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with chris mcgreal. his new book, joining us by skype. good morning. you open this story of the american opioid crisis in williamson, west virginia. wyden and why there? guest: one of the things that was most striking to me and my book came out of my report for the guardian, and i talking to people in west virginia which is really a crucible of opioid epidemic and it has by far the highest overdose rates in the country, but one of the things that was really striking to me was that a number of people i spoke to the talked about how they were drawn into addiction through prescribing in the late 1990's and early 2000. i was really struck by the fact that this was an epidemic that

had begun under bill clinton's presidency and had run through george bush, george w. bush, and here we were finally at the end of the obama presidency and into the trump presidency before it was able to get the kind of national attention that it needed. i decided to go back and look at where it began. reallyrginia of thelated a whole lot epidemic, but one of them was the beginning of the prescribing of these very powerful drugs for routine pain. which helped to draw people into addiction, but the other reason itlook at williamson was became not only an area in its own right where there were very -- a lot of people became hooked on these drugs, but it became a distribution center for a whole part of apple galati -- appalac

hia and beyond. you see the establishment of one of the biggest pill mills in the country, and that came over individual, henry benson, who was an undertaker. he had come out of prison and he had been imprisoned serving four a gay escortning agency in washington dc busted by the secret service and federal government. he was sent back to williamson by his parole officer nbc's a business opportunity in setting up a group of doctors in an industrial warehouse as a technically pain clinic this -- prescribing drugs to just about anybody who wanted them provided they can slap down the cash. eou see williamson become r to forly the place to go

a while, for a decade, doctors in this pill williamson medicine it was called, prescribing thousands of prescriptions a day. overdose" is the name of the book. you are a british reporter for "the guardian" newspaper. how is this a uniquely american crisis as you described it? guest: one, it is the scale. there is nowhere else in the world that we are seeing the scale of death that we have seen over the past 20 years. numbers, no one really knows the numbers because particularly opioids, deaths from were often not recorded because of stigma or because they were not recognized. says at least 350,000 people dead. the real figure is probably higher.

you're not seeing that in any other country, but the other thing that makes this unique is how it became about. ans is not the result of accident, it was described by a former head of the fda is one of the greatest mistakes in modern american medicine. but it really is not the mistake. theas a strategy by pharmaceutical industry to up -- co-oped medical practice and ensure that these opioid pills became the first stop for treatment. they were very effective in that. ony actually managed to get board not only medical institutions, but they got on board regulators like the fda, they got on board the hospitals, state medical bodies,

and the medical p in -- profession in a big way. that comes out in the fact that in the united states, medicine is an industry. in other countries, it is a service. run publicly are very strictly controlled by public bodies. in the united states, it is an industry and really, i think that is what this opioid epidemic was driven by. we are talking about the opioid crisis in america, we usually have phone lines and set up. if you have been impacted by the opioid crisis, (202) 748-8000 is a number, and all others, (202) 748-8001. we are talking with chris mcgreal about his new book "american overdose: the overdose -- opioid tragedy in three acts." this from the washington times,

this chart showing the deaths from opioid overdoses since 2017. up from 2000. can you put the overall numbers in perspective over the decades that you study this crisis. guest: they run into the hundreds of thousands. and for most of that time at least for the first 15 years, the single largest numbers were from prescription opioids directly. in the past five or six years, we have seen that change with the rise of deaths from heroin and that has largely been driven by the fact that people have that out the awareness mass prescribing is filtered through the medical profession and there has been a great hesitation, and even some political control on prescribing in some states. towards seen a shift

heroin simply because it was available and not because it was cheaper. time, prescription drugs were an easier option. and we have seen the rise of fentanyl and as been introduced but morethen heroin, recently, there is a lot of people using it directly at or without their knowledge. opioidbeen used to fake pills and prescription pills. about are in a situation -- it is estimated that in 2018, about 50,000 people would have died from opioids, and half of 15,000,ll be fentanyl, , and the thing about those numbers is although

fentanyl has become a very large number, the number of people dying from prescription opioids has not dropped very specifically, a adjustment overtaken. to showe of their chart ,ou from "the washington times" this map showing the opioid epidemic across america. this is drug overdose rates in each state per hundred thousand residents and you can see the epicenter in west virginia. drug overdoses per 100,000 residents in that state. andsylvania with 44.3 elsewhere. taking your calls this morning as a talk about the opioid crisis in america. those impacted by opioid and all others. kevin is on the line from indiana. caller: hi, good morning.

i just had three died throughout the years. soe are high school friends i've always kind of been impacted by and paying attention to it. and seen how old it affects people. i do not know if it is so much an epidemic or an enforcement issue. like i got involved with some local police officers and they went out and started arresting people in the sheriff tells them to slow down because they are all afraid of the gang members and ms-13 and the mexican mafia coming back and getting them for arresting people that are selling drugs. so i do not know if we will ever have a solution, but until we stop the supply and have the right stuff for our cops to do their job, i do not think this

will ever go away. host: kevin, thank you for your call. chris mcgreal, your thoughts? guest: i think there are two things going on here. undoubtedly this has now taken on a criminal element, particularly with the rise of heroin and fentanyl. that is a lawn forstmann, that is true. but what has driven this and what has created this, and the reason it is an american instead of a global epidemic is the mass prescribing that has taken place in the united states. you have two things with that. you have the people, because they were prescribed these drugs for relatively low levels of pain or for long periods when they should not have been, or they were prescribed in large doses, you have seen significant numbers of people become dependent on these drugs, even hooked on them, and then they seek to top up because they

cannot get everything from prescriptions, on the black market, or their doctors cut back because they are concerned about signs of addiction. you have the mass prescribing driving and although prescribing has fallen from about 20% from its peak, you still have very large numbers of prescriptions being written in this country, so you are still drawing more people into addiction. but then yes, you do have the criminal element, you do have the smuggling of heroin and fentanyl across the border. i just spent the month in huntington, west virginia, which has been of the worst hit cities one in the country, and they have been quite effective in bringing down overdose rates, in part through law enforcement. there are a lot of other elements to it, including on cutting back on the prescribing, but giving people who are addicted to these drugs access

to treatment and breaking down the stigma around drug addiction. i think that is one of the biggest issues around getting help to people who really need it, many of whom don't become addicted because they began by experimenting with the drug. that is to say they took these drugs as they were prescribed for them. book, thetitle of the opioid tragedy in three acts, the fact that you went through those, is that the three acts that you talk about? guest: essentially, i look at the origins of this epidemic, which is as i described to you, but one of the things in the researching of the book and why this has gone on for two decades now is you wonder where the alarm bells are being rung. why was this allowed to drag on for so long? where were the early warnings about this?

one of the things that became quite apparent, there were quite a lot of doctors out there who were deeply concerned in the -- disturbed in the very first years of this epidemic, they saw the signs. i will give you an example of one, dr. jane valentine, head of pain management at harvard university and its associated hospital. she bought into the idea that patients needed these drugs, the wereource -- the drugs safe, but they were not addictive, and that there was a stigma against them that needed to be broken down, and they can be used for all kinds of treatment and pain, and then she began to see over many years in her patients that many of them were becoming dependent, addicted, but above all, she was

seeing long-term opioid prescribing was not working for many of her patients. they were still in pain, they just needed more and more drugs. and she was also hearing from their families that they were not the people that they were, that their personalities have changed, that they were constantly in pursuit of these drugs, they were spending a lot of time and money on them, and she wrote a study in the new england journal of medicine in 2003, which really should have caused the industry and the regulators to pause and say to themselves well maybe these , drugs are not what they are promised to be. and she expected that would have a real impact, and it did not. there were other doctors who found the same thing. a doctor called charles lucas who was a surgeon, a detroit general, and he was saying the same thing.

patients after surgery who were given large dosages of pain killers were starting to die, and he wrote a study about that. what you see happen in the early years of the epidemic is instead of the conversation being about whether these drugs are the "right thing" to be prescribing for most people, even though there are definitely people who need them, the industry is able to shift the conversation to paint the people that become addicted as abusers, to blame the victims, in essence, and to say look, we have these abusers, they should not be allowed to take the drugs away from the innocent patients who need them, and these were the same people who had begun prescriptions and then become addicted, but the industry successfully termed these into the goodies and baddies.

for many years, this is in essence to keep the doors open to mass prescribing and keep selling the drugs, and this keeps going until really about 2010, 2011, when finally the cdc stands up and says we have an epidemic on our hands. host: a lot of folks waiting to chat with you, especially those who have been impacted by the open your crisis. hayes is next. go ahead. caller: this is one of the biggest frauds that have been perpetrated on people, the opioid epidemic. i am in my 70's, suffering from colon cancer. i have to go to the doctor every month. you are subjected to urine tests, blood tests to see if you have them in your blood stream. i have never had a problem. i took less drugs before all of the laws took into effect because i have to keep them in

may now or i will be cut off. i have a legitimate thing. we militarize our police force and everything, people are treated like animals, if you have to have a pain pill at all. you show these certainly areas like west virginia, but the reason that is the people have , been cut off, and they set up pain clinics and they draw and people from miles around. because they are done without it. i've seen drug addicts. they were the same people that i knew back in the 1960's that went out after every drug that they could get a hold of them. host: got your point. mr. mcgreal, your thoughts on that. exactly the kind of person that needs these kinds of drugs. they are designed for people who actually have cancer. the medical profession still is

not really in charge of pain medicine management. it is still controlled by the the industry and the politics now because of this epidemic. if you look at how opioids came to kind of be mass prescribed in america, because there had previously been an epidemic after the civil war and into the early 20th century, there was a crackdown in this country on the use of opioids. that continues for 50 years until you see the hospice movement emerge in the u.k., and they use the end-of-life, and that comes to america. there is a group of doctors that say if you can use them at end-of-life care, why can't we use them for all pain patients? i think hayes is the exact person who should be given them and given them according to what

his doctor thinks he needs. but i would disagree that this is just about the police. this epidemic has been rising for 15, 20 years long before the , police got involved. it is clear this was a pain management issue. it was driven by an industry that wanted to sell drugs. it has not been artificially created by law enforcement. host: alex is in virginia, also impacted by the opioid crisis. go ahead. caller: yeah, good morning. thank you for having this discussion on c-span. yeah, so about the opioid epidemic and everything, i have been personally affected. i am only 22 years old, and i have had a couple of friends passed away this year. they are my same age and everything. because of drug overdoses. i just kind of want people to understand that it is not only happening in these rural areas in america, but it is also happening in wealthier areas,

too, like in fairfax county, one of the richest counties in the united states, there is an extreme drug problem here. and i think that the younger generations, like the one that i belong to, are moving more towards diazepam as well, like xanax, in terms of the actual clinical name. i just want people to kind of understand that it is not only happening in the room america -- rural america but also in wealthier areas. host: alex, got your point. chris mcgreal. guest: alex is exactly right. you see the cbc has a map, and you see the beginnings of the epidemic in the mid-1990's in the area of appalachia that i talked about, is virginia, kentucky, and it is a red dot. it grows and gets deeper and deeper and it spreads across

that park, that region of the country, and then the red dots pop up everywhere else. by the mid-2000's, partly because mass prescribing meds -- meant very large numbers of pills going to people, whether they needed them or not, it is not just the number of people that were getting these drugs, it was also that when they were prescribed perhaps for two or three days worth of treatment, they got 30 days' worth of pills. they were left in the medicine cabinet. a couple of things that happen. one, they simply got passed around within the family. these are good pain pills, why don't you take one? or you have other people in the family, perhaps younger people, who start to experiment with their parents' drug supply. but the scale of the prescribing, not only the number of people, but the number of

pills given out with each prescription, meant that a lot of these pills were floating around. alex is exactly right. you see that in a lot of communities in very well-to-do communities but pretty much across the country. and so by the mid-2000's, it really has become a national epidemic. host: fort worth, texas is next, james. caller: yes, good morning. i suffered a spinal cord injury that left me 100% disabled and in a wheelchair. i had been addicted to morphine while in the military and being treated for an injury there. i had a little experience with it. so i do not take opioids. and of course when i was in surgery, because i have a back full of titanium, a column full of titanium, under surgery i took it.

but i found that i do not have to have opiates. i have not taken them in years. i found that herbal meditations, medicine, and a little will will do it. i think it is a scam. we pay the highest price for drugs in the free world, and we have pharmaceutical companies doing the same thing that tobacco campaigns are doing. thingk it is a horrible and it is an unpatriotic way to treat the american citizen. my answer is i have suffered as much pain as any human being can suffer, and i find that i can get by. i am not out of pain, but i am not a junkie walking around with my tongue hanging out. host: chris mcgreal. guest: yeah, i mean, it is interesting to hear that. one of the things, when you look at how the epidemic evolved, one of the things the drug companies do is they studiously avoid any

in-depth study on whether these drugs are effective long-term and what the long-term consequences are. they do no clinical trials. they are not really interested in that. they push the idea of pain at -- as a fifth vital sign. the concept behind that is your heart rate, your blood pressure, and they can all be measured. pain -- the drug companies push the idea that you should also have to address pain, doctors should also have to address pain. to give you an example, one of the areas they pushed it, a body called the joint commission. in essence, it licenses the country's hospitals. the hospitals need those licenses in order to get federal funding, and the joint

commission essentially got into a financial relationship with various drug companies that saw it heading up regulations that require doctors to treat pain as a priority issue. the drug companies end up writing the manuals for the doctors. it is one of the reasons that you see those smiley faces and hospitals and clinics. 10, those are result of the joint commission requiring doctors to address pain, and a right to manuals for the doctors, in effect. the makers of oxycontin wrote those manuals, the drug producers distributed them. they all pushed of opioids as the answer. there is not really talk about the alternatives other means of , dealing with pain, whether it is dealing with it through

physical therapy, dealing with stress, or other kinds of medicine. that is partly about selling pain pills, but it is also because other parts of the industry have an interest in that as well. the insurance companies looked at the pills of a cheap alternative to, say, physical therapy. doctors came under enormous pressure to prescribe from the hospitals, which wanted to keep the joint commission happy patients, who saw this as a way , -- as an easy way to go, and insurance companies, which saw the opioid prescriptions as a cheap option. along with that, the medical industry also bear some responsibility because it pushed on the medical profession and pushed the idea that people can live pain-free. i think, as we just heard, particularly when you're older or your injured, a lot of

doctors will tell you, you cannot live pain-free, you have to find ways to manage pain, but pills are promise of living pill-free, in a country which is now a "pill for every ill" mentality. host: in your book, "american overdose," you talk about a "lost decade, the years between the unequivocal warnings from those grappling with the early impact of mass prescribing of opioids and the cdc stepping up to the plate, in which the epidemic could have been contained and hundreds of thousands of lives saved." when was that lost decade? guest: from the early 2000's, when doctors like jane valentine were giving her warnings enter journal of medicine article appears, and the now former head or then head of the cdc, dr. tom friedman and -- in 2011. there is an epidemic in this country.

those years, that decade of the 2000's really was the decade where the epidemic could have not only been reined in but actually prevented. if those early warnings had been heard and if the industry had not so effectively, by co-opting, not only congress, because it pays money in lobbying and campaign contributions, but also, to be honest, regulators like the fda, which essentially was compromised by its relationship with the industry. in that decade, i think you see a missed opportunity to assess the effect of these drugs and to rein in the sheer scale of the prescribing. host: let's go to bluefield, west virginia. kelly is waiting. good morning. caller: good morning. i know that prescription drugs are, as he stated, a smaller

problem than the ones that drug dealers are pushing on people, but now there is a push in this country that the drug dealer gets the first time, a smack on the hands, because we do not want to put them in prison, but they are forgetting the lives that they may have killed or put people into situations that they cannot get out of, and instead of just giving them a smack on the hand, we really need to look at it and say hey, you push these drugs, you may have been doing it for years, even if it is the first time you got caught. to me, it should be, hey you are , going on trial for murder, because that is probably what you have done, you have probably killed people. to me, there should not be a

push in this country to let people off with a smack on the hand. if you made it stiffer, maybe they would think twice before pushing those drugs on the american people. host: mr. mcgreal. guest: there are states now which are pushing the idea of a murder charge for people who distribute drugs, particularly fentanyl, where it can be shown that they knew it was fentanyl and it leads to an overdose death. there are law enforcement issues simply, and somewhere like west virginia, i was speaking to the police chief in huntington, they do not have the resources to lock everybody up. there is a distinction to be drawn between those people who are dealing because they are also users and they are addicted and they have been , driven down a path that perhaps they would not have chosen to go down, and those who are purely doing it for money. obviously i think the nature of prosecution would probably be different in those cases.

also, doctors prescribing on a very grand scale. those doctors i talked about at the warehouse in the pill mill in williamson, west virginia. one of them, dr. katherine -- katherine hoover, was prescribing more pills in the 2000's in west virginia's biggest hospital. one of her fellow doctors, dr. diane shafer, was prescribing much less than that, and diane went to prison for only six months. is a feeling among law enforcement people that a lot of doctors of got offer really lightly as well as the street doctors. and there is some sympathy as well, actually, from some of the some of theses people did not have the opportunity, that they got dragged into this, whereas doctors who were involved in this had every opportunity and privilege in life, and yet they still chose to go down this path

just out of pure greed. host: a few minutes left with chris mcgreal, author of "american overdose: the opioid tragedy in three acts." taking your calls this morning. sandra, eastpointe, michigan on the line for those who have been impacted by the opioid crisis. go ahead. caller: yes, hello. i now have -- 50 years, and she has severe osteoporosis of the spine, and she cannot even stand up straight anymore. breast implants that were hardened, and they wanted to do a double mastectomy, she had been taking pain medication for eight years. she takes the same amount that she did eight years ago. it does not take away all of the pain, but it makes it bearable so she can stand it. so people like this guest, they have no clue what real pain is

like. no clue at all. my neighbor, she has a friend that was on pain medication. he had a problem, too, with his back, and he was taking pain medication for six years. the doctor was afraid to give them to him anymore, and he took him off of his pain medication. within a month, he committed suicide, because he could not stand the pain. there are millions of people that are taking pain medication. you should not have to have cancer -- by the way, my sister-in-law had cancer surgery four months ago. she was sent home with enough pain medication for 10 days. after that, she suffered terribly. so these people who are abusing drugs are hurting people who sincerely need to take them. host: andrea, thank you for telling your family's stories. chris mcgreal, give you a chance to respond. guest: yes, again, i go back to

there are clearly people who need these drugs and there are clearly people that these drugs work for. and that is true in other countries as well. is againens here because the policy, the medical policy has been driven by essentially, greed, it is still not run by the medical profession. we are seeing an overcorrection, a swinging back and the dog seven -- and the doctors have become fearful of prescribing because of the consequences, because of the political climate, because they feel like there might be some sort of sanction against them. many primary health care doctors in this country, the vast majority, get very little training in pain management. they might get two or three days in four years of initial medical training, so actually they have very little information on which to base their decision, frequently.

they do not know very much about how opioids work. they do not know very much about addiction. and frequently, they were getting their information from the drug company's salesperson who were coming in and telling them how these drugs work and how they should prescribe them. the medical profession through the american medical association for a very long time resisted that kind of training. they said it was an inconvenience to doctors. when two members of congress, hal rogers and mary bono, both republicans introduced an act to have trainings to to prescribe opioids the ama , opposed it. i feel very sorry for those people who do need these drugs and who are finding themselves now struggling to get them. profession is really making no decisions and i

, think that is what needs to happen is the medical profession needs to take care of this rather than industry or politicians or anybody else. host: one last call for you, carl, waiting in kansas city, missouri. good morning. caller: good morning. i am calling because i had recently an operation on my hand for what they call trigger finger. and they cut a little slice in my palm, and then i was out of the hospital at the v.a. in a very short time, and they gave me 30 tramadol opioid hills, which i did not take a single one of them. i am fairly educated. i still have them still in the -- sealed in the package, and i talked to the v.a., who said they are good for a year, so if i get a headache or a severe toothache. i do not know what to do with the things. i took a wet wash rag and shaped it to my hand and put it in the freezer.

then on my hands got stiff, i took the drag out and held it in my hand until the swelling went down and i put it back in the freezer until later. the pain is miniscule. this one thing about making pain a diagnostic tool, what they do, they ask me when i go in there for a routine check, do you have any pain? yes, i have pain i am 74 years , old. occasionally i work too much in the backyard and my back goes into a spasm for about a day and , then it goes away. the point i want to make was when they tell you to write your pain between 1 and they are 10, really giving the doctor's responsibility over to the patient, so if you are a drug addict, you are going to say 10, you will get a prescription. if you do not want them, you will say 1. most people can deal with a small amount of pain. i tell you what, they just made it way too easy to get these

drugs. and i am surprised, because, don't get me wrong, the v.a. is great, but i am surprised with them giving me those pills, it really surprised me. host: carl, thank you for the call. mr. mcgreal. guest: the scale in prescribing like i was saying earlier, the people's thatf people get has been a big problem. the cdc came up with a recognition in 2016 saying that for acute pain, which is what you have after an injury or operation, really should not get more than three or five days worth of pills, as that is because after five days, there is a sharply increased risk of addiction. again, it is about the convenience not of the patient, it is of the doctors in this case. the ama had proposed a reduction

in prescribing, because it said it would inconvenience the doctors having a new prescription. the insurance companies do not want the doctors having to deal with the paperwork. it comes back to money, convenience rather than good medical practice. host: final 60 seconds here, how did this book change you, through the process of researching, getting families to tell their stories of addiction? guest: getting people to tell their stories about addiction was not as difficult as i thought it might initially be. for a couple of reasons. one, the people in west virginia that i was talking about are angry. they are angry at what has happened to their communities. these drugs have devastated communities. they feel that they were duped into taking these drugs. doctors did not warn them, they were not protected. you have a lot of people in those communities who take the pain in middle-age, from labor, from down in the mines, from

working in lumber, so i think their communities have been devastated, and they feel duped. the other group of people who have been very open with me are those trying to break down the stigma. their children have become addicted, and they see the stigma, particularly around heroin. their kids may have started taking these drugs because they had sports industry, they end up -- sports injury, they end up on heroin, and they end up dead, and they end up being blamed for the death, by the communities, and, to be honest, by the drug companies. a lot of people are keen to break down that stigma. it is one of, perhaps, the biggest changes over the last two years is the courage of people to come out and talk about what these drugs have done to their communities. host: the book is "american overdose: the opioid tragedy in three acts." the author is a journalist chris mcgreal. appreciate your time on this morning's "washington journal." guest: thank you. ♪ journal"'s "washington

, live every day with news and policy issues that impact you. morning, monday we will open up your calls and take your reactions to the government shutdown in the top news stories of 2018. the sure to watch c-span's "washington journal" and join the discussion. following a lunch with president trump, south carolina senator lindsey graham spoke to reporters outside of the white house about the border wall funding, the government shutdown, and isis. lindsey graham: well, we had a two hour lunch and had a very enjoyable lunch. if anything, he is not a man under sieg