which is a crucible of

the epidemic and remains its epicenter to the extent that it has the highest overdose rates in the country. one things that striking is the people i spoke to had talked about how they were drawn into addiction through prescriptions in the late '90s and early 2000's. this was an epidemic that began on the bill clinton presidency and had run through george w. bush and barack obama. here we were, finally at the end of the obama presidency and into the trunk presidency before it was getting the national attention that it needed. so i go back and look at where it began. west virginia really encapsulated a lot of elements of the epidemic. one was the prescribing, the

beginning of the prescribing of the powerful drugs for routine pain which help draw people into addiction. the other reason is that it became not only an area in its own right where there were's a lot of people became hooked on these drugs but actually it became a distribution center for a part of appellation and beyond. as you see the establishment of one of the biggest pill mills in the country. that came out of an individual. a man who is appropriately an undertaker. he had just been in prison serving four years for running a gay escort agency in washington, d.c. that was busted by the secret service and the federal government. he was sent back to williamson by his parole officer. he sees a business opportunity in setting up a group of doctors

in a warehouse is technically a pain clinic prescribing drugs to just about anybody who wanted them. you see williamson become the place to go to for a while. for a decade doctors in this pill mill were just prescribed thousands of pills every day without really consulting a patient. you paid hundred $50 you got a prescription. >> american overdose is the title of the book. you are a british reporter for the guardian newspaper. how is this uniquely american crisis as you have described it? >> one is the scale. there is nowhere else in the world where you will see the

scale that we have seen over the past 20 years. nobody really knows the numbers. particularly early on deaths from opioid were not recorded because of stigma or because they were not recognized. the cdc says at least 350,000 people dead. the real figures probably higher. you're not seeing that in other countries. the other thing is how it came about. this is not the results of an accident. he was described by the head of the food and drug administration is one of the greatest mistakes. but it really isn't a mistake. it was a strategy by the pharmaceutical industry to really co-opt medical practice. particularly in treating pain and ensure that these opioid

pills became the first stop for treatments. they were very effective in that. they got on board with medical institutions, they got on board with regulators like the food and drug administration. they got on board state medical bodies. they got on board the medical profession in a big way. that perhaps comes out of the fact that the united states medicine is an industry. in most developed countries it's a service. to some degree it's either run publicly or very strictly controlled by public bodies. in the united states is an industry. i think that's what the opioid epidemic was driven by. >> were more talking about the opioid crisis in america, we usually have phone line set up differently. if you been impacted by the

opioid crisis you can call one number. were talking with chris about his new book, american overdose. the opioid tragedy in three acts. you are talking about the numbers of this epidemic. this, from the washington times showing that deaths from opioid overdoses since 202,017. 47600 deaths, up from 8000 to 2000. could you put the overall numbers in perspective. >> they run into the hundreds of thousands. for most of that time, at least the first 15 years, the single largest numbers of death were from prescription opioids themselves. in the past five or six years we

see that change with the rise of deaths from heroin. that's largely been driven by the fact that people have found that when it is not prescribing how it has filtered through the medical profession and even some political control on prescribing in some states. you've seen a shift towards heroin simply because it was available. for a long time the prescription drugs were the easiest option. more recently we've seen the rise of functional which is a synthetic opioid. that's been reduced through to strengthen heroin and more particularly recently there is a lot of people using it directly or without their knowledge it's been used to fake opioid pills, prescription pills. now were in a situation where

it's estimated in 2018 about 50000 people will have died from opioid. about half of those will be fentanyl in about 15000 will be heroin in about 14000 will be from prescription opioids. the thing about the numbers it's low fentanyl has become this very large number. the number of those dying from prescription opioids have not been dropped that significantly. >> one other thing to show you, the special section that came out late last week, this map showing the opioid epidemic across america. this is drug overdose rates in each state per 100,000 residents. you can see the epicenter in west virginia.

ohio with 46.3, pennsylvania with 44.3. chris, taking your calls as we talk about the opioid crisis in america. the phone lines of those who have been impacted. kevin is on the first line in indiana. go ahead. >> good morning. i've had three close friends die throughout the years, summer high school friends and we lose touch after college but i've always been impacted by it. was 37 years old and seeing how it affects people. i don't know if it's an epidemic or an enforcement issue. seems like i got involved with some local police officers and they win out and started busting

people the thing is they're all afraid of the gang members in the ms13 and the mexican mafia, and back and getting them for arresting people that are silly drugs. moreover we were have a solution. ritually stop the supply and have the cops to do their job i don't think this is going away. >> i think there's two things going on this brings on a particular element that is in many ways a law enforcement issue. what is driven this and created this and the reason it's american rather than global epidemic is the mass describing that took place in the united states. you had the people who because they were prescribed the drugs

what were relatively low levels of pain or for long times when they should have been they were prescribed in large doses. you seen people become dependent and hooked on these drugs and then they think they can get everything they need from prescriptions on the black market where their doctors cut back on their prescriptions. so you have the mass prescribing driving on low prescribing has fallen by about 20% from its peak. you still have very large numbers of prescriptions being written in the country. you're still drawing more people into addiction. but then you have the criminal element in smuggling of heroin invention all across the board.

i just spent a month in huntington, west virginia. they have been effective in bringing down the overdose rate, in part through law enforcement. that's important. there are other elements to it including cutting back on the prescribing giving people who are addicted to these drugs access to treatment and breaking down the stigma around drug addiction. i think that's one of the biggest issues thanks many of whom don't become addicted because they began by experimenting with drugs. they took the drugs as they were prescribed. >> the subtitle is the opioid tragedy in three acts. is that cycle that you went through the three acts that you talk about? >> yes. i look at the origins of this.

one thing in writing the book and why this one on and has gone on for two decades is that you wonder where the alarm bells are being wrong. why was this a long allowed to drag on for so long. where were the early warnings. one thing that became quite apparent is that they were deeply disturbed in the very first years of this epidemic. they saw the signs. an example is doctor jane valentine. she was head of pain management at harvard university. she bought into the idea that patients need these drugs. that these drugs are safe which

is what the drug companies are saying. they were not addictive. there is a stigma that needed to be broken down. they could be used for all kinds of treatment of pain. then she began to see after a few years that in fact many were becoming dependent some were becoming addicted. above all she was saying long-term opioid prescribing was not working for many patients. they were still in pain they needed more more drugs. she's also hearing from families that they were not they were not the people they were. personalities were changed they are in pursuit of these drugs and spending time and money in them. she wrote a study in 2003 which should've because the industry and regulators to pause and say

maybe these drugs are not what they are promised to be. she expected that to have a real impact on it that it. there are other doctors who found the same thing. there is a surgeon in the 1960s in detroit he was saying the same thing. patients after surgery who were given large doses of painkillers were starting to die. what you see happen in the early years is instead of the conversation being about whether these drugs are the right thing to be prescribing for most people even though there were people who need them, the industry is able to shift the conversation to paint the people who become addicted as abusers. and just we have these abusers

and they should not be allowed to take the drugs away from the inner sent patients who need them. some of these are the same people but the industry successfully turns the conversation into the good and bad. the black-and-white issue. for many this is in essence to keep the doors open and keep selling the drugs. this keeps going until really about 2010 or 11 when finally the cdc stands up and says we have an epidemic on our hands. >> there a lot of folks waiting to talk to you. >> this year was one of the biggest frauds ever been perpetrated on the amore can talk people. i'm in my 70s suffered from

colon cancer and i have to take and go to the dr. every month, there is a lot of time for urine test and blood test to see if you have them in your bloodstream. i never had a problem. i took last drugs before the loss went into effect. i have to keep the memory now or i'll be cut off. i think it's a cash cow for the police forces. we militarize * week workforce. when you show this certain areas like west virginia. they set up these pain clinics from miles around they were the same people i knew in the 60s

that one out after every drug. >> i think it's exactly the kind of person that does need it. they are designed for people who have cancer and are grappling with that. one problem that has evolved is that the medical profession is not really in charge of paying management. it still controlled by the industry and the politics of it. if you look at how opioids came to be mass prescribed, because they had previously been an epidemic after the civil war and into the early 20th century there is a severe crackdown on the use of opioids. until you see the hospice movement emerged in the u.k. and

they use end-of-life care for cancer patients that comes to america and then there's a group of doctors who say well you can use it for cancer patients in end of life why can't we use it for all pain patients. those are the type of person who should be getting the drugs on should be given them according to what his dr. thinks he needs. i would disagree that this is just about the police. this epidemic has been going for 15 or 20 years. it's clear that this is a pain management issue was driven by an industry that wanted to sell drugs. >> alex's in virginia. also impacted by the opioid crisis. go ahead. >> good morning and thank you for having this discussion.

about the opioid epidemic i've been personally affected. i'm only 22 years old. i had a couple of friends pass away this year. there my same age. and because of drug overdoses. i want people to understand it's not only happening in rural areas but also wealthier areas like in fairfax county one of the richest counties in the united states there is an extreme drug problem. i think the younger generation like the one i belong to our moving more towards things like xanax were some others in terms of the actual clinical name. i want people to understand it's

not only happening in rural america but also other areas. >> you see the map and you see the beginnings of the epidemic in that area and it's a red dot. it grows and gets deeper than it spreads across the region of the country. and then the red dots pop up. but by the mid to thousands partly because mass prescribing that large numbers of pills going to people whether they needed them or not. it's just not the number of people getting the drugs when they were prescribed perhaps two or three days for the treatment they get 30 days with the pills.

a couple of things could happen. one is they simply got passed around within the family as these are good pain pills, weathering take one, or you have other people who start to experiment with their parents drug supply. but the scale of the prescribing the number of pills given out with each prescription meant that a lot of these bills were floating around. you see that in communities and very wealthy communities but pretty much across the country. by the mid to thousands it's become a national epidemic. >> james is on the line. go ahead. >> i suffered a spinal cord injury that left me disabled and in a wheelchair.

i have been addicted to morphine while in the military and being treated for an injury there. i had an experience with it. i don't take opioids. when i was in surgery because i have a back full of titanium, under surgery i took it. i found that high don't have to have opioids. i find that herbal medicines, meditation and the little will, will do it. i think it's a scam that we play the highest price for drugs and the free world and probably the entire world and we have pharmaceutical companies doing the same thing they are intentionally addictive and they pay off the doctors to prescribe it. it's a horrible thing. my answer is, i've suffered as

much pain as any human being can suffer. i can get by. i'm not out of pain but i'm not a junkie walking around with my tongue hanging out. >> chris. >> guest: it's interesting to hear that. one thing when you look at how this epidemic evolved, one thing the drug companies do is they avoid any kind of index study on if these drugs are effective long term what the long-term consequences are. they do know clinical trials because they're not interested in that answer. they push the idea of pain as a vital sign. the concept is that you have other signs, your heart rate and blood pressure and they can all be measured. the drug companies push the idea

that you should also have to address pain. to give you an example, one place they pushed it was with the joint commission. hospitals need those licenses in order to get federal funding. the joint commission essentially got into a financial relationship with various drug companies that that sought setting up regulations that required doctors to treat pain as a priority issue the drug companies end up writing the manuals for the doctors is a reason why you see the smiley faces in hospitals and clinics. they are between one and ten. those are a result of the joint commission and then the drug

companies write the manuals for the drug companies they wrote the manuals what so striking is that they all push the idea of opioids as the answer. there's not really talk about the alternatives whether it's dealing with that through physical therapy or through stress. for other kinds of medicines. that bit about selling pain pills. the insurance company looked at as a cheap alternative to say physical therapy. doctors came under enormous pressure to prescribe patients who saw these as an easy way to

go. and then insurance companies which saw these as a cheap option. along with that the medical industry also bears responsibility because it push the medical profession the idea that people could live pain free. the fact is, when you get older or injured, a lot of doctors will tell you you cannot live pain free. you have to learn to manage pain and find ways to manage it. these pills were the promise of living pain free. so that swatted as well be one in your book you talk about the lost decade. you defined it as the years of the unequivocal warnings for those grappling with the early impacts of mass prescribing of opioid and the cdc stepping up.

he could have been contained in hundreds of thousands of lives saved. when was that? >> that's what i'm talking about the early to thousands when jane valentine was giving her morning and when now former head in 2011 said there's an epidemic in this country. and in those years that was really the decade when the epidemic could not been reined in but prevented if the early warning have been heard and if the industry had not so effectively by co-opting not only congress but also to be honest, regulators like the food and drug administration which essentially was compromised by its relationship with the

industry. in that decade you see a missed opportunity to assess the effect of these drugs and terrain in the shears gala prescribing. >> let's go to bluefield west virginia. good morning kelly. >> caller: i know that prescription drugs as he stated are smaller problem than the ones that drug dealers are portion of people. now, there is a push in this country that are drug dealer gets caught for the first time he gets a smack on the hand because we don't want to put him in prison. they are forgetting that they may have killed corporate people and situations that they cannot get out of. instead of getting them a smack on the hand we need to look at

it and say you push these drugs, you may have been doing it for years but even if it's the first time you got caught and to me it should be your going on trial for murder because that's what you probably done. you probably killed people. to me there should not be a push in the country to let these people off with a smack on the hand. if you made it stiffer sentences then maybe they would think twice about pushing the drugs on the american people. >> there are states that are pushing the idea for murder charge for people who distribute drugs, particularly fentanyl when it shows that there was fentanyl in at least one overdose death. there are law enforcement issues in west virginia speaking to the police chief in huntington.

they don't have the resources to lock everybody up. perhaps there's a distinction to be draw between the people who are dealing because they been driven down a path that perhaps they would not want to go down. on those who are purely doing it for money. obviously i think major prostitution would be different. also the doctors have been prescribing it on a very grand scale. and those that i talked about, one of them doctor kathleen hoover was prescribing more pills in the 2000's than in west virginia's biggest hospital. one of her fellow doctors was prescribing not much less than that. diane schaefer went to prison for only six months.

there is a feeling among law enforcement that doctors got off lightly as well as the street drug dealers. there's some sympathy from their street drug dealers. they say perhaps some people never had an opportunity. they got dragged into it where is doctors who have been involved in an have every opportunity and privilege in life and yet they still chose to go down this path out of pure greed. >> we have a few minutes left. the opioid tragedy in three acts. sandra on eastpointe michigan for those impacted, go ahead. >> is going on 50 years and she has severe osteoporosis of the spine. she cannot even stand up straight anymore. she had breast she had implants

and she scared to have the surgery. she's been taken pain medication for eight years. she takes the same amount now than she did eight years ago. it doesn't take away all of the pain, but it makes it bearable. people like this guest has no clue about what pain is like. my neighbor has a friend that was on pain medication for six years. he had a problem to with his back. he was taken pain medication for six years. the dr. was afraid to give it to them anymore and took him off. within a month he committed suicide because he couldn't stand the pain. there are millions of people taking pain medication. you should not have to have cancer. my sister-in-law had cancer surgery four months ago.

she was sent home with enough pain medication for ten days. after that, she suffered terribly. these people who are abusing drugs or hurting people who sincerely need to take the. >> jon: thank you for telling your story. chris, a chance to respond. >> guest: i go back to that there are clearly people that need these drugs and clearly people that these drugs work for. that's true in other countries as well. what has happened here because the medical policy has been driven by essentially greed, and still not run by the medical profession. in some ways were seeing in overcorrection a swinging back. doctors are fearful of prescribing because of the consequences and the political climate and they fear there

could be a sanction against them. partly because a shocking thing in researching the book was to discover that many primary health care doctors, vast majority get very little training in pain management. they make it two or three days and four years of initial medical training. actually they have little information on which to base their decisions. they don't know much about how opioids work her addiction. frequently they were getting their information from the salespersons who are coming in and telling them how the drugs work and how they should prescribe them. the medical profession through the american medical association for a long time resisted that training. they said it was an inconvenience to doctors. when two members of congress

both republicans introduce the rank that said they would have to have treat the ama opposed it. i feel very sorry for those people who need these drugs. and who are finding themselves now struggling to get them. it's because it's the medical professions making these if they need to take control of this healthcare industry. >> carl has been waiting. >> good morning. i'm calling because the i had an operation on my hand for trigger finger. they cover a little slice of my poem luminaries out of the hospital in a short time. they gave me 30 tramadol opioid

pills which i did not take a single one. i'm fairly educated and i still have them sealed in the package. they said they were good for a year so if i get it toothache or a severe headache, i don't know what to do with the darn things. i took a wet washrag and shaped it to my hand and put it in the freezer. when my hand got stiff i took it out and held it in my hand till the swelling went down and then i put it back in the freezer. the amount of pain i had was minuscule. this thing about making pain a diagnostic tool. they asked me when i go in for routine check do you have pain, yes, i'm 74 years old. occasionally i worked too much in my back goes into a spasm a minute goes away.

when they tell you rate your pain between one and ten there giving doctors responsibility to the patient. if you're a drug addict you're gonna say ten and get a prescription if you don't want him you're going to say one. most people can deal with a small amount of pain. they made it way too easy to get these drugs. don't get me wrong, the virginia's great but i'm surprised giving those pills really surprised me. >> thank you. >> this prescribing the sheer number that these people get. the cdc came out with recommendation which they say true pain really should not get three or five days worth of

pills. carl got 30 days. that's because after five days there is a sharp increased risk of big diction. it's about the convenience not of the patient's it's of the doctors in this case. the ama had proposed a reduction in prescribing because it was inconvenient. insurance companies don't want to deal with the paperwork. it comes back to money, convenience rather than good medical practice. >> jon: the final 60 seconds. how did the book change you from getting families to tell their stories about addiction? >> guest: getting people to tell their stories was not as difficult as i thought it might be. one, the people in west virginia was talking about are angry.

they're angry at what's happening to their communities. drugs have devastated communities. they feel they were duped into taking drugs. doctors didn't warn them. you have a lot of people who take them for the pain of middle-age from labor and working lumber. i think their community is devastated and they feel like they're duped. the other group that have been open and those who have tried to break down the stigma. children have been like, addicted and they see the stigma around heroin, their kids may have taken the drugs because of a sports injury and they end up on heroin and end up dead in blaine by their own death.

a lot of people are wanting to break down that stigma. perhaps the biggest changes the courage of those who have come out. >> the book is american overdose. the authors journalist chris mcgreal. we appreciate your time. >> thank you. >> here's what's ahead. . . .

>>host: introducing kai-fu lee author of the book ai's superpowers. mr. lee will talk about that book in just a minute but first give us a sense of your background and the jobs you have held. >> a phd in artificial intelligence from carnegie mellon 1988 after that i worked in various capacities