debate is going on and i am not weighing in on which side of it. i am pointing out that president obama is going to make this a central part of his last year and a major part of his presidential legacy. in insion him weighing the public schools, holding town hall forums, working to make chicago safer and use the model of what he does in chicago for other places in the united states. i would not be surprised if he do more town halls on the gun issue. in the end, we are going to vote. the president will see who wins the 2016 presidential election and it will be very telling. our guest is professional

-- professor of history at rice university. we found this piece in politico. they ask a bunch of history professors which president had the best last year in office. who do you think had the best final years in office? bill clinton did not have a bad at last year in the sense that the economy started getting so strong that we were able to, by the time he left office, we were able to balance the budget and have a surplus. he was able to survive the lewinsky scandal, people almost wishing he was running for a third term. unfortunately, the vice president did not realize he still had the magic in him and

distanced himself from him because of the moral impropriety. it hurt al think gore. he could have won the election if he wrapped his arms around bill clinton. i would give him the last year nod. usually these last years are tough on presidents. harry truman's last year, he run for reelection because he had a 27 approval rating and nobody wanted much to do with him. consumed by be a non-, almost an irrelevance in the country that had the most angry and tumultuous year in recent memory. i would say ronald reagan had a good last year, along with bill

clinton. his vicele to get president elected. people started saying that reagan won the cold war without firing a single shot. it was starting to be clear by term, that the berlin wall would soon come down. fact of the matter was democracy was on the march in eastern europe and the soviet union was stressed. prettyand clinton had good last year's, all things considered. host: eric, thank you for waiting. caller: thank you. i appreciate c-span. prediction, what may be, of president obama with chicago efforts. i had another idea.

president half went on to become the supreme court justice. i wonder if you might be able to go back and talk about -- he careerto have a positive on the supreme court, and what potential there might be with intellectual and common sense approach of barack obama, how he might do. what might be the likelihood something like that would be a positive for the country. that is an interesting question. we have had many good ones. john quincy adams left the presidency and became a congressman. he spent years fighting for the abolition of slavery.

he came in second behind woodrow wilson. taft had to find himself a political loser after 1912. the country honored him by putting him on the supreme court, where he did a fine job. barack obama would make a good supreme court justice, but i do not know if the politics of the moment when allow him to get congressby a sent in a -- by a senate or a congress. is not of faire justice, but a bipartisan one. i could see him being engaged in things in the university of

chicago. the main thing he will be doing , findingg a memoir public policy issues he is most passionate about. is passionate about all of them. theck obama may try to make -- may try to make himself not as thin as bill clinton did. he has had to raise so much money. i do not see that he wants to become this nonstop fundraiser every moment of the rest of his life. he is cerebral, more scholarly. the gun violence issue and climate change are two that he will be wrapping his arms around. ratedtaft was an underage

-- was an underrated president. it was a good choice to get him on the supreme court. rob, good morning. i was calling about the robert e lee statue. you have this guy on and he is so-called and collective in his demeanor and he is actually in agreements with keeping the statute. was -- inever said i never agreed the statue should be kept. i never said that. i did not want to weigh in on it. it is a complicated issue. i have not studied what is going on there. issue. that's my

it is not complicated at all. i equate robert e. lee to a hitler. host: thank you. we get the point. is a: mitch landrieu friend of mine. i am not a honed in on that particular issue. sometimes memorials are part of a city ordinance. they get challenged in court's. i got a random phone call about that statue. i have not looked into it. mitch landrieu told me he is determined to make this a big part of his legacy. statuet mind if the

comes down. au have to start having dialogue. is going onw what in new orleans. university of texas, they removed a statue from campus. it was done in a smart way and in a way ituseum, all makes sense. in each to be done in a way that does not create unnecessary acrimony in a community. caller: i hope your new year is really good. i wanted to know something. there are two points i would like to make. you being a presidential , the big thing is,

have you seen through the history of our nation, more disrespect for one president than we have had against the people on the right, some people on the left have had towards our current president. also, i think he has done a wonderful job for the gun debate. thing called the second amendment. veteran, carrying a gun, i was in the united states coast guard, i was a law-enforcement agent.

there is one thing about it. right,f people on the even some on the left, they do not think about the first part of the second amendment which says a well regulated militia is necessary and the defense of a free state. all people have the right to keep and bear arms. host: that was eric. has been tough on president barack obama. part of the reason is that once the affordable care act was congress got rankled. it has been an unproductive relationship between president obama and congress. think president obama will

come out fine in his history. he inherited the great recession. we will have to see what the economy looks like when he leaves office. if it is much better, we have to wait. there is also the saving of general motors. there are going to be trouble spots. , some of that foreign policy problem in the hurt hisst is going to long-term reputation when we look at it in terms of foreign policy. i have no doubt he will go down as a successful a merit and president, even though his relationship with congress was not good.

a special report on a historic presidency. when you look inside, you can bills signede 1064 . that is about 740 fewer than george w. bush signed and 720 fewer than bill clinton. five bills, including the defense authorization act. bush vetoed eight bills and clinton 35. 228 executive orders signed by the president, compared with 292 under bush. to sean in florida.

caller: my question concerns his or pre-knowledge of the attack on pearl harbor. i predicate this on having taken the anon, the first .ulf war my father was an intelligence officer. i asked him if he knew about it the aircraft carriers were supposed to be sent out of perl and that the reconnaissance aircraft flown re-tasked one week before the attack. he said you can take whatever you want out of that. did he have the type of

personality which would have allowed that if he felt it was safety of thethe united states? guest: i would read a book that came out last year called mantle of man. it will answer your questions much more than i can. -- e was no argumenta hocus-pocus that scholars used to do to blame fdr for pearl harbor. what has occurred is there is intelligence information that has bubbled forth. we did have indicators of things.

i would dispel that idea completely. franklin roosevelt spent his whole life collecting ship models, d a naval library. -- he wanted to convince people to go to war is ludicrous. caller: good morning. i could talk to you all day. i am a history fan. a few things. the rift between president obama

and congress did not start with the affordable care act. there were jackals on the republican side on the night of his inauguration that were going a one term president. there is evidence to suggest that al gore won the 2011 election. there has been plenty of information that barack obama chicago.move back to will [indiscernible] lastly, my regards to reagan, there does not tease -- there does not need to be any revisionist history in

comparison to fdr, with whom i consider one of the two best presidents of all time. my ultimate question is why is there no movement to put him on rushmore? barack obama, they will be living in new york. new york is going to be a big part of their life. hawaii wants to get involved with the legacy of barack obama. he did not get much of a

honeymoon from congress. racism has been part of the .nti-obama movement i agree that people say al gore won in 2000. if it were not for the dangling of florida. were -- if he had picked joe lieberman as his vice president to him number two, if gore would have been left stiff, if he would have embraced bill clinton, it would have enhanced that vote. it would have been close.

is an interesting thing. fdr's facee to see added there, but it is a monument frozen in time. i know a lot about the history of the carving of mount rushmore. it is not going to happen doing active dynamiting and drilling on the mountain. host: we will try to take more calls. we will look at info from the gallup pole. -- gallup poll. clinton 66% approval rating.

landis, north carolina. republican. caller: good morning. a question. i was curious to know what reading you would put on obama's fundamentally changing america. would you give him an a on that or something else? you say fundamentally changing america, what do you mean? inauguralat was his statement. he was going to fundamentally change america. i was wondering if the professor rating he would give him on the success of that goal. guest: i do not think he

fundamentally changed. to kind of pull the country together in one voice. i do not think that has been successful. if you are a gay american, the ability to get married, the whole push to get married would be a big change if you were a gay american. some of the work he has done for latino americans in trying to , the change has come. the amount of women appointed in the obama administration has been skyhigh. seeing that kind of inclusive change. when it comes to partisan healing that dilemma,

no, the president did not succeed in that regard. ofis a longer conversation why not. dave, what is your question or comment? caller: thanks. interesting program. this is one of the more insightful programs. enforcement, this term has bothered me for a while. product of the truman administration. the obama administration has is term openly and selectively whether to prosecute criminals. any other president from a

historical standpoint has used his term decisively in speeches. guest: bill clinton did that a lot. , 1992, i am tough on crime. moreof this idea of adding policeman to the streets, cleaning up. about billhat first two years. everything with violence and crime in america, it comes in waves. profile crime happens, the country's language changes.

we got the gun policy act from lyndon johnson. we are going to start doing something and you can see the rhetoric ratchet up. people forget. ronald reagan was shot, almost died. new brady bill. it goes in these cycles. the obama years have been one where the crime rate has gone down. murder rates have gone down under president obama. it is a headline you do not see. we are doing well fighting violent crime. the mass shootings that plague our country have caused to use moreama vigorous language to explain what they want to do and how

they are trying to do crackdowns in organized crime. that might be what you are getting at. what are you writing about next? i am about my fdr book. it is coming out. i am interested in the dust bowl. it ind we responded to the 30's and 40's. planted the conservation. where in history can we get public service, get young people working for america, doing things like they did during the new deal years. that is my focus now.

host: one last call from marisol. caller: good morning. i have a question for you. i am a proud american of puerto rican dissent. our president has done some things within his scope in trying to help puerto ricans who are also american citizens, do what they need to do, all of those things. have any idea if the president would be doing anything after his presidency to for the effort. they have been doing this for over 100 years. they cannot vote for their commander in chief, yet they can

take orders. i have a couple that are still out there. as an american of puerto rican descent, i would like to see our government do more. final thoughts from doug brinkley? guest: i wish our country would do more to help brenda rico also. i love going near the island. as the caller points out, puerto andns are in rolling defending our country.

.e need to care more whether president obama will focus on that, i do not know. it will be part of what he tries to do. puerto clinton goes to rico frequently. she is also senator of new york, where there is a large puerto rican population. doug brinkley, thank you for your >> on the next washington a preview of the state of union address. then, u.s. immigration up

policy. as president obama prepares for his state of the union address on tuesday, he released this video on twitter. obama: i am working on my last state of the union address. i keep thinking about these past seven years. that is what makes america great, our capacity to change for the better. our ability to come together as one american family and pull ourselves closer to the america we believe in. mes,s tough to see someti but it is who we are and it is what i want to focus on in at this state of the union address. >> the coverage starts at 8:00 with james harken,

looking back at the history and tradition of the annual message and what to expect in this year's address. and then 9:00, our live coverage of the president's speech, followed by nikki haley, plus your reaction by home, facebook, twitter, and e-mail. re-air our state of the union coverage and the republican response starting at 11:00 p.m. eastern, 8:00 p.m. pacific. you will hear from members of congress, regarding the reaction to the address on the c-span2. >> coming up on c-span, house ways and means chair kevin brady and then the task force to combat the heroin epidemic on addiction and treatment. hillary clinton has endorsed the planned parenthood action fund.

new jersey governor and republican presidential candidate chris christie delivers the new jersey address tuesday. live coverage at 3:00 p.m. eastern on c-span3. next, house ways and means committee chair kevin brady in a discussion with politico chief economic correspondent, ben white. his plans for tax reform and what he sees as the priorities for congress and the next president. this is 40 minutes. [applause] >> thank you. thank you. >> thank you for joining us. we appreciate this as we start this new session of congress. we will start out with the broad picture. theident obama will deliver

union address to the nation tomorrow night. he said it was a nontraditional address. we don't expect powerful proposals to go before congress. he will talk about his vision for the country, may be reviewed the past a little bit. is there anything you are looking for or hope to hear from him? are there any things he could say legislatively that you might be able to work together on during 2016? >> the general consensus is, nothing comes from capitol hill 2016. >> i am a texan fan. we had a really rough -- they will be back for next year, count on it. the president has kind of a clear choice here. he can continue with items that have been so divisive for this country, or he can lay out a clear vision for where the country can be in this economy.

there are some questions, but the president inherited a very tough economy. here we are 6.5 years after the recovery began and we are still holding out breaths month after month for the jobs report. we can do far better than what we are rats. i'm ready to see this president layout where he can work with republicans on fixing this. it is too costly, too complex, basically unfair. my see him take some stems regarding lowering the red tape. him workike to see with us on welfare reform because we know we can get more people back into some real opportunities. why can't we build more here and sell around the world? i think there is common ground there. i expect him to talk about the transpacific partnership. those are areas i am convinced we could work well together on. >> we will get into the interest

a little in-depth and bit. let's talk about the tax reform agenda. yearll be a very difficult to get any comprehensive tax reform package done. would you introduce a comprehensive tax bill in this neck session of congress? >> the answer is, it depends. >> i want you to give me the day. >> down to the hour? [laughter] going to have five people sit in a room and decide our tax reform. it will be created from the ground up during our conference next week. this week, we are going to lay out our principal audit. we are coming off very strong momentum by this tax bill. oment.as a critical mm

there has been very good work done, going forward. we're going to continue that work with paul ryan. i intend to have a vote on international tax reform this year in the ways and means committee. we will lay the foundation for built forl a tax bill growth. billed for america's economic growth. i often ask, what is your tax plan? i like to make the case that there are several ways we can get to, several paths to get to a tax code built for growth. andow what i want us to go where i think our conference house republicans want to go. we want a fair and simpler tax code. lower deductions so we can lower the rates for

everybody. have to make sure that small businesses do not pay more than large businesses. i want all businesses, no matter how large or small they are, to compete adn nd win. and when they do, i want them to bring those profits home to america. the final principle is that we are not bailing out washington's spending problem. we are creating a tax code that actually grows the economy. that alone, will help us. >> you jumped into my next question, which was the international tax reform. you said you would introduce a bill on that. do you have a positive outlook that y can get bipartisan support for the tax reform? do you think it can get through the house, senate, and be signed by the president in 2016? >> i am optimistic that we can do this.

i know it is a very complex political environment, but i am also optimistic that we can fix this overall tax code. it will take a new republican president to get that done, but this year we have a very important step. we are being forced to move overseas, merge, acquire and move headquarters overseas. plus, internationally this global effort to capture profits , most of them american profits. .t is urgent we move forward having a system that lowers the gate and allows us profits to go back to the united states is critical. in earlier drafts from the ways -- those aremittee in the right ballpark for rates.

the fact that you have democrats like senator schumer that are willing and eager to sit down and work with republicans. we are very interested in fixing this. , if weoverall tax reform can take a major step this year, it's not only sends the signal that we are dead serious about competing again, but i think it allows us to focus in 2017 on the rates and the design. tax reform is tough, there is no question about it. taking it step by step could get us to a pretty good place. i am assuming you were hoping for a permanent change. not a single one off repatriation that we have seen in the past. tell me a little bit more about your vision for that, how to get that money on a permanent basis. rep. brady: you are right in the

first part. we do not need just a one-year tax. 2004-2005, in a sense, the company brought back $300 billion in a very short time. that is not what we want to do. we want a permanent change. if it makes economic sense. and oftentimes, they do. looking at drafts that we have laid out, now i think in four years, and the feedback we would get an 8.3% for those profits. i think we are right in the ballpark, as i said, allowing them to be able to count on that long-term and having plenty of time to be able to pay that toll coming back, i think is important. i am convinced if we start with trying to figure out where to spend the money, rather than how we get the policy right, we are making a mistake. pective it wills

send the signal to ceos and businesses that they can safely invest in the u.s., or wherever it is around the world. ben white: if you were going to allow these profits to be brought back to the u.s. that certain amounts would have to be dedicated to infrastructure, building, hiring. is there any common ground between republicans and democrats about requirements that would be put on those overseas profits? rep. brady: great question. date has been highway funding and infrastructure funding because there has been common ground there. i have a good source of funding. it would have been a 5-6 year transition. a, nobodyng is that a dollaronvinced me

stranded overseas is better than a dollar brought back to the u.s. for any reason. secondly, if i had my druthers, we would dedicate any revenue to lower rates in a comprehensive tax bill. i actually think using those dollars below the rate has become more competitive in a 2017 effort. that is the area i would most like to be focused on. ben white: let's go back to the moment you were talking about. the discussion of using repatriated tax revenue for the government to fund the highway bill, as opposed to the direction that ultimately, congress decided to go. how close was that to a reality? was thedy: speaker ryan one leading the negotiations and it seemed to me that he was very encouraged about the policy there.

there was a lot of agreement between republicans and democrats on that policy. the other discussion there was nd, reallytion bo trying to prevent america from being isolated. the technology and pharmaceutical companies were thrust away from investment in the united states. that took a lot of time in those discussions as well. the short answer to your question is, they made a lot of progress in those negotiations and discussions. it is worth picking up where they were at and continuing this to see if we cannot find some bipartisan agreement. ben white: i want to come back to those tax related issues. trade is obviously, a huge issue for you. n doug to bring int palmer to ask questions about that.

[indiscernible] rep. brady: how would you gauge the prospects for ttp and what does president obama need to do to get republican support for the agreement? rep. brady: i think passing that agreement is difficult, but doable, doug. it is doable because the economic value of moving in to asia-pacific area under our trade rules are critically imp ortant, with half of the world's middle-class customers being in that region. you askwhen a bank robber, why are you robbing banks? he says, that is where the money is at. madey decisions have been

that cost boats on both sides of the aisle. first, taking up this agreement and the most open and transparent process that has ever occurred. we can thank those who passed the trade promotion authority bill for laying out that agenda. thosel exceed requirements for openness and deliberations going forward. the other part of that is building support in the areas from biologics to the tobacco area. they are working with those members of congress to build support. standpoint,a timing substanceg is let the and the support of the agreement drive the timing. we neither hasten it or delay it. doug: freelancing what you just said, looking at the

congressional calendar this year, there is not a very long summer session. the best next opportunity seems to be after the lame duck ses sion. do you think this is something that could be done before the summer break? it all depends on how well support continues to grow. i think there is a good solid basis for it right now. i think there is a good solid base of support. the agriculture community and the business community has been telling the white house it is critically important in a serious way. i have seen signs of that occurring, by the way. i think the timing is to be determined. ben white: timing to be determined is something i have heard a few times in the past regarding ttp. i want to turn to that it little bit.

you can review the entire thing now. are you happy with it in its current form? or other specific things you think need to be changed, or should it be signed as it is now by the administration? should we move forward with that document? rep. brady: there are areas that i have concerns about and while we all follow different parts of those agreements to see the impact economically on our state or region, like other members i look at the architecture of an agreement. how does it deal with investor state relations? how does a deal with labor and environmental issues? architecture will continue through the next agreement. i have concerns i have labeled out to you. theless, you have to look at the agreement in its entirety and find ways to improve the areas that need

improving, and then bring it to the floor. i think it is important for us to have a vote and work out these differences because this is really the first 21st century trade agreement. i know this phrase gets thrown out there a lot, but in the past trade agreements -- and i think i have been involved in 12-14, in some way. most trade agreements have been country to country or in central america's case, six countries negotiating amongst themselves. this is designed more like a plug and play, where the standards have been set. they will have to plug into it without renegotiating everything. we still need approval, but that adds a great deal of value to this agreement that has not existed. it is important we keep that in mind. i want to patn white:

myself on the back. forave been doing this 15-20 minutes and i have not yet mentioned donald trump. rep. brady: you can mention him if you want. ben white: i do want to deal with the political environment you have been dealing with and trying to get ttp approved in an environment where you have donald trump against it, ted cruz against it, hillary clinton has come out against it. trump says china will come in afterwards and screw everybody over. i know the whole idea is they will eventually become party to it when they see the ground rules have been set in ttp. education jobthe among -- that is just the republican base, but the broader electorate is in the mood not to sign big trade agreements. you will have a political environment where big trade deals are not particularly popular, not being endorsed

among the candidates. you have others like rubio and bush who are more pro-free trade, but they are not leading. how do you overcome that? rep. brady: it is counterintuitive. when the economy is not well, we are missing 6 million jobs. missing $1000 a month. the family paycheck ought to be back by now. there are many people concerned about the economy. in those cases, trade is normally a tougher sell, but i think quite frankly, it helps us in the sense we have local companies who want to compete around the world and go after those customers and create those jobs. as a result, tpp is so aggressive.

it has the potential to be very neneficial for job creation i local districts. mosi amr thing is again, most familiar with republicans and conservatives. for us, our core beliefs are a keepingational sense, communities and family safe, less government taxes so you have more control of your life, and third, the economic freedom to trade. to buy and sell freely over the world with as little government interference as possible. day,nk at the end of the our republican nominee will embrace those values. as we break down tpp and allow the public to see it and lawmakers to examine it, we will

make a course going forward. we still have some work to do, but at the end of the day, if they were to absolve the issues that are outstanding, there is extreme value. ben white: because you brought -- whati will just ask do you make of the fact that donald trump continues to lead by a very wide margin for the republican nomination? it is always been in the media that there would be a peek for demo trump and then a recession. that has not happened. he could move on to rack up a lot of delegates. what do you make of that? is he somebody you could support as a nominee? rep. brady: what is the next question? [applause] no, it is a great question. it is such an uncertain environment, political environment.

people have a lot of frustration with government, that they are not solving real problems. thatany have given up hope we will do things like fix this broken tax code and tell people get back to work. it is just manifesting itself in mr. trump. this selection though, has a long way to go. i have a lot of faith in voters going forward in these primaries. whether it is mr. trump or others, the cream will rise to the top and we will coalesce the hind a candidate. -- coalesce behind a candidate. i am hopeful that we are able to coalesce sooner rather than later, as primary voters. we will see where it goes. ben white: i do make a heard an

answer about the question regarding donald trump. rep. brady: the answer is yes. ben white: you would support him. excuse me for not having done the research, but have you picked a candidate? rep. brady: i have not. back toe: i want to go tax issues with of the ways and means committee and talk about the dynamic there. you have paul ryan. he was very happy with that job and wanted to stay with that job. i will read you this quote from him from a breakfast i did with him last year. wass about how dedicated he to seeing tax reform through. circumstances changed and he became the house speaker. what is your relationship like occupied or is he so with the leadership of the house that he would not be particularly, heavily involved?

how does he play in the ways and means committee now? rep. brady: it is important to have a chairman so knowledgeable about these issues. it is a benefit across the board. butlearly knows the issues, paul ryan is a generational change in the speaker's office. he sees things differently and so, he continues to push power mbersto our ranking me into the committees. i expect him to do the same thing in ways and means. he is the coach of the conference across all of these different issues and topics. i see myself as quarterback of the ways and means committee. our job is to move the ball down the field and the priorities he has laid out for 2016 -- the top five priorities, the ways and means committee is responsible mainly for four of them.

tax, trade, welfare reform, replacing the affordable care act -- we have a lot of work to do. ben white: i hope he will move the ball down the field, better than the texans did in the playoff. rep. brady: you had to go there didn't you? sorry.te: yes, i am i have put all on the brain. i asked paul ryan whether he would consider running for president himself. he had family reasons for not wanting to do that, he also said he thought he had four of a chance to really change the economic dynamic in the united states through the ways and means committee. he said, i can make a huge difference for the country. these issues all go through the ways and means committee. they originate in the ways and means committee.

i want to be a good husband and father. he basically said the ways and means committee is perhaps, the most artful engine to affect economic change. do you approach the job with the same idea? rep. brady: i do and to be honest, i am still pinching myself. i love -- we all came to congress to do big things. you never come here to do small things. the ways and means committee is all about the big issues. fundamentally changes the course of the country. if you think about creating a tax code built for growth, if you think about saving social security and medicare -- medicare, especially. our budget has to be addressed for medicare. congress took a big step forward last year in solving the way we pay our local doctors going forward. that billl had a lot of momentum . if you look at trade and a number of other issues, even have a lot of impact.

someone -- he and i came into the other, sat next to each other, worked our way up, and the hopes of someday being able to lead real change with a positive agenda. the chance to work with my friend to do that is as good as it gets. ben white: back to the overall political environment question. last time you mentioned how hard it was to do tax reform. it is very hard and once you talk about closing loopholes, they all of a sudden become, not loopholes. last time tax reform is passed was 1986. -- nothingt less close to what congress is like now and the campaign trail is like now. it is hard for some people to imagine a scenario under which you could rewrite the entire pass code without losing a bunch

of republicans and democrats. they say these corporate tax reforms would be giveaways too big companies. have you see the environment developing in a way that there is not this poisonous, political environment that would make a tax reform bill possible? rep. brady: if you look at the elements that made the 1986 reform work, it was a country that had had it up to here. they knew the tax could was unfair. they blamed other people forgetting breaks, but not them. it was too complex for the families and the businesses to handle and address. sounds very familiar. secondly, presidential leadership is so critical and i am really encouraged by a republican candidates for president. all of whom have laid out very serious tax reform proposals. some of them are going places republicans have not gone before.

i think that tells you they are serious about leading on the issue. and what they are hearing from the american public, or they would not be laying out that agenda, they are hearing that people are ready to tackle this issue. in fact, i think the biggest challenge we have got is that american families and businesses have almost given up hope. part of our job, and i look at tax reform as a marathon. -- it has been 30 years. the quick that to a marathon. in effect, if we are picking toward 2017, we are in the last couple miles of that marathon. how we run 2016 is very critical for how we finish in 2017. laying the foundation is very important. ideasd to listen to the of our conference, bringing those different proposals out. i think that is very critical to next year.

let's go back to the republican candidate tax reforms. what are you referring to specifically? which candidate's plans do you like the most and what elements of the most innovative? ben white: they all -- rep. brady: they all have strengths, but they all have ideas.wth if they did nothing else but that, that is enough because it lays the foundation for the president, that candidate to be president and actually follow through. to me, that is 99% of the issue. you see members, or presidential candidates, looking at value t e xes. we are looking at increases in earned income tax credits. that is that pro-work tax credit into problems

because of fraud with conservatives. we have conservatives leading with some of those issues. the fact that they are willing to do what some would have thought was too politically risky and not only are they comfortable, they are enthusiastic. i think that tells us just about everything we need to know about their seriousness. [inaudible] -- corporate rate? rep. brady: it was three years of relentless work and i think the fact that he laid out a -- it grewve draft the economy and shrunk the tax code by 1/4. and then, he essentially said,

now make it more pro-growth. .e proved to you can do that 35% to started taking 34%, they have moved even lower. my belief is it needs to be under 20%. ben white: is 15% the number in your head? rep. brady: to do that we need to think freshly. we need to look at these issues a new to get these rates down. it is hard within this construct to do that. jobsinking is, the steve approach, when he took apple and they followed the advice he had given to microsoft in a similar situation in innovation. when you are behind, leapfrog. when you are that far behind your competitors, you better

strive to go past them. i am convinced for us to make the change to really be competitive, we need to be bold in our approach. ben white: let's talk about a couple other things in your purview with ways and means. one of them is the affordable care act. republicans have had some successes in targeting pieces of that. the medical device tax being one of them. you will likely not get it repealed, despite getting the bill to the president's desk. what are onsome of the next things you are looking at in terms of approaching the affordable care act and taking up pieces of it that you don't like? 30 hour work week, certain mandates, what is on the agenda? rep. brady: 2016 lays the foundation for 2017 and frankly, this argument. there is a reason why, with all

the efforts that have been done essentially they have stalled out on the number of americans choosing, or being forced into the affordable care act are actually taking that up. , big reason for that is besides architecture is all wrong and the centers are all wrong and it is far too bureaucratic, is people have figured out the true cost of health care is not just the monthly premium. it is those out-of-pocket costs. it is the deductibles. the cost sharing. it is the fact that they may local able to see that doctor. people are smart and they figured out this is not the affordable health care that we were promised and that is why i approach2016, as we it, we will have a family discussion about how we lay out our alternative. i think we agree on the principles of it, but we have again, the new approach. that is, this, be five committee

chairs sitting down and deciding what the replacement plan is. it will be the collaboration of 246 members. that ben white: is going to drive this. ben white: and we will definitely have a replacement plan put forward in 2016 saying, this is what we replayed the affordable care act with? when i look at tax reform, where a want our health care to go, health care has changed. people more like they have never had before. allok at our principles in of the replacement plans that have been introduced and what in effect, we have been laying out is the health care backpack, the option for workers to choose a plan that is tailored to them, they goes frowith them from job to job. is, if it is a plan that

working for them to be able to take it into retirement as well. republican principles really focus on that type of a backpack idea. i am convinced that people are hungry for those types of choices. not driven from washington, but driven by their needs and i am convinced we can provide them that. ben white: one was welfare reform. putting together a welfare reform bill that you can introduce? bigrealize this is a question and we have a short amount of time left. but i want to hit welfare reform and medicare reform. will we see bills on those? rep. brady: with welfare, you will see bills on that area. clearly it is a priority for speaker brian and many in the conference. we will go through this discussion again and talk about ar ideas in as conference going forward. my am convinced people want to get out of the welfare and

poverty traps. that really traps people, their opportunities are limited by the government. versus the unlimited opportunity. i think the public is ready for it. and i think, with good intentions the government has made it harder for people truly to get out of those traps. and so yeah, i am pretty optimistic that we will be able to produce a bill on the area. with medicare, if you look at last year's solution for how we reimburse doctors, which transforms it from how many procedures to the quality of care. the second step is redesigning how we reimburse other providers throughout medicare. hospital,g into the the care you get in the hospital, to outpatient care, and then after that, where you go. from rehabilitation to home, to

wherever. so, you are going to see ways and means continue that work and don't be surprised if many of the steps we take our bipartisan in nature. i will stop here, but getting madnesshat year to year of the doctor fix, which sucked isall the oxygen, gone. they get the oxygen they deserve. these are very good steps going forward. don't be surprised if they are not all bipartisan. ben white: you are introducing completely non-bipartisan bills on welfare and medicare reform in the election year when democrats are coming to him pretty hard. vulnerable to that?

you could open up a big opportunity for hillary clinton and democrats. rep. brady: my gut is that the reason washington is at such a low level of confidence and trust and support is not because of what this institution is doing, but because of what it is not doing, tackling the big issues. step is solving how we pay doctors. the second step is redesigning how we pay others. the third step is giving seniors more options for may have, tailored medicare. some will be combining part a and part b. the other will be what others call premium support. options are former tailored to seniors. that is step three. we're going to continue to lay the groundwork for that. ben white: we're going to wrap

up, but it wanted to ask you. we have a blissful year ahead of us. we have no threat of a deafening crisis. like the political weapon is being retired and no longer will be a threat that can be used in future budget negotiations. this is done as a political weapon that can be used i? will we see this in 2017? ,ep. brady: that could reemerge but even though we have lowered dramatically the annual deficits, we are still spending far beyond our means. it will take back up in less we make changes. budgetpportunity in our to find better ways to manage our money and get ourselves on a better path, we're going to want to do that. that is why we have these discussions. the question is, could we have a president who did not see that

as a political game, but as an opportunity to find bipartisan ways to shrink the size of the government to within our means and make it more pro-growth. you can actually turn the issue into a real fossil, constructive discussion on how we live within our means again. ben white: i will let you go after this one. you are about to talk about your policy for the coming year and what you would like to propose legislatively. how much goodwill does speaker ryan have? has the conservative wing of the party united with the moderate or pro-business wing? rep. brady: we have a diverse country, and a diverse number of republicans. i think they are excited about what paul ryan brings, a new thinking to how that speakership runs.

it is common for members in the des --- i mean, for deca to hand that leadership, whoever it is. ryansomeone hands paul that bill, he hands it right back to them. let's let legislators be legislators. people are really excited about that. the are really excited for the end of the euro crisis to end. both on taxes and the chance to tackle the issues. rather than principles on the big ones, we have tactics on small issues. and i think that is where we need to go. ben white: what paul ryan emerge as the republican nominee? [laughter]

give us a thrill for the potential of a broken convention. rep. brady: i don't know. i am hopeful we disappoint you mildly in that. at any point in his life, he would be an excellent president. no question about it. i think he would tell you right now, let's let the primary process work and let voters have their say. competition works. people rise and they fall. i thought some who could make the leap didn't. to gatherenty of time behind a good candidate. ben white: not that much more time. thank you, chairman brady.

[applause] ben white: i want to thank my wonderful sponsors. and those of you joining us on the live streaming, thank you! stick around and hang out. have some fun. thank you so much for coming. [applause]

>> we will be live with the house armed services committee on c-span3. as president obama prepares for his state of the union address on tuesday, he released this video on twitter. obama: i am working on my last state of the union address. i keep thinking about the road we have traveled in these past seven years. that is what makes america great, our capacity to change for the better.

our ability to come together as one american family, to pull ourselves closer to the america we believe in. it is hard to see sometimes. are and it iswe what i want to focus on in this state of the union address. >> c-span's coverage starts at 8:00 p.m. eastern with james harkin, looking back at the history and tradition of the annual message and what to expect in the address this year. and it 9:00, our live coverage with the president's speech. that is followed by the republican response with nikki haley. plus, your reaction by phone, mailbook, tweets, and e on c-span, c-span radio, and www.c-span.org. we will greet their the state -- we will re-air our state of the union coverage.

we will hear from members of congress in statuary hall with their reaction to the president's address. next, a bipartisan congressional ask force held ia hearing on opioid addiction and treatment. johns hopkins university and the substance abuse mental health services administration are pr esent here. this is two hours. >> thank you for joining. the task force is made up of more congress representing districts all around our nation. the investment of so many members with different illustrates the

reach of her win into our communities. if a national emergency to say the least. time this roundtable will take place, 10 americans will die of a drug overdose. each was a brother, son, sister, daughter, mother, father helpless in the group of heroin addiction who ultimately succumbed to the disease. in new hampshire, over 400 people died from a drug overdose in 2015. that is one out of every 3000 people in my home state. is transforming these productive members of society into desperate addicts -- caroline is transforming these productive members of society into desperate addicts. the risk of experimenting can be other treatment options, we can help save many thousands of lives throughout our nation. today's roundtable will focus on the effect of recovery

treatments, some involving medication and psychotherapy resulting in almost 60% recovery rates. to get even more success, we must study which treatments work best and encourage their adoption in other states. joining us in that effort in our panel of experts, deputy director for the national , andtute on drug abuse medical officer for the division of pharmacological therapies and dr. jessica pierce, the associate director of addiction treatment at johns hopkins. i want to thank all of our participants for joining us today and i look for to hearing their perspectives on this growing problem.

there are other facets to this problem. acttroduce the stop abuse to coordinate law enforcement and public health agencies at a federal, state, local level. strongercreate a program to monitor prescription pill trafficking. over prescription of legal opiate leads to large numbers of legitimate patients lead to street heroin. we need to crack down on the black market for legal opiate medication, including treatment and protection -- prevention grants. as members of congress, we must do everything we can to help those affected. by hosting roundtables and briefings, it gives members an opportunity to hear from experts to combatat we can do this.

i want to thank all of you for joining. i look forward to hearing from the panelists about treatment options. i would like to turn this over to the cofounder of the bipartisan task force to combat the heroine epidemic. >> thank you. and thank you to all of you for being with us today, my colleagues who have joined together in the bipartisan task force to combat the heroine epidemic. grown tod epidemic has his stork proportions. medical providers are struggling to keep up with the flow of overdoses entering the clinic and to secure treatment. our law enforcement and first responders have taken on the burden of responding to more and more dangerous situations. becoming moree and more frequent. statistics show more americans are dying from drug overdoses than car crashes.

in our home state of new hampshire, the opioid epidemic sadly continues to grow. debts --number of drug debts in the granite state exceeded 400, surpassing the record set last year. without quick action, these numbers will continue to rise. in new hampshire, we face a deadly combination. we had the nations highest per theta addiction rate in second lowest treatment capacity. last week, i highlighted the results that can result in a lack of treatment options in telling the story of the stepdaughter of a dear friend of mine who passed away at just 22 years old. while incarcerated in craving treatment, a bed finally became available for amber at a wonderful treatment center.

but the prison would not let her out to take that big and meanwhile -- that bed and the prison itself offered no recovery services and when she was released, the bed wasn't available. she died of a heroin overdose, lacking treatment, and without support. once someone does get treatment, it's not the end of the road. frank and i have learned as we've traveled around the state that substance abuse disorders can often send patients into relapse and it's vital that proven evidence-based treatment methods are available across the country. why our conversation today is so important. at the federal and state level, legislators are working to forlop the best practices treating substance use disorders. these decisions need to be guided by the latest research so those who seek treatment at the best chance for full recovery.

i look forward to hearing from our panelists. we need to know what works and what is not working so that we can make the best decisions in this bipartisan task force. best best develop practices and share them across the country. i was proud to introduce the stop abuse act, a bipartisan bill to bring together our federal agencies to coordinate our response. we can work with physicians, dentists, subscribers, experts ,n pain research and addiction representatives from the addiction community, and develop best practices for pain management and prescription medication. legislation will bolster prescription drug monitoring program. jackie has an important bill for veterans on that regard.

i thank you for coming together. no single bill will provide the silver bullet for this challenge but by working together, i am confident we can pass legislation that will start to change the tide of that epidemic. thank you. >> thank you. i would like to now introduce the first of three panelists, dr. wilson compton. dr. compton is providing valuable scientific leadership developing and managing the institute's research portfolio to improve our understanding of their results. i would like to recognize dr. compton. dr. compton: thank you very much. seeing such a great turnout for this issue

that has devastated so many communities. this has been such a major impact in so many parts of our country. i applaud you for the task force to address these issues in a proactive way. i am glad i have my slides. through theseo very quickly but i will leave them with you and if there any questions, please let us know. the most important information is on this first slide. it reminds us of the tremendous number of deaths associated with drugs of abuse in general, the deathslers over 19,000 from 2014 and 10,000 deaths from heroine. i will point out that even the surveillance data has some messiness. how debtook at certificates are coded, there

are a lot that are coded as drug overdose generally and don't specify whether it was related to prescription opioids or heroine. there may be a greater number of these. there --ve mentioned, it is the increasing rate of prescription that has given many people a taste for an opioid. their brain has been exposed to it or the communities are exposed to it in a way these pills can be misused and taken nonmedically. what we have seen is as the number of prescriptions go up, the numbers of deaths increase. there is a fourfold increase in deaths associated with these painkillers. that's drugs like oxycodone, hydrocodone. all of these narcotic opioid pain relievers. the reason i am starting with

prescription opioids is that the upstream driver of this epidemic. that the deciding factor that has exposed so many people to opioids and lead them toward that pathway into a heroin problem. you bring it doesn't distinguish between different types of opioids very well. the brain sees them almost all as very similar. has the same impact on the brain as oxycodone or hydrocodone. in laboratory studies, people cannot distinguish the difference. rates of prescription drugs have become more available, we see an increase in heroin. because of the initial exposure to opioids and then the availability of heroin in so many communities around our country. misusingr of people

opioids has sky rocketed and the heroine deaths have seen an increase. the next financial increase in the last few years and it certainly concerns me because we like to see a curve bending and eventually coming down and we don't know where this will end. it's still on the upswing. been increases everywhere. if i only showed you the south thought, we would have a doubling was a terrible scourge but look what is going on in the northeast. it is a sixfold increase in the number of deaths. it is in all the major ethnic, racial, age groups. young whites. it shows these new injection ,rug users tend to be younger

equally male and female. that's a novel change. we think of most drug users being male but that's not true in these new users. that's another concern. why do people abuse these? they abuse them because they have an impact on the central circuitry. they make you feel good. a basic principle for much neuroscience are not going to go into detail but that's the underlying feature. these are habit-forming. not for everybody and that's a conundrum. some people take these drugs and they find it extraordinarily unpleasant but some really like it and there are at risk for doing it again. i am pleased our secretary of health and human services has made this one of her keynote issues. she convened a small group helpn the department to

her address this in a proactive, consistent way. we have developed three priorities. these are not the only things we are doing but the three priorities relate to a prevention approach. many change how prescription opioid are available by focusing on prescriber practices. let's focus on saving lives immediately with greater access to life-saving overdose treatments. ,nd let's focus on treatment medication therapies and particularly as the proven treatment for opioid addiction theeduce -- to increase likelihood of people going on and recovering. thell focus briefly on first two. when it comes to prescribing this is, one of the issues we try to address relates to the opioidses for providing that pain clinicians use that come from a variety of sources.

ine of them are outdated and conflict of interest. as an alternative, the cdc has been undertaking the development of prescription guidelines and these -- when it comes to the overdose, we are pleased to be able to work with one of the pharmaceutical industries and for the recent approval of a formulation. the only fda approved formulation being an injection, there is a nasal spray. it was approved in november and it should be on the market shortly. to the main issue

which has to do with medication. there was a's ready in baltimore a couple years ago that showed us as they increase the availability of methadone, they showed a stunning drop in heroin overdose deaths in that city. we see this as a population-based example of how you can save lives and increasing treatment access. methadone --ned i've already mentioned methadone, opioid substitution treatments. methadone works as another open your eight. -- opioid. let's take a quick lesson in the cellular chemistry. when a chemical is taken, it works by fitting into a receptor. think of it like a key going into a lock. methadone goes into the

receptors, they go onto to the receptor and produce a lot of activity. that's kind of like you turn a lock and the tumblers move and the doors open. a blocking agent is like a dummy key. it goes in and doesn't turn. it fills the keyhole, keeps other keys from getting in, but doesn't produce any action. those are the easy ones. -- weone or opioids haven't and between agent that is somewhere between the two. it's a partial agonist. it turns the lock but the door doesn't open fully. that's a quick way to think of these different classes of medication. blocking agent is one of our in a that can be given long-acting form and when people take it successfully, they don't get high. they used heroin or other

opioids. the same thing happens with methadone. when they are taking those successfully, they generally won't get any intoxication when they slip so they learn not to use them. that is the key to use these as a learning experience. that's the short version of the history and melinda will go into this with more detail. i will tell you what we're doing with new approaches focusing on extended-release medication. medications bit on and we are pleased to have partner with the release of a long-acting vivitrol. we have even developed vaccines as another way of keeping drugs out of the brain. one of our new medications is this long-acting. one of the issues as people will take these medications but there's an issue.

my patient has to make a decision every day whether they want to stay in treatment and use their medication or they want to not do that and head back into a path towards relapse. sometimes as a conscious decision, sometimes not quite so but they need to make the decision every day. with a long-acting injectable form, they may not need to make that decision as often. you're interested in this idea , a longplantable device acting implant that only needs to be implanted once every six months. that means someone only has to make a decision about their life and turning things around about once in every six months rather than more than once a day. patients are more likely to be compliant when they take this. caprices greater abstinence. greateroduces abstinence. this was submitted to the fda in september and it's under an

expedited review so we expect an answer about whether it's met the threshold and whether the data supports its actual use by clinicians within the next couple months. want to focus on a promising area of that scene development. the drugs have to get into the brain to have an impact. vaccines attached to those drugs so they create a protein binder to those drugs and they keep them in the capillaries. they keep them in our circulatory system and not the brain. that's the theory. there's a bit of preclinical research animal models. there is emerging human research to suggest this might be able to be effective. we had a way to go before we have that scenes that are useful.

our job is to always be charting a path forward for what we can do tomorrow even better. the last challenge i will focus on is implementation. we have had these medications like methadone for about 50 years. naltrexone for 30 years. so what is going on? not very many people are treated. this is a major gap. we are pleased to see increasing prescriptions so more people are availing themselves. we have been pleased to try novel trials. ale noticedyield -- y they were seeing the same people over and over again coming in with an overdose or problems related to air when and other opioid issues. they said maybe we can start it here in the emergency department.

they're not going to the clinic down the hall so why don't we act as their primary care physicians? they found they were more like you to be in treatment and less likely to be using drugs when they were reevaluated weeks later. this is just one center. we are not sure everyone else can do it as well. but we think that's promising and we are working now on testing this in a number of other senators -- centers. finally, i was saddened by the story representative custer related about a patient who died shortly after being released from prison. the importance of linking our criminal justice and public health efforts. i represent more of the public health and treatment area and i have issues with people dropping

out of the treatment readily. sometimes working together through models like the drug activeodels, extensive work with probation and parole, we can do a better job using the best pieces of both whether that's the close supervision, the treatment the treatment providers provide and even , incentives for people to turn their lives around through modification. these models have been shown to work for 20 years but we don't see them in wide enough use. these efforts seem to be an area where we are doing research. i remind us that even medications can be used in this setting. tookdy out of baltimore offenders who were about to be released from long-term incarceration.

to all had a history of heroin addiction in the past. this wasn't withdrawal. they referred them to methadone, actively referred them which means they actively made that referral and engage them in treatment after released where they started him on methadone a few weeks before release. those were methadone was started prior to release had a better outcome whether that related to less criminal activity as well as less drug use. this speaks to the importance of being practical and thinking through what happens. people get out of prison, they are not usually thinking about getting treatment right away. there are other motivations that are their first goal when they are released so starting treatment and setting them on the right foot could be very important. thank you very much for your attention. i'm going to turn it over to melinda. have theould just

congresswoman make the introduction. >> thank you very much, dr. compton. the doctor who currently serves as a medical officer for the division of pharmacologic therapies at the substance abuse and mental health services administration. she's a physician board-certified in family medicine with additional credentials in addiction medicine. thank you for being with us. >> it's my pleasure. thank you for having me. before i get down to my presentation, i want to take a moment to thank you. sa is providing a new round of grants to help in assisted treatment and has funds to dedicate to overdose prevention thanks to the budget you worked so hard to pass. i want to thank you for setting aside the block of time to gather more information about treatment options for opioid abuse disorder.

i cannot begin to fathom the number of equally critical issues you are faced with and that demand your attention. i came away from the first forum a few weeks ago really deeply impressed with the urgent need i felt from the members in attendance for ready come out-of-the-box direction for what could be applied to help your constituents. so, i'm going to try to really be concrete today in this presentation and not be too high too much of what dr. compton has already presented. the other thing i want to tell you about myself is that i spent 10 years as a prescriber before i came to government. five years in my solo private practice doing primary care medicine. as medicalears

director of an opiate treatment program in pittsburgh. i maintained my private practice over that time. the single most therapeutic thing i did for anybody was provide respectful medical treatment. whether that included medication or just listening and advising and coordination. obviously, medication was an important part and i will spend a lot of what i talked about today on that. one day, i asked everyone i saw it a would give me permission to take a picture. this is far less than half the

people i saw that day. people waited their turn. nobody could

-- when they were being treated with respect. when they were getting the care that individualized them as human beings. that in a little bit. reiterate, as far as your brain is concerned, an opiate is an opiate. problem we may have a to start with, once that horse opiateof the barn, and disorder is an opiate disorder. you may have different strategies on the prevention and that the treatment and looks pretty much the same for everybody. is, how quickly

it affects you, the individual person brings risk factor to be. when they are functioning highly and getting their opiates either by misleading a prescriber or getting pills from a friend and they keep the social front in tact, the consequences are less. unfortunately, and opiate is just as deadly whether your social facade is intact or not. but if your existence is more marginal, if your personal safety is at risk, if you have as asubject to trauma result of your addiction, it

does snowball. there is a cumulative risk. so, while the brain and the opiate are energizing in whatever way, we in society have ise role in how the illness based on how we define what we expect from people. criminalize their behavior or medicalized their behavior. i want to talk about the essential ingredient for recovery is that one be alive. the locks and is not medication assisted treatment. it is the antidote to opioid poisoning. has the shocking ability to take somebody who was completely without life, no air moving, and

bring that person back to alert, talking to you. to seeays very happy you, but alive again. it is astonishing the effect of that drug. so, it is absolutely essential to any treatment that people have access to the antidote when they need it. available making it to people who are leaving detox or rehab because they are going out in a fresh baby state. they are extremely vulnerable to any exposure to opiates. that peopleant likely to be on the scene of an overdose, friends and emily or other users, have no locks and. -- what i used to do was write

prescriptions for it at he prevention program and supported developing a training offered in at jails where we were not the time able to offer it. doing it as putting it in your personal effects so you haven't when you walk out the door. there are all sorts of innovations going around the country that will result on lives saved instead of lives lost. toolkite updating our for the intranasal version which latere available publicly this month as a piece of work we are proud of. another point for you, detoxification is not treatment. detoxification is necessary to dependence,cle of

tolerance, and withdrawal. it is not always necessary to begin treatment. you do have to be detoxified to start it. if you are choosing to be detoxified because that is what is best for you, then being offered the drug should be an important step. it should be standard for that person who was not seeking the opioid. detoxification is better thought of as the medical management of opioid withdrawal. the risk ofchange disease or the factors for relapse over the course of the disease. it does increase the risk of fatal overdose should the person relapse. even if it is followed by a rehab stay. medication is not a

treatment by itself. it will control the disease much the way your hide led pressure medicine will control your high blood pressure but it will not change the course of the disease itself. just like if you are diagnosed with high blood pressure and you have to lose weight, stop smoking, control stress. of behaviorhole ton change the cames with most chronic illness. high blood pressure so, and i am sure there is many of us here with it now. i'm sure what we would want would need to be treated with the medicine most effect it for us and to be given the opportunity and the education to change our lifestyle. lady, sociallya and culturally the way we have looked at medically assisted treatment is a treatment of last

resort. if you have gone to detox and treatment however many times you want to pick, pick a number. then, well, gosh, you have to go on medication. youris not how we look at blood pressure. we say, let's go on this while we get weight off you and learn how to control stress. look athow we have to treatment. you have to be alive, you have to get your ducks in a row. i still have my wooden ducks, my pool toys, because i used to use that a lot. are your ducks in a row yet? dr. compton reviewed a lot or you and i won't go into detail except to talk about the difficulty that we can have in getting our heads around the

idea of giving and opiate to an opiate addict. that is intuitive, it is not where you would expect to be going. but as dr. compton was laying out for you, if you get on the right dosage, take methadone. agonist, if a full you get on the right does it control short withdrawal so you can stay engaged in treatment and function, but it also fills up your receptors and it eats them on and make even key also you are not constantly being also your to use, but receptors are full so if you use something, there is no receptor for them to wind to to reboard you for that slip up. so you are more likely to move on with your recovery instead of the whole octopus out of the top

of. morphine is different because it is not just getting the dose in the right to range and saturating the recep doors, it is a little bit that, but bupropion seen has this ability to bind to the receptor. most of the people who will take on the street will not budge that. the beauty of it is when it is bound to the receptor, it does not fully stimulate the receptor. the receptor is only working part time. your body says, i don't need as many and it starts to deregulate. that is when it starts to reduce tolerance over time. that is just kind of a cool pharmacology aspect of the drug

if you are really geeky you will enjoy that aspect. now, the antagonist, of course, gets on the recep or, lines it, blocks it off, makes it impossible for any openly -- opioid affect to happen. because your system has to be cleansed of opiates in order for you to take that locker. because if that opiate goes into your body and ribs all the appearance of the receptors, you will wish you were dead. you might not die from your withdrawal, but you will wish you did. the process coming on it has a couple steps you have to go through. so it clinically and in terms of how you will interact with the patient, keep them safe, get them from they want treatment to on treatment, depends upon the

medication you choose for them. hopefully i have not confused anything further. let's talk about methadone. this is the clinic i was in charge of. there is nothing inherent about methadone that requires it be administered in an ugly, dilapidated building. that is just how we decided it needs to be done. to their credit, they painted and they fixed the broken windows. you can see there is broken glass block. my office was in the shed. i used to say yes, i am the medical doctor. my office is in a tin shack on -- my office is in a tin shack on a cement slab. you find your neighborhood methadone clinic it will not look much different from this. there is the frank lloyd methadone architecture.

brick, iron bars. not where you want to have to go every day or three days a week or certainly not where you want your kid or nephew to have to go. have 1400 of these programs in the united states mostly providing only methadone. they are subject to regulation conceptually and in reality, giving controlled substance to a drug user is a high risk undertaking so it airs special attention. havetunately, some states chosen to prohibit opening programs. some communities have decided they have to have special zoning which is how you end up in ugly buildings next to a car wash. find out,want to everything samsung has about opening one, how they are regulated, accredited, would you

have to do and the to operate a program, we have a website here and we have a resource for your providers and program staff, to go into it a little bit. this is where my private practice was. i saw the same patience here. i moved up to the third floor where the lights are on. this is where you might rather go if you needed treat meant. this is where you would rather your friends or family went. this is your standard. or's office. i spent about five years there doing primary care. naltrexone.me oral