heavy paper with my feet, and i could not get any in killers. i was telling them, i was taking 500 milligrams apiece of tylenol, seven at one time, and my boss was letting me sit down when i could, and i was still going through this. finally, i went to surgery. they fixed my back and i woke up, and i was able to stand up straight, completely, 100%, and walk with no pain. host: that was terry, woodridge illinois, getting your opioidtive of the crisis. as we told you at the top of the show, our show will focus it on how the city and state is dealing with this. the state is maryland, the city of baltimore, and several guests are joining us from the city and an agency known for health care -- known as health care for the homeless. a big problem ini

that community. our first guest joining from the facility in baltimore, dr. commissioner of health in baltimore. we shared some numbers earlier about the city situation, but could you give us your perspective of what baltimore is going through right now with opioid addiction? guest: there is no question that we are at a state of emergency and a public health crisis here in baltimore. last year in 2017, we just got the numbers that there are 761 people in our city who die from overdoses. is major contributor fentanyl. the number of people dying from fentanyl in our city has climbed from 12 in 2013 to nearly 600 last year, which is a 5000% increase. this is terrible.

this is terrifying because these are our community members and family members who are dying. but it is also tragic because we know what works. a scathing order, a blanket prescription 2.5 years ago so that every resident in our city could have asked this to naloxone or narcan -- access to naloxone or narcan. we have saved 600 lives in the past 2.5 years. we are having to ration this life-saving medication, which i do not understand how, in the middle of an emergency, are we having to deprive people of something that can literally save their lives? baltimore, iday in have to decide who gets this life-saving medication and who has to go without. and i see the number of people who are dying at this unprecedented rate. they were not even at the peak of the epidemic. we actually know what works.

question is, do we have the political will? will we commit the resources that we know will be effective to combat this epidemic? to thosen it comes resources, what is the cost factor like for the city of baltimore? how much is getting paid by the city and how much are you receiving as far as help when it comes to the state and federal government? are glad to have partners in the state and federal government who have assisted us at the time of crisis. nearly numbers are not enough, and i will give you an example. starting with naloxone or narcan, the antidote. the discountedt price is $75 for one kid. it is my belief that at the time of a public health epidemic, every single resident in our city needs to carry naloxone in their first aid kit and medicine. $75 timestiply

620,000 residents in our cities, that is $49 million per year just for naloxone. that is more than the city spends on public health in its entirety. it would be ludicrous to say that the city alone should shoulder or could even begin to shoulder this burden, not just for naloxone, but not to mention increase access to treatment. we know that addiction is a disease. we have to have long-term treatment available as well. lotave the city have done a in this regard. we started a stabilization center, which is the beginning er. 24/7 we are working with our hospitals to increase treatment within the four walls of a hospital within our health care system, but those funds have to come from somewhere, and those needs to be sustainable in nature. we cannot have one off funding for a year or two from congress, because we are talking about establishing clinical

infrastructure. that is why we are so much in favor of a care act that was introduced by congressman elijah cummings and senator elizabeth warren, who will be it.ng here to speak about it is direct funding to local jurisdictions like ours that are the most impacted. thes proportional to severity of this epidemic, and now we do not have to rely on one off funding. thatis similar to the act at the peak of hiv-aids epidemic, people said similar things. people were dying at record numbers. however, there is a solution. there is evidence that we can turn the tide, and that is what we are seeing on the front lines. we know what works. everything we can

in baltimore. we just need the resources and the will to scale up the successful evidence-based intervention have already started here, and we need the assistance not only of the city, we in the city are doing so much on a shoestring budget, we need the assistance of the state and we critically needed assistance of the federal government. president trump has declared a state of public health emergency. we need to now see the resources that follow that declaration. is with us until about 8:00. if you want to ask her questions about the perspective she brings is the city's health ifmissioner, (202) 748-8000 you are impacted by opioid and want to give your perspective. (202) 748-8001 for residents in maryland. (202) 748-8002 for all others. before we go to calls, dr. wen, talk about the prescribing side. a lot of people start with prescription painkillers. what is your opinion on the prescribing of opioids and the role you play in curbing of that -- curbing that?

guest: there is a role i play as a physician as to help stop the over describing -- overprescribing. but we need to be honest and admit that doctors are part of the problem. things that i and my fellow health professionals have done unwittingly. when i first started medical school, when i was in my medical training, opioids are what you prescribed to take away something pain -- someone's pain. of the misleading, false, and knowingly inaccurate information by drug companies. this is seriously culpable in getting to where we are. supply side,that the overprescribing side, is one piece of it. we need to work on it. the cdc has come out with guidelines for some more

judicious, more careful prescribing by doctors. we need for patients also to step up and say, there is a pain or pill for everything in our culture, and we can all change this together. just onely side is piece of it. there is also the demand side. according to the surgeon general's report two years ago, only one in 10 people with the addiction are able to get the help they need. which means that as long as there are all these people who have addictionassistance, that g to continue to fuel supply. now, every physician should be able to treat addiction just as we do any other illness. imagine if there were a state of emergency around any other illness. we would absolutely have to learn how to treat it. so it is not only recognizing the supply side, we are critically working on the demand side.

we are working with health systems and primary care doctors so -- my goal is that any patient can walk into their doctor's office and have their disease of addiction treated the same way as if they had heart disease or diabetes, because that is what addiction is. it is a disease. treatment exists, and millions of people around the country are in long-term recovery to illustrate that recovery is possible and it is possible to reclaim the lives of people in communities. host: our guest is the commissioner of health for the city of baltimore. before that, she was director of care in -- at george washington university. is fromt call tallahassee, florida. go ahead with your question or comment. in 2015, i was rear-ended in an automobile accident. and i had terrible pain in my back. nothing worked. except tram at all.

is that can -- tramedol. is that considered an opioid, number one? took that as prescribed, and i still have five tablets left from 2015. my question is, why are people taking these pills by the handful? it fore hurting everybody who wants to legitimately take medicine for pain. i am tired of the minority ruling it for the majority of people who need this kind of medication. as i said, i think it is similar to opioids. pain and iood for my think the problem is people that are willing to take four and five of these tablets at a time. host: thank you. dr. wen? guest: you bring up a really important point, and one that i

and our entire profession of medicine and public health really struggle with, which is that opioids do good work. there are people who need opioids for all types of reasons, and these opioids would fentanyl,rphine, oxycontin. opioidse many types of that are there, and they are legitimate and very appropriate uses for them. individuals with chronic pain, cancer pain. opioids for quality of life. there are other -- acute uses of pain. if someone is in a car accident or recovering from surgery, you might need these opioids to recover. it is challenging, because what we want to do, the last thing we want to do is to hurt people who legitimately need opioids, because there are real medical uses for them. we also note that the pendulum has swung far in the opposite direction. according to the cdc, there are over 230 million prescriptions is opioids every year, which

enough for every adult american to have their own bottle of opioids. are americans really in that much pain? i recently, as a patient, i gave birth 11 months ago. i have an 11-month-old son. when i was discharged from the hospital, after having a routine, unconjugated delivery, -- uncomplicated delivery, i was given a prescription for percocet. i was even quite a few days of percocet. i asked my practitioner, why am i receiving this? i did not have any opioids in the hospital, where my required than when i leave? he said well, this is standard medical practice. they are not doing it in order to get meat addicted -- get me addicted to intel's. -- painkillers. it is for my convenience. they are thinking well, if you are in pain later you do not have to come back and ask for help.

but this is -- we need to do two things. first, physicians have to be more careful about general prescribing of opioids. we need to be asking questions ourselves about what is the standard practice? we need to look at the new guidelines that have come out so we are doing the right things that are evidence-based for our patients. also, patients have to ask the questions as well. there are some patients who need to be on long-term pain is veryon for that appropriate, but many other patients are being prescribed opioids may not need them. , what isions asked are this for? do i need these opioids or is there an alternative? what happens if i do not take this medication? what happens if i just do watchful waiting? i think in this country, our physicians and medical practitioners need to become better about non-medication, non-opioid methods of pain management, and this is

something that we as a research community, medical community, and public health community all need to work towards. host: stephen in maryland, you're next. caller: i have a couple things. the first is a question for dr. wen. as i have been trying to help a family member who is struggling with a heroin addiction, i have what sorts ofrch strategies work best, strategies for treatment. what i found, to my surprise, is that there is a plethora of information available. things -- research things, it is not too difficult, but i have never seen a a 12 stepe study of program versus a maintenance drug program that uses suboxone or some therapy. i wonder if you could direct listeners to something like that, if it exists, a

large-scale type study. the other thing is more of a suggestion. i really wish that the ability for addicts to have access to maintenance drugs would be increased. think that suboxone, based on my reading of this, is very from a thing and allows people to get to a point of stability -- promising and allows people to get to a point of stability were they are either able to get off it, or they stay off it and are not overdosing. and people by and large, and maybe you can correct me on this, are not typically overdosing on both, as i understand it. it is usually iv drugs. could you speak to that as well? host: thank you, stephen. dr. wen? guest: i am glad that you brought up with a point about treatment, because this is so important. every single major medical society agrees on standard treatment for diseases

addiction. there is substance abuse disorder for those that are heroin, suboxone, oxycontin, etc.. the treatment that is evident space and endorsed by every medical organization is threefold. it is medication, social counseling, and wraparound treatment. this is medication assist in .reatment -- assisted treatment there are three fda approved medications for opioid use disorder, methadone, suboxone, and now tracks on -- the patrol -- vivitrol . all three are fda approved and all three should be available to patients who need them without insurance companies, so no authorization or duration limits. it is the same thing we wouldald all three should be available to patients who need them -

-- -- do better with another. we need to have all forms available so that we do what is best. stephen also mentioned another point about these medications, which is that, he alluded to this, there is a stigma surrounding the idea of medication assisted treatment. secretary of health and human services tom price, for example, made the comment that medication assisted treatment is "substituting one drug with another." that's offensive and scientifically not true. assisteddication treatment is the gold standard for opioid abuse disorder. it reduces mortality and overdose deaths, it reduces other illness. it also reduces the chance of relapse and of crime in a neighborhood. if you think about the analogy to any other illness, would you ever say to somebody who has diabetes, would you say oh, you have been on insulin for 30

days. that is long enough. you should quit. many patients require insulin for lifetime, and many patients require medication that assist with their recovery from addiction for a lifetime. that is the scientific fact evidence, and that is what we should have. more thing, i hope that all the listeners on your program, pedro, will help us with changing our language. studies have shown that when you refer to people as addicts instead of people with addiction or patients with a disease of addiction, there is a difference in perception. and now that there is overwhelming evidence that addiction is a chronic brain disease, i hope we can all change our language. theformer director of officer of nash -- the office of national drug control policy, a person in recovery himself, often likes to say, if i am clean it now, what was i before?

for an illness that is so stigmatized, it is important that we talk about what is the right language to use, in particular in reference to andes that are evidence science-based? 's a medication assisted treatment ishen. treatmention assisted is the gold standard in the treatment of addiction. from twitter,on why wait for a federal handout? relocate local and state funds and seek reimbursement later. guest: this is an emergency. imagine if this were ebola. imagine there were 115, 120 .eople a day dying from ebola in the time we are here, dozens of people will die around the country from ebola.

could you imagine that cities and states alone would take care of it? we would never do that, because cities and states are not able to with the resources they have. talking about -- and congress been elijah cummings, who will be speaking later on, something he often says, we should not be referring to the cost of intervention, we should be talking about the cost of doing nothing. at the moment, opioid use disorder addiction costs our country $600 billion, 600 billion, with a b, dollars. incarceration, lost economic opportunity, in families and communities around the country. what if we reinvested that so they lives and allow people -- so we could save lives and allow people to continue the treatment they wish to continue, and do what is right? i do not want to look back in years to combat my child, at our grant -- to calm at my child, my

grandchild, and say they're dying in record numbers. we know it is working, but we need the assistance of the federal government to help us get there. naloxone is a perfect example of this. why is a generic medication available by the pennies in other countries cost $75 per dose, per kit for us in baltimore city? this is something that requires the assistance of the federal government. we in the city and the states have already negotiated. this is the best we can do for a negotiated price, but there is something the federal government could do to negotiate directly with the manufacturers of naloxone, so we can get this life-saving medication in the middle of an emergency. that is a federal issue. not a state and local issue. i hope that all of us can request this of the trump administration and say, if you have declared this as a state of emergency, president trump, please, please give us the resources in the way that we need.

we are on the front lines. we know what is working. we need your help so that we can save the lives of our fellow residents and citizens. as the declaration of emergency, we on the front lines have seen no difference in baltimore. seen no difference, no change at all. what is the declaration for and how can we answer the call, and how can we even look at the future generations to come if we are not committing the resources and the political will in order to save lives? caller's donald, in san antonio, texas. go ahead. caller: [inaudible] i understand that -- my question is, i hear people saying cocaine abuse. can you explain the difference? with opioid abuse, it is really hard to save these people, and the majority of these people, they are not from the minority communities.

so explain to me the difference between cocaine abuse and opioid abuse? host: thanks, donald. go ahead, dr. wen. guest: opioids are some of the most addictive substances out there. the name opioid is derived from poppyseed, and again, it is an extremely addictive substance. many individuals who have the disease of addiction in opioids, they also use other substances. they might use alcohol, benzodiazepine, and they might use cocaine. ok and can also be an addictive substance when mixed in with opioids. -- cocaine can also be an addictive substance when mixed in with opioids. we are seeing an increase in people dying from both cocaine and fentanyl. because fentanyl is now being mixed in with cocaine and causing a record number of overdose. that is the medical side. but i want to address something else that you alluded to, which

is about the racial injustice, if you will. here in baltimore, i hear this a lot. why is it that in our city, we have had the cocaine epidemic, the crack epidemic on the heroin epidemic, and their record numbers of people dying at that time as well. but why is it now a state of emergency? president and governor declaring a state of emergency when people have been dying of overdose in our city for decades? i think it needs to be said, that when it was black and brown people who are poor in inner cities who are dying, addiction was seen as a choice. a moral failing. people who have been incarcerated or dead, it was their fault. now -- and it is true that there is still a face of addiction, and we are recognizing it as white people in suburbs who are wealthy, who are dying.

now addiction as seen as a disease. i have no question at all that there is a lot more that we have to do. there is still so much stigma and we have to recognize the truth based on science, that addiction is a disease. but to begin treatment, to begin the resources, we also have to to critically address this underlying issue, which is the structural racism and the legacy of inequities and disparities that have gotten us to where we are. in effect, we owe an apology to generations of minorities and communities that have been decimated because of our so-called and failed war on drug policies. host: one more call, from alexandra in virginia. go ahead. caller: good morning, and thank you for c-span, for everything, or, fornk you, doct

addressing those questions. i want to say i am 29 years old and i know 15 people off the top of my head, whether they were friends or acquaintances, who are or were dealing with opioid addiction. of the 15, 6 of them have died. ,hey are all generally my age and now it has gotten to the point where, i am wondering who is next? it is really not a surprise anymore when somebody in my neighborhood or in my area overdoses or dies because of opioid addiction. that's all. host: thanks, alexander. dr. wen, final thoughts? guest: alexandra is the story and what you shared -- alexandra's story and what you shared is what i hear across baltimore. people are dying in record numbers. they are dying in part because fentanyl is everywhere. it is mixed with cocaine, prescription drugs, heroin, and

people who are using drugs and not able to access treatment are now dying at record rates. i think this is a call to action for all of us. we on the front lines, based on science and based on what we are seeing right here in baltimore, we know what works. we have programs that are proven to be effective and based on science. we have done a lot here in baltimore with we need more assistance. we need the ryan white act. this is a solvable problem. usope everyone will join saying this is affecting all of us. this affects every single one of our communities. these are not random people who are dying. these are our family members. our friends. our community members. resources tommit fighting addiction. host: the commissioner of health

for baltimore city's health department. our first guest of many talking about the opioid crisis. we have learned about the city's perspective. now we're going to get a statewide perspective. clay stamp with the maryland operational command center. elijah cummings joining us talk about his legislative efforts for more money to cities and states for the opioid crisis. we want to thank an organization known as health care for the homeless for hosting our c-span cameras and guests today, treating those with opioid addictions. he spoke about, his message to washington toward treating addicts. >> one message is public policy matters. expansion, medicaid

the percentage of our clients that health care for the homeless that gained access to care skyrocketed. in 201330 percent of those we serve every year had access to insurance. by 2014, 90% did. anddiately gained access primary services here, access to specialty services they needed. very transformative. organizationd our to focus as much attention on the housing that can stabilize our population and improve their health. we need to not think of treatment for specific diseases in isolation. we need to provide care in a whole person way. reality we applaud the that at every level of

government, federal, state, local, we are talking about opioid addiction as a public health crisis, as a health care issue. for decades we have talked about it as a moral failing. we have enforced laws disproportionately that have had a devastating effect on communities of color especially. multiple decades we have had a population that has been locked up. now they are locked out of the services they need. saddled with criminal records that make them ineligible for housing assistance or financial assistance, if that is available to them. we need to, recognizing now and going forward, opioid addiction is a public health crisis that demands a health care approach.

we have to undo the harm public policy has caused over multiple decades. so we can get people the treatment they need, and help people integrate back into mainstream. we think kevin and health care for the homeless for hosting our cameras as we continue our conversation on the opioid crisis. joining us now, the executive director of maryland opioid command center. guest: good morning. host: tell us about the organization you lead, particularly its role in the opioid crisis in the state. guest: the governor in maryland recognized when he took office he was told by folks all over the state of maryland communities were being ripped apart by this opioid crisis. he engaged the lieutenant governor, came up with

recommendations, and nothing was denting the crisis gripping families apart. he activated the emergency response system in maryland using the national response framework. that organizational system that we have in this country to coordinate emergencies would work well in this crisis, meaning we needed to get the right people in the room to develop a balanced strategy and push toward a high level. the operational command center is a platform where state .gencies it is designed educate and share information in support of our local jurisdictions. there are local coordinating bodies led by the health officer in erg