opioidse prescription of that started it. ost: a box of rocks knows that heroin is bad but people use it anyway. how much money can fix that? eople will abuse drugs or anything until the end of time. guest: i hear that sentiment a ot, and there's a couple of pieces there, that people will use drugs, that we're not ever going to get to a place where we've finally solved our drug problems once and for all. it's a part of whatever you want to call it, human nature, not re, that our goal is going to be let's imagine a time where there are no more drugs using drugs.eople at the same time, pretty much everybody has made some bad choices or hard choices at some point or another in their lives. it may not be drugs. it may be something else. a bad business investment, a bad relationship, a bad argument,

and i think that we have to hink about what our role is in helping to mitigate the of people's choices. that doesn't mean they're not capable of making choices. not doesn't mean they're responsible for the choices that they made. but when we see people getting with drugs, i step back and o say is it in society's best interest to keep following, or interestsociety's best to say we don't want to see families torn apart. we see potential in these people. we see potential for recovery, their potential for growth, their potential for contributing to society, and we want to help them fulfill that. host: wayne is in jonesboro, georgia. go ahead, wayne. caller: good morning, sir. been around this almost all my life, prescription drugs and street drugs. both sides of the fan.

it looks like the major problem is it starts off pharmaceutical companies. of h are making trillions eople s off of these p getting on heroin. if they have to go in for and they something have to have opiates when they come out, and there's no movement to get them off, and they want to switch them over to methadone, and -- that they'll host: wayne, is that what happened to you? sir, that's sir, no, just what i've seen from friends hat, you know, i would never have thought of -- never tested in the world. though at 42 died of some kind of chemical imbalance,

f some kind of methadone, and some kind of other pill. i don't know what it was. but i know methadone was involved. host: thank you, wayne. any response? guest: yeah, raymond, thank you story, and i'm sorry to hear about your loss. i do think that that speaks to n experience that a lot of people have had. and national surveys are bearing this out. a lot of people know somebody who developed a problem with this prescription pain killers. they might have gotten prescribed after a surgery, after an accident, for chronic pain. collectively, t we're starting to see, we have overprescribed these pain kill ers and maybe miscalculated who's most going to benefit and likely to suffer harm from them. so that's why we saw a couple of centers for e disease control put out guidelines for primary care roviders to say, if you are

considering using opioid pain chronic pain, t here's some principles. don't use them as your first therapy. try other things first. go slow, and stay slow. dose.the low and monitor people closely to see if they're getting into a at lem and then look tapering, look at strategies to ing ae the risk for develop serious problem. so we're seeing a concerted been too saying we've generous, too liberal with our that's rescribing, and creating this crisis now where people are getting dependent on opioids, people are overdosing. we need to start to recalibrate make reign that back in, sure people who do benefit from the opioids and who do need them for pain still have access to them but at the same time say, e can't keep writing prescriptions for opioids when there are better ways to manage pain. host: recently in the washington

post was this information, over 900,000 physicians in the united of themnearly every one can write a prescription for but to ainkillers, prescribe treatment drugs, doctors must take an eight-hour a special apply for license and fewer than 32,000 such a have received license. what is that treatment drug, daniel raymond, that can be used? sabaxone.'s called it is derived from the same -- it's an opioid drug that can help transition people off the roin, off of painkillers they're addicted to and it also has a lot of benefits. it's very hard, even if you take too many doses and overdose on it.

it's been very successful in treatment, but when it was years ced back about 15 ago, the way it was set up was requiring that you have to go through a special training course. so it's a much higher standard actually rs need to write prescriptions for painkillers. we're also seeing that there's a limit to how many patients a doctor can treat. you can only treat 30 patients in the first year, up to 100 after that. look at ss has taken a this. the white house has taken a look at this, and we're starting to ay if we want more doctors treating addiction, then we cannot impose these constraints disincentives them from becoming prescribers who are prescribe o buprenorphine and support peoples' treatment and recovery process. host: do you agree with that? guest: i absolutely agree with

that. it's been alarming to me to hear the stories of people who have been seeking treatment, who have tried other things, who have tried detox and rehab and trying their own, they haven't been successful, so they find a sperately to doctor who can prescribe them buprenorphine so that they can to recovery ath they're trying to seek. and you hear these stories of have to call doctor after doctor who says, i'm orry, i'm not taking new patients, i've reached my cap, who have to drive hundreds of take to find a doctor to them. the most tragic of all, who die of an overdose while they're waiting for a slot to open up for a doctor who could prescribe this drug to them that could overdose in ed the the first place. it's really serious -- overdose, we need more doctors who are phine.o prescribe buprenor host: daniel raymond, earlier this year, congress lifted the ban on needle exchanges. was that a positive development?

guest: absolutely. hadress took a look at what been a long-standing prohibition on use of federal funds for exchanges. back in the late '80s, when these programs were very new, there was a lot of concerns about, are they going to send the wrong message? are they going to encourage drug use? and there wasn't a whole lot of research on them yet in this country. so 25 years later, we've learned a few things. we've learned that these programs work so there's no more concerns about research, they're not encouraging drug use. they're actually helping people. that as so have seen the drug problems have spread urban areas and really into suburban rural areas country, that the big cities were prepared, because states like new york have needle places programs but like rural appalachia don't have

needle exchange programs and that's where we're seeing it spread the fastest. process that limited these federal funds was contributing to the spread of and when congress recognized that, they revised their policy. sign,is is a very positive and we're hoping for some good news in the near future around more guidance about how states and communities can redirect their federal funds if this is a olution that makes sense for them. host: wendy in hedgesville, west virginia. you've been very patient. you're on the "washington journal." caller: hello, good morning. to say that i am almost 90 days clean from heroin. i got clean on january 6th, and i just don't understand why no ne's talking about the aa/na program, because that's what saved my life. suboxone and subutex addiction.ck to got my suboxone and sold them

for heroin. i kept going up on my dose until effect i was getting from the heroin so it led me back to active addiction, and i had to lose everything to want to get clean. i lost my house, my cars, my driver's license and ultimate, cps stepped in and took my kids. so i came to west virginia, got myself, was sick as could be for 30 days. day. to aa every got a sponsor, read the big book, and i'm working the steps, and this is the only thing that has worked for me. almost 90 days clean is the been clean in 10 years. host: wendy, how did you get heroin? on caller: oxycodone. went to a pain management doctor in the baltimore, washington, area and all i have back.thritis in my lower they made me do an mri and he milligram oxycodone, just escalated.

fe fentanyl patches. i was getting discharged and doctor shopping. and when maryland caught onto that, i just got discharged and went to heroin. host: and how did you find the heroin? caller: well, daniel raymond, one thing i disagree with, you everywhere. an addict can spot another addict. you can spot a dealer. it's everywhere. it's all over. i could go to the 7-eleven or and i could tever spot somebody. it's that common. it's not subtle. it's out there. it's everywhere. disagree with daniel raymond on you cannot function as a heroin addict. morning, p every you're dope sick. you can't get your kids on the bus. and that'so to work, just how it is. host: wendy, did you lose your job? caller: i lost everything, yes. i lost my job, my house got driver's license,

my car broke down on the side of the road. left it dope sick, i there. they towed it. i never got it. you don't care about anything. my kids from school one day, cps came to my car and said you're not taking them. this was just in october 2015. you can't get them here on time. they say you're a mess every morning, and that was the day god interfered in my life and i came up here and i got clean. and i still used from october to january, even though my kids got used., i still overdosed three times. just had to get clean. host: wendy, why did you go to west virginia? caller: because my parents, i lost everything. my sister had my kids and i called my parents and said give me one more chance. rehabs, the he clinics, kept relapsing, relapsing. they gave me one more chance. i came up here, fought through the withdrawals, to the emergency room, swore i was dying. the doctors kept being positive,

go home, suck it up, stick it out, and you'll get through it, i did. host: you detoxed mostly at home? bedroom, home, in a with immodium ad and benadryl. host: and your parents? caller: and my parents. host: and you go to a meeting every day? caller: every day. host: wendy, thanks for sharing your story. daniel raymond. guest: wendy, i want to thank congratulations, i'm glad you're doing well, and congratulations on coming up on your 90 days. i understand what you're saying. i do think that you've said you've tried methadone and buprenorphine and it didn't work for you. aa and na were the only things that worked for you. that a number of people said aa didn't work for me. na didn't work for me. methadone was what worked for me or buprenorphine was what worked for me. i think like any other kinds of treating thise're

as a serious disease, that it's not one size fits all, but we have to find the right treatment for the right person, and it's enough estion of having options for people, it's about making sure that all the options are available and that we find people ideally before they've lost everything. i hate hearing stories about people who had to lose everything before they got help. that's got to be something we've got to intervene in earlier, wherever possible. host: john is in waterbury, connecticut. you're on with daniel raymond at harm reduction coalition. caller: yes, good morning, and thank you for the program. i would like to also say to wendy, blessings and good luck on your recovery. i'm not one of these people who's going to sit here and think that this is all great and all. , that it's just a simple problem. it's a huge problem. it's a self-induced problem. and i truly feel the only cure being clean.

wendy made it perfectly clear. i can't speak on it, i've never been addicted to it. the problem i have is you guys guys -- not particular people, but programs for recovery are aking money from senior citizens who are healthy and worked their whole lives and also children who are in schools who could be benefitting from sports and music and other school programs, and you want to take those taxpayer dollars and put them towards people who don't want to be clean, which is the simple truth. you can't put poison in your system and think you're going to be able to function normally. and you know, how do you go about justifying that you could go on one drug from another when i bet you $100 you're not going to go and put swamp water in your car and think you're going drive it to work. i just don't understand how you're justifying this problem by trying to say, well, we have drugs that will bring you back these people are going to live on the street and cause how many millions of dollars, whether it be through

hospital care, psychiatric care, he problems they caused for families and society in general. host: i think we got the point. daniel raymond, a response for that caller? guest: i think there's a certain to ask, are e have we going to treat people who suffer from addiction different treat people who suffer from heart disease? are these all medical problems? you talk about them being self-induced. some people develop physical problems that are related to lack of exercise, nutrition, obesity, things like that, smoking, all of these things. where do we start to draw the line about who's deserving of ealth and who's not deserving of health? i think an illness is an illness. addiction is an illness, and a very difficult process. ultimately, investing in saves money.ually we're not necessarily taking away from here or there. investments, we

know that that every dollar we spend will come back to us many times over as people become more stable, more economically productive, pay taxes, support those support all of things that i think that we all care about. so i don't think that it's an either/or situation. host: daniel raymond, what's the role of insurance in treatment? guest: i think that's a big issue right now. typically had a has, you system that know, for decades operated outside of the rest of the medical system and insurance has lways treated addiction as something of a second-class itizen, that insurance companies have not covered, provided the same level of addiction treatment as they have for treatment of physical diseases and conditions. big push been a

that's been part of federal law with some so worked attorney generals who are saying, listen, if you're an insurance company and providing an insurance policy, health insurance doesn't just mean physical health. it means behavioral health. it means mental health treatment. it means treatment for substance well, and yours as parody. show you have * parity. the same.o show you can't say we'll treat your yourcal conditions but not mental health. that gap is starting to close, but it's been a slow process. so i think there needs to be a big push around getting insurers to take their responsibility providing coverage in helping to manage both mental ealth and substance abuse disorders. cambridge, is in maryland. go ahead, tracy. caller: how are you doing today. touch on a couple of

points. i started doing heroin back in '90s.arly of course, went through the problems with the family, not wanting to listen. i'm only 43 so i haven't really been a long time. so going in and out of jail, not wanting to listen. serenity gh rehab, lodge in chesapeake, virginia. heroin was just as easy to get on the street. got out of there, went right back to it. ended up, you know, traveling around doing whatever in the up getting into a lot of trouble in a bad dope deal. went to prison for eight years and actually had easier access to better heroin in there than i on the street. what it took and what i've seen, i've sat with my friends for their death bed trying to come off of heroin on their own. i've seen them addicted to methadone, trying to come off of

methadone and not wanting to go through it and getting back on the methadone because it was harder than coming off the heroin. like the guy said a minute ago, making new drugs to counteract a drug, i mean, you can throw money at things as much as you can until you search for the source. i'm not hearing anybody talk anymore like years ago about fighting the influx of drugs. where are the drugs coming from? who is -- you know, i believe it years ago during the wars, 70-80% of the orld's heroin came out of afghanistan, the majority -- the rest of the heroin, i believe, asia.ut of southeast here again, speaks to a point, vested interest in afghanistan, we've got more troops in afghanistan now than any other middle eastern country, yet that's where the majority of their heroin comes rom, and it takes a lot of poppies in a huge poppy field to

get the sap from them to produce the heroin. these should be able to be seen imagery,know, satellite things like that. seeing i'm just -- i'm throwing money at the programs, and i understand. the help, some people get the help. some people use that help to get on other dope that's given to them such as methadone. do you see where i'm going with this? host: we'll get a response from a second.mond in just do you think -- what about legalization from your point of view? caller: oh, no. no, no. the devil is already on earth. you don't want to make him president. that's what you would be doing heroin. host: how do you manage your sobriety today? caller: i'm sitting here talking shaky.t, getting i remember when i first got about two fter i was years clean. we went on lockdown in prison and they brought the cart in to diabetics their shots

and just seeing that gave me sweaty my stomachs and palms. it's an everyday thing. you have to say no. i don't hardly drink anymore, because i know if i do, it's going to mess me up. it just comes a time in a person's life where you just have to say enough is enough. i can quote you the serenity prayer and everything in the does me no good unless i myself want to stop what i'm doing. cambridge,'s tracy in maryland. daniel raymond. uest: yes, i think tracy was talking about looking to the source of these drugs. mentioning afghanistan. afghanistan has been a major heroin. globally of but much of the heroin in the u.s. doesn't come from fghanistan, and i think the challenge here is what i was saying earlier, that we wouldn't problem if heroin we hadn't had the levels of prescribing and levels of availability of prescription some of your

guests and callers have talked about as being the path that led heroin, the road to that if we're talking about then iack to the source, think -- we've never had a world here heroin doesn't exist, and we've spent millions and hundreds of millions of dollars eradicate poppy ultivation, trying to get farmers to use different crops cocaine or rowing opiat opiates. we have not had enough success strrategies to keep saying we need to keep doubling them.ripling down on we have not shown where that's going to solve our problems. instead, we're seeing more now than we were 10 years ago. at i think we need to look the underlying drivers differently. it's not just the availability of drugs. it's the desire and demand for drugs and the lack of treatment options for people that are going to work for them, and not all treatment options are going

to work for all people, but if you don't have any treatment options, then we never -- we're going to end up with more addiction.d more so i think it's really that demand side rather than the that we haven't done enough on, that demand in terms of the prevention level and in terms of all entries are available for viewing online at studentcam.org. >> "washington journal" continues. host: our conversation on the heroin epidemic in the united states continues with meghan mccarthy. she's the chief of a newsletter what "morning consult",

is what? it we're one of the largest newses in d.c. hill and we tol have a poling division that helps us get at what americans actually think about the issues we're covering. host: and your background is as correct? reporter, guest: yep. host: so in that background, is congress addresses the issue of so, how?idemic, and if host: yes, as someone who covers health policies for about five or six years, this has been a passing me, especially of the affordable care act and how much fighting has gone on and on with obamacare. ou know, the center has a bill that sets up new programs to address the opioid epidemic. host: what kind of programs though? guest: a lot of it is helping

states coordinate efforts or helping states get more federal monitor the help iption drug use, to educate doctors about prescribing factors and things like that. host: this bill passed this year. passed by the house or signed by the president? host: no tjust passed the house a few weeks ago. they have had hearings about different legislation. they haven't moved the bill to the senate yet. house speaker ryan staff said it's something they are moving and there's some things that could happen by the end of may. host: how much money? guest: that is a question that g point. a stickin there's obviously bipartisan action to address this issue, ut how much money to spend on it is the question. still something that separates democrats and republicans.

and the senate wanted to spend $600 million to bolster the epidemic. fight the republicans voted it down and hopefully it will play out in the house. host: we spend about $50 billion a year on the war on drugs. e spent about a trillion dollars in the last four years on the war on drugs. what do we spend in the macro on treatment type issues? host: that's a good question. and i think both sides might disagree on exactly how much money gets spent on that, and portion of the federal budget. there's a couple of different these s involved in dc.orts, the c these are smaller items in their budget. issue, s this a partisan democratic or republican issue? guest: in health policy, there's bipartisan cooperation before something gets done. the biggest sticking point remains whether or not to appropriate more money to do existing f there's

funds you can call from to fight this epidemic. host: what about the states? guest: in the state level, you see -- and i think this is kind of common but because it's such acute regional issue in certain states, you see a little you see more ity activity between democrats and republicans in passing legislation or spending money on prevention or treatment programs. host: 202 is the area code for all of our numbers as we discussion this morning on the "washington journal" about the heroin epidemic in the united states. 202-748-8000 if you've been impacted by the use of heroin. 202-748-8001 if you're a medical professional and all others can call in at 202-748-8002. we want to begin with a call martinsville, west virginia. arl, meghan mccarthy out of "morning consult" is our guest. caller: hello. a heroinchild that has

been to , and we have princeton house in new jersey. we have driven to suboxone clinics, which are 50 miles these last -- it's impossible. someone who u have works, they cannot get treatment a, drug back home, and to go to work. the one thing that did seem to is a drug called vivitrol. it's a shot. it lasts 30 days. owever, it sometimes wears off early. but we understand that ohio is program where they se the vivitrol shot in

conjunction with vivitrol pills so that when the shot wears off early, the person can then take these pills. and this has to be available in community.e you can't expect people to drive 40, 50 miles to get this treatment. and then get back home and go to work. because you have to realize that lot of addicts have families and jobs. to providew, we need something so that they can function and hopefully conquer their addiction. has heroin addiction cost you money personally? does your insurance cover any of this, and what would you suggest federal policy?

the vivitrol shot itself i believe was something for the shot. i think that the involved vernment got in this, they could bring the cost of that shot down, you providing that it actually does work. we need to do some more research on all of these things. host: all right. we're going to leave it there. carl, thanks so much. meghan mccarthy. guest: carl, you bring up a lot f points that are being highly debated right now. the cost of drugs is something that has really become a huge topic on capitol hill and for the federal government. the issue that you're talking you also, specifically, know, is that the different what kind lines for of medication assistance and

treatment people can receive so it is kind of a patchwork where you'll have a different treatment in one state versus another state so that's something that the committees on capitol hill are looking at as well. host: in the past, congress has funded what they call demonstration projects, which done in of experiments different areas of the country. are they doing any so-called demonstration project funding for treatment in the united states? host: if so, you know, the agencies do have authority to try to fund things out. medicare and medicaid services was trying to ook at medicaid and limiting beneficiaries who they thought were the high risk of being prescription painkiller abusers, limiting them to one prescriber and one pharmacy they could actually go fill those prescriptions at, and that's something that, you know, the senate finance committee has medicare,expanding to so there's activity on that front.

gaithersburg, in maryland. go ahead, jeff. caller: good morning. i want to ask if anybody is make sure we to don't throw out the baby with the bath water. there are people in chronic pain these drugs, and you know, this whole situation is lumping them in with drug abusers. i think it's unfair. t creates a stigma that's unfair. people in pain didn't do way.hing to get that people that are hooked on heroin opiates, obviously went outside the prescribing hooked.tions to get it's an action they took on their own. one to really have no blame but themselves, but it's hurting people in pain. and i wonder if you have any comment on that. jeff. hanks, guest: yes, that's a point that the pharmaceutical industry

definitely makes, that there are people out there that these drugs are a life-changer, and eradicate help and pain that otherwise might not be addressed. you know, i think a lot of the educate doctors or to have the prescriptions be, you know, 30 days, to maybe limiting it to seven days. that's what massachusetts just did and other states are looking at efforts like that as well. tweets in, it seems heroin addicts are becoming hite kids in the suburbs, but not inner city kids. it's a big problem to be solved. you know, i think the statistics you have already showson the program today g: so you know, i think the is statistics you have already cited on the program today shows us how widespread this issue u: statistics you have already cited on the program today shows es: so you know, i think the statistics you have already cited on the program today shows us how widespread this issue is statistics you have already cited on the program today shows

us how widespread this issue is and it is certainly hitting senators and members of the house on the campaign trails and they're hearing about it from their constituents. host: thomas in fairlong, new jersey. go ahead, thomas. you? : hi, how are thank you for taking my call. well, let's see. ost of this problem actually starts when the little children and even babies, unfortunately, we have doctors prescribing rit adderall, which leads to meth later on, but these drugs,n are taking these especially babies, inhibitors, they don't do the drugs anymore. meth re they looking for amphetamine, heroin. as a parafactor, i treated people in pain for over 30 years without drugs, without surgery. hy isn't the government, the pharmaceutical industry and the insurance companies telling people go see a chiropractor when you're in pain. it's safe. there's no drugs. we actually help these people, even chronic pain people. we do get results, and i don't hear anybody talking about this. throwing more money at the problem, not going to make any difference. we've already spent $300 billion now we've drugs and got more people taking prescription drugs.

host: meghan mccarthy. guest: so, you know, your the nt makes me think of c.d.c., which just came out with guidelines last week or two ago that basically suggest that doctors, you know, should they ything else before prescribe these intense lookillers to patients, so for other forms of treatment, forms ofs or other treatment that aren't addictive. host: a story in the recent national review about dope sick through heroin usa. .ooking at walgreens how monitored, has there been an monitoring of drug sales, etc.? are they monitored pretty closely? guest: that's one piece of the bill that the senate passed recently is really trying to

address, and a lot of these issues, again, is a state patchwork, so different states to monitor which doctors might be prescribing a lot more of these prescriptions, and others, so the databases state-by-state a lev level. host: randal, stephenville, texas, go ahead. caller: yes, ma'am. i'm a veteran. harm reduction was introduced into our classes two years ago, a lot s really relieved of us that were total absentence and don't have the discipline to walk the line and stay clean and sober. the question i want to ask is comments ion to your on legislation. we're going to speak to our county attorney and we have a state representative here, returning dignity to the addict. addict addiction is terrorism. terrorism.nduced i know. but my view is, couldn't we

2? t a national guard not just a national guard, but a national guard 2 that was a community service. in my home town, we had about 2,000 yards from tornado lift the roof off of a college apartment laundry and some other damage in town. is there any way a panel could study a national guard 2, return these guys to the community out. e when they come host: out of stephenville, texas. guest: this is how to address people that are already addicted nd how to get people into treatment, something that obviously getting on the discussion right now. democrats on the presidential campaign trail, hillary clinton, are calling for maybe not a national guard, but would volunteer, participate in, but allowing the number of doctors that can participate in

assistance and treatment to be vastly expanded from what it is now. here are caps placed on the number of doctors that can use this kind of therapy and that is definitely one of the ways people are talking about addressing this epidemic. host: sea of tranquility tweets in, is there enough funding for medical detox? guest: i think the answer to that question would depend a lot on which side of the aisle you fall on. so democrats wanted to spend million to, you know, buffer the bill that the senate passed. he president has called for $1.1 billion in his fiscal 2017 budget to address the opioid epidemic. already ns say there's money line items in this for a udget, and senate majority leader mitch mcconnell specifically pointed to $400 illion in the omnibus package that passed last year that could actually be for this. host: next call for meghan

consult" f "morning comes from virginia in langhorn, pennsylvania. hi, virginia. hello. think we are avoiding the whole issue. we have to seal our border. drugs. to declare war on we have to limit what our president can spend. ur president has spent trillions and trillions of dollars that could have been these drugs. limited.ng has to be it's out of control. host: thank you, virginia. the war on drugs. any talk of -- in congress about what to do with that? whether to maintain or. ost: so this is something that's coming up specifically in the house judiciary committee, as you know, the focus could be on stopping the flow of illegal drugs. it's something that's come up on he presidential campaign trail as well as how donald trump and ted cruz have kind of addressed this issue, talking about

stopping drugs from coming in illegally from mexico. host: but that doesn't do demand. to the it's definitely a point that they like to hit on that i think speaks to some of the supporters but yes, certainly democrats make the point that is not actually of ping the flow prescription drugs that are, perhaps, getting people hooked the line. own host: is there any talk at this point, about the legalization of all drugs? guest: there's been a huge ation of the legaliz marijuana. a know, the issue here is little bit different and unique because prescription painkillers the big are viewed as gateway into heroin and how the epidemic has grown so significantly and quickly over the past few years. separate nd of a

track. host: patrick in vincenttown, new jersey. patrick. caller: yes, i definitely wanted a state first off that i was therapeutic addict. i had back pain and ended up being on up to 600 milligrams of morphine a day, but you just to come ave the will off of it. i came off of it within two and-a-half months. my point is within the medical professional, i think there's a when vice to the patients you have pain management physicians that are putting contracts narcotic or agreements where if they, you know, go over, you know, do one a violation, you now, that they are completely dropped from being taken care of by the physician. i think that's a medical injustice. you don't see that in heart heart patients which

disease and heart failure is a huge killer within the united states. you don't see patients coming in that have eaten chinese food and failure into heart because they didn't follow the eatment or you don't see diabetics that are kicked out of treatment because their blood ugars went out of whack for a month or so. o i think that the focus and stigmatization has forced medical professionals to push offices due toir minor violations as opposed to patients, and s like the caller said before, the stigmatization of this, within the medical profession, is a big factor. they have -- physicians have to creating at they are it throughout this thing, and hey have to follow through and not abandon the patient, putting them out into the streets, going

into it to get heroin access and think that one part of it, if we can -- when we're talking about the opioid factor, and the rescription of it by the medical professionals, is they . ve to change their mind-set host: all right, i think we got the idea. meghan mccarthy. guest: yes, so you know, the issue that i think is two-fold, first, is that there are so many that can rs out there prescribe opioids than are actually trained to treat addiction. as we've been talking about, the different caps on medicated assisted therapy. it varies by state. and then, you know, the point you may have is something that people have pushed back on in assachusetts, where you know, it's limited to a seven-day prescription and the hardship certain t place on patients after a major surgery, if they're dealing with a illness. and so policymakers are trying

to figure out a way to write these laws that will help address this epidemic that hey're still figuring out as it's going on. host: 900,000 doctors in the most all can prescribe opioids. 32,000 can ut prescribe the treatment for heroin addiction. and you have to take an ight-hour course, et cetera, for that. nathan is in dayton, ohio. nathan. caller: good morning. i am currently and will always be on opioids. i have a disability i was born with. it's a peripheral neuropathy with age.worse allowed me to function every day. i don't take it to party. i don't take it to feel good or forget things. i take it to function and i've got to say in the state of ohio, disappointing that they have set up a random drug g for g and pill countin

pain patients. i'm waiting for the next step for them to start tracking my movements. i mean, this puts me in a a uation where i feel like criminal and i have done nothing wrong. i have done everything by the book, and they don't need to treat me like this, because my 're already tracking medicatio pharmacy.s through my i've been questioned by my pharmacy before about why i need particular prescription or do i need the amount of the prescription, but i was forced into a situation where i signed would allow my doctor to share my results with the government. so now you've got the government who has access to my medical entire as well as her staff doing drug testing in the and you alsolways, have the fact that i'm disabled, i'm going to be dealing with my life.the rest of injustice inso much

that. and i don't understand how this doesn't violent civil rights. i don't understand how this doesn't violent and become discrimination against the disabled, and i really don't this isn't a direct violation of hipaa. y government leaders i called in the state of ohio, most of them aren't even aware that this is happening. two to call for about months before i talked to the pharmaceutical board, because medical board understood what this was. host: all right, thank you. let's hear from meghan mccarthy. i think what know, you're bringing up, why this is so hard to address this policy, you know, healthcare is so personal, and it really, you places theyeople in don't want other people knowing about, and particularly, the government. highlights how this is strange bedfellows in some ways for democrats and republicans, because this is -- it's often stepping up and, you involvement

know, the monitoring of people's healthcare, and that's not omething that philosophically republicans are typically behind, but the issue is so that youcertain states see that effort and republicans saying that there is a role for the government in this. host: and john kasich, the governor for ohio, has talked bit on the uite a presidential campaign trail, hasn't he? guest: he has, yes, and it's a lot of the that candidates, some of whom have dropped out now, have talked personal level and, you know, it's a way for republicans, i think, too, to talk about healthcare where they don't have to get into bamacare, necessarily, and repealing health insurance for millions of americans and what they're going to replace with that. this is a place where they can be seen as actually helping and issue that is allowed to... host: about $34 billion a year economic, andheft,

healthcare costs is the estimated cost of the heroin in the united states. salem, in ben pennsylvania. go ahead, mark. caller: good morning. thank you for taking my call. i don't think we have to reinvent the wheel and the statistics you said about the costs of this is staggering. es is beingce compani overwhelmed with how many kids go back and forth to rehab. great tool but also hardly unsuccessful in treating this because heroin, we have two heroin addicts in my family, and they've been in and out of treatment facilities and halfway houses, recovery homes 16 times in the last year. i mean, it just doesn't work real well if the addict is not it.dy for but what we have found is that consequences ave and treatment for the parents and helping them understand, it doesn't work to be just a good to.nt like you used this disease takes on a whole different parenting skill set parpents on't have as and get them educated so they know how to handle addicts.

the consequences is what leads to cures, and that's free pretty much to get them into treatment. they have to be broken and not want to use drugs anymore before treatment n accept and there's nothing out there like a transitional period from when they go into rehab, they can walk out whenever they want. the legal system doesn't provide any type of forced situation where they have to stay in for a period of time. and i think we can do something on that that would be really to effective and also talk the insurance companies about letting kids stay longer, the ones that are getting the instead of m them, letting them walk out the door days, which or 28 seems to be the protocol right now. there's a lot they can do. host: mark, has your insurance covered a lot of the rehab costs family members? caller: yes, it's been really good but when you're in state sometimes, it covers a portion out of nd if you go state, it's better for some reason. guess it's the out-of-state benefit but i've seen a lot of families that have been cut out after the first five days of

retox and they're always saying oh, you've been denied, like the weekend, two weeks in. it here's no set protocol seems like for the treatment. he max you can usually stay is 28 days and that's nowhere near long enough for an addict in recovery. host: what's been the impact on your family? caller: it's horrifying. more families than you can even imagine. i've seen thousands of families coming in broken, not knowing hat to do, completely and emotionally destroyed. you don't understand the impact it has on the families. it addicts, you can see visually but what's behind the oors is even much more damaging. host: if you could come up here and testify, mark, what would you suggest for the 535 men and do? n to caller: well, i would suggest that there is some sort of thing here the addicts can't leave the treatment on their own. cruel, but t sounds

they need to be broken and have to reach their bottom. i would suggest when they get drug related, ui incarcerate them for a period of time but not ruin their whole life. give them a chance to get it ruining their whole life. a lot of family members enable t, and it's hard for a parent to throw the child out on the street and say you can't live here anymore or i'm not paying anything anymore. it's very difficult. it's a combination of the education for the family members who are suffering from this on ase, maybe even shows television have to do it because they just glorify the drug use and everything else these documentaries i've seen. they don't really talk about and i've seen ks first hand what works. they have to want to do it and the only way they want to do it is the consequences get so great in their lives that they can't stand it anymore and they want to change but that's sometimes a really dark place. host: that's mark in ben salem, you heard what he had to say.

go ahead, meghan mccarthy. guest: mark, what you're talking about reminds me of another big capitol hill which is mental health legislation and some of that is coming from republicans and from democrats. area where there's bipartisan coordination. they're all looking at going as far as suggesting, you know, and requiring people to be committed for a certain amount of time, but making it easier to get rehab, and to have sustained treatment instead of and out every couple of days. so it's not moving as quickly as the opioid legislation did, but it is something that they are talking about, and it is something unique that's happening. calling in from mapleton, illinois. hi. caller: good morning. this might sound callous and i don't mean it to be. i'm retired law enforcement from alifornia, and i told your screener that i'm not expecting nyone to inject the racial

component in this but there were a lot of sick people we were '80s ng in prison in the and '90s and early 2000s when i was working and now all of a udden, this is a sickness, a disease, it's an epidemic, and the reasons is because it's of society it nt never was intended. if this had been confined to the lower classes and the minorities, we'd only be talking prison. and i do believe that, yes, we there is aatment but crime in california called 11550. influence,d under the health and safety code, and possession of is a crime. o unless we go and do this across the board, i am not in favor of any kind of treatment until they start treating everybody. but if we go according to what we always do, we'll put the prison, and s in we'll put johnny suburb in rehab. so i'm sorry to put it that way, but that's just the way things are. so if you can address this for everyone, i'm right with you. otherwise -- host: valdez, when you talked

previously, were you referring to the crack cocaine epidemic of the '80s and '90s. caller: a number of things. junkies, users. i was assigned to the jail bus at one point, every thursday transported them down to california rehab, and they were just in and out. but, i mean, there was never any indication that they were going to get any kind of treatment. it was strictly incarceration. heavy mexican population, so a lot of them were mexican people. issue ofdn't have this suburban people being under the as you're s much hearing now. sir. thank you, so inner city poor people versus johnny suburb. guest: i think there is an argument to be made that the reason this is getting attention is because it is hitting people making their -- or their families are making their hill in ad on capitol way that perhaps, you know, poor

er populations struggle to do, you're know, what talking about also makes me think of criminal justice reform is slation which, you know, similar to the mental health bills that i was discussing a earlier.it there is actual discussion about and there are democrats and on blicans working together that, but it is not happening quickly as the opioid population. joe this is from davidson's federal insider the "washington post" this morning about the hearing earlier this week in congress. addiction, war then, the treatment now. representative elijah cummings, of maryland, has seen the effects of drug abuse in his neighborhood in west baltimore pointed to the difference in the way heroin addiction is dealt with now compared to years ago. he difference between the war

on drugs and drug treatment is like the difference between black and white. baltimore, where many of the victims were poor and black, our nation treated this a ue like a war rather than ublic health emergency, said cummings, a democrat on the panel. generation ted a rather than giving them treatment they needed. now things are changing, he noted, between 2006 and 2013, the number of first-time heroin users nearly doubled and about first-time users were white. elle marie in birmington, vermont. ellemarie. caller: hello. host: your governor in vermont has spoken out about this issue quite forcefully, hasn't he? has. : yes, he host: go ahead. caller: my story is rather simple. i was working as a med tech, had the medical professional for a few years, decided to get license.

went back to school, 2008, i was ssaulted, did damage to my spine, and i am now on disability. refused to take anything stronger than codeine, although amazed that it was still being offered. patients coming in and drooling to get their me.scriptions, it horrified then on february 19th of this codeine ent to fill my prescription, and my pharmacist by me it has been rejected my insurance company, and they wanted me to take either hydromorphone or morphine sulfate. managing since 2008 on codeine. has increased.ce i wake up, it's an average of a 3. if i work around the house and do other things, it can go up to that's when i nd

start, you know, hitting the codeine. maintained since 2008 pillsy the same amount of that i have started with, because i -- host: so why do you think your ce company insuran flagged your account? caller: i have no idea. becausefight with them, i was in a lot of pain, to give me seven days of codeine, and then i had to go back to my doctor the following monday, and have her fill d out these ridiculous forms i couldn't take morphine one or take sulfate because i had a deathly fear of it. become one of o those people who sits at their doctor's office drooling because they need to take something that

wasn't necessary. host: is it kind of like our caller from ohio, a little bit. guest: right, so i think this -- one of the things about this, health insurance and prescription drug coverage is complicated already. so it's already difficult for or figure nderstand out, navigate what tier a versus what'ss in not and whether you're going to pay a generic copay, you're oing to get a brand name prescription that's going to cost you a lot more. so that might be what's happening there, in your case, but you know, that's already what people are doing just to et any kind of prescription drug. so when we add another layer of, government regulations, tracking, it just gets all the more complicated. host: you've mentioned this a couple of times but as far as egislative efforts actually becoming law, it's an election year. chances? the host: so one thing the senate

the house can move things faster than the senate often. it does seem like the bill could actually make it to the resident's desk and be signed in law, which is pretty remarkable. it's an election year and with the fight going over the supreme right now.ee so it's actually one of the few things that might make it to the white house. host: and with funding? guest: there will be no money attached to it additionally. it's an authorization of directing o it's not funds to it yet. host: so would there be any immediate impact? guest: you know, i think that we have to ask the attorney general, because he's the one that will get the additional bill. through this i don't think democrats would have acted on this if they withoutit was pointless funding, so it's a step. i would think they would make judgments that it's a step in the right direction. and there is federal funding that exists for these programs agencies u might see

get creative with how they andet to treat this endemic you might see the appropriations committee kind of moving money round from different pots to address it. host: thomas tweets in talking about valdez, our caller from illinois. caller was right. johnny suburb goes to rehab johnny city goes to jail. drug war is a political war. richard is in west bloomfield, michigan. go ahead, richard. caller: hi. work with a company that makes from colorado-grown industrial hemp, and we've been eeing a lot of promising results for a lot of different nerve and muscle pain. antiinflammatory with no cbd, effects, and that there's a lot of scientific data and lab result tests for the

products that we have. so for people that don't want to have -- take the road to get to heroin that are in pain, i think , so i a nice alternative just wondered what your thoughts were. host: richard in west bloomfield, michigan. we won't make you comment on that commercial product. meghan mccarthy, in all these discussions, is there talk about the colorado experiment on legalization? guest: you know, pain management is what these drugs are prescribed for, and that's a big who supportt people the legalization of marijuana make, that this is something that could help people and not be, you know, as addictive or a pathway as the caller said, to heroin. there are other people that would say it's just another drug, and it can be addictive as well. host: has there been a discussion of, we've been through this before.

we went through this with the crack epidemic of the '80s and '90s. e went through this with alcohol throughout our history. we had cocaine back in the 1920s. mean, is this -- has there in the discussion historical, putting this in the historical perspective? ost: i think you're absolutely drug that it's a indicator, and perhaps this is the one of this time but i think hat's unique about this is the element of the medical community being involved in it, and that getting hooked on some of these drugs or heroin ecause they got prescribed something by a doctor. in so it's just a -- it adds a different element, and it's honestly, i think, why the federal government can get more involved or that you see more legislation than you might have cocaine, which was obviously focused on the judicial system.

cdc coming ve the out with guidelines, you have the fda just coming out and there are going to be new blackbox warnings on these prescription drugs. know, you have medicare and medicaid looking at different prescribing.ol the host: then we're hearing from the viewers who say look, i need my drugs, my pain pills. tim, flatrock, michigan. lease go ahead with your question or comment about the heroin epidemic in the united states. caller: thank you, c-span. i just wanted to put my few cents in on this heroin epidemic. t's really hit hard in our family, mainly because my father was a heroin addict. he still is. he worked a great job, made buyout, year, took a year.out $100,000 a and he spent it basically all on heroin in one year. and that's when my parents got divorced, we tried the

treatment, inpatient, and was ful with the results, and he would come out within an detroit,wo, be back in rying to find more heroin, and it just completely devastated our family. he's homeless because of this. like i said, he had a great job, and this drug is just killing everybody. he's been hospitalized, i would times obably five or six for heroin-complicated infections, you know, from using dirty needles. have a granddaughter who's -- i have a daughter who's eight years old. he's never even met his granddaughter. host: so do you have any contact with your father anymore? guest: no, i do not. he is homeless, living on the streets, you know, he had a job.t $80,000 a year host: has he stolen from you? caller: he's stolen not from me

but from my brother. e took all the savings bonds, and right before my parents got divorced, you know, it just ramped up and, you know, he would actually be offering me to take him to detroit to go get because he would get so sick. host: what would you like to see the federal government do, if anything? caller: it's a very complicated issue. , you know, to see in-treatment. he would get out within an hour. he'd be there 28 days. forced en you say treatment. if he's 28 days and within an hour he's already back out on street, where is the enforcement? caller: that's where we're kind of lost. host: right. thank you, c-span. host: what has this done to your family?

brothers, yourur relationships? caller: oh, we don't even talk anymore. he's homeless in detroit. occupy your emotional bond anymore? caller: what do you mean by emotional boppednd? host: well, the family. how has the family dynamic changed being so close to this vortex? caller: well, we went through counseling, you know, when it first started, and it's been a rough ride over about the last eight years, because it seemed to really ramp up from just using it every once in a while, and then at his peak was he spent ,000 a year on it. host: thank you, sir. i think that's a tough story and, you know, there are a lot of americans that are in the same boat as you.

sponsored byolling cbs health that found that 41% of americans know someone that with heroin or opioid addiction, so it's definitely a growing issue. it cuts across party id, it cuts , across the country. ost: maria tweets in: more people die from alcohol than all other drugs combined. pat, i think you're going to be hit for our guest, meghan huntington, west virginia, hi. caller: hello, good morning. you about my l family, sir, i'm from huntington, west virginia. this is the ground zero for drug use. just look at the map. it's covered, the state of west virginia, by red. user, had hep c, was one of the people that went through for seven months

injecting myself in order to get stages ofin the early his ongoing epidemic from drug use back in the '70s. had ughter and son-in-law $150,000 from my mom's death, years,w thank god for two they've been clean. heart by spaded her the use of cocaine back in the '80s. use had 18 friends die from f drugs, directly or from od, or from complications. moneyton.lled moneyton by call the cartels in detroit and columbus. almost got it set up like a business model. but the reason for this is the hypocrisy that comes from the top part of our government. you ask what our government can do.

our government could have nixon on using blacks using heroin and marijuana on the hippies, to make the news every night in place of the deaths and the drug use from the people in vietnam we were sending to die. and we had the reagan and the selling nistration drugs under the counter invading west during the conquer. and we have people walking borders with drugs we've blinked our eyes saying, oh, we're taking care of the drug problem. there inve people over afghanistan walking by fields of andies while the drug lords the tribal chiefs continue to grow their poppies and send them here to destroy our youth. and you say oh, our government wouldn't do that. urely they're not that hypocritical. but i say they let the drug companies sell all the drugs

distribute them to make money out of greed, and you have -- host: all right, pat. got your point. meghan mccarthy, what were you hearing? know, people you want action on this issue and mentioned, you know, we found that 52% of voters want presidential andidates to come out and actually have a plan for this and that includes 59% of independents, 59% of republicans. so it's something that the voters are definitely keenly interested in, and i think a lot of people sharestate of marylank force chair for the governors association for the united states.

what is the situation in maryland? guest: it is a challenge throughout the country. we have been grappling with it since it tookars off a year ago. in 2014re campaign in throughout the state, -- campaigning in 2014 throughout the state, we were hearing from small communities, that the biggest issue at the local health and law enforcement and providers had was heroine? -- was heroine. once elected we would convene an emergency task force to come up with recommendations to try to address this particular challenge. host: what are some of the

guest: we hads? 33 recommendations that ranged .rom prevention and education we included treatment options. we talked about quality of care and had proposals and terms with quality of care, because it is often the discussion of treatment, which means inpatient treatment. not everybody needs inpatient treatment. so we have recommendations in that area. legislative/in our -- legislative session. we are it mandatory for prescription drug monitoring.

the reason for this is the new date wage rubbed to heroine is prescription opiates. 70%, 75% of new heroine users are coming off of prescription medications. that is the real distinction between a lot of the drug problems we have had in the past and what we are facing now with heroine. is there an estimate what the use causes the state of -- what they use costs the state of maryland? guest: when you look at emergency rooms, when you look , wehe response from emts deaths from heroin

overdoses and anecdotally there is pretty much an assumption for everyone heroine death. there are eight or nine that survive in overdose. treated inill being emergency rooms and expenses associated with that. and then of course the lack of ,roduction, the potential crime the petty crime that comes from it. host: was there anything that surprised you? what surprised us early on, and before we even convened a task force, was how pervasive the problem is. particularly in some of the , i'm not sure how

many listeners are familiar with the geography of maryland, the eastern shores is a rural area. towns may have less than 1000 people in them. they were maybe 1000 people, 2000 people in the town. host: have you shared or learned anything from other states? guest: we are constantly looking at other states and what they are doing. i was with the national governors association this week and talking with some of the other governors and what is going on in their states. vermont has been aggressive in that area.

that is a good example of how it has extended to small states, a small new england state talking --the massachusetts new massachusetts governor. >> on the next washington journal, university of maryland professor shibley telhami talks about those in the views of those who practice islam. about sales talks whether they should be changes for the visa waiver program. we will take your calls and he can join the conversation on facebook and twitter. washington journal is live at 7 a.m. eastern on c-span. defense secretary ashton carter

and joints chiefs of staff chair isisrd says a top leader was likely killed. he also told reporters the u.s. now has the momentum in the fight. this is about 30 minutes. >> good morning. thank you all for being here. i want to start by reiterating that our thoughts and prayers remain with all those affected by tuesday's bombings in brussels. as you know, this tragedy has

hit our military community as well. our hearts go out to the injured airman and his family. like paris, brussels is a strong reminder of why we need to hasten the defeat of isil, wherever it exists in the world. today, the united states is as committed as ever to our european friends and allies. our enemies are one and the same. together, we continue to do more and more to bring the full weight of our best military capabilities to bear in accelerating the defeat of isil. after chairman dunford and i spoke with our commanders this morning, let me update you on some new actions we have taken in just the last few days. first, we are systematically eliminating isil's cabinet. indeed, the u.s. military killed

several key isil terrorists this week. including haji iman, and isil senior leader, and finance minister, and also responsible for external affairs and plots. he was a well-known terrorist within icicles --isil's ranks. when he worked as a liaison for operations with pakistan. the removal of this isil leader will hamper the organization's ability to conduct operations both inside and outside of iraq and syria. this is the second senior isil leader we have targeted this month. after confirming the death of isil's so-called minister of war, a short time ago. a few months ago, when i said we would go after isil's financial structure, we started at a site where they held other cash.

and now we have taken out the leader, who oversees all the funding for isil's operations, hurting their abilities to pay fighters and higher recruits. as i have said, our campaign plan is first and foremost, to collapse isil's parents in raqqa and mosul. they recently took a town, repelled isil's counterattacks, and severed the main artery between syria and northern iraq. as a result, it has become much harder for isil's leaders and forces to travel between raqqa and mosul.

i am also pleased to see iraqi soldiers have advanced to new positions as part of the early stages of operations to collapse isil's control over mosul. the u.s. marines we have sent, where staff sergeant cardiff gave his life, are now providing artillery fire through the crest of the iraqi's, against the enemy, protecting forces. in both syria and iraq, we are seeing important steps to shape what will become crucial battles in the months to come. as our partners move forward, we are continuing to bring relentless pressure on isil commanders and mosul. and we have taken significant actions at week, one i have mentioned. second, we targeted a top leader charged with paying fighters in iraq. next, we targeted a number of associates involved in external plotting and training. these precise actions came after recent strides had destroyed a significant quantity of

improvised explosive devices and on making equipment that could have been used against our partners headed for mosul. we believe these actions have been successful and done damage to isil. as chairman dunford noted earlier this week, the momentum of this campaign is now clearly on our side. the united states military will continue to work intensively with our coalition partners to build on this progress as our counterparts throughout our government work to defend our homeland at the same time. one final note before we turn to questions. yesterday, i spoke with my saudi counterpart, the defense minister. we agreed a council defense ministerial on april 20 in riyaad. i had a president obama's

participation in a leaders summit there, the following day. this would be an important forum to build on our counsel -- counter-isil, and discussing regional defense initiatives we all committed to during the 2015 camp david summit last may. chairman dunford and i are now prepared to take your questions. we have limited time to do that because we have something else that we both need to do upstairs. i will ask you also to respect the fact that we are not going to go into any further details about how our coalition conducted the operations i mentioned earlier. any more details than that could put lives and our future operations at risk, and the effectiveness of our campaign. so we will ask you to be restrained in that regard, as we

tend to be. gen. dunford: i join you and expressing my condolences in the americans and belgians and european losses week. we also lost soldiers in operations in iraq. >> secretary, i know you said you did not want to go into any more details, but the senior leader was in syria, more broadly, can you talk a little bit -- we all saw a lot of al qaeda leaders killed over the years, one killed every six months or so. what do you think this actual death, in terms of plots,

particularly those involving the west, does that mean anything, or will they simply replace him? gen. dunford: let's take your first question first. a striking leadership is necessary, but far from sufficient. sec. carter: leaders can be replaced, however, these leaders have been around for a long time. they are senior, they are experience. and so, eliminating them is an important objective. it achieves an important result. they will be replaced, and we will continue to go after their leadership and other aspects of their capabilities. it is important. joe? >> this week, their support of the iraqi offensive operation, if this, as time goes on in the

fight to get to mosul, can you talk about whether this is a key part of what you want to see the militaries do more of in iraq during. gen. dunford: we are talking about conditions of success in mosul, to begin to isolate mosul. that has begun. they were in direct support of that. we but the battery there to support the americans that are there, advising the iraqi forces. also, in a position to provide support to iraqi forces. certainly no different conceptually then fire support we have provided for iraqis all along. in regards to further accelerants, the secretary and i expect increased capabilities

provided to iraqis in mosul. those decisions have not been made yet, but we certainly to expect more of those things we saw in raqqa --riyadh. and will be enough position to provide capabilities to make them successful. >> what about more of a ground combat role than we have seen before. gen. dunford: no it is not. we have example that we have used in the past. there is not a fundamental shift in our support. this is the most appropriate tool for that particular location. >> secretary carter, al-qaduli was in an iraqi risen up to 2012.

he was released shortly after u.s. forces were pulled out. do you see this as a cautionary tale for releasing these prisoners, who are already cutting captured? sec. carter: a number of the leaders of isil were in detention in iraq act in former years, including the head of isil, himself, in iraqi detention. so it is important that these are people that have experience, people who have shown dedication over the years, and that is why is so important that we eliminate them. >> doesn't give you pause about releasing prisoners from gitmo? sec. carter: that is precisely why we need an alternative detention facility, because it is not safe to release everybody and transfer them to the custody of another country.

that is the very point of that. >> we have just heard that there are 5000 troops on the ground in iraq. why is the pentagon and senior military leadership reluctant to say that it is more than 3800. gen. dunford: the number that we track, in our force management level is 3800. that is not inconsistent come in terms of people that are in and out, temporary duty, people in direct support of the embassy. those have not been counted, with a consistency, it is been going on for 15 years. at any given time we have 3800 and direct support of the mission. we don't double count numbers, so if a unit of 200 is replaced by a number of 200 and they are on the ground at the same time, we do not counted as 400. that has not counted against our

force management level. we are not denying that there are more people than 3800, but in terms of what we count in the mission, in accordance with the direction we have been given, the 3800 is against the mission. i did not say 5000 was accurate, i said 3800 was the management level, and the rest, people that support good embassy, people on tdy. >> i have questions about the marines, and the firebase. unlike the previous military combat positions and fires -- fighter support, this is u.s. military only. by all indications, they are not just a defense of, but in this latest movement by iraqi forces, they provided fighter support

for offense of operations against isis. why is this not the first program of a u.s. combat ground operation in iraq? gen. dunford: it is simply a function of geometry. they are designed to support forces in an area, and the camp provides effective fire support. this position was selected because the geometry necessary to support that particular location. in regards providing support for iraqi defensive capabilities, to me, there is no inconsistency between what the art hillary did and what our aviation support is doing every single day. i don't draw distinction. we are enabling support to iraqi forces as they conduct operations, exactly what the all -- artillery unit was doing. >> it is a common position now, that after a short. of time, -- after a short period

of time, there are still all indications that the u.s. military is directly involved in the ground operations with the iraqis. gen. dunford: even since last week, as iraqis have consolidated their positions, the situation on the ground has changed in terms of where the iraqis are in terms of a relationship with defensive support they are providing to our artillery unit that is there. that has changed in the course of the week. in all honesty, i cannot see this being inconsistent with everything we have been doing over the last several months. sec. carter: let me just add to that, what we will be doing in the coming months. this is our approach. to eliminating isil from mosul. the iraqis are carrying out the assault, but we are helping them. that has been our approach.

and we will continue to do that, starting in ramadi, going up to mosul. >> aren't u.s. ground forces closer to the front lines? gen. dunford: i need to clarify, this position is behind the forward line of troops. it is by no means out in front on its own. secondly, what i would say about your question about the future, we have a series of recommendations that we will discuss with the president in the coming weeks to further a neighbor our support of the iraqi security forces. the secretary and i both believe there will be an increase to u.s. forces in iraq in the coming weeks. that decision has been made. you alluded to decisions already made, all that is pre-decision. no decisions have been made about this particular position in the future. but it will be decided in the context of a bigger issue brought to the president, focused on what do we need to do

to maintain a campaign, and to continue operations in mosul. >> did you say whether or not this was a u.s. raid? sec. carter: i am not going to say where and how it was done, i simply will not do that. the only thing i will say, it is consistent with our strategy there, to put pressure on isil every way we can, from the leadership which we have discussed previously, with right down to supporting local forces on the ground. with respect to operations, in iraq, i want to make clear and to reiterate everything we do is with the consultation and approval of the iraqi

government. >> can i ask you the same, the city targeted, was that an airstrike? sec. carter: again, i am not going to talk about that. we have a number of ways we can do that, and i will ask for your forbearance there. we will be disciplined about that. >> you had sent to congress of that, europeans need to step up their intelligence sharing. i know several people from the brussels attacks, on the watchlist, not let into the united states. are we sharing our intelligence with of the belgians? gen. dunford: i can speak at the military level, i was speaking broader when i spoke to congress. intelligence agencies, military

given abilities, law-enforcement, from a military perspective we have significantly increase our information and intelligence sharing over the last few months. we have specific locations where we bring together our coalition partners to do just that. we believe over 100 countries have fighters in syria and iraq, you see the numbers that exceed 35,000. i would not put it with a high degree of confidence, but it gives you an idea of the problem of the magnitude we are dealing with. those affected by the foreign fighters are cooperating on the law enforcement level. and though intelligence and military levels. it is necessary to take action against these individuals prior to attacks like the one we saw in brussels this week. sec. carter: getting back to the fight in syria and iraq, i should also mention, a number of european partners to include

belgium in the last month and a half after i had the ministerial chairman in brussels, they have increased their contributions. i wanted you to know that the belgians did that, too. in the fight in iraq and syria, i wanted to note that the belgians have intensified their role in lieu of what happened. >> in the attacks that happened in paris, can you tie some of this together for us? do you see these lots being directed from isis leadership? you said he had some external affairs plotting as well. could he been -- could he have

been involved in the paris attack? are they training them to make bombs? what is the link you see between isis and syria? gen. dunford: i cannot confirm that this individual had anything to do with the brussels attacks specifically. the general phenomenon you are describing is correct. the kinds of influence are various. they range all the way from a fighters who have trained in and participated in isil operations in iraq and syria, returning to their countries of origin. sec. carter: and that is when these mary -- many foreign fighters are coming. right through ones who are recruited and traded -- trained by such individuals, but not have been in contact with isil forces directly. right back to those who are

simply inspired by, maybe get some general instructions from isil, but are otherwise self-motivated and self radicalized. there is an entire spectrum here that law enforcement and counterintelligence colleagues are dealing with. >> we see the link -- sec. carter: one other thing we should say, they have been part of the apparatus of isil to recruit and motivate foreign fighters, both to return from iraq and syria to countries in europe and elsewhere, and also simply by using the internet and other communications to do so. >> so the leaders that you see in the paris and brussels attacks, what is your assessment? do you think that this cell that

has emerged in europe, do you think they are being directed by isis leadership, or being inspired, is that enough to have the expertise, equipment, technology? sec. carter: it is a relevant question. we want to eliminate the people who are directing them. but even if it is just inspiration, it still takes you back to iraq and area, and the need to eliminate the sources of that inspiration. the idea that there can be an islamic state based upon this ideology with the capital in raqqa, we will eliminate that image. it is an important part of eliminating the inspiration. even if it is not direct. there is both direction and

inspiration. we need to combat them all. i cannot speak for the paris and brussels cells. that is a law enforcement matter. my impression, it is a mixture of some who are inspired either by the internet or by a friend or associate or family member, who himself, did travel to iraq and syria. you see that next and what we already know of the cells involved in paris and brussels. that i will not presume that i know everything that the law enforcement officials know that they share through a law enforcement channels. >> you mention, for months, the process against isil has been frustratingly slow. now you say things are on your side. is this a turning point? are we seeing a sign that isil is it ready to crack? are they offering less

resistance? sec. carter: we are certainly gathering momentum, and we are seeing that that momentum is having effect. we are broadening both the weight and the nature of our attacks on isil. we have learned a great deal and continue to learn who is who in isil, so we can kill them, dry up their finances, and the forces that we are working with on the ground in both iraq and syria, continue to gather strength. our strategic approach for the retaking of territory is to help local forces to do so. you see both in iraq, first with ramadi, and now other towns of that euphrates valley, and other areas of mosul, gathering

momentum. you can see it also in syria, with -- an example i gave at the top of my statement, the taking of the town, the key connection between raqqa and mosul. the idea is to dissect the tumor of isil. in all of these ways, we are gathering momentum, broadening both the tools and the weight we are bringing. gen. dunford: we talk about momentum, and it is indisputable. we have made a dent in the resources, affected their control in a way.

but there is a lot of work that remains to be done. at the same time, while isil has not seized ground in the last months, that is not stop them from conducting terror attacks and guerrilla operations. i think momentum is in our favor. there are a lot of reasons for us to be optimistic in the next few months. i know means, what i say we are about to break the back of isil, or that the fight is over. and one final note that i would make -- sec. carter: one final note that i would make, brussels reminds us that he central as the military effort is, and as confident as i am that we will be successful, it is necessary, but there is a critical law enforcement intelligence and homeland security ingredient to this.

and there are partners in this fight here and in other countries. brussels is a reminder that that fight is necessary as well, both in european countries than any other country potentially affected by that. with that let me all thank you , very much. >> thank you. >> book tv is in primetime on c-span2 starting monday night at 8:30 p.m. each level feature a series of topics from politics to education for medicare to national security. plus, encore presentations from recent book festivals. book tv in a

primetime all next week on c-span two. go to booktv.org for the complete schedule. directora and nsa michael hayden discussed his book and offered his views on intelligence and national security. he talked about waterboarding, the apple iphone encryption debate and the brussels terrorist attack. the american enterprise institute hosted this 90 minute event. >> thank you. we are live. good afternoon, everybody. welcome to the american

enterprise institute. i'm a fellow here at the american enterprise institute and we are pleased to be joined today by former cia and nsa director michael hayden. with the events in europe this week i can to give anyone better than mike to enlighten us and put everything we are seeing on our television screens into perspective. thank you for joining us today you have a new book out called "playing to the edge." what does that mean? mr. hayden: just a brief terms of motivation. in the forward, which i wrote when the men's group was already done. penguin says why did you write this book? i talked about being in australia, in the outback a joint facility. is called pine gap, we call it ellis. is really in the outback. the get on the road and you come to a "t." ayers rock.

it's way out there. we were having a schmooze and we were walking off the floor into this brilliant outback sun. i turned my counterpart and said when you like to take your citizens and their and show them of the kids are doing? of course the answer was yeah. that is kind of the book. and the longer form of this, and this is a knowledgeable audience, i don't know of something so essential to american democracy that is less well-known by the american population than american espionage. the purpose of the book is to punch in numbers, bring my countrymen along by policy inside the endzone, introduced him to the people in many of the things to do on their behalf. that is really the objective. it comes back to really

something so essential and so consistently misunderstood. >> you called it plain to the edge. what does that mean? mr. hayden: that is my wife's title. [laughter] she read the manuscript. that is what she put. into reflective of her reading the manuscript and the conversations we had over the last 10 years. in essence the summary, the intel guys don't go to the edges. that's created by the american democratic process. once you have gotten those lines, here are your limits. when circumstances dictate you have a moral responsibility to play all the way to the lines. even though you know when you do that it is inevitable that you have an ugly hearing and an ugly

op-ed, probably want on the other coast about how it shows up in the omaha world herald. from one paper to another along the coast. and friendly your life will be less pleasant. the point i make is if you play back on the edge you may be defending yourself or maybe protecting your agency. you are not protecting america. there is this moral that when the -- moral compulsion. if the government authorizes it in the situation demands it, you have to go all the way to the edge otherwise you are not doing your duty. >> use the phrase getting chalk on the. gen. hayden: thing when arranged a session with cbs sunday morning. it was a very generous piece. david and i float the pittsburgh -- flew of the pittsburgh. we filled a chunk of it at this year's practice facility. one of the the role elements of

the morning show was my walking along the sideline with david at the practice facility. one of the conversations that did not make it into the final product as we were walking along i send those of the hashmarks. if you really conservative and really concerned, you can tell your team i want to avoid any potential mistakes. i don't want to see that ball moved outside of the hashmarks. the ball is not going beyond the hash. i know how that game will end. it will end badly for that team. >> one place for the don't have a lot of chalk is europe. [laughter] didn't mean to make you choke up

your water. four days before the attack in brussels, they capture the logistic chief of the cell. he was given a lawyer and told the other rights or -- to remain silent he was then put in the criminal justice system. in four days he successfully protected the information he clearly had about the cell, how it operates in moves and then the attack happened. is in the something of the indictment of the law enforcement approach to terrorist and irrigation? gen. hayden: the answer is yes. i think your premise is probably true. i don't know the fine print. but i think this attack clearly had already matured to a certain point. i think it was put in motion because they feared he would say something that would interfere with it.

this is a fully grown plot. this did not get cooked up sunday night and somebody basement. this had a lot of work done. i think you are right. they knew he knew, and they feared so therefore they acted. i am going to go through the consciousness on the. there is a passage in the book when i am the director of the cia. i get to go to the german enzi here -- embassy here. the ambassador, the german ambassador, is bringing us in every two weeks for lunch. it is the ambassadors from the union to the u.s. every two weeks, lunch on the germans. the ambassador, i'm sure they had euro conversations, but from time to time they would bring in an american. i suspect bob gates may have shown up. and me, the cia guy. we took this very serious.

we could've been entertaining and talking about soft topics in building deeper intelligence cooperation. i went with interrogations. i will never have this chance again. it was a very candid, very polite, very respectful, very valuable conversation. by about page two or three of my notes i saw the speech. we had good speechwriters. this is one i did some personal work on. i just say to the europeans look, let's the candidate. let me tell you what my agency believes in my government believe in what i believe might come true. we are a nation at war. we are at war with al qaeda. its global in scope. it's my responsibility to take the fight to that enemy matter where they may be. al qaeda, global, there was not another country in the room that agreed with any of those four sentences. that not only rejected them for

themselves, but clearly felt we were not on solid legal ground in terms of applying them to us. you do have this dichotomy between ourselves and the european. there was another part of the book were talked about targeted killings. i have to use one that was made public. the killing of a shibab leader in 2009 by navy seals. there really was no attempt to capture. this was a kill operation. there is not an intelligence service in europe that would have given us information to enable that raid. it would have been unlawful under their law to enable the americans to do something they viewed to be an illegitimate use of force.

you do have this sharp dichotomy between the north american view and the european view of what this really is. when you got a lot of americans who claim if we don't do this in the law enforcement model, we are therefore being lawless. i say that is not true of law -- not true at all. it's a long answer. the second point is this. i think the europeans have an incredibly pathological structural problem. by pathological i'm using the literal meaning. it will be to the death of the organism unless you fix it. the problem is this. it is the division of labor between brussels as a european capital, not the victim, between brussels and the sovereign states. the sovereign state exported to brussels big chunks of their sovereignty. they have exported to brussels all questions of commerce, a lot of questions about finance and

money, and frankly all questions with regard to privacy. we have a dialogue with the europeans. we are talking to brussels. the european commission of this or that of the other thing. national security remains in the capitals. it remains a national responsibility. the path elegy i've seen, and i said this to friends over the last couple of years, is you have a bunch of folks up here in years, is you have a bunch of folks up here in the euro institutions making declarations about essential privacy and what constitutes essential privacy freed from the burden of guaranteeing the safety of their citizens. we have got issues here, but we get the privacy mavens and security mavens in the same room and they have ugly fights. the europeans don't.

you have this body creating rules and the only imperative is how much privacy can we guarantee. them a have these. here who have to live with those rules. they have got rules that of an developed -- i'm overstating is a bit. roles that of an developed largely absent security considerations. that is another -- waiting at the war and they don't. even within the law enforcement model you have got limits on what the nations can do to protect themselves. i am finally down. now i am in brussels, the victim, and that is a small under resourced, from time to time is functional security service working for what is almost all the time a dysfunctional government. nature -- 90 have real issues. marc: yet people with no responsibility for the -- when they canre