users. we will keep this pretty light -- not light, not exactly a light topic. keep it moving and keep it fairly casual. a conversation amongst all of us. start off with, i just gave the twitter version of who you all are. give the facebook version, or a slightly longer version of why you're here talking about heroin. keep in mind the clock is running so keep it fairly tight. we heard about the state of the state. what brought this issue to you or how did you end up making this a major part of your policy agenda? mistake probably like a lot of people here. as the governor of vermont, i spent a lot of time talking to people and i find that when i went to chamber of commerce meetings and not just talking

about the tofu growers of this state, but all sectors of the state, i had people tell gone my downt and look sheepishly and say governor, i lost my son, my daughter, my mom, my dad. off.ore has been ripped we never used to be ripped off. my car has been ripped off. a state that values quality of life, as a governor, i have to do with the real problems we are facing. any person who claims this challenge is not one of the main contributors to the decrease in quality of life to the death of innocent folks who suffer from a terrible disease just is not facing the fast here that is how i got into it and it is an honor to be here. >> thank you and kathy, i know you well enough to know you come social right now as a

scientist, but you come at it through your own personal journey. >> yes. i started using heroin in college, a new york city akin in 1980's. i was able to get treatment that works for me. it turned out to be methadone treatment. have beensince 2004, trending the increase in heroin use from central city outside. so it has been a long time, a decade of doing that work. that is where i come at it, from a public health perspective. 10 years ago, we cannot say the words exchange or methadone, we couldn't say many words like the overdose prevent dust prevention drug without people wanting to throw things at my head. like, now i am out of

the facebook version and i am like get off my soapbox version, but i feel like we will -- we are in a change of state in the country. i did not have my hook out but i was getting ready. thanks. dr., you have woven some of your own story into the research and try to explain what you do. can you tell us more about that? >> i will ask the question you asked about why am i here. i am here because i came last year and i love chicago. hello, chicago. [applause] i am really here, but i am also here because i got interested in heroin in part because i really like opiates myself personally. and i amo do research also really concerned about

major distractions at the political level, particularly as it relates to drugs. i have seen how drug use is used in ordertical football to distract us from the real issues. i see this as -- the situation with heroin as the same way. i think we have to be careful in that when we talk about heroin being an epidemic, and when you start to look at heroin use compared to other drugs, it pales in comparison to cocaine. in comparison to marijuana. then when we start talking about heroin overdose deaths, 75% of the heroin overdose deaths occur in combination with another sedative like alcohol. i start to see all of this info -- misinformation, which distracts us from really dealing with the real issues.

i get concerned so i want to have my voice in that discussion and that is why i am here. >> great. chief, i read you started your initiative with a post on facebook. tell us a little bit about how you are here and how this got started. >> it started in a community in which we needed to do more about the epidemic that affects so many communities. definitely be doing more. my officers came to me and said we are arresting the same people over and over again. they're are not getting treatment. the idea of jail cells back on the street, they are hurting themselves and others. we decided to take a provocative step of refusing to arrest any -- that we would facilitate treatments for them. that is why i'm in chicago.

[applause] i guess the bottom line is, what was the responsibility has become the responsibility for the region and may larger peer that is to bring the calvary, to bring a new powerful voice saying we are just not going to do this anymore. we will not arrest our way out of the situation. it is a public health crisis and not a public safety crisis. >> a lot to unpack here. there are five people appear who all think the previous approaches have not worked. how come we're still where we are? the argument that things are starting to change. are they? governor.rt with you, let's keep this free-flowing. feel free to jump in. >> can you tell us where we are first?

>> i will put that back to you. why don't you tell us? you said they were playing political football. you are basically saying the lost.t is >> yes. you talked about the epidemic. when you look at something who hasde, things like used heroin in the last month, an indication of recent heroin users. when you actually look at the number, there is about 300 thousand americans report heroin use in the last month. the number is actually down from 2006 or so. if you look at the past year, someone who has used the drug in the last year, that number is up. it all depends what your indicators are. we have to be careful. are, i am where we concerned we tend to think about

heroin use, when we talk about heroin use, we go to the frame of the heroin addict. the vast majority of the people who use heroin are not addicts. i think what the chief is doing is creative, innovative, and i think a great approach, approach. the thing we have to be careful thereis to just remember are a number of people who don't need treatment. they need education about what the real dangers are. >> i think what we have to remember is we are not talking about heroin, but opiates and painkillers to. -- too. the best in the country. better than chicago p i am not getting votes here. you know that. [laughter] here is the point.

oxycontin,a approved and we started handing it out with irrational exuberance, think about this. in 2010, we prescribed and not oxycontin america to keep every single american adult high for a month. that is what we did. companies that sell it made $11 billion that year. the fda justgo, approved opticon for kids. a year and a half ago, they approved oxycontin on steroids, even though the fda's own advisory panel of 13 folks voted 11-2 not to do that because if he is the opiate addiction we have in america. this is not a huge puzzle game per one we started passing out off the con or other painkillers like candy, we created an addition problem in america that in vermont and in illinois and other states across the country,

it is now transforming into a heroin addiction because it is cheaper, stronger, and easier to get. we should not be having a long debate about what the problem is. the problem is we have way too many people at the -- addicted to opiates. in this nation, if we do not quickly have a conversation about how we treat it, we will not only have many more people dying and many more people's lives being destroyed and many more governors like me spending endless resources trying to build out treatment centers and treat it like a disease instead of a crime, we will continue to lose the core and the fabric of our quality alike. >> to that point, the average drug use or of any drug including opiate is not an addict, right? plus can i say something? i think there is a tension that

might be different from everyone else on the panel. that is the moral panic associated with drug scares. we know there will be another drug that will come along that the same kinds of concerns among people. that is not going to change. what is changing is the way we're treating people with opiate use disorders. that reframing, of seeing people as people who need help and care, to me, influences the entire drug discussion. we can debate whether or not it is an epidemic. there are a lot of little things in there. but obviously, it is clear there deaths, theye in

are in, nation with a lot of is thebut what i see, way we're coming at it is fundamentally different than the way we were coming at it with what the governor is doing, with what the states are doing, it is different than it was 15 years ago. hugely different and more effective and more targeted. >> so i just met you. i love you, but the statement most heroin users are not addicts is the most irresponsible one. >> it is not a statement. it is database. >> it is not. >> it is. >> every single person, is the -- is a desert -- is addiction a disease? >> of course. >> why isn't every single person

with an addiction to heroin getting treated itself you're getting addicted? >> i don't know. has nothing to do with the numbers. >> it is irresponsible and not correct. every single person that presents to law enforcement and is addicted without choice and deserves treatment, by you saying that the people are not addicted -- >> i did not say that. i did not say that. please do not misconstrue it i did not say that. what i said was the vast majority of people who use heroin are not addicts are not present tojority who you. the vast majority of people who use heroin are not addict. >> i think it is irresponsible. >> it is not. it is reality pair whether he not it makes you uncomfortable, it is the fact. the facts are the facts. >> it is difficult to untangle this because there is something

called selection bias. the folks we run into, but people who cause problems in our communities, that are using heroin, are addicted to heroin. ofse are the vast majority the people we see. but that does not mean every person who is using heroin or opiates is addicted. what are we talking about by addiction? what we talk about in medicine. what we define as addiction according to the diagnostic statistical manual of the american a safe -- american psychiatric association. there is a set of criterion which we go by to determine if people are addicts. it is clear people can come addicted because they do. when we havee is extreme terms, labeling everyone who uses these things, like the vast majority of people who use prescription opiates do so safely and according to their

physicians. prescription opioids are important in medicine. if we say everyone using these things are addicts, what we do is we run the risk of restricting or maybe eliminating this important tool in medicine. that is my concern. >> let me respectively this -- respectfully disagree. for a governor, i have constituent after constituent, for me and says, i went in for a medical treatment, had an accident, whatever, and i'm headed a lot of oxycontin by my doctor for painkillers and i can get as much as i want until i get cut off because they recognize i'm abusing it and that is what leads to addiction. that is the reality i deal with. we can talk about the nuances and i think the question for the panel is, what the heck are we going to do about it #>> excuse

me. >> we have to define the issues. [indiscernible] >> i have too many ripping off stores, ripping off their the mostighting difficult and awful disease i've ever learned about, opiate addiction, because they are addicted. >> hold on a deck -- hold on a second. >> what we have to do is figure out why they are dying. if 75% of them are dying because they're using heroin or prescription opioid with alcohol , then you educate those people not to do that combination. classy are talking about several different things at once. there is a health issue of people using drugs, namely heroin or other opiates, which at least anecdotally appear to be connected to we're talking about criminal justice issues, people who for various reasons may be kennedy -- committing

auxiliary crimes apart from drugs because they want to use drugs. we are also talking about the drug markets created by of course the demand for them but also neighborhoods that emptied out whatever. this is an economic opportunity for people to we are talking about all of these things at once. also the political response to these things. i would throw out there, and print -- please disagree if i am because the physical signs of heroin abuse and namely overdoses move into places that have not traditionally seen them. dr. hart. now -- >> can i say one thing? really important to remember, i had someone ask me, shouldbecome addicted -- i tell my daughter if she uses the drug once, she is automatically an addict? i said no because that is not

accurate. important when we are talking about drugs, not to minimize the problem with opioid and heroin addiction and the demand and need for treatment, which is huge, but we need to be having honest conversations. drugs are not magical. that this causes us to become addicted. but what is probably underlying substance use disorder is some other co-occurring disorder, some other thing that someone is self-medicating for. that is an important thing for us to knowledge and we do not want to give the wrong message so i kid goes and uses heroin and says, i did not get addicted. i think that is tremendously dangerous. the idea about being real about what we are saying to the public

about the effects of substances needs to be grounded in science. >> one reason i think we are if not theause of rise in overdoses than the coverage. maybe we can agree on that. not, i am still a moderator for five more minutes. ok. you know, there are other places that tried different approaches to drug use and drug enforcement. i will throw out portugal. i'm sure all of you guys heard about this and talked about it. i will grossly generalized basically, drugs had been decriminalized and they are not legal, but decriminalized. if someone is essentially caught in certain -- certain circumstances with drugs including heroin, they are steered toward treatment. correct me if that is wrong. >> that is not entirely what they do in portugal is you get assessed to see if you need

treatment. the vast majority do not. they may get a fine or they may just get a warning. the vast majority do not need treatment. true in the czech republic. they are doing the same sort of thing. for our discussion since we're talking about opiates and heroin, we should probably think about this swiss. i spent the last three months in and heroin in geneva clinics where they actually administered heroin to heroin part of theda -- as treatment. a large percentage of those people come twice a day for their heroin and then they go to work and take care of the family's and do all of these things. >> this happened in this country. >> what would you do with someone -- >> just to clarify [indiscernible] >> why am i here if there is not an addiction problem? the vast majority of people are

addicted to the strong and the vast majority of people are addicted to pharmaceuticals, either legally prescribed or that they got from the street. to underplay that i think is a very dangerous path to take. just because no one has presented to it police department who is addicted, i understand what you're saying, i have not seen it because you are the police department. but i have never met any ancillary people who said my kid is on heroin but they're not all addicted. i think the clarifying message here is whether they are right or whether somebody else's right or whether the data is right, there are vast numbers of people who are not getting treatment for addiction. that has to change for the number of reasons we're all here. >> absolutely.

>> i just want to go to the cheetos point. by the way, more power to portugal and switzerland. we are in chicago and chicago as part of the united states and we should ask the question, what will we do about this in the united it's in america or it this is what i found. in vermont, we were doing everything wrong. everything. we discriminated against the disease. it like it is not cancer or kidney disease or diabetes. we just do. we say to folks who need treatment, go to jail. foes who need treatment, you're in a different classes of people than everybody else that is sick. so what we were doing wrong is just about everything. system,inal justice with all the good intentions and to the right, come conclusion, and more folks should, cannot fight the battle alone.

people say, this is your problem and prosecute them and lock them up. forget that it is our sons and daughters. weekrmont, i spent $1135 a putting people in prison. addicts. people suffering for this disease. one reason is because we are changing the way we deal with addiction. it costs me $127 a week to put someone in a great treatment program. this is what we were doing wrong. with any addiction, and you have probably all dealt with it with friends and family, there is a huge denial factor. with opiate addiction, put the denial on steroids. i found we would make the arrests and all the research suggests that is the best chance to move to a treatment. their life has come to a tough spot. or fivewould take four months between the charge and a

conviction to wind their way through a court system and then by the time they got to a judge, they were back to using. third-party assessors, objective folks who know what they are doing who come in and say, this is someone who is suffering from a disease. they should be offered treatment, wraparound services, and they should get back in the workforce and get back to their lives. that is 89% of the folks we are dealing with. folks to wait in line and we actually moved it from being treated as if criminal prosecution to treating the disease as it is. >> we're out of time and we have to go to questions. i would throw out there that what you are talking about is in some ways decriminalization moving toward a treatment model. >> i do not disagree. >> there is enough time to deal with some of the statements ma.

this is a fraud, this conversation. >> you are wrong. >> thanks for offering that. >> please stand when you ask your question. not fly 1000 miles to come down here and have someone sit next to me and say the people who walk into my station who need help and cannot get it are a fraud. [applause] >> please do not point your finger at me. >> gentleman. we are going to have some questions from the audience. we all have different views of differentd in positions. we come at a different angle. please be respectful. >> you are so disrespectful to those of us here.

very disrespectful. >> we want to hear from all of the panelists. if guests a little passionate and i think that is a good thing. i actually think this is a great discussion. >> it is good. good afternoon, almost evening. i am jake from illinois. my question is, what else would you like to tell us? >> thank you. one is saying addiction is not a serious problem. thepoint i was making is majority of people who use the drugs are not addicts. but if you treat everyone in these extreme, anecdotal cases, you're going to go down the and missh -- opportunities to actually help people. death,e worried about for example, tainted heroin in some cases, if we're worried about tainted heroin, why don't police forces, for example,

is taintedt heroin for local communities to know. heroin itself is not as likely to or not as ,ause been overdosed particularly for people who have been using it for a while. the thing we were about is pain and harrowing, we worried about heroin being used in common nation with other sedatives. that is what -- >> i would like to apologize. we are both passionate. the doctor deserves it has earned his opinion for anyone listening. please, it is no disrespect to you. publishon we do not what is in the heroine is because we do not think there is any good heroin. what are some -- what are we supposed to say? this heroin here is bad but we think that is ok? that is our feeling not

publishing what is in a particular bad batch. >> my name is kim. my question is, from my perspective, is heroin addictive? once, twice, i do not know much about it but everything i have read about and reviewed, it you cannot really use it recreationally. if you do it once or twice, i mean, it is like a slippery slope. you can use it recreationally. this is not an endorsement to. >> much more severe than someone drinking or someone smoking pot. it seems like the repercussions and more way bigger severe and people's lives seem

to spiral out of control. >> once you have a habit and and i think you cannot understate that, once you have a dependence and you don't have access to the opiates, heroin, you're going to be sick, that is the point where you are physiologically dependent. you might not even have addictive behavior if you were to end that there. i will tell you, from my prettynce, that is strong and it happens pretty quickly. it is obviously different for every person. have i known people who recreationally used heroin? i have known people to have known people -- more people who did not get addicted van up -- that i knew then who did get addicted. that is not to say we don't have a problem.

that we do not have a problem with how we are treating this. and our treatment capacity in the way we are approaching this. probably agree, that the way we are learning to approach this in a different way is a much better way to deal with it. >> can i quickly take a shot at that one? opioids are highly addictive drugs. if you start to take any of these painkillers on a continual basis, you will be addictive. if you start to take heroin in any kind of routine way, you will get addicted. i am a little surprise we are sitting here suggesting that this is not a terrible disease to get an to avoid it in the first place.

>> i am not sure we are suggesting that. there is a line of thinking that if you basically put out the word every time you use heroin, you will automatically get addicted, that is miss information and that makes the situation worse because some people think everything they have heard is wrong and that can draw people deeper into use and abuse. >> and there is no withdrawal system, that it only happens to other people. it can be -- if you send that message, that this leads immediately to addition, and it does not. for the people who are going to develop disorders, there is a honeymoon period. dig deeper toou what is going on in their life, it is not just a drug. why are they using the drugs in the first place? listen. you are not taking a huge,

tremendously potent painkiller if you're not in pain. you could maybe be doing it recreationally, but you are not doing it every day unless you are dealing with physical, psychic, emotional pain. i think when you do that a lot, that isto recognize indicative of another issue. us to not think about heroin as if it is magic or opioids are magic. it is about the underlying conditions that the president is living in. environment, their individual nature, what they are bringing with them. oxycontin prescribed and you are working and you get bed off, that use that might prescribed might give you a

different feeling, it might -- might make you feel less sad about your job. you will like it more. it is about the environment and the individual and all these other things. gov. shumlin: we all agree on that. a i have got to get in like surgeon. whether or not we are talking thection or casual use, amount that our profession has is ain terms of pain factor. you get a room with doctors, physicians, clinicians, and we were told to treat pain. with semantics on what is pain and you gave a wonderful example. social destruction and the environment. it is so many factors that to tease them out, we cannot do it. very clearly, when i look at 80 will not my city, i

sit on the head of a pin and wonder or not whether that person was an addict. it is at a moment in history where whether it is the social fracture, the neuropsych: pharma college he, there is a disruption. what you give as an antidote to what is going on in these communities. thank you. dr. hart: that is a question to me. >> [indiscernible] dr. hart: right on. >> [indiscernible] the bottom line, what these people are attempting is to change the paradigm of how we wake up every morning, whether or not it is real pain, [indiscernible] thank you. you asked what i would do. issue, the at this

people most likely to be addicted to heroin are white men , typically young white men in their 20's. unemployed, uninsured. ones wete men are the are primarily concerned about. we talk about the issues you raised. were employed, make sure they had something to do, activities. but they are not the most likely people to die from heroin to the people most likely to die from heroin and other opiates are individuals who are 45 to 54 years old. are the people taking also other medications and they are older. that would require another solution. that is all i'm trying to do, ask people to specifically look at what group we are talking about, as opposed to lumping the whole thing into one problem.

>> [indiscernible] would,e the things you what is it you would put in everyone's mind, whether you are the police sergeant, whether you are the government? what are the tools? what should we be doing? should we go on twitter? should we see where is the last -- coming in question mark let's get creative. -- coming in? let's get creative. the example: happening in vermont, the police chief and the mayor, we said we have got to deal with this. we literally put everybody on one floor, law enforcement, prosecutors, agencies, you name it. everyone is there. we laundered a police screen with the police department. we find out where the hotspots are, and we literally go into those houses, knock on doors,

and we say, what is going on with your light, how can we help, how can we preempt the ?isaster add that the big conversation is, what do we do to cut this thing off in the first place? it baffles me that as we all talk about the things we're trying to do and the crises we are facing, everyone from hillary clinton to jeb bush, republican, democrat, what do we do about this crisis, we still refuse as a nation to talk about what you brought up in the first place, which is, the way we deal with pain, and pain medication, has changed drastically since the approval of aussie cotton and if we don't get a hold on that, and i have got isaac on for kids, we will be having the conversation for years and years and losing more and more lies and more more battles. we have to get a question from somewhere else.

>> i am michelle. i love the conversation. thank you, dr. hart for your plate of you. , mynt to post everybody stance is i think all drugs should be legalized. full scale with every drug. i think people should be up to use them recreationally and take care of people are i would like to hear your thoughts on that. drugs shouldhink be decriminalized and we should implement something like a portugal model. i cannot think of any country in the world that has legalized all drugs. i am a pragmatic person in that sense. i like to see what a model looks like before i understand how that could be implemented. i do think there is a lot to be done on the public health front but i don't see what that would look like. i don't understand how the regulation or the education,

what does that mean? -- let'sle say what's legalize all just, what does that mean question mark i can buy it at cvs? i am just going to dice on that one thing and say, that is a complicated question and we need to operationalize what legalization means to you. mike: let's hear briefly from the panelists. gov. shumlin: i am a governor appeared i deal with what i have, the tools i have. in effect, that is what we are doing by saying this is a disease. we will treat it as a disease, in for not. if you are busted for heroin or opiate addiction or other drugs, and you are not deemed to be a youat to the community,

will never see a judge, a court, a criminal record, you will never see a criminal process if you join up and deal with the disease as it is. that is in effect what we are doing it we are saying, one of the past has not worked, we don't know what the future will bring. we have to figure out how to shut off the supply. meanwhile we're going to treat this as the disease that it is. hart: this is not that complicated. we put people on the moon. when you think about regulating marijuana or regulating drugs you can regulate it in the same way we regulate things like alcohol. that complicated. in terms of the governor's response, treating this like a disease, that is great.

particularly for those who have the problem. but you still have those people and arenot addicted using them recreationally. what do you do about those people? to uselse have the right to alterive substances themselves in the same way that some of you all will go tonight, particularly after this conversation -- [laughter] as have alcohol? do adults have the right to go and alter themselves with an opiate, with cocaine, in the same way? from aampanello: law-enforcement standpoint from you will get a semi-law enforcement answer. you will like it. marijuana will be legal whether we like it or not i really don't care.

listen to me. for marijuana, people who cannot make choices for themselves under 21, it can be regulated. we are to b make it so that people does not drive and go to work and go to the workplace and adversely affect others. i'm not for the decriminalization of any drug. with all due destruction that have caused over the last hundred years, the billions and billions upon billions of dollars that it has cost of health care for those drugs, they would be illegal before they had the market. [laughter] [applause] it does not have anything to do with these illicit drugs that cause is so much-- that caused so problem.

mike: i do not think this is simple at all. going theis clearly way of legalization around the country. -- we aren illinois screwed up in so many ways, you cannot even get a medical marijuana program off the ground. i think there are so many political interest computing, so much money involved. need more panels of political debates at the highest levels about what to do about all drugs including alcohol, tobacco, which are legalized drugs now. i'm reading from a script no. thank you for taking part in today's conversation. make sure to check out chicago ek and tell us what you thought about today's event. i'm sure you had no opinion whatsoever, just like the panelists. [laughter]

thank you for being here, and thank you for all the panelists. [applause] [captioning performed by the national captioning institute, wiich is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2015] coming up on c-span, the british prime minister david cameron addressing parliament. then an update on military operations in afghanistan. >> abigail fillmore was the first lady to teach outside of the home. maybe eisenhower's hairstyle and love the pink made a fashion sensation.

jacqueline kennedy was responsible for the creation of the white house historical association. nameancy reagan saw her mistakenly on the blacklist of ected communist sympathizers. these stories and more are featured in c-span's books first ladies. giving readers a look into the personal lives of every first lady and how their legacies resonate today. it is based on original interviews from the first lady series and has received numerous reviews, including this one from the presidential historian and author. c-span is a national treasure, and it's series is another reason why.

c-span has performed another valuable public service with his series on the first ladies. world can oneno find such a useful and insightful look into the lies and influence of these woman who played a crucial role in the history of our country. historian anddies biographer noted that c-span's first ladies as an invaluable collection of rare insight based on our nation's first ladies and the important role they shift in and inflated shipping america during their husbands presidency. arst ladies is available as hardcover or e-book from your favorite bookstore or online bookseller. be sure to order your copy today. british prime minister david cameron addressed the house of commons thursday on his plans with conduct airstrikes against isis in syria.

he took questions about several issues, including the number of anti-isis fighters in syria and russia and turkey's involvement in the war. this is an hour and a half portion of the event. -- response have been made available to every member of the house. to listen to the whole thing on both sides of the house. there are different ways of putting them, but they boil down to this. why, why us, why now is what we

legal, whereting are the ground troops to help us , what is thectives strategy the rings together everything we're doing, particularly in syria. is there an end to this conflict, and is there a plan for what follows? let me deal with each of these questions is strictly as i can. they have attacked angora, and paris as well as the likely blowing up of a russian plane with 224 people on board. the have already taken lives of british hostages and inspire the worst terrorist attack against british people since the beaches of tunisia. they have repeatedly tried to attack us right here in britain.

stopping the means taking action in syria because it is their headquarters. why us? responsibility is to keep the british people safe. that is one reason why members of the international coalition, inclusive president obama and say they wantande to stand with them. these are our closest allies, and they want our help. partly this is about our

capabilities as we are showing the area can carry out dynamic targeting. our pilots can strike the most difficult targets at rapid pace air support forces on the ground. we have the missile system that .nables us our drones are providing up to 30% of the intelligence in syria rate they are not currently able to use their low collateral high precision systems. we also have the ability to sustain operations. for months into the future.