she has been there long time. one caller said earlier that she did a great job. as far as we >> we might've taken greater hits than we would have if she weren't leading our caucus in the house. got two or three more terms. she's got a nice pension. to come up from underneath her and start to include younger leadership. we need to replace some of the people who are just as old as she is. do it that way. caller.is is our last we want to let you know about tomorrow's program. we will be joined by stephen townsend.

we will talk about efforts to defeat isis. we're also going to be joined by presidential transfer of power and how that process works. anders rasmussen will join us. he is a former nato secretary-general. natoll talk about u.s. -- relations. our show tomorrow begins at 7:00. have a great sunday.

>> next, newsmakers with the u.s. surgeon general. the discussion on the future of law enforcement. after that, african-american leaders and activists discuss the future of civil rights protections in the next administration. our guest is the 19th surgeon general of the united states. for those of you who have not met him, for taking on this position he had a career at harvard medical school and in public health and technology. along with other officials, he works on it uniform health officers representing the united states in 800 offices around the world. we are here because you just released a report on addiction in america.

we are going to talk about the message there. let me introduce to reporters. lauren is from the associated press. sarah is from the hill. opioidsthis report on is an dissipated. what do you think is the message for a country that has already been dealing with opioid addiction. why issue it now, late in the administration? vivek murthy: the decision to commission the report on how to haul, drugs, and health was a decision i made at the very beginning. it was the first major decision i made in december 2014. these reports take several years to produce. we did it on the quickest timeline possible. we knew there was a great need for this report i am issuing a call to action for our country to take on the public health

crisis of addiction. there are 20.8 million people in america with substance abuse disorder. that is similar to the number of people with diabetes. despite this heavy burden of illness, only one in 10 people are getting treatment. that's what we have to change. how does the report do that? in several ways. it lays down the scope of the problem, which is one not everyone understands. it raises on the property list. it also lays out the evidence for prevention and treatment strategies. when i travel the country and talk with families, many don't realize that we have evidence -based methods to treat their family members. need -- we have the need to

expand our treatment. people should not think there is effective treatment out there. there is an we lay out the prevention strategies. what's remarkable is this is cost effective. for every one dollar we invest, we save for dollar -- four dollars in treatment. return $64 for every one dollar invested. most challenging, the report issues a call for our country to change how we think about addiction. cultural shifts are the hardest to make. they require each of us to stop and think about how we think about addiction and recognize that it is not a moral failing. it is a chronic disease of the brain. we lay out the latest science about the biology of addiction that helps people understand that addiction affects the brain's circuits in specific areas that control

decision-making and impulse control. it explains why it's so hard to manage addiction and so easy to slip back into relapse. i want to talk with you about how you see the role of government in this problem. some of the advocates with this who are trying to get the mandatory to take training for doctors and a larger role for the federal government. ,ou sent a letter to many thousands of the nation's doctors addressing this issue. can you talk about how far the for ament needs to go mandatory policy or any kind of stricter guidelines for working with doctors on this. vivek murthy: one of the key points i make in the report is the only way we will address addiction in america is if everybody does their part. that means policymakers invested in treatment and clinicians

ensuring that they have the training necessary to diagnose and treat substance abuse disorders. in the last chapter of the report, we lay out a call for enforcement,n law teachers and families, local leaders. i believe the government is an important player here. many times in history the government has laid role in sounding the alarm bell on public health crises. the report on tobacco did that. in the late 1980's, there was a similar report around hiv. andope this will kick off accelerate our work in this area. the government has a role to play in that respect. playow the government can a powerful role in investment and the expansion of treatment and prevention programs. ,hen it comes to treatment

particularly for opioid users, we have a lack of treatment. we have over 2 million people who need treatment and less than one million who are getting treatment. theave to close that gap in obama administration has taken many steps to expand treatment and fund work to sharpen prescribing practices, including guidelines the cdc issued for prescribers. from my office, we issued a letter to health care practitioners around the country. we wanted to call them to action. while we can put recommendations in place, we need the profession to step up and take a larger role in ensuring it is training the current and rising generation of health care --ctitioners and practitioners. sarah: when it congress and the fda ehrlich and it died lines,

guidelines,ng at how much scrutiny needs to be on the drugmakers as you address the epidemic? look backhy: if we with the lens of history, we use a retrospective scope. was a role is there the pharmaceutical companies played. there were a number of people who played a role in the development of the crisis. we did not have enough investment. we also had pharmaceutical companies that were marketing these medications heavily to clinicians, often without the emphasis on the harmful effects and the addictive intentional. back in history, that is something we could change. looking forward, we have to be careful about the marketing of medications in general to patients as well as to clinicians. benefit andne has a

a health risk area -- risk. it's important that patients and clinicians understand that risk. i would love to see pharmaceutical companies step up and play more of a role in the training and the treatment. we know there is a huge problem on our hands. i would like to see the companies in general pay more attention to their marketing practices. messages canthose be very powerful when people see them in advertisements. myself, i have had patients come to me and ask about medication they have seen advertised on tv. they are led to believe it's harmless and will cure their problems. that is often not the case. it presents an added burden to doctors and nurses when you have

advertising that is not entirely accurate or doesn't tell the full picture, is imbalanced. you have additional risk and work for doctors. mysterythat rings up a -- interesting point. ain'tare a lot of people attention to the news of the opioid addiction. what i even want to take one regardless? there is a lot of science on the addiction, there is not a lot on the risk factor and why some people have disorders and not others. what makes people vulnerable. if your doctor is saying you need medication, what the you say that helps decide if this is the right choice for you? what is there that you can look for? that murthy: what is it determines if someone is prone

to developing a substance abuse disorder? we know that somewhere between 40 and 70%, it's through genetics and the remainder is related to your environment. what were you exposed to when you were growing up? in the cases of alcohol and cigarettes, people drinking heavily or smoking around you? exposure constitutes a risk factor. when it comes to prescription pain medication in particular, there is a need for public education. i have found that many people assume that if it is described by a doctor or a nurse practitioner that it must be safe. prescribedould be with weighing the benefit and the risk. one of the key points that i have found is important to share with the public, they are addictive. that simple message is one that has -- when i was training in

medicine, many clinicians were top that opioids are not addictive so long as they were given to someone who had legitimate pain. i was in florida a few months ago, having dinner with a caneague and i said to him you believe we were actually taught this in medical school? -- is a man who is very bright and well trained. there were errors in how many clinicians were taught and trained. there is a need for public education. any patient out there who is in a situation for you are prescribed a medication, have a discussion with your doctor or nurse practitioner about the risk and the benefits. ideally they would bring it up with you. i would ask them proactively. the more people in the community are able to take charge of their

health, the more you can safeguard yourself. susan: is there any research being done to treat pain other than chemically? vivek murthy: one of the things we call for in the report is the need for us to invest more in research on alternatives to opioid medications when it comes to treating pain. we have a limited number of tools. more would be better. toknow now that in addition non-steroid medications like , physical therapy can be effective when it comes to reducing pain. cognitive behavioral therapy is helpful with pain. we know that the veterans

administration and other health care centers are using massage, acupuncture, acupressure as methods to treat pain. the more we look, the more we will find there are alternatives to using medications like opioids. we have to do that research and that's going to be an important part of moving forward and treating pain it safely. susan: we are at the halfway point. sarah: a lot of politicians are hopeful that we might see that before the end of the year. happen, whatnot are you thinking about the next administration coming in? have you had any conversations with incoming president trump? he did not release much detail

about this issue ahead of next year. vivek murthy: that's a good question. i have not had any conversations with the next administration. everywhere i travel i see very clearly that addiction does not discriminate and it affects everybody of all political persuasions. i have been happy to work across the aisle on the issue of opioids with legislature from both parties. has hadan issue that bipartisan report. you have seen that with the work that is being done. my hope is that will continue. my hope going forward is that we will not only work on expanding we can be that mindful of how we think about addiction. one of the things i have seen very clearly is even if you have treatment centers available, you

need people who will want to go to them. they need to be willing and able to stand up and say i need help. i have found that in city after city there were people who did not feel comfortable even coming to talk to me if there was a camera nearby. they were worried that if somebody found out they were struggling with a disorder, they would be ostracized by their friends or fired from their job or their doctor might look at them differently. we have to address the policy issues, which are around investing more in programs. we also have to work on that cultural shift. you can't legislate ships and attitude. that is something we must model ourselves and it needs to be changed from the grassroots up. people have to share their stories. $1ah: do you think that billion that would go to expanded treatment, could that still be achieved this year? vivek murthy: i don't know if it

will be achieved or if it will come later. i certainly hope it comes as soon as possible. we can't wait. the families of already waited too long and are often in the shadows and don't feel comfortable coming forward. they are desperately in need of treatment. when we have treatment that works, we know how to help people and we know how to reduce the risk of relapse, we haven't been able to expand this further. we have made progress in the last few years. in thishave illustrated report is there is much more progress to make. anyoneen to working with to do what i can to make sure we have the support and the information to make the case for expanding treatment. lauren: if people do seek care,

they have to be able to pay for it. president trump campaigned on repealing the affordable care act. what happens if that goes away? vivek murthy: the coverage is a key part of this equation. i had the privilege of practicing medicine in massachusetts. i saw what a difference having insurance coverage made to my patients and their ability get care and the level of stress and anxiety, not having to worry that they would not have coverage if they were to get sick. when it comes to getting substance abuse, that is an important part of it. benefits were included in the benefit package, that is important. as the new administration looks for ways to improving and

building our health care system that we find ways to not just maintain but to expand our coverage. despite the progress we have made for 20 million more people enrolled in coverage, there are millions more who are uninsured. we still know that we have a parity law in place. tos is advancing our ability reimburse for substance abuse services. we have to ensure that that is realized and fully implemented. my intent is to do whatever i can with the next administration to make sure that our coverage expansion continues. it's going to be an important part of ensuring people with addictions. with president trump coming in and talking about ripping out the affordable care act, what do you say to providers when they talk to officials on the ground who were worried about this disruption? this may be preventing people

from enrolling and causing them to rethink their current coverage. publiculd be a major health problem for people who have coverage right now if there are changes in that and they don't have options. what is your strategy, your to your strategy for looking at this? vivek murthy: times of change are hard for everyone. asthma progress as we made some realms of health coverage, there are other gaps to fill in. are weare wondering going to keep the gains that we made it. what's going to happen? i can't fully predict the future. i am going to wait for the next administration to come out with its policy proposals. i am willing during the remaining two years of my term to work closely with them and see what we can do.

that's the most important thing that all of us can do. our needs are being voiced and clear. , have found through my efforts we have a lot of good people in washington who want to provide help on this issue, that want to address substance abuse disorders. they are hearing from their constituents and the public's what they need. -- public what they need. people have incredibly poignant heartbreaking experiences dealing with addiction. they haven't really shared those with others. i understand why they haven't. there is an unacceptable stigma with addiction. we need more people to share what their needs are with their elected leaders and with the media as well. one of the things that has helped turn the tide on the opioid issue has been people stepping up and telling their stories.

they make it more acceptable for others to look for help. susan: we have five minutes before we finish. i will segue over to medical marijuana. you brought up in a report that there are some concerns that research is raising about marijuana use in general. tot is the public attitude marijuana? vivek murthy: public policy is outpacing science. there are two points i would make. one is what we know and what we don't know. what we know is that marijuana is in fact addictive. this will come as a surprise to many people. there is a marijuana use disorder. that number is higher if you start in your early teens. marijuana is addictive. it has an impact on the developing brain.

there is also what we don't know. highn't at this point have quality evidence that tells us marijuana is safe and effective for use for medical purposes. that is the standard that we used to approve any drug or medication with the fda. we should hold marijuana to the same standard. right now, if you ask somebody what are the guidelines on what dose and what frequency and what type of strain of marijuana to use to treat a particular have an't specific guideline that is evidence-based. a different frequency is based on judgment. that is not how we want to operate in a universe where we care about safety and efficacy.

my believe his we need to accelerate our research on marijuana so that we can understand more fully what the benefits and the harms are. that is why i was glad in this administration that we made research easier, including removing some of the hurdles in the process and increasing the research grade marijuana that was of their level. -- made available. million and 250 studies have been funded to better understand the impact. i wanted to pivot to a different epidemic. you have talked about gun violence as a public health crisis. with president obama leaving office, can you point to any anti-gun file its or mental that youovisions

believe will have a lasting effect if we do see some of these rolled back in the next administration, which is possible. what are the things that are working right now that you think should continue? just zoomhy: let me out a little bit in thinking about gun violence. gun violence is a problem in many parts of our country. i don't think there is anybody who wants -- everyone wants to address gun violence. this is a debate tickets very polarized very quickly. if we really want to address gun violence in america, we need commonsense laws in place. we do need a focus on gun safety education. we do need an investment in metal health services. that is something that the expansion does help as well.

to ask a deeper question about what contributes to violence in the first place. diagnosablee has a psychiatric condition. the majority likely don't. there is something that is giving rise to violence. we have to ask ourselves how we can improve our communities, especially communities that are under high degrees of stress due to poverty or existing violence in their communities. the good news is we do have programs that are being developed and implemented in different parts of our country which are for guessing -- focusing on well-being in schools. they are having a striking impact on reduced violence. one is the becoming a man program in chicago. in one year it was able to demonstrate a 44% reduction in violent arrests among at risk

youth. i hope going forward is we can actually focus on investing in the emotional well-being programs. that is an area i intend to continue focusing on. susan: we are out of time. your term is structured to last two years into the trump administration. would you like to serve for president trump? hask murthy: my intent always been to continue serving as long as i feel i can make a contribution to the public health. i feel that i can still do that. i have a lot of ideas about how to fill some of the needs we abuse andd substance addiction and emotional well-being and other areas. i have recognized from the beginning that health is

something that matters to all of us. people get sick regardless of what party they are from. it gives us a reason to come together and work on health. there are many areas of shared concerned. substance abuse is one of them. my intention is to keep working with the next administration and do everything i can to advance the public health of our country. we have big challenges. i believe we are up to the task. susan: thank you very much for being our guest on "newsmakers." we are back after our conversation with the surgeon general of the united states. cover public both health. the new report from the surgeon general on addiction in america which he hopes will be as practical as the early reports

decades ago on smoking, you asked about the timing. asked about timing, so we are going through a presidential transition, a lame-duck congress, you know this town, what is likely to happen at this particular time? in congress, because there are so many other things going on that do take precedent over public health matters. dr. murphy did make the point that addiction is a problem that affects all political persuasions, and the previous legislation this year was overwhelmingly bipartisan, so i'm sure it is something that they will come back to. so manyrt is coming up months after the bill was passed, we do have an upcoming spending bill and there could be money involved with that. the head of the house appropriations committee is a strong advocate. there is a chance that there could be money before the end of 2016, but this is something the

democrats are worried about. >> the only part of the equation is talking about the need to educate physicians at the patient interaction level. >> the surgeon general's office actionis call to probably has the effect for a resonating throughout the country, then necessarily in congress. if he can get dr.'s attention and other groups of tensions and just raise this idea of stigma that people should not be afraid to seek help. >> the government walks such a fine line on prescription guidelines and any kind of mandatory training is not seen well by the american medical us is the asian. we have seen signs from the fda and cdc in their recommendations, which are not enforceable, but there are signs that say this needs to be a bigger priority for doctors,

getting trained in their day-to-day life, and some go years without additional training. a lot changes. research comes to fruition and some doctors may not be aware of the updates. >> we just saw this week, a video from president-elect trump where one of his 100 day pledges was on regulatory reform and that for every new regulation, two others have to be rescinded. we are in such a state of flux. could you see those kinds of mandatory policies going forward in a certain environment? >> it is not likely. incoming president trump has said he wants people with opioid disorders to be able to seek treatment. he wants to help people on this issue, but we have not seen a lot of details on this, unlike the plans we saw from secretary clinton, which had a lot of details. he might take on -- after he saw

the reception of her policies, we might see some of those carried out, but we have not seen them yet and there is still so much going on. especially in terms of how the country has approached this, there are legal substances. does this fall under a criminal justice area? public policy issue because despite the problems with opioids, there are many prescriptionre opioids are truly the appropriate treatment. the rest of the a treatment out there, but doctors and patients need to know how to get the balance right. >> you both spent some time with this report. what is the takeaway you have from it? i think we know these numbers. they have been hammered home for so many years. the message of