and at 11:00 a.m. eastern, the funeral service at the national cathedral. the state funeral for president george h.w. bush, watch our live coverage all this week on c-span and c-span.org, or listen on the c-span radio app. when the new congress takes office in january, it'll have the youngest, most diverse freshman class in recent history. new congress, new leaders. watch it live on c-span starting january 3rd. a look now at the opioid epidemic in america. we'll hear from an assistant secretary of health and human services and a correspondent for "the washington post" at this event organized by the brookings institution. >> all right. well, welcome, everyone.

thanks for coming out on this rainy day. really appreciate it. i'm a correspondent for "the washington post." i cover drugs and other issues around the country. with me we have admiral brett gerrard, the assistant of health and human services. i'm going to ask some questions, we're going to get a robust conversation going. and open it up to all of you. i'm going to ask everyone on the panel to respond to this question. there's been a lot of policy implemented around the opioid vie s crisis, but the number of overdose deaths is continuing to rise. is what is being done at the

state and federal level sufficient? what must be done to stem this tide of overdose deaths? admiral, go ahead. >> good morning, and thank you very much for inviting me to be on the panel, and i look forward to open discussion. i always have trouble sitting down and speaking, but i'm going to do my best. now that i'm tethered on the microphone. as i've said many times, particularly opiod misuse crisis is the health challenge of our time. >> although we are doing as many things as we think that we can. there's always room to do more. our five point strategy has been well documented about improving pain control, data, access to treatment, and improving research, and availability of reversal. what i want to say, though, in response to this question is the number of deaths and overdoses

are far too many, and no one can declare victory, you need to look at the most recent data, the number of overdose deaths have increased. when you look at the data more recently. it does look like we are making an impact on the overall crisis. some of the things you would like to see happen that are happening, since january 2017, the amount of morphine milligrams prescriptions have gone down by 19%. the number of individuals receiving bupenorphine is up 21%. the data is from the national survey of drug use and health, shows that pain reliever misuse and pain reliever use disorder have both significantly decreased, between 25 and 2016 and 2017. the number of overdoses going to

the emergency rooms between the third and fourth quarter of 2017 have declined for opioids almost 14%. if you look at the mortality curves, looking at the rolling 12 months, not just 2016 to 2017, the most recent 12 month periods, we're starting to hit a plateau and start to go down. what i'm not doing here is declaring victory, we have to redouble our efforts, and you saw three weeks ago, we had a major opioid push with $1.5 billion in grants. with the new surgeon general's documents, with new cdc money all going out. but what i don't want us to believe is everything we're doing is not making an impact. we're starting to see signs that your efforts, your efforts, our efforts together are starting to impact that, and i look forward to answering specific questions

and elaborating on what our next steps are. >> thank you. >> so thank you very much for having us here today to talk about this important issue. i previously served in the obama administration in the white house office of national drug control policy for the entirety of the terms, the two terms. in answer to the question of have we done enough, i think that i'm really pleased that this is one of the few areas in this country and in congress where we have bipartisan agreement on what to do. and many of the things that we began in the obama administration have continued and actually been increased and expanded upon in this current hhs under the leadership of the admiral and others at hhs. so that's a wonderful thing. but i think we can all agree that we still haven't done enough to address the issue in light of the fact that we're still seeing increased rates of

overdose deaths, but also, we need to make sure we're looking at the issue of opioid use disorders not just about opioids themselves but about addiction. if you look at the addiction epidemic, in all of the drugs that are involved in driving rates of substance use disorders in this country, that's really -- i see the opioid epidemic as kind of the on-ramp to the broader discussion about the totality of substance use disorders. we have a long way to go to change our health care system, our criminal justice system to recognize the disease of addiction and recognize that it is a disease that can be prevented, treated, and from which people can recover. so i think that if -- certainly we haven't done enough yet on the opioid epidemic, but we

haven't done enough to address the entirety of the diseases. hr-6, which i think we're going to talk about today, which is legislation that congress just passed in a bipartisan manner to address the opioid epidemic, that has a lot of good pieces of legislation in it. the other piece that i think is important is to look at the barriers. not necessarily passing new laws but looking at existing laws that stand in the way of treating addiction as a public health issue. what are the legal barriers? what are the policy barriers? what are the regulatory barriers? so those are some things that i actually plan to be looking at in the future, in the next couple years to explore how we can remove those barriers to address addiction as a disease that it is. >> so i think one of the challenges with an issue like this is that it is so dynamic, and one of the benefits we've seen from this administration

and continuing on the work of the previous administration is a recognition that there needs to be a coordination of strategy, a coordination of data, a coordination of a variety of means of communication. ultimately, while federal policymakers are setting agendas and federal policymakers are making recommendations, this is a local level issue. this is not just an issue that individuals in counties and municipalities are facing on the front lines. they're facing it in different ways. what is creating problems? what is motivating opioid use disord disordere disorders or overdose deaths in one state may be very different than the underlying forces causing it in another state or in another area of another state. and so one of the biggest challenges is this idea that there can be one size fits all

strategies, that you can design something at the federal level that will help ohio and will help alaska and will help arizona. the reality is that the key to success, the pathway to success here, like in a lot of areas of policy, is to make sure that federal policymakers assist local leaders and assist local policymakers in addressing the opioid crisis but also that they get out of the way when they're causing too many problems. we have a lot of policy at the federal level that is creating those types of complications. hr-6 tries to deal with a couple of them, and hopefully it ultimately will once the legislation is signed. but there are a variety of ways that i think local leaders can continue to communicate with state officials and with federal officials to say, this is where we need help, and of course help in some cases means money. in a lot of cases, it means money. but in other cases, they can say, here's what we need help

with, and it is the freedom to do what we know will work, what we have seen has worked elsewhere, or what we think might work and whether that's working with a pilot grant program from hhs or whether it is just expanding what they have seen in other areas as helpful on their own with their own money so long as federal officials and federal law allows them to do it. that creates this, as i said, dynamic area of policy that is extraordinarily difficult to tackle. one of the reasons why overdose rates are as high as they are is because this is so complicated. because throwing money at it might help a little bit, but it's not going to solve the problem. because again, what is helping in one state isn't necessarily going to help in another state. that creates a complexity that local level officials just are not prepared for. they don't have the capacity to deal with in necessarily a

strategic way. so it's that broader conversation, that inclusive conversation among policymakers that's going to solve this. one of the benefits of the opioid crisis as it is right now is that it is so widespread that individuals are naturally involved in it. this is not something localized to one or two or three states. because this is an issue that affects every public health official in the united states, every member of congress, every state legislator, everyone has some stake in this. while that's unfortunate because it means tens of thousands of americans are dying of overdose deaths, hundreds of thousands of americans have opioid use or other substance use disorders, it does mean you can shore up that kind of political support, as regina said, to create an area of policy which is rare in our politics right now. that's where bipartisan support can be applied to tackle what is a massive national level issue. >> since we're talking about the congressional bill now, i'll ask

you this, john. what in it will make real changes? there's been criticism that a lot of it is tinkering around the edges. some have said it's a political document rather than a policy document. what in it do you see that you think will make real change on the ground in these states and places that are really suffering from this? >> i agree with the criticism. this is a small bill relative to the size of the problem. this is an issue that i think a lot of members of congress can pat themselves on the back over and go to their constituents and say, hey, we're working to tackle the opioid crisis. but there are a couple -- there are a handful of real palpable benefits from this legislation. one is an expansion of funding opportunities for pilot programs within states. now, whether the appropriations process ultimately funds these programs to the levels that are necessary, that remains to be

seen. i think we have an experience this year with an appropriations process that has worked better than it has in quite some time. so i think there's some optimism around that. but if those programs are funded, that's going to mean money in the hands of local governments to do what they need to do to begin doing the research and data collection and having those types of coordination efforts that can be meaningful. second, there are several provisions in the legislation that, as i said in my opening remarks, gets the federal government out of the way or at least lessens their impact. so the caps on the number of patients that a doctor can treat is a real positive. lifting that cap from a hundred patients to 275 patients, that's a real benefit. that means that people will be able to engage in this. we'll be able to use this in a

way that they were somewhat restricted from before. that said, that's one part of a problem. there are a lot of doctors who are not prescribing this medicine to their full capacity. part of this is physician education as well, making physicians better aware of these opportunities and for the benefits that we know come from medication assisted treatment. third is the removal of -- i said third, not that is exclusive -- third is the removal of limitations in terms of medicaid reimbursement for in-patient treatment for individuals with substance use disorders. this was something that was restrictive for in-patient facilities, was creating the types of incentives that pushed individuals into other avenues of treatment when in-patient treatment might have been best for them. it's not universally best for everyone.

but for sets of patients, it can be. again, that is government getting out of the way. that's government listening to local health officials and to physicians and saying this is something that can help. so let's do what we can to make sure that outdated federal policy is not restricting our ability to serve those people most in need. >> you talked a bit about the additional money that you all have allocated recently. was any of that money reallocated because of the public health emergency? has any money been reallocated because of that? i'm hoping you can talk about that and what you all have done in the past couple weeks with that money you spoke of. >> so the additional funding that has been supplied in a bipartisan fashion is not a result of the public health emergency declaration, per se, but it's a result of the fact that this is a public health emergency. i want to stress and build on some of the comments earlier

that one of the philosophies of the funding cycle, at least currently, is that we want to promote local activity. so if you look at the state opioid response grants through the recent 930 million and the 500 million before that, it allows great flexibility for the states and localities to use that money as is seen fit in the localities. we have really stood fast upon that with the one caveat that it has to be evidence based. so we need to support evidence-based practices. again, to build on some of the discussion, addiction is a disease. it needs to be treated holistically, and the best evidence shows that medication-assisted treatment, combined with psychobehavioral support and recovery services are really key. we do insist that it's offered in order to get reimbursed by the programs. similarly, the technical assistance has been dramatically changed from sort of the d.c.

centric de centric technical assistance program to decentralize that. in every state, all 50 states, there is a program and contractors working at the very local level to supply technical assistance as is needed. so i fully do agree that this type of local empowerment is very important. the money that's gone out is to empower the community health centers and the community health centers are very, very responsive to the local needs. dr. segunas has, i believe, about 70% of the health centers with mental and behavioral support, along with typical physical services they've already done. so we have really tried to push that down to the local level to the degree that we can. i would say the cdc as well is providing grants to localities to empower their data collection systems and very importantly to

link the electronic health records with pdmps and prescription drug monitoring programs. so i just want to build on the comments that we absolutely believe and assess this as a public health emergency, addiction as a disease. opioid use is only one aspect of that disease. if you look, methamphetamine is on the rise, cocaine on the rise, 35%. the underlying psychosocial issues among the 18 to 30-year-olds, suicidal thoughts, suicidal ideations, decisuicida attempts, all on the rise. so this is a more generalized problem within our society of which we do believe addiction is an important symptom of that, but one that we're tackling, you know, head on right now because of the deaths in the overwhelming disruption to families and society. >> has any additional money been allocated because of the public health emergency that was declared? >> again, the declaration itself

hasn't caused the money to be allocated. it's the fact there's an underlying need that led to the public health declaration, really, is what's driving the funding. >> you made an important point i want to talk about, which is meth use is up, cocaine use is up. if you go out and talk to people, you know, local law enforcement in the field, they say they're having really big issues with that. fentanyl is being mixed with them often. is the public policy response to the opioid epidemic helping build an infrastructure in place to respond to these other emerging drug threats that are happening right now? regina, if you want to talk about that. >> so the bulk of funding for states to deal with all substances comes through a block grant provided through hhs. that has been level funded for a number of years. so that money would be, you know, could be used for everything.

the opioid moneys can also build the treatment system that can help with this, but they're not specifically -- you know, they're specifically tied in many cases to the opioid issue. however, i think one thing in terms of the meth use, i was speaking with someone from kentucky the other day. many states are seeing increasing meth use rates. because the supply right now of meth is mostly liquid meth, not what we used to think about with trailer parks, people making the meth in their trailer, that's not what we're seeing. we're seeing liquid meth coming through mexico in many cases. the meth is being injected. so to the extent that the syringe exchange programs are.

and so the great thing -- first of all, i want to comment hhs for the recent sor grants, the 900 million. they require they be used for evidence based treatment. basically you're saying you may not like medications to treat opioid use disorders, but the science leads us to the use of medications. that's effective. if you want to use federal funds, you need to provide evidence-based treatment. and that's really critically important. and hopefully that will make a difference. but in terms of cocaine, we don't have that same type of treatment for meth or for cocaine. so we need to -- again, we need to focus on prevention, but the treatment will be a little bit different. but the recovery supports will remain the same in terms of making sure that people have

stable housing, that they have employment opportunities. so the continuum of care is the same, but we don't have the same types of treatment available for what we're seeing as emerging drugs. >> i absolutely agree, but i just want to say the absolute intent of all the funding is to not just solve, quote, opioids, but to create the philosophical, scientific, the infrastructure to look at addiction and issues such as mental illness all across the board. that really includes, for example, enabling our community health centers to have the type of providers to shift the work force so that we have more behavioral health providers, that we understand models of care that include not just an addiction psychiatrist, which is very important, but when you're talking about 2 million people with opioid use disorder, you will never have enough addiction

psychiatrists. we need to train primary care physicians, nurse practitioners, mid wives, everyone to understand how to treat addiction as part of a team with m.a.t. and all the very important components to that, including peer counselors, including social workers, including behavioral health people who can work holistically on a team. it is certainly our intent that what we're building right now will have broad applications across the spectrum of use disorders because this is not going away. in fact, if you look at a recent publication by dr. burke that just came out in science, it basically shows that if you look at our overall addiction problem since the 1980s, we're on an exponential curve. that really hasn't changed. the substances that are the subject of any given five or ten-year period changes, but that is on an exponential curve that we have to fundamentally engage as a government and as a whole of society. >> you know, people often say

that in order to have an effective response, you need what is basically a three-legged stool. so a prevention, treatment, and enforcement. they're different policy initiatives that work in concert together. how do you craft policy where each leg is equally balanced and y you're able to deal with those three issues that are so important for the drug issue? >> so i just want to really briefly -- i'll turn it over to you in a second. the white house office of national drug control policy is supposed to do that. hr-6 did reauthorize that office. what our role was in the 7 1/2 years i was there was to bring law enforcement together with public health. the first individual we had was a former police chief. but he also really embraced public health approaches. so he could go to law enforcement and say, this is why

carrying naloxone is an important part of community policing. also, he could speak to public health about what was important to law enforcement. so they were -- it really -- it was communicating across many spectrums of opinions about law enforcement. then the second person we had in the office was in recovery who came from a public health perspective. it kind of lent itself to that change, that reform we saw. but that office which was just reauthorized can allow for that dialogue. by establishing a strategy with goals for the entirety of drug policy across the federal government and also to set an example for states, that's really the goal of that office. >> i think this is a really important issue, particularly around opioids, not just striking that balance in terms of the design of policy but striking that balance in terms of rhetoric around that policy.

so enforcement is going to be a critical part of this fight against the types of substances that are creating use disorders, particularly with opioids. i think the fight against synthetics is something that is challenging not just in terms of their source, which in many cases is china, but their routes of entry into the united states, which are not being smuggled across the u.s./mexican border in the dark of night but are actually coming through the mail system and through other shipping routes as well. so being able to combat that, having a more powerful conversation with china, not about steel, not about soybeans, but about the production of synthetics, i think, is a really important part of american foreign policy, which is so often left out of this conversation or in decades past, so terribly mismanaged in the fight against the in-flow of drugs into the united states.

but having that strong enforcement side, particularly foreign enforcement or border enforcement, rather than domestic enforcement, is an important signal to individuals who are dealing with the struggle of addiction. for too long in this country, addiction was treated as a public safety issue and not a public health issue. because of that, it disincentivizes individuals from getting help. the admiral, i think, very eloquently explained the purpose of new grant funding and continued grant funding in this area. it is to do reverse those prior trends, those prior sorts of perceptions of what addiction was. and that's important. that starts at the local level, being able to convey to individuals that you are not a criminal, you are ill, you are dealing with a medical condition. and that is a very easy -- or i shouldn't say easy, that's a

very important first step towards finding prevention and treatment strategies for those individuals. and i think layering on top of that, for a lot of people in this country, they see addiction as someone else's issue, a disease that affects other people. i think in many ways, the pervasiveness of opioid use disorders and the overdose crisis around opioids in this country has pulled that curtain back to show people that it can happen in anyone's living room, in any family, and most family members know or probably don't know that someone in their family has an opioid use disorder. part of that conversation, part of that broader rhetoric around treatment and prevention is talking to groups who are sort of nontraditionally thought of as individuals who are susceptible to use disorders. that includes increasingly

senior citizens, veterans, retired athletes, and enormous numbers of americans who are often forgotten in the conversation around substance use disorders who policy and efforts in this area have to begin to address and have to begin to embrace to say, you are patients too. we're here to help you. your service in iraq entitles you to health care, but it also entitles you to be treated when it comes to substance use disorders in the same way that we treat anyone. with compassion, with care, and with extended care, beyond that moment where you're having a crisis with an overdose or the moment where you're making a certain decision about using a substance or not. but to have that continuing conversation, whether it's through va, whether it's through, you know, private physicians, or whatever platform you're getting medical care from, but to make sure that

those groups are being included as well. >> i just want to make a comment as the senior adviser for policy at hhs. part of my job is to build bridges to other agencies. i can say that the interaction between doj, particularly dea, but doj, ondcp, and our office has grown tremendously, even in the past few months. everybody understands we cannot arrest our way out of addiction. addiction is a disease that needs to be treated as such. that being said, i can't have 120 pounds of fentanyl coming into our country on a regular basis that's enough to kill 30 million people. our job will be a whole lot easier if we could eliminate those supplies. on the second day of the acting director of dea, i was in husbahis office. just last week, i think it's

sort of emblematic of what we're trying to do, we organized a panel at hhs. there may have been panels similar to this before, but certainly not within the current administration, where jim carroll, the acting director, john martin, who runs dea diversion control, the surgeon general, myself, and the pain management inner agency task force met with the american society of addiction medicine, the family practice people, the nurse midwives, the nurses, about 20 different organizations of health care providers to have an open discussion about how we need to work better as an entire community, integrating doj with hhs and public health. it was a tremendous dialogue we had because we do need to bridge some divides. there are differences in culture. my parents were both police officers. my mom's a retired police officer. everybody in my family is police officers. i understand kind of that point

of view and also the public health point of view. we can work together, and i think we're getting there very productively, but it's going to take continued work and dialogue. that just can't happen in d.c. those kinds of things have to happen at the local level as well. bad prescribers, that's a law enforcement issue. people smuggling -- i mean, really bad prescribers, intentionally bad prescribers, not just on the tails of the normal distribution. those are law enforcement issues, as is the smuggling of all these drugs or the mail of all these drugs primarily from china. >> so i'm sure you all have some questions. i would love to open it up to you to see who -- >> people aren't shy. that's great. >> i know. fantastic. people will bring around microphones for you. just hold tight and we'll get all your questions in.

i think this woman up here had a question. >> good morning, distinguished panelists, as well as good morning to this amazing, dynamic, and diverse audience i have the pleasure of sharing one hour with. my name is dawn lee cartey, foun founder of speak life pip don't profess to be a policy writer, but i am an activist. i am an advocate. and i am a lobbyist for medicinal cannabis therapy. i stand before you today -- oh, and i am a mom of an 11-year-old child who also medicates with medicinal cannabis. i stand before you today with a suggestion. 98 seconds of a suggestion. the money that we invest into these politicians as far as going into their candidacy and

the support given to these politicians, why don't we make big pharma great again? why don't we make big pharma great again by cherry picking the best growers, the best farmers, the best doctors who have been documenting medicinal cannabis treatment for years and develop a think tank? the moneys that you give these politicians, create a think tank. from there, create an exit drug from this opioid crisis. in return, you will gain respect from the community, from the world, and also you'll stand and let yourself feel like this -- you're taking accountability for creating this opioid crisis. by doing that, i just really feel that it'll be a positive movement moving forward, something you may want to

consider. i know that cannabis is not the most safe thing or happiest thing that this room wants to hear right now, but i have an 11-year-old daughter who at one time had 60 seizures a day. imagine a 6-month-old child having 60 seizures a day. medicating on valium. she's been a medicinal cannabis therapy patient for three years now. my daughter is now 90% seizure free. so although my words might be a little muffled today because i know i'm the big elephant in the room, i'm speaking life that there is advocacy in cannabis. there's advocacy, and people are really wanting it, and they're being penalized by it. i feel like the politicians, such as andy harris, are being paid to stop this progression. >> do you have a specific question about how it can help opioids? >> well, it was just a suggestion that this might be something that you may want to create, consider.

i think it will be an alternative to crafting your public policy. it would be something that i know a lot of americans do wish for. >> okay. thank you. thank you very much. yes, you, right there. >> thank you. usually the best way to get someone to not do something is to offer them a preferable alternative. now, humans developed in a situation where they have to struggle really hard just to survive. today it's not a struggle. there's no problem at all surviving, and that leads to a loot of boredom. boredom is a major driver towards drugs and other addictions, screen time, video games, and such. it seems like you're treating the symptoms of basically boredom. the question is, is anybody looking at alternatives, productive, useful things that people can be doing, you know,

actually creating alternatives for people so they don't get bored and get into drugs and stuff like that? >> i mean, there are social determinants that go into why individuals develop a substance use disorder. it's a combination of the environment as well as hereditary. so there's not one thing. we're not one factor. there's a combination of factors. but i'm a lawyer, not a doctor, so i'll let the doctor -- >> oh, thanks. >> again, i agree what was just said. i will say scientifically, the number one reason why people misuse opioids is because of pain. 62.4% of people misuse opioids because of pain. so in order for us to solve the opioid crisis, or at least one aspect of the overall substance abuse crisis, we have to deal

with pain. and pain needs to be dealt with not just as a pill but as a holistic, multimodal, kinds of therapeutic option that include physical fitness, psychoemotional support, non-opioid pain medications, other behavioral therapies. i don't think we have the magic answer about why 18 to 35-year-olds, despite our youth making tremendously positive choices almost across the spectrum, have an increased issue with substance abuse. part of it is our fault for overprescribing opioids to begin with, having them so available that if you're bored or you're having trouble sleeping or you're stressed, you pull them out of the cabinet. two weeks later, if you're on a high enough doze, you have the disease of addiction. telling that person to stop is like telling you to stop breathing for 15 minutes. so again, very complex. many social determinants. i want to highlight pain as an

issue that we need to deal with. we can't just say, stop doing opioids. we have to provide an alternative solution. again, the pain management inner agency best practices task force, which is run out of our office, it was legislated and also has dod and va, the draft gaps and recommendations posted on the web. there will be a report posted for all of your input within the next month. >> and i know there has been one piece of this that's trying to create an abuse deterrent pain medication. that's something people are working on. can you talk about that and how that's coming from the government? >> i mean, abuse deterrent formulations have been in existence for a little while. i know there's $500 million, i believe, that went to nih to identify alternatives. one of the issues, however, is

coverage, insurance coverage of alternatives for pain treatment. so that's a big part of the challenge. >> i will be talking to 700 insurance companies today. it certainly is on my -- >> what will you be saying to them? >> -- on my list. in addition to assuring that we limit the inappropriate prescribing of opioids, we need to guarantee the appropriate prescribing of opioids for particularly pain patients who have chronic, unrelapsing pain, such as cancer patients, patients with sickle cell disease, which is one of my personal causes, who have discrimination even before this, much less after the opioid issues, to treat addiction as a disease in a comprehensive, holistic way, and to cover alternative therapies. you know, the data show that for many chronic pain syndromes, physical therapy, physical fitness, overall health is much better than chronic opioids. these alternatives need to be

covered. in terms of the nih, i want to mention that there is an exciting new initiative that feeds into what we're talking about before. that's one of the cross-cutting initiatives. it's called the healing communities initiative. this is going to supply in the neighborhood of $100 million a year for five years to communities that are very hard hit to really bring the federal government, all of our agencies, together. dod, hud, department of labor, in complete conjunction with local and state authorities to try to reduce the overdose disorders, overdose deaths by 40% within three years. it's again trying to empower community models in urban, suburban, and rural communities to really understand what the best practices are. so a lot of the nih money does go to basic type of research. can we have nonaddictive opioids? how do we treated with m.a.t. better? m.a.t. is good. it's better than the alternative, but none of us are satisfied with the current results. we have a long way to go.

a lot of the money is going to community models of how to provide holistic care across the spectrum and bring everyone together and then spin that out community to community to community. >> you know, each community is dealing with something different, but we're at this point where we have this prescription issue that we have had for a very, very long time. we've had the heroin issue, which we had for a long time. now we have this fentanyl crisis happening right now. are we kind of fighting the current crisis, or are we still fighting the one from ten years ago? how do you do all these together since there are very specific things that are contributing? >> i think one of the important parts of that was mentioned before. we have this struggle with addiction in this country, but in any five to ten-year period, the substances that are of most importance cycle in and out. ideally, they would just cycle out and go away, but that's not what the experience is. what i think the crisis with opioids has shown us is -- or shined a stronger light on is

just how vulnerable the mental health and addiction medical infrastructure is in this country and how ill prepared we are because we have not built that up in a sufficient way in a variety of areas. i talked earlier about different groups of individuals who are nontraditional or at risk, including veterans. but one of the biggest struggles in this country, particularly around this infrastructure, is in rural communities. if you're 75 minutes from a local treatment center, what do you think the likelihood of going to that treatment center for help is if you live in a city and it's seven blocks away and you're unlikely to go to that treatment center? so what is going to work in washington, d.c. is not necessarily the same type of problem, infrastructure problem, that exists in rural idaho, even though the problem might be the same in both places, it might be worse in rural idaho. and that's not just an ep yoopi

issue. it's a meth issue. it's for a variety of substances. designing and strengthening that infrastructure in ways that makes up for a lot of lost time and is able to be designed in the right ways for what that population faces, whether it's the substances that population faces, the infrastructure that population faces, or the socioeconomic forces that can affect choices over substance use as well. designing those -- and the grant programs do a very good job, as the admiral said, giving local flexibility, recognizing there's a need for that. like i said, making up for what is really an embarrassing mental health and addiction service infrastructure in this country that can't keep up. >> and admiral, i know you have been involved in telemedicine as well. can you talk a little bit about that? >> telemedicine is very important across the board, i think, in many aspects of the health care system, not just in

telemental health. again, we provided clarification based on some of the dea's interpretation that you can deliver m.a.t. by telemedicine now. that's, i think, very, very important as long as you have a dea registered provider. they don't need to be wavered. so we're very hopeful of that. i think part of the legislation also said that for medicare reimbursement, you don't need to, quote, be in a rural area. you can be in an underserved area and be reimbursed for that. coming from texas, you know, there's still a dozen or so counties that don't have a physician or any health care provider. i think it's like 20 or 25. it's a very big country. we're going to need to use technology to our advantage. again, not only have the providers but build the model systems, the hub and spoke systems, the ancillary providers to make sure that care is distributed and we focus on behavioral health. again, behavioral health, critically important for addiction, but smoking, alcohol

use, obesity, you know, there are huge behavioral health components to all of these. what we're building now has very long-lasting benefits, but we need to build it fast and we need to build it in a resilient fashion with the appropriate reimbursement because a billion dollars here or there won't go very far unless the entire reimbursement system is geared to building and incentivizing the system we need. >> i want to add one thing that both of my colleagues said. substances go in and out of vogue, but the one constant is alcohol. i think that we can't forget the number of people in this country with alcohol use disorders, the number of people with untreated alcohol use disorders. that has to be something we focus on when we're talking about treatment and addiction. >> i think we have time for more questions. you here. >> good morning, everyone. thank you so much for being here with us today. i was wondering if you could talk a little bit about what you would say is at the root of the double standard in terms of how

our country responded to the crack cocaine crisis in the '80s and '90s aemnd the sort of cris we're facing today. as you know, today is mostly white opioid addicts, considered part of a public health, whereas crack cocaine addicts who happened to be african-american in underserved communities were faced with a full-blown war on drugs. so i was wondering if you could talk about what you would say is at the root of that double standard and how it changes and clears our own perceptions of drug addiction. >> well, i mean, i think the answer is fairly obvious in your question. the roots of the manner in which racism affects public policy in the united states and frankly elsewhere in the world as well, is profound. it is hard to defend the differences in enforcement and

even in laws around punishment between powder and crack cocaine, particularly in the 1980s, other than a racialized basis for it. now, there are also positives growing out of the opioid crisis, in that if it is affecting groups of people who raise awareness, then it means the awareness around that struggle is going to be more than if it was in under served or communities of color. now, that is unfair, but there are a lot of individuals in this country who are people of color who face opioid use disorders, or other substance use disorders. and i would hope at least, if sort of the bleaching of substance use disorders in this country means that it raises awareness, it builds a better substance use infrastructure, it helps with treatment and

prevention. that will be spread around. and hopefully, that is the case. but i think you're right, there are a lot of areas of public policy that have very dark histories in this country. and mental health and addiction services are absolutely toward the top of that list. i think there are a lot of really competent professionals. there are a lot of well-intentioned individuals in our government, and in our congress now, who are not only thinking seriously about racial divisions and the way that individuals can access treatment and prevention program, but also how we can learn from our past mistakes. and so hopefully, the future of mental health and addiction treatment in this country is brighter than like i said what is a pretty dark past in this country. >> time for one more. right there with the mock

turtleneck on, woman, you. >> thank you. so thank you for your leadership and sharing your perspectives this morning. i'm from the alliance of community health plans and our clinical leaders are very much invested in addressing the opioid epidemic, and in recent meetings together, there's been a concern about some of the challenges and sharing health information, substance use disorder, so from their perspective, trying to coordinate care, you want to have as much information as possible, including understanding the history of addiction and some of these challenges, or someone is actively under treatment, and there is a standard, i believe it is 42 cfr part 2, which is a bar higher than hipaa, it several, which makes it very difficult to essentially have that information be coordinated. so just curious about your perspectives on that discussion, if you see in the future at all some of that relaxing, given the, you know, state of emergency we have with the opioid crisis, and you know, what can groups do to try and

help, you know, and frankly just sort of share that information more freeliy? >> 42 cfr was the aspect of congressional, a lot of congressional intention this year, sant has done for the last several years, put out clarifying information, because there is a lot of misinformation. so congress, i'm sure, will take it up again. it didn't, they did not remove it entirely this year. in this legislative session. so, but it will come up. because there are a lot of people who want to share information. i think the most important thing is to listen to those who, i mean to both sides on this issue. those who are opposed are very opposed because if we think that stigma is gone on this, and that is just another disease, we are kidding ourselves. this is not just another disease. there is a lot of stigma attached to substance use disorders. >> there are a lot of doctors who don't want to treat those patients.

so that is something that if a change is made in the next year, we need to have the realization that stigma is alive and well. and that removing that, in its entirety, i actually, removing it in its entirety, will, could have an impact on individuals who have the disease of addiction. but it is, they will discuss it a lot, i'm sure, it is going to come up again, because there are a lot of health care providers that want that information. i don't know if you have anything else. >> so it is 11:00. so i think we are unfortunately done with this, but thank you all for coming. i really appreciate it. and to say thank you to everyone on the panel for sharing their thoughts and taking the time. a good discussion.

funeral ceremonies and services for former president george h.w. bush begin today on c-span. at 3:30 eastern, the arrival at joint base andrews in maryland. at 4:45 p.m. eastern, the arrival ceremony at the u.s. capitol. where his remaining will lie in state in the capitol rotunda. on wednesday, we will have live coverage of the departure ceremony from the u.s. capitol and at 11:00 a.m. eastern, the funeral service at the national cathedral. the state funeral for president george h.w. bush, watch our live coverage, all this week, on c-span, and c-span.org.

or listen on the c-span radio app. this evening, senator bernie sanders holds a town hall meeting to talk about climate change. senator sanders will be joined by congresswoman elect alexandra ocasio-cortez. live coverage starts at 7:00 p.m. iran -- 7:00 p.m. eastern c-span 2. this week on the communicators, california attorney general xavier becerra on monitoring california's $385 billion technology industry. >> general becerra, are the googles and facebooks of the world too big in your view? >> i think you can look at the companies that are becoming very large, and wonder if they're getting to the point where we have to take a closer look. but because the internet is a different animal, we used to deal in widgets, now we deal in digits, and so it is a very different thing.

one you could always touch, the other is a bunch of zeros and ones, and how you tackle that is i think what we have to get a grip on. but when we do, i think then we will be able to answer that very clearly, is anyone being anti-competitive, is anyone becoming monopolistic? to the point where our anti-trust laws take effect? and do we have to take a closer look at our anti--trust laws to make sure they have adapted to meet the needs of this new internet world. >> watch the communicators tonight at 8:00 p.m. eastern on c-span 2. up next, authors and law professors talk about free speech and national security. the center for strategic and international studies is the host of this event. it is about an hour.