its products. after taking this journey, we now know the different backgrounds. even with this new understanding of what we are eating, it does not mean you will change your diet or what you choose to eat. now that you are and lighten did it will make you think before , you take a bite. >> to watch all of the prize-winning documentaries and this year's studentcam competition, visit studentcam.org. coming up next, from washington journal, a look at efforts to combat opioid and the -- opioid and diction in the u.s. mosta discussion on the recent executive order on immigration and refugees. a rally from earlier today in washington dc calling on president president trump to release his tax returns. back. tel is here with us this morning to talk about her recent he's in the wall street

saving lives is the first imperative in the opioid academic." what is your background with this issue? guest: i'm a psychiatrist. i focused on addiction and i work in a local methadone clinic. host: why did you write this piece? guest: the opioid epidemic is an epidemic. that strikes some people is a little histrionic but i think it's fair to say. atan average, 15 people a 1000 overdose on opioids. it used to be 1.5. we can go on about statistics but it is clearly a major problem. i wrote about it because we have to think clearly about what to do. i think people with clinical experience have a great contribution to make. i wanted to do that. host: you mentioned

unconditional ideas for opioid treatment. tells about some of them. let's start with the harm reduction philosophy. guest: people think there are three axes about drug policy. supply reduction, demand reduction -- supplied means less available and demand means getting people to one and less. and harm reduction for people you know are going to use. either they don't want to stop or they can't stop. you want to make it safer for them to do with they do. in this epidemic, this drug crisis, we are really thinking of things that were kind of inconceivable before. from programs where police can tell citizens to bring in their drugs and we will not charge you. we will try to get you in the treatment. all the way to something that is rather radical for the united states, not for british colombia or europe which is called consumption sites.

some call them supervise injection facilities. that is when people bring their own drugs they have obtained illicitly, heroin/sentinel -- fentanyl, which is very powerful. they bring it to a site that is staffed with nurses. they consume the drugs usually by needle. nurses are there with an antidote call narcan and oxygen if needed. it is on the front lines to save lives. i consider it an emergency kind of intervention. sites try to get people to pursue a more traditional recovery route but at least they keep people alive. host: in canada, they urge patrons to go in the treatment but they also distribute clean needles to reduce the spread of viruses such as hiv and hepatitis c.

one study found opening the site has reduced overdose death in the area. one analysis showed reduced injection of places like public bathrooms were summit can overdose undiscovered and i. -- die. what is the biggest pushback in the states to adopting this idea? guest: i believe seattle will have two injection sites by the end of the year. new york city is at least trying to pursue them. there is a bill in california to establish one. burlington, vermont. boston, philadelphia. it is declining. it is certainly controversial, but i think sentinel has -- fentanyl has changed it. is much more potent than heroine, about 50 times more. it's a synthetic opioid. there are other synthetic opioids. many come from china and a

little from mexico as well. they are so powerful. there is one that is literally 1000 times to 5000 times more potent than heroin. you had no chance with these drugs. is a public health emergency. host: we are inviting you to weigh in. if you have been affected by the opioid epidemic, call (202) 748-8000. if you're a medical professional, call (202) 748-8001. everybody else call (202) 748-8002. of more unconditional ideas. one is the idea of a drug court. guest: that is not a conventional. the first one was in 1989 in miami. former attorney general janet reno established it. that was during the crack epidemic. that has since multiplied.

now we have about 3000 in the country and i think we need more. gets a diversion program. the point is not to arrest people and put them in jail. the point is to arrest them so they can stand still. so many people involved with drugs need structure in a neat supervision and leverage. these drug courts defer people the treatment. they collect urine regularly. if they are negative, there is a consequence. the big reward however is at the end if one completes the program, 12-18 months long, and many courts the charges are erased. that is a huge benefit to people who have gone off track but have the potential to reenter society and do well. host: you mentioned the swift, certain and fair approach. guest: it is one way to look at it is its drug court without the mandated treatment. whererted in hawaii

there's a huge methamphetamine problem. the idea is to use the sanctions and incentives. --a person is sometime somehow not in compliance with the program, that is their responsibility. you do what we expect and we will not force you to do any kind of treatment. we will not impose anything on you. if you can't meet those expectations, we will send you to treatment. -- swift refers to the consequences are immediate. they are certain. and they are fair. everyone is treated the same. when you think about that, that is behavior 101. if you want to train someone, change their behavior, shape their behavior, that is how you do it. through incentives and sanctions. they have to happen quickly, not severely, but they have to happen everyone else.

a lot of the majority of people in the hawaii program do not even need to get a treatment. the structure was sufficient for them. guest: let's start with a call from north carolina on the other line. good morning. caller: can you hear me? host: go ahead. caller: usually i say my comments for something more political. but this sparked my interest. it's a little too late. ago. looking back 20 years i think the methadone treatment does work for those that really want to get off. for those that don't, it won't work. i don't understand why -- 90 have all these programs, but back then you put black folks in jail. i don't get that. he threw a bunch of black people in prison. the same is going on now with white people but they are treated totally differently.

they understand the concerns and needs. when i was growing up in baltimore city, he did not care about black people. you just threw them in prison. the solution was prison. that was the solution back then. , but i know the answer think the solution should be a job package. that's the reason why black folks went to jail and used heroin. they were desperate and there was disparity. host: he raises a point that we've heard before. how we feel about addiction is how we feel about the addicted. guest: he raised four good points. the first was about when this started. if you're living in different areas, it did start in the 1990's. why it took so long to pay attention is an interesting question. my colleague has two theories. unlike previous drug echo things

-- epidemics, this did not start and a major area where there was media markets so it was hidden for a while. and it is not that associated with violence. a mother passed at a walmart parking lot with kids in the back seat. it's a different epidemic in many ways. it did take a while to come to the national attention. he mentioned methadone. will it work? it does work and he's right. it works when people are motivated. then he mentioned the racial -- it seemshich is undeniable. a combination of society being drug war weary, incarceration fatigue. i do think there was an element to racialization. the emphasis is more on seeing as a public health problem. president trump said that many

times, rather than a criminal justice problem. although i mentioned there is a role for criminal justice in the diversion programs. the last point was -- i can't read my notes. he had a lot of good points to make. host: some a ghostly article you wrote. this is about reducing opioid deaths. most don't realize they are taking. they are driving the rate of 33,091e a total of deaths. of philosophy known as harm reduction, the goal of reducing opioid related deaths and disease. but good to krista from cocoa, florida. she is affected by all of this. caller: in many ways. i would first like to mention that i have been prescribed opioids by a doctor.

i would like to preface that. i am a drug in a call abuse prevention specialist -- and alcohol abuse prevention specialist, for i was. i don't think this started in the 1990's. in the 1980's we were already going to the homes of five-year-olds and teaching them how to set alarm clocks and how to get themselves to school because of the crack going on. it was not considered a radical position to advocate for 24 hour day schools where i lived in the lehigh valley. when i became ill with severe migraines and chronic time they really liked to give up the pills. -- get out the pills. i could not believe some of the things my girlfriend's were on. my doctor was judicious.

he would take me off opioids every so often, but he said you're not getting rebound. you need this. i didn't it addicted to it because even now i went off it because i don't want to be on it. and i just went off it. into the five days. it was not -- it took me five days. it was not bad. -- i knowe people that are prescribed that. the one lady was taking it with morphine. she was a nurse. what is the treatment plan here? i think might personal experience is if you want to become addicted, don't do it. especially down here. of north you have to take breaks. it down here they will give you -- but down here they will give

you any kind of opium pill to take three times a day. that is just too much. you should be able to go on and off it when you really need it. if you're having a surgery or something. then try take down. that was my experience. guest: the color mentioned she took opioids for quite a while but did not become addicted. the truth is that is the most typical experience. most people who received opioids, especially for short-term problems, do not become addicted. if a person really needs them and they are managing them well, it would be irresponsible to take them off in my opinion. however it is also true that physicians have been too liberal and their prescribing, especially for chronic pain.

there may be other kinds of therapies and medications that would be effective. insurance should be more generous and covering those and doctors are becoming more aware of that. who is at risks for misusing these drugs. when you look at the history, most people who do get in some trouble with them -- the average person is not a patient, and that's a really a problem with totors being promiscuous with prescribing. unless the patient has a previous history of drug or alcohol problems or mental illness. is the fact they give you a months worth. you put it in the medicine chest and someone comes along and takes it. that is how these drugs -- these medications get into circulation. percocet, oxycontin.

things like that. host: john is a medical professional. good morning. caller: yes, i'm 70 years old. i'm a respiratory therapist in the emergency room dealing with overdoses for 40 years. withther worked in chicago jim jones. not the jim jones in california. they called him the program priest.- the hoodlum i've been following draws on my life. i think the consumption concept is very good, but using narcan. if an individual was to graduate intentionally or unintentionally, i say allow them to graduate. i think it's more humane than going to the battle.

the primary problem i find his money. it is a business. an individual it, has to, if you want to say, put bread on the table. -- there areey do no jobs. it sounds rather ridiculous but it is true. it is just like any other business. mattel toys or whatever. i think we have to hit the source from that aspect of it. when it comes to shaping behavior, shaping behavior is very good for the individuals that want to do it. if not, allow the individual to graduate on their own. that's about all i have to say. thank you. guest: i think you make a good point about what you might call the upstream causes of addiction. you mentioned jobs.

by thent report princeton economists, they call these deaths of despair. they are now causing an increase in mortality in middle-aged white people, which is the first time in history that mortality rates and whites are actually going down -- i should say up, excuse me. middle-aged whites have a higher mortality rate now than they ever had. higher the minorities. these are white folks who don't have good educations so they don't have good job prospects. they are in communities where they are manufacturing jobs and mining had gone away. -- have gone away. it's a desolate situation. they are literally hemorrhaging hopes and jobs. use is very high and

overdoses from opioids is very high. that is very much an environmental or social cause. it gets filtered through one psychology. individuals feel despair and communities feel despair. but people appear to have everything the world and yet they have their own psychological pain. quiteo find opioids soothing and compelling. they are very in double about giving up -- very ambivalent about giving them up. host: let's listen to new jersey governor chris christie, taps toledo white house commission on drug addiction. [video clip] >> the president and i both agree that addiction is a disease. it's a disease that can be treated. when you make sure we let people know. the president talks about how folks don't talk about it.

we talk about cancer and heart disease and diabetes. people are afraid and shamed to talk about drug addiction. probably don't talk about it we lose lives. addiction. and why they don't talk about it -- we lose lives -- lives of good people. the president ended by talking about pro-life. the president and i are pro-life. we are pro-life for the whole life, not just the nine months in the room, but the whole life. gift life is an individual from god, and no life is irredeemable. people make mistakes -- we all have. mistake. a we cannot throw their life away. host: what is something the administration has signaled about how they might handle the public health search for this or how the justice department might handle drug crime? guest: president trump has said all the right things, thanks --ple -- i like to hear

which is the emphasis on the public health dimension, the emphasis on treatment. it mirrors what governor christie just said. on the other hand, folks are heartened by that, but they are worried at the same time that the republican repeal of obamacare goes through, that will fall very hard on people who rely on medicaid for their substance abuse problems, and they are also concerned about attorney general sessions, not so much in terms of dealing harshly with people who are trafficking -- i do not think there is any debate about that -- but will they put an effort on incarceration for people who commit minor drug crimes? so kind of mixed messages. host: let's go back to the phones. ann is calling in from louisville, kentucky. she has been affected by the opioid crisis. how so, ann?

caller: first of all, i want to disagree with two things governor christie said. he used the word "disease." i do not agree it is a disease. he also use the word "mistake," that,do not agree with either for your i think using those words takes response ability off of the individual as far as their own personal circumstances. those words are important the disease, that is connotation that they cannot help it. that isall in mistakes, a connotation that they did not mean to use the drug. i prefer the word choice -- they chose to use it. my nephew is in prison right now because of using heroin, also selling heroin, and the way this all started was he was in the air force -- he was not even in there for 15 months before he was declared disabled. he was diagnosed with schizophrenia. , ands honorably discharged

he was given a check for over $2500 every month. this money was from the air force, he was considered a veteran, even though he never saw combat, and he was also declared disabled. he was using this money every month -- he did not get a job when he got out -- he was using this money to go out into buy heroin for he and his girlfriend. my sister called in, she called the v.a., she tried every way to get them to test him to see that they were on drugs and to stop them from getting this money, so what i would like to see happen, i would like to see anyone who is getting a government check in any form or government assistance to be drug tested areuse if these people using drugs, then there is no way that they are going to be able to go out and get a job because most places now drug test. so if they can't get a job and they are sitting around and getting money from the government and they are using

this money to buy drugs -- and i'm not saying that all people who are getting money from the government are doing this -- but if people have to take a drug test in order to did a job, why should they not have to take a drug test in order to get money from the government? guest: i think the caller makes a lot of very considered points. one of my very first papers when i was an assistant professor at yale before i came here was actually on veteran to use their checks and disability recipients who use their checks to buy drugs, and what can we do to basically use the money, if they are disabled and they do need that money, that is fine, but how can we distribute that -- those benefits to them in a way that helps them rather than reinforces the drug use?

,o we came up with some ideas and actually social security does this, it is called representative payees, where the check goes to somebody else. that actually is a problem. it you do not want to deprive people of support if they needed, but you want to make sure they are not using it to make themselves worse. another point she makes, which is a good one, which is the word "disease," and i do think it is problematic. this puts me probably at odds with others in my field. what i am referring to is the fact that when most people hear the word "disease," they think something is involuntary, that a person has absolutely no choice at all. and while it is certainly true that no one wants to -- as they say, "no one wants to become an addict," i agree with that, but that is what they

want. they want to feel better in the short term. a craving foreel drugs, and that is a very real biologicallye driven, if you will, but that craving pushes them. but it does not commandeer them. they also want to feel better in the short term, and when you read addiction memoirs, when you talk to individuals with this problem, you can understand why they want to feel better in the short term. from next we have a call denton, texas, jim, calling in only all others line. good morning, jim. caller: actually, i was involved in the development of the transdermal delivery system, the fentanyl product that was working with the transdermal delivery system. what i want to say is these overdose deaths are directly a

product of government's --ervention in patients particularly chronic pain patients. these people have found their costs go from $700,000 a year to treat their law chronic pain, probably spinal, back pain, and notice tends to -- tens of thousands of dollars a year. especially those without good insurance, the they no longer have access to a health care system, so they go out side into the illicit market. and sentinelnyl, ntanyl analogues, deathstrack the overdose of these drugs, you will see a direct correlation, a cause and effect, of government then thesen and

drugs coming into the illicit market and people, whether they are self treating actual pain that they used to be able to afford to have treated by trained medical professionals, and they can no longer afford it. is all self-inflicted, driven by our change in policy, because politicians would rather go after these simple things than address more serious concerns. that is where i wanted to say. thank you. guest: you do bring up an interesting paradox, which is that the more doctors become alert to generous prescribing, the more we enforce prescription monitoring program so doctors can see who has gotten prescriptions, if they have gotten them from several places, if they are dr. shopping

, these kinds of things -- the state of new jersey is considering passing a law that would determine how big of a prescription a doctor can give in an initia visit. i think there should be surveillance, however, there are legitimate pain patients who do need these medications and take them responsibly, and they are very nervous that something is going to happen to make it more difficult for them to get their medication, and already we are seeing examples of adware thatcians who -- of where physicians who have treated a patient for years, now the physicians are pulling back. now is that the average patient going to a drug dealer for heroin? there is a high bar for that. but then you have somebody in

more pain, and that is a bad outcome as well. host: the last call for this segment comes from david. he is in missouri and has been affected by all of this.house so, david ? caller: hello. a youngeri was man, i was into major accidents together. crushed him and then eight month later, i had my hammer, and ith a lost my left doctors. i've been on opiates. on 300 milligrams at least of oxycontin a day. if scared right now because this happened to be taken away from me, there is only one alternative to that, and that because i am in very serious pain constantly.

that is my concern. i have never used street drugs in my life. i never even knew of a pain pill before i got hurt. this started coming up, it is really scary because if i lose my doctor, which he is an elderly doctor, i don't know what my options would be except death. guest: wow. what we haveechoes been talking about, that there is fear among people who take these medications legitimately. that is one of many lessons of what is going on now is that the pendulum should not swing too far to the other side. arguably in the early 1990's, doctors were becoming more aware of treating nonmalignant pain, that is noncancer pain.

i think there was something to that. there is a movement to be more attentive to patients with different kind of pain. that ended up contribute into the problem that we have now, and i worry that we might go too far in the other direction and end up compromising people who really do need this medication. host: sally satel announcer: c-span's washington journal, live every day with news and politics that influence you. about the rising tensions and david wasserman note will discuss nonpartisan

outcomes from congressional districts at the residential level in and preview the house in 2018. the sure to join "washington journal" and join the discussion. >> monday night on the communicators, a look at the and bloombergsis bna. >> your saying that google look at fcc. google saying that should look at fcc on platforms. i think the threat google posts in particular to innovation