daily. in 1979, c-span was created as a public service by america's television companies and brought to you today i your cable or satellite provider. next, a look at opioid addiction in the u.s. speakers include a journalist, an investigator, and a director of a treatment center. this is one hour. now, it is my great pleasure to introduce tonight's moderator. lisa is a top news editor for the america's at reuters could as a former investigative reporter at the los angeles times, she worked on a series of stories that connected drug-related deaths to the doctors who wrote prescriptions and the pharmacies that sell them. her team also recorded an

oxycontin producer which failed to disclose risk factors for addiction, as well as evidence of illegal drug trafficking. she has one awards for her exposes on alleged human rights abuses, and on health insurers who resent the coverage for six members. welcome to a warm miss lisa -- to lisa. [applause] i want to just -- [laughter] introduce most of our panel. we are really lucky this evening to have a really diverse group that can speak to many aspects of this problem. scholarwitz is a legal at ucla who is quiet a bit of research into the open epidemic

and efforts to fix it. of -- who has written many books. and has since written this amazing chronicle of this epidemic called "dreamland." i highly recommend it. it is a really fabulous and touching and tragic book. runs andooney addiction clinic at ucla and helps doctors learn how to cope with some of the victims of this epidemic. and she has also done research into some medication responses to the epidemic. and benjamin barron who i have watched an action is a federal prosecutor down in the courthouse in l.a. as an assistant u.s. attorney, he has prosecuted doctors and

drug rings, and gangs that moved drugs, and he has seen quite a dangerous risky and side of this problem, and has endeavored to try and attack it from the end. saying, irt out by first began looking at the opiate epidemic is a prescription drug epidemic in 2010. i joined colleagues at the paper and began looking at the problem. years, moret 15 than 200,000 people have died of drug deaths in this country. are prescription drugs, prescription opioids, but increasingly, on heroin. they are closely linked, as sam continue about. there are 20 million people currently addicted in this country to illegal and legal

drugs. only about 10% of them manage to get treatment. it is underfunded and just not that available. i wanted to stop the conversation by hearing from each of you, your perspective on what is the biggest part of the problem, or what driving -- or what is driving this problem? >> there are a lot of people who live in touched by this. can you talk about that? >> what is going on with this problem are two things -- one, was heavily promoted as a nonaddictive drug. there we go. a cure-all for a lot of pain. the difference between oxycontin and the opioids that it been

used before, was there was no abuse before it. vicodin, percocet -- all of these opioids had acetaminophen or tylenol. -- cannot develop a healthy an unhealthy bad habit without destroying your internal organs. what i think undead -- because sobecause of the cotton was heavily prescribed, it had the effect of raising people's there -- raising people's tolerance to a level that was unsustainable because on the street after people had to turn to the these pills costed a dollar a milligram. story is part of this

back in the late 1870's, a lot of our heroin came from the far berlin, taiwan, etc. that is what the french connection was all about. that change in the 1980's. on, heroin came from either columbia or mexico. and heroin is a commodity. it is not like red wine. the participant on how far you have to travel with it. heroin was coming up from mexico and it was potent and cheap. the problem was no one paid attention to the change because he wrote it was not a problem in the early 1990's. recognize how to big a deal it was when the geographics which happened. when the heroin from mexico and

colombia outcompeted the heroin from the far east. a wisdom tooth extraction, pills for pain, 60 vicodin, 90 oxycontin. what you get is a huge number of addicts and looking for an alternative to very expensive pills, and the heroin coming from mexico for the colombian heroin provides that alternative. it is potent, cheap, and it is extraordinarily mortal and deadly. that is what we are seeing all across the country. it is a combination of those two historic changes that really created the heroin issue we have today all over the country. and where it is hitting most is

in white families. families and communities that are not used to this -- families in communities that are not used to this. and it is in the heartland, suburbs, rural areas. it is a very different thing and it is deadlier than any epidemic we have ever had. that the heroin and the pills -- can you talk a little bit about what law-enforcement is doing about this and what really you are playing right now, and how you are trying to attack this whether it is gangs, doctors, pharmacies? >> i will answer your first question. basically, the reason the problem is so hard to tackle is is a multifaceted issue.

there are so many heads you have to cut off. there is the issue of corruption with medical practitioners, negligence, and overprescribing these drugs and ignorance of the public of what these drugs are. issue of the fact that you can stop doctors from prescribing these drugs, but you still have a black market of heroin addicts to deal with. , the abuse ofd the prescription drugs, heroin abuse has skyrocketed. then you have the public safety issue. fentanyl being imported from china. unlike other opiates, fentanyl is purely synthetic. you can have super labs in china imported. fentanyl is more powerful than heroin. elephant tranquilizers are now being abused.

and it is causing a massive deaths we are seeing when cut with heroin or counterfeited as pills in west virginia and new hampshire. we have a lot of different people between regulators and educators involved, and where law enforcement comes into play is obviously to turn corruption in doctors. with apt doctor prescription pad can sell as many prescription drugs as any gang. we are involved in the prosecution of this heroin importation and the fentanyl importation problem, and we cooperate very closely with regulators involved in deterring negligence among medical practitioners, and taking licenses, and disciplining were that needs to happen. to --ok.just wanted i need to go mics. i just wanted to follow-up on

what sam was saying. i started out by saying that there have been 270,000 deaths with opioids. sam has a good point. kind of the genesis of all this, or closely linked in time to changes in medicine, and new drugs like oxycontin coming on the market in the late 1990's, that is where it starts. window structure the market, there were 4000 approximate drug deaths every year. now, there's upwards of 36,000 a year. 2009, as my colleague and i reported, drug deaths actually surpassed car accidents as a cause of mortality in this country. industrialized, modern country, one of the huge goals

is to drive down preventable deaths, right? that is why the of seatbelts, speed limits, childproof, right? fors really unusual mcculloch health perspective, to look at mortality charts and see everything going down, right? cancer, heart disease. everything we can do something about, we are invested in that, and all of a sudden to see , very clearlyg up a byproduct of medicine and therapies, right? i need it again now? [laughter] most of the drug deaths actually involve prescription medications, but increasingly, they are involving heroin. -- jill has think studied -- one of the responses

as it snuck up on to setdy, was for states up prescription drug monitoring programs. you are as that if doctor writing one of these dangerous prescriptions to a is recovering from surgery, or a car accident, or has really bad pain, you want to make sure that person is in getting that same prescription from three different doctors. so, in most of the states, the idea is the pharmacy sends a of a prescription at is dispensed to a state agency, oftentimes the attorney general,

and the doctor has access to a web interface, and is supposed to check to see what you're up to before he or she prescribes. joe will tell us how that is working -- jill will tell us how that is working. >> one of the things that is interesting about this epidemic is that the states onto it pretty early, and there was a ton of activity. paper in the journal of medicine last summer and i worked with a group -- an economist, dr., and a lawyer worked on this paper because he wanted to cover all the facets of it. and the period we studied, there were 81 separate state laws passed to deal with opioid prescriptions and abuse. the one that gets all the liketion are things tamper-resistant's prescription pads.

it used to be fairly easy to still a pad. now there are special pads that say void if they get heat on them. they are preprinted, all kinds of things. states passed these laws and there was a lot of hope that they would make a difference. we studied a very tough population. we studied people who were primarily disabled and on medicare even though they were under 65 because they were disabled and could no longer work. among that relatively small population, about two to 3%, they accounted for about 50% of opioid deaths. it is a population that is very hard hit. when we look at the passage of these laws, we are looking to find something. if you look at when the laws were passed on average and then look at the trend in , what youon abuse

find is a slight slowdown in 2010. when you look at the states that passed the laws when they passed the laws and compare it to states that didn't, we found no effect for any one of these interventions at all. be thaton here could maybe we had a particularly tough population, but we want to be really careful in how much money we throw at interventions that might not be working area our results were not welcomed by the cdc. wey wrote a letter saying don't have research. we're going to keep trying and look at different populations, but this is not good news. benjamin: for this perspective of law enforcement, it is

essential and has made a huge difference for us in taking pharmacists and doctors off the market. we don't know every instance when they sell drugs, but with the pdm p, you know every time a doctor has prescribed drugs. , so if ahe dosages doctors prescribing the same drugs and the same maximum dosages, we know if the patients are living miles away, if there are dangerous cocktails being prescribed together. it is essential, not just for medicalion, but for board regulators and pharmacy board regulators in combating the problem. every time we get a conviction and the "l.a. times" reports on it, it sends a message to doctors. us want to emphasize how

important the data is. -- i just want to emphasize how important the data is. jill: the states operate them very differently. some states are in stating border controls. new england is particularly hard hit. it is not so hard to drive to new hampshire to get the things your parents didn't want you to have. states are right next to each other there, so it could be working in some places and not and not inrea -- others. lisa: on the topic of imperfect solutions, this would be a good opportunity for you to talk about treatment options. i know i have spoken to way too

who exhausted their retirement funds and mortgaged their homes and set a family member into treatment numerous times, only to have them relapse, overdose, recover, and in many cases, then finally die. there, and how well is it working? in terms of treatment, i view the most important element of treatment for this population, even more so than for other addictions, is prevention of overdose death because nobody can be engaged in rehabilitation and recovery if it has caused their death. the gold standard for treatment for opioid addiction, based on evidence that is emerging from research, is medication treatment. that doesn't mean that is the only type of treatment, and fact, a conference approach is

very beneficial. we have different types of treatment and behavioral therapies and skills that are important to learn. approved medications that are available to treat up we had addiction -- to treat opioid addiction are the gold standard. methadone and naltrexone , and i can go to the differences between these medications, but essentially, norphineor seem -- bupe and methadone are opioids. enorphine acts a little differently than some that we have been talking about. methadone is a long-acting opioid substitution therapy. what that means is you are giving a medication that can take the place and really break

the cycle of intoxication with drawl -- intoxication, withdrawal, and a vicious cycle of addiction. these medications can stay in than 24em for more hours at a very steady level. it really can be lifesavers for many people. individuals with opioid addiction to improve their functioning, the wallaby --life, get their lives back their quality of life, get their lives back. there is a monthly injectable form that is long-acting that seems to be a better option for people with opioid addiction. if you are on now tracks own -- if you are on now tracks own -- naltraxone, younl

can stave off the effects. naloxone can reverse overdose and has been used in ers for a long time. there is a public health movement for laypeople to have access to naloxone. tosicians are encouraged prescribe naloxone so that a family member or loved one and use it in the case of a suspected overdose, because the benefits far outweigh the risks. i have a question for you, sam, but i want to throw out one more fact that i found very interesting. when we were really digging into the mortality statistics, what was really interesting for us that the population at greatest risk of death were the it wasn't kids

seeking a thrill, it was people in their 40's or 50's. that is the hardest hit population in terms of mortalities from opioids. that gives you a sense of what we are dealing with. one of the solutions that people have talked about lately, particularly in the presidential the flow is stopping of heroin into this country from mexico. or by building a wall improving the border. youuld like to hear explain, as i've heard before, how the heroin got into the midwest, and what effect you think a wall might have on that. we absolutely need to do something about the heroine running from mexico. it is an outrage.

the fact that most of our heroine comes from mexico had a lot to do with why donald trump one of very key states that were key to his victory. , people inylvania that area know where their heroimn is coming from. heroin is a great traffickers drub -- traffickers drug because it is easy to conceal. you don't need a lot of space in , and to traffic heroin what most likely needs to happen is not a wall. we have a lot of walls on the border. yards intoarts 50 the ocean and goes for 14 miles until it hits a big mountain.

we have a lot of walls all around the border. we have them everywhere, but heroin -- walls won't stop heroin. they will stop -- stop people, but they won't stop heroin. sincemand we have created the mid-1990's across the united states, what will stop the flow of heroin is a mexico that starts to change in fundamental ways. i wrote two books about the country, and it seems to me that what we really need to do with regards to mexico is not not value its friendship above all things. we need to be in conversation with mexico and the constantly relating to mexico as one of our most important foreign

relations. we need to be pushing them to do the kinds of changes that will make that country a place where people aren't dying to leave, which is literally the case. when mexico begins to change and develop the kind of law enforcement capacity that canada has will we begin to see a modern partner. believe,e get there, i is not by alienating and insulting and inflaming, what trump has done more than anything, and allow the elites of mexico to distract the population with those inflammatory rhetoric while they do nothing to change what is an essential component of a bilateral relationship. a mexico that has better law enforcement, a criminal justice system, so that cops here can

call down to areas where they are growing heroin and be partners with their mexican counterparts. it exists to some degree, but not the degree it ought to. example of perfect this. we could probably stop a lot of the marijuana and cocaine. --oin is so convinced will is so condense a bowl -- is so able, it is so easy. we need to treat them as neighbors and not as some kind of dysfunctional family. wall hass on the inflamed that and has done nothing positive.

lisa: with -- we've talked to a lot of doctors on this issue. many doctors who were trained, up until recently, have all told me they were trained when they met with local school -- when they went to medical school, be really careful prescribing opioids. you have to weigh the risk of addiction with what you're patients are facing. until the mid-1990's, doctors were loads to prescribe opioids -- were loathe to prescribe opioids except in cases of internal pain or cancer. the humanity idea was expanded to include a much broader range of pain. the doctors prescribing

tendencies shifted. it got to the point where opioidswere prescribing frequently for all types of pain, including gentle extractions and short-term pain and all kinds of pain. do you have ideas on how the transformation went from the stay away from opioids, they are very dangerous, you don't want to get your patient addicted, to , you are going to have a tooth pulled, i'll write you a prescription for an opioid russian mark -- opioid? sure of all the historical and political reasons . sam would be able to comment on that more. recall in medical school

exactly when the transformation occurred. it was pretty dramatic. suddenly, doctors are under treating pain. we need to be more aggressive. i am not a pain management doctor, but in med school we were hearing exactly what was supposed to be done. think the pendulum completely swung the other way, and now it is swinging back. based on all the problems that have emerged, doctors were told that opioids for pain are both effective and has minimal risk of addiction in patients with pain. we are learning that that is not true. much of the research is showing that opioids are actually -- i want to make the point, they are valuable medications. a are highly effective for acute pain.

we need these medications. if you have a surgery or an injury, they are highly effective. but their efficacy for chronic pain and long-term use in the management of chronic pain is being questioned. the risks are very clear. guidelinesre new shifting back to needing new approaches to manage pain and considering non-opioid medications, physical therapy, and even cognitive behavioral therapy to cope with pain. hopefully we see a return of more conference of pain clinics to manage these problems. sam: i think a lot of it had to do with us. i thought when i was starting my book that i was writing a book about drug traffickers and drug trafficking. what it became was a book about americans and what we became. at the end of the cold war, we

became a country that loved to exalt the private sector. the country where people were applauded for making lots of money even though the way they made their money didn't do much for the community. we savaged government, exalted the private sector, and became a country that wanted comfort, convenience, and a lack of pain. you can see this in a lot of ways. we have padded playgrounds because god for bid our kids skin their knees. everybodyophies for because god for bid somebody should feel left out. we don't want our kids to feel pain. now, in college, they are asking for trigger warnings so that when a professor is going to deal with an issue that might be , we go from protection

of physical pain to protection of emotional pain. ,octors were seeing this particularly in the 1990's. patients would come to them and say i just can't have any pain. people begin to believe that we really could not suffer any pain at all. to not when we began just prescribe these pills for some kind of ailments, but prescribe maximum dosages and believed they were not addictive. out, i got appendix 60 vicodin. we became a country that went indoors and isolated ourselves. this is a story about isolation and the end of community in america. it is the hallmark of the crack

epidemic, the crack house, a public place that had been taken over, a rental or read have you. -- a rental or what have you. hallmark of this epidemic is the private bedroom. the place where every mother wishes her child should be. don't be outside, there's child molesters or someone that is going to hurt you. it is in those private bedrooms were kids are hiding their dope, shooting up, and dying. doctors picked up on this and begin to see this in systems with which we wanted to have no pain at all. doctors were the vectors for this whole problem. my feeling that what started this is all of our health consumers believing we had won the cold war, it was time to get act.

-- it was time to kick back. cars, huge, huge halloween candy. not have apossibly full record bar at every house they went to. i think this is all part of what the story is and why doctors felt such pressure. all of a sudden they are getting pain specialists telling them yes, we now know that opiates from the opium poppy, the oldest medicine we know of, we now know these drugs are knotted it is -- are nonaddictive. so go right ahead. and they did. if it was all wanting to be nonaccountable for our own consumer choices and choices of a variety of sorts. way,push them in that that's what led us to where we are today. this is not a story about dope.

it is a story about who we are as a country and who we are as americans and what we think will lead us to happiness. lisa: one of the things i haven't heard us discuss yet is some of the systemic drivers of in thisors prescribe amount in these kinds of drugs. we have to look at what our insurance system is and how our doctors get reimbursed. it is very hard to get reimbursed an adequate amount of your time to do the kind of slow, careful intervention to do alternative treatment for pain. of them haveome been shown to be quite effective. the insurance system tells our doctors to reimbursed -- through reimbursement to write the prescription. it tells the doctor to write the prescription for a lot of pills because you don't do so well if the patient keeps coming back.

i think there are some fixes we could easily put in the reset up a system where you get a certain number of bills -- number of pills and call-in to get a certain number more. it wouldn't stop the problem, but it would slow down things. there are systemic changes week -- systemic changes we should make. i'm not sure i agree with you about the candy bars at all, but i agree on the cultural progress of this. if you look across the country, there are really different levels of prescription and kinds of treatment for the same illnesses. that has to do with the culture of practice. ofnically, this is a problem white america. is one of the few ways in which racism has helped minority groups, because doctors will prescribe these prescriptions to people of color. in some respects, they have been saved from some of this.

the cultural causes of some of this problem really need to be looked at from the doctor and, from the patient end, from the community end. think probably larissa is the person who can speak most directly about this. when he to think as a culture, what happens in our society that makes an 18-year-old take her grandmother's pills from the medicine cabinet? what is happening at this point in time that someone does that when they wouldn't otherwise do that? a large part of the problem is people who get addicted when they have pain. but what about all these young people, in some states harder hit than others, what makes them so desperate that between this and that, i choose reaching for this pill? one element is lack of perceived risk.

this problem is getting a lot of media attention. we are starting to talk about it. thathere was a perception this is a medicine prescribed by a doctor, not a street drug. therefore it must be safe. that is one component. not the whole story, but for sure, a lot of experimenting with the pills. people do experiment with drugs. they seek a high. there is recreational use of all sorts of substances and experimentation is very common in young people. and high school students, the use of prescription opioids for recreational drug use was rising exponentially. of element there is a lack perceived risk. i can get a buzz and feel good, and what do opioids do? they block pain, they are

analgesic, they cause euphoria. then they talk about the lonely person and people struggling with depression, anxiety, stress, the memory associated with taking that they'll and the immediate relief -- taking that pill and the immediate relief, we want instant gratification. that is a powerful memory. when you look at the neurochemical changes in the brain that happen over the acrossof addiction and addiction, there is a big the opioids what and other substances due to reward the system. they are reinforcing. you feel really good and form these memories. and the next time you are feeling bad and stressed and toressed, the tim tatian is quickly obliterate that feeling. temptationive -- the is to quickly obliterate that feeling. sam: on a lot of school campuses, what has driven this

is football. football is a gateway to heroin addiction in america today because that is how we have learned to treat pain, by throwing pills at it. most places, many high school football players are the cool guys. people watch football players, lacrosse, wrestling, baseball, mainly football though. i was finding and a norma's number of football players getting addicted to these pills because there is enormous pressure to get back on the field. this is how you treat chronic pain is with dope. and there is lots of spillover. you go in for a surgery, everyone knows you are getting those pills, and pretty short the pills you got prescribed are in a four or five other guys lockers. all across america, this is happening. football players being the kind i thinkrs on campuses frequently set the standard, as

well. it is a hunch. i don't have any evidence or studies to show this, but i was running into it a lot. lisa: i can completely corroborate what you are saying. it was younger kids in their teens and early 20's, and almost every case had a football injury, a wrestling injury, a ski accident, motocross, car accident. they are 16 or 17 years old and put on opioids, which is probably the right response in the hospital and immediately after a surgery, then there is no follow-up. there is no care. you go from the surgeon and he hospital to your family

, anditioner and your rehab no one is paying attention to how many refills you have gotten. it doesn't take that long. if you put it in those terms, parents would say, oh, really? let's go easy on this. nobody ever got that talk. not that i talked to, anyway. larissa: i spent quite a bit of time at the betty ford center, which has a very long center -- has a very long history of treating all types of addiction. you can track the history of addiction at the betty ford center. part of the oughts,

2003, 2 thousand five, all of the sudden, opioids. , oxycodone,ercocet that is what is bringing the patients to them. mn said he was written a ,rescription for a tooth pull and they did just said you don't -- and the dentist said you don't have to fill it, but i don't want to call in the middle of the night that you are in pain. sam: that right there explains the enormous supply story. i livedo believe when in mexico that drug problems begin with the man. this book changed my mind completely. this is a supply story. it starts with supply.

doctorsly is prescribing like that, or the guy who gave me 60 vicodin for my two or three days worth of appendix operation pain. if you multiply that by millions of doctor visits and millions of surgeries over a 20 year. , that is what creates this thatve supply of opiates transitions to heroin. then, could you talk about ben,asy it is -- been -- could you talk about how easy it these pills and los angeles and how you have seen that evolve over time? benjamin: thankfully, l.a. does not have the same level of an opiate problem you are seeing in west virginia, ohio, new hampshire. not to say we don't have a drug , but it is rampant and

those areas and relatively low here. we are starting to see guests spread east to west, and just a couple months ago, sacrament of had about two dozen potential overdoses. withhas to do counterfeiting. you have this incredibly powerful opiate, only two milligrams is what it takes to kill someone. it's being imported, and you have counterfeit pills being created out of it. you go to a party and take whatever you get me think you are just taking a vicodin, and this pill is manufactured by a drug dealer in his basement. you don't know what you're taking. you don't know how strong it is or how safe it is. of whatrance and whation drugs are drugs that someone hands you are is fueling a lot of deaths.

it's an interesting point i wanted to make. i went to make one other point, which is the insurance industry was brought up. the public health insurance industry, not intentionally or because of anything medicare or medicaid is doing wrong, is fueling the black market for these drugs. that should outrage everybody here. not because they are doing but you have an industry of people in los angeles and other areas who are not drug traffickers or doctors. their sole involvement in this is to recruit medicare and medicaid patients to go to doctors. maybe steal the identities of elderly people in exchange for a $100 cash kickback, they get a prescription filled. usually these are drug addicts using the money for their own drug habits. what we are starting to see or schemesnd more complex

that involves these recruiters, beneficiaries, doctors conspiring with pharmacies, just my blowing amounts of these pills. hundreds of thousands of these pills on the street. two weeks ago we convicted a doctor whose prescriptions were of billingsne cause to medicare in the state by more than double the next doctor for scheduled to drugs. this is your taxpayer money going towards this. and createso tragic all sorts of other issues. so many ofnsible for the drugs that are being spread. lisa: when i first started looking at this, there had been that many prosecutions for doctors. it is nearly impossible to convict someone in a white coat of drug dealing, and drug dealing was the only law in the books at the federal level.

has that changed at all? benjamin: it absolutely has. when i did trainings on these cases, i help people who might be afraid of charging a doctor with drug dealing. these are some of the easiest ases we prosecute because paper trail exists left and right. pdpa, bankhe records, billing records. who runs a cash business? you have it all over the place. number two, there is a very narrow range of conduct that is consistent with legitimate practice. that narrow range of conduct is not consistent with what a corrupt doctor is going to do to profit from these drugs. you have to prescribe maximum dosages of the same drugs over and over again in dangerous commendations. why is your pain doctor prescribing maximum strength of xanax to everyone who comes in

the door? why are they only doing two-minute examinations? there are 50 different things you see in these cases over and over again. we have incredible tools to go after these cases, not just as prosecutors, but as regulators, as well. i think that is even more important for come batting -- for combating corruption. one thing we will have to do is combating corruption and pharmacies, which is more difficult to do. drug trafficker, you prosecute whatever drug dealer. with a doctor, you have to be licensed and educated, be willing to commit a crime. as a get better prosecuting in these cases, there are fewer and fewer doctors doing this. now we have to turn our attention to the pharmacies. criminale an array of tools beyond drug charges, obviously. there is safe handling of drugs,

a doctor in a lady who was convicted of murder -- a doctor in l.a. who was convicted of murder. it was a righteous result. in the last couple of years, we haven't 27 or 25 year sentences of doctors who are murderers and need to be treated as such. we have a lot of tools and our toolkit, we just need to use them. we are going to take questions for all of you. there are two of us walking around with microphones. if you would please say our first and last name when you ask your question, this program will be recorded and rebroadcast on our website. it will also be broadcast by c-span at a later date. we will take your first question. >> my name is todd.

there is a trend going on that i suspect will intensify with the recent election about drug testing people on public assistance. a two-partf question, which is, does that kind of drug testing catch prescription drugs? highlight, does it the income disparity with regards to this particular epidemic as opposed to other ones? lisa: it would depend on how sensitive the drug test is. i'm not sure what kind of drug test your talking about, but it might not be able to distinguish between something illicit and something you are taking legitimately.

it's all the same stuff when it gets down to the chemical level. but that would only catch people who would go in for public assistance. to what extent is the opioid epidemic affecting people who to not be dependent on public assistance? sam: i would say that this affects white people. that's in appalachia, where you get some really poor -- if we were paying attention to appalachia, we would not be in the situation. for my books, i was in appalachia, but also in suburban charlotte, one of the wealthiest parts of america. portland, salt lake, indianapolis, you are talking best inople doing the

the run-up since the mid-1990's of economic expansions we have had. is why is itestion only white people? i still don't have a complete answer to why that is. ,'ve been racking my brain reading things, trying to understand it. heart of it does have to do with doctors prescribing, but i don't -- many black people have received these drugs, but in the latinoommunity, the community, it is not. i think part of it may have to do with cultural memory. in the 1970's, the latino community in east l.a. was destroyed by heroin. there is a cultural memory of that. that might have something to do with it. i don't know. y say that addiction is colorblind, but in this case, it is very much not. it is white people, and it is all over wherever you find a white person.

the other role public assistance place in this epidemic, people with medicare and medicaid cards who may be easily manipulated or maybe ssi, if you have a government card, you can get a prescription filled for a very small co-pay. you are valuable to drug dealers. you become recruited and a straw patient. are driven in a van. you are probably taken to lunch, take into a corrupt doctor, and a prescription is written in your name after you pass through the mail. you turn the prescription over to your cap or who is driving you around.

and you are taken back to the homeless shelter. that's the way i've seen public assistance play out in this particular epidemic. and you are paying -- benjamin: and you are paying for drug dealers to get their source and supply. thanks for an excellent panel. i have a question for sam in particular. i am writing my dissertation about the opioid epidemic, and your book has been super helpful. thank you for that. if you couldit speak a little more to this gray area that exists bridging the highly regulated official market for prescription drugs and the market for heroin. you have spoken a lot about medicaid and medicare and ssi's, that divide ins places like suburban charlotte? i heard the sure

question, it's kind of echoing here. why is there a market in suburban charlotte for this? >> you've talked about how medicaid, exercise, those kind of things set up this transition between the market for prescription opioids and the market for heroin. a lot of people who take that kind of assistance. what about this epidemic cuts across? sam: they get back to what i was saying about doctors accepting the idea that these pills could not be prescribed with virtually no risk. that was the fundamental change, and that's with the pharmaceutical companies did very well. to convince an entire generation and more of thatrs that the pills everyone knew were addictive were actually not so. it was a magnificent piece of marketing.

that these drugs are not -- so you have a massive prescribing of these pills in many parts of america. medicaid and medicare were a big part of what happened and continue to happen in various parts of the country. doctors and scandalous doctors were not the reason this happened. it is an entire generation of thatrs buying the idea these pills could now be prescribed with virtually no risk of addiction. we went in 1990, the world supply of hydrocodone was three tons, it went to 43 tons in 2010. supply, 99% was used in our country. similar figures for oxycodone. thinking,volution and

list through marketing -- revolution in thinking accomplished through marketing. all over the country, you have this supply. in some areas, it is definitely exacerbated. but overall, you are talking about a general change of mind on the part of many hundreds of thousands of doctors all across the country. jill: i just want to add to that that we have heard lots of guy,es, getting the bad and there are bad apples out there. is dull, of this unwitting participation in the system where we don't like regulation, we valorize independent decision-making, and i think we are going to see that increasing in this next administration. when public health experts like getalk about regulation, we

pushback on that. they are called death panels instead of evidence-based medicine. i think if we have a medical culture and insurance culture and regulatory culture that doesn't like taking systemic evidence into account and forcing people to participate in a system like that, then we are going to end up with a lot of prescriptions, in part because they are bad apples. it is very important we have law enforcement dealing with the bad apples, but also because that is the way we tell doctors to practice. that is the message we send with the way we structure our insurance. that is how we reward them. that dentist who didn't want to take the call in the middle of the night, i don't blame him. he is not paid to do it. we had to have systems that pay people to take those calls. that would take a reform of our health care system, part of

which obamacare was on the way to doing, but i think we are going to see the problem worsening. my name is robert, and my question is, do you think the amount of attention given to this issue would be different if it wasn't the case that, as you described, more of a problem in what communities? -- in white communities? i can't speak for statistics on racial demographics, but i do a lot of cases where the doctors we investigate have addicted african-americans. at least here in l.a., i haven't seen it being exclusively limited to white people. maybe that is just l.a.. maybe that's just my perspective. it is a unique issue because it crosses every ethnic group and age group and class.

it is impacting everybody. i don't know if that answer your question at all. it's not that people of color can't get hurt from it, you are not immune from it. people of color are getting hurt from this. the: i think what's got attention is that we have seen for the first time in 75 years a turnaround in life expectancy for white people. it is caused by this. we are not seeing it in these other racial groups. that is one of the shocking things that was showed for the first time. that is the opioid epidemic, and it is hitting white people in a particular way. if it were another racial group, i don't know. we have a fairly lousy history for dealing with problems that

hit only some racial groups and not others. in this one, there is something very dramatic going on with this one group. >> final question on your left. practitioner,e and this is a great panel for the community. i hear you talking about the doctor-patient relationship, what about the nurses? the nurses are pivotal in this fight. there is a number one educator -- they are the number one population in health care that is forefront in dealing with patients. i have heard none of you mention a nurse. lisa: my colleague harriet ryan interviewed the new surgeon general of the united states, a guy named dr. murphy i think.

, he dropped aonth report on the opioid problem. the product of a lot of work. he works in the same hospital ever since he was a resident, and when he became surgeon general of the united states, the nurses who had known him for his whole career said they gave him one request, do something about the opioid epidemic. i can tell you absolutely, they are on the front lines. nurses in the state of california commoners practitioners can write these prescriptions and do work for doctors, so they can contribute to the problem and to the solution. they certainly are dealing with a lot of the rehab centers and addiction treatment centers. i know they see it. they are on the front lines. a lot of them like you are

looking for a solution. >> we are going to close our program. ucla forike to thank making this event possible ceiling. all of you for joining us tonight. i invite everyone to join us at the reception afterwards. we can continue the conversation over wine and talk to our panelists and continue to pick their brains. iq to our wonderful panelists -- thank you to our wonderful panelists for sharing your thoughts tonight. [applause] [indiscernible]

announcer: c-span's "washington journal," live with things that impact you. wainer will discuss his recent opinion piece, "why i cannot fall in line behind