is the people i talked to every single day and my son's legacy. i am a mother on a mission here to represent everyone. congress, newew leaders, watch it all on c-span. host: our "washington journal" authors series concludes with chris mcgreal. 's book is "american overdose -- his book is "american overdose" you were hoping this story of the opioid crisis in west virginia in the mid-1990's, why there and why then? was researching the book, one of the things that was most striking to me, and the book came out of my reporting for the guardian. talking to people in west virginia, which is a crucible of the epidemic and remains its

the sense that it has the highest opioid overdose rates in the country. one of the striking things to me was the number of people i talked to who were drawn to addiction buy prescriptions in the 1990's and early 2000's. this was an epidemic that begun under bill clinton's presidency and had run through george bush, george w. bush and barack obama. here we are -- here we are, finally at the end of the obama presidency and into the trump presidency before it was getting the kind of national attention it needed. to kind of go back and look at where it began, and west virginia really calculated a whole lot of elements of the epidemic but one of them was the prescribing, the beginning of

the prescribing of these very powerful drugs for routine pain which helped draw people in to addiction, but the other reason in particular williamson was it he came not only an area in its own right where there -- were a lot of people became hooked on these drugs but it became a distribution center for a whole part of appalachia and beyond as you see the establishment of one of the biggest pill mills in the anntry, and that came out of individual named henry vincent who was appropriately and undertaker. he had just come out of prison, arving four years are running gay escort agency in washington, d.c. that was busted by the secret service. he was sent back to williamson by his parole officer and he sees a business opportunity in

setting up a group of doctors in an industrial warehouse as technically a pain clinic, prescribing drugs to just about anybody who wanted them, provided they could slap down the cash. become ailliamson place to go to for a while for a decade. williamson wellness as it was called, they would just prescribe thousands of pills every day without really consulting the patients. you paid $150 and got a prescription. host: "american overdose" is the title of the book. you are a british reporter for the guardian newspaper. how is this a uniquely american crisis, as you described it? guest: a couple reasons. one is the scale.

there is nowhere else where you will see the scale of death we have seen over the past 20 years. nobody really knows the numbers because early on, deaths from opioids were not recorded often because of stigma or because they were not recognized. the cdc says at least 350,000 people are dead. the real figure is probably higher. you are not seeing that in any other country. the other thing that makes this unique is how it came about. this isn't the result of an accident. it was described by the former head of the fda as one of the greatest mistakes in modern american medicine. when you get under the skin of it, it really isn't a mistake. it was a strategy by a pharmaceutical industry to co-opt medical practice, particularly in treating pain and ensure these opioid pills

became the first stop for treatment. they were effective in that, they managed to get on board, not only medical institutions on board, regular readers like the food and drug ministration, the regulators and the hospitals. they got on board the medical profession in a big way and i think that comes out of the fact that in the united states, medicine is really an industry. in other developed countries, it is a service that is either run publicly or very strictly controlled by public bodies. in the united states, it is an industry and that is what this opioid epidemic was driven by. host: when we are talking about the opioid crisis in america, we usually have phone lines set up

differently. if you have been impacted by the crisis, (202)-748-8000 is the number to join. all others, (202)-748-8001. we are talking with chris mcgreal about his new book, "american overdose" a minute ago, you were talking about the numbers of this epidemic. this from the washington times. this chart showing the deaths 2000opioid overdoses since into the -- in 2017. you put the overall numbers in perspective over the decades you have studied this crisis. guest: they run into the hundreds of thousands. there is no doubt about that. largest numbers of deaths were from prescription opioids themselves. in the past five or six years,

we have seen that change with the rise of deaths from heroin. that has been largely driven by the fact that people have found that as awareness of the mass prescribing has filtered through the medical profession, there has been a greater hesitation and even some political control on prescribing in some states. we have seen a shift towards heroin seven because it is available and not because it was although for a very long time, prescription drugs were the easiest option and more recently we have seen the rise of fentanyl which is a synthetic opioid that has been introduced initially to strengthen heroin but more particularly, recently there was a lot of people using it directly or without their towledge it has been used fake opioid pills and prescription pills and now we it is a situation where

estimated that in 2018, about 50,000 people had died of opioids and about half of those would be fentanyl and about 15,000 would be heroin and 14,000 would be from prescription opioids. is thing about those numbers the numbers of people dying from prescription opioids has not dropped that significantly. it has just been overtaken by heroin and fentanyl. host: one other chart to show you from the washington times. this map showing the opioid epidemic across america. this is drug overdose rates in each state per 100,000 residents and you can see the epicenter they are in west virginia. 57.8 drug overdoses per 100

residents in that state. ohio with 46.3, pennsylvania with 44.3. chris mcgreal taking your calls as we talk about the open euro crisis in america -- the opioid crisis in america. kevin is on that first line in indiana. go ahead. morning.ood i have had three close friends die throughout the years. some were high school friends and we kind of lost touch after college, so i have always been impacted by it. i am 37 years old and i have seen how it affects people. i don't know if it is so much an epidemic or enforcement issue. it seems like i got involved with some local police officers and they went out and started busting people in the sheriff

tells them to slow down because they are all afraid of the gang members and ms 13 and the mafia coming back and getting them are arresting people that are selling drugs, so i don't know if we have aso i do not know ifr 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 hair when and fentanyl -- heroin and fentanyl. has created us, and the reason it is an american and instead of a global epidemic is the mass prescribing that has taken place in the united states.

you have two things with that. have people who were prescribed these drugs for relatively low levels of pain for long periods when they should not have been, or they were prescribed in large doses. significant number of people become dependent on these drugs, even hooked on them, and then they seek more, because they cannot get everything from prescriptions, on the black market, or their doctors cut back because they are concerned andt signs of addiction, although subscribing 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. have the criminal element, you do have the smuggling of heroin and fentanyl

across the border. just spent- i the month in huntington, west virginia, which is one of the worst hit cities in the country, and they have been quite bringing down overdose rates, in part because of 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 it was prescribed to them. describing 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 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 very first years of this epidemic, they saw the signs. an example ofu one, dr. jane valentine, head of pain management at harvard university and its associated hospital. she brought into the idea that

drugs, theeded these drugs were saying that they were not addictive, that there was a st them that needed to be broken down, and they can be used for all kinds of treatment and pain, and then she over many years in her patients that many of them were becoming dependent, addicted, but above all, she was long-term opioid prescribing was not working for many of our patients. they were still in pain, they just needed more and more drugs. and she was also hearing from 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 as the

toulators to pause and say themselves well, maybe these drugs are not what they are expectedto be, and she 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, thewhat you see happen in early years of the epidemic is instead of the conversation being about whether these dogs are the "right thing" to be prescribing for most people, even though there are definitely people who need the, the industry is able to shift the conversation to paint the people who 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 are the same people who had been offering to patients who get prescriptions and then become addicted, but the industry successfully turned these into the goodies and baddies. to mass open prescribing and keep selling the drugs, and this keeps going 2010, 2011, about when finally the cdc stands up and says we have an epidemic on our hands. host: a lot of people waiting to chat for you, especially those who have been impacted by the open your crisis. hayes is next. go ahead. theer: this is one of

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 your and to see ifod tests they are in your blood stream. i have never had a problem. i took less before all of the lost again to affect,. i have a net legitimate thing. we militarize our police force and everything, people are treated like animals, yet you have to have -- if you have to have a pepain pill at all. the people have been cut off, and they set up pain clinics that come from miles away, because they have done without it. 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. they are not designed for need theseactually drugs, they are designed for the voice 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. cameu look at how opioids 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 cracked out this country on the use of opioids. continues for 50 years until you see the hospital more

emerge in the u.k., and they use the , and they say if you can use them at end-of-life care, why can't we use them for pain management? i think hayes is the exact person who should be given them if it is what his doctor thinks he needs. .ut would disagree this epidemic has been going for 15, 20 years, long before the police got involved. it is clear this was a pain management issue. and 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: yet, good morning. thank you for having this discussion on c-span.

the opioidout epidemic and everything, i have been personally affected herd 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 an 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, our moving more as well, likeam xanax, in terms of the actual i just wante, but

people to kind of understand that it is not only happening in the room america but also in wealthier areas. host: alex, got your point. chris mcgreal. guest: alex is exactly right. the cdc has a map, and you see the beginnings of the epidemic in the mid-1990's in the area of about,hia that i talked is virginia, kentucky, and it is a rend 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. mid-2000's, partly because mass prescribing meds 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 two or three days worth of treatment, they pills,days' worth of

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. 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. it so by the mid-2000's, really has become a national epidemic. host: fort worth, texas is next, james. caller: yes, good morning. . spinal cord injury

that left me 100% disabled and in a wheelchair. morphinen addicted to while in the military and being treated for an injury there. i had a little experience with it. so i do not think opioids -- and of course when i was in surgery, because i have a bagful of column full of titanium, 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 cost for drugs in the free world, world,edly in the entire and we have pharmaceutical companies out there doing the same thing that tobacco companies are doing, intentionally over prescription, and they pay off doctors to prescribe it. it is a horrible thing. 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 involve inv, one of the things the drug companies do is they studiously avoid any studies for long-term, what the long-term consequences are. they do no clinical trials. painpush the idea of at the least vital sign. is yourept behind that 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. the hospitals need those licenses in order to get federal jointg, and the commission essentially got into a financial relationship with sawous drug companies that it heading up regulations that require doctors to treat pain as a priority issue, and the drug companies end up writing the manuals for the doctors. it is one of the reasons that in hospitals and clinics, between one and 10, those are the part 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 annuals, the drug producers distributed them. there is not really much talk about the alternatives, other means of dealing with pain, dealing with it through physical therapy, dealing with stress, or other kinds of medicine. 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 physicalve, to, say therapy. the hospitals, which wanted to keep the joint commission have become a patients, who saw this as a way to go, and insurance

companies, which saw the opioid prescriptions as a cheap option. push on the medical profession, it also 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 ree, you have to find ways to manage pain, but they still have a promise of living in a country which is now a "pill for every ill" mentality. host: in your book, "american overdose," you talk about a lost decade, unequivocal warnings of grappling with masked 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 is that decade? 2000's,rom the early when doctors like jane valentine, the journal of medicine article appears, and the now former head or then head of the cdc, dr. tom friedman and 2011. there was an epidemic in this country. of theears, that decade 2000's, that 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 effectively, by co-opting, not only congress, because it spent a lot of 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 into rain and the sheer scale of prescribers. host: let's go to bluefield, west virginia. kelly is waiting. good morning. caller: good morning. drugs that prescription are, as he stated, a smaller than the ones that drug dealers are pushing on people, but now there is a push in this country that the drug dealer smack onfirst time, a the hand, they 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 smock 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. a you areshould be going on trial for murder, because that is probably what you have done, you have probably kill people. to make, there should not be a push in this country to let people off with a smack on the hand. 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 they can shown that a new it was fentanyl and it leads to an overdose death.

somewhere like west virginia, i was speaking to the police chief in huntington, they do not have the resources to lock people up. becausele are dealing they are also users and they are addictive, and they have been driven down a path that perhaps they would not have chosen to go down, and those that are purely doing it for money. obviously i think the nature of prostitution would probably -- 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. kathleen hoover, was prescribing more pills in the 2000's in west virginia's biggest hospital. one of her fellow doctors, dr. wase shaple, prescribing much less than that, and diane went to jail for six

months. there is a feeling that a lot of doctors have gotten off lightly as well. there is some sympathy as well, actually, from some of the drug police, 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: our guesses chris mcgreal, author of "american overdose: the opioid tragedy in three acts ." taking your calls this morning. ondra, eastpoint michigan the line for those who have been impacted by the opioid crisis. go ahead. and she has0 years, severe osteoporosis of the spine, and she cannot even stand up straight anymore, and she got

implants, and they wanted to do mastectomy, she had been taken 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 the drug dealers, they have no clue what the real pain is. my neighbor, she has a friend who was on pain medication. he had a problem, too, with his back, and he was taking pain medication, and 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 whos are hurting people sincerely need to take them. host: andrea, thank you for telling your family's stories. chris mcgill, 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. what has happened here, again, because the 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 doctors have become fearful of prescribing because of the

consequences, because of the political climate, because they feel like there might be some reaction against the. -- them. many primary health care doctors in this country, the vast majority, get very little training in pain management. daysmight get two or three 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 a 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 long time resistant that type of training. they said it was an inconvenience to doctors.

went to members of congress, hal rogers and mary bodo, both republicans, introduced and acts to have doctors with pain training, the ama opposed it. is actually the medical professions really making the that iss, and i think 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. had calling because i 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.,

and 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 package, and i talked to the v.a., who said they are good for r, so if i get a headache or a severe toothache. i do not know what to do with the things i took a wet rocks rag -- i do not know what to do with the things. i took a wet wash rag and she did to my hand and put it in the freezer. i held it in my hand until the pain went down, and i put it back in the freezer. 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 got pain, i am 74 years old. occasionally i work too much in the backyard and my back goes

into a star them for about a day, and then it goes away. the point i want to make was when they tell you to write your pay between one and 10, they are 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 one. 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 with, but i am surprised them giving me those pills, it really surprised me. host: carl, thank you for the call. mr. mcgreal. guest: the sheer number of people, the phils people get has been a big problem. the cdc came up with a recognition and 2016 saying that for acute pain, which is what you have after an injury or operation, really should not get day's'an three or five

worth of pills, as that is because after five days, there is a sharply increase risk of addiction. again, it is about the convenience not of the patient, it is of the doctors in this case. the ama has 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 do the paperwork. it comes back the money, convenience rather than practice. 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 her story of 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 her angry. about what has happened to their communities. these drugs have devastated their communities. they feel like 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 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. it people are keen to break down stigma. it is one of, perhaps, the largest 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 guest 1 announcer 1: c-span's washington journal live every day with news and policy issues that impact you. monday morning, we will open the andes and take your calls reactions to the government shutdown and your top news stories of 2018. be sure to watch -- into journal come alive at 7:00 eastern monday morning. join the discussion. the government shutdown is now in its ninth day and congress is out for the weekend. the house and senate return for what are expected to be