washington. >> today, family and friends hono former first lady rosalyn carter, a tribute service being helped and memorial united methodist church. president biden and first lady jill biden are expected to attend. along with former first ladies melania trump, michelle obama laura bush,nd hillary clinton. the service lllso include remarks by a long-time aid and friend, katherine cade. journalist judy woodruff. and the carter's grandson, jason caer. watch live at 1 p.m. eastern on c-span. sp now, our free mobile video app, or onlynn at c-span.org. >> c-span is your unfiltered view of government. we are funded by these television companies and more, including comcast. >> you think this is just a

community center? no. it's way more than that. >> comcast is partnering with a thousand community centers to create wi-fi enabled places so students from low-income families can get the tools they need for anythg. >> comcast supportc-span as a public service. along with these oth television providers, giving awe front row seat to democracy. wa. host: a focus on drug addiction and the fentanyl crisis in the country. regina labelle serves as the addiction in public policy director at the o'neill institute. this is the headline of a political story -- politico story that you were in, the opioid crisis has gotten worse. what does that look like in america today, what are the numbers? guest: the opioid overdose epidemic affects hundreds of thousands of people annually.

however, it was about 108,000 people dying every year from overdoses. primarily driven by ely consent -- illegal fentanyl. it is an opioid illegal -- illegally manufactured and that is what is driving a lot of the overdose deaths. host: why is it getting worse, why have we not been able to get a handle on it? its not like we have not known about it. guest: the supplier. the supply of drugs is a lot more lethal. we do have substance abuse disorder not being new. more people die actually from alcohol use disorder annually than illegal drugs. but, really this is not a problem that we got into overnight and it will not be solved overnight. we need to build out a whole prevention and treatment and

recovery system that we do not currently have. that will take a while. host: we have mentioned that you serve as the addiction & public policy initiative director at the o'neill institute. you are the former acting director of the white house national drug control policy. what has the biden administration been doing to build out the efforts and to combat the situation? host: eyes -- guest: i served on the transition team between administrations and we identified the top things needed to be done. i started on the afternoon of inauguration day and we put out the priority is in april. many of which were expanding for the first time in a century, harm reduction services. having more serve services. and having fentanyl test strips. a lot of people using opioids and thought they were using

heroin were actually using fentanyl, illegal fentanyl. those test strips help them identify what was in the drug supply so they could either use safely or choose not to use. and we also have expanded, the administration expanded access to treatment by removing barriers to evidence-based treatment and they are continuing doing a lot of that work. caller: talk about needle exchange -- host: talk about needle exchanges and test strips and callers were saying that is enabling addiction. what would you say to those people? guest: it is part of a continuum. we want to prevent it from happening. we need to treat substance abuse disorders that there are people not yet in treatment or perhaps they do not have a substance abuse disorder but they need access to services like harm reduction services. there is a lot of evidence behind syringe services program

which reduces hiv and hep c. those are known and proven to work. they are a public health approach to a public health issue. host: on getting the funding behind some of these approaches. what is the support act? guest: it passed right before 2018. it was a 600 page document with a lot of authorized programs, some of which got program -- got money through the appropriations act which expanded access and medicare benefits to methadone, one of the evidence-based treatments for opioid abuse disorder. it is currently before congress for reauthorization. it also reauthorized the office of national drug control policy in the biden -- where i served which is also up for reauthorization. congress is looking at that now and hopefully they past that. it has pieces that need to

continue and be reauthorized. host: why is it not automatic? what is holding it up? guest: congress has had a lot of things on its plate and i am hoping that we can restore regular order and have hearings and go through the process so that these types of programs are not only authorized but also we have an appropriations process that provides the funding for prevention treatment and recovery and harm reduction programs. host: how soon does it need to be passed before the programs do not have the funding that they need? guest: the continuing resolution has helped with some of that. there are a couple pieces, a couple of access to treatment pieces for juveniles in particular that need to be reauthorized today. host: regina labelle is our guest, the addiction & public policy initiative director at

the o'neill institute with us until the end of the program at 10:00 a.m. eastern. that may get the phone lines, split a little bit differently. if you are in the eastern or central united states, 202-748-8000. the mountain or north pacific region, 202-748-8001. and if you have been impacted by drug addiction, a special line for you, we want to hear you and your families' stories, 202-748-8002. go ahead and start calling in. for folks who are not familiar with the o'neill institute and the addiction & public policy initiative, what do you do? guest: two things. first we work at the intersection of public health and the law to advance evidence-based policies for a number of people. our areas are focused on substance abuse disorder. we work a lot with the americans with disabilities act to make sure that it provides protections to people with

substance abuse disorder. and then also, i direct and teach in the master of science and addiction policy and practice program at georgetown university's graduate school. this is the first of its kind program in the country to train people so that they can hit the ground wanting -- running. it is a one-year program. and they can provide evidence-based policies at the state, federal and local levels. this is our third year and we have people who are working across the government and in the private sector. and when they go -- it is not a time with over 100,000 deaths annually, there is no time for on-the-job training. these people go and they are prepared to implement evidence-based practices. host: what job do you foresee them taking on the state or federal level? guest:

another is working for the state of new york. another is working in the state of maryland. and another works in treatment, recovery. so these are positions, policy analyst positions where they know what works and what doesn't, but they're also looking, keeping an ear out based on their training for what might be around the corner, what the challenges that we might face and how to best address them. host: how long have you been working on this issue? guest: i've worked on it when i was the mayor's legal counsel in seattle, but really full-time since 20089 when i joined the obama -- since 2009 when i joined the obama administration. host: have we gotten since 2009 on any front? guest: yeah, i think we're not making strides as fast as we can, but i think there's a growing awareness that people with substance abuse disorder, stigma and shame don't cure people.

and locking people up doesn't make people better. that we need to have, you know, evidence and science, but also compassion toward people with substance abuse disorder and address it as a condition that we know that it is, that it is a condition that can be prevent, treated, and from which people can recover. host: when did we make that change on stigma? when was that recognition that this isn't helping solve the problem? guest: i think there's always been an undercurrent of people who recognize the importance of reducing stigma, but when i was in the obama administration, michael was our director of the office. he was the first drug czar who was in recovery from an alcohol use disorder, and he really -- he was on "60 minutes," he really personified for a lot of people what the challenges they faced as people with substance use disorder. we changed the language of addiction. the last year of the obama

administration, they're terms that just add to the stigma and don't help anyone. so that change has slowly started to occur, and i really think it's speeding up with more and more people coming forward and saying, i am in recovery from addiction, recovery is possible. host: as the place to go to to make changes on this issue, why did you leave the office of national drug control policy? guest: i was there for a year. that was my -- you know, i was acting director. the really great thing about this biden administration has put in an m.d., a doctor for the first time as director of that office. so our drug czar is someone who comes from a public health background, who understands and treats addiction. so he's perfectly situated to address the issue nationally. host: and what are those treatments that we are discovering that we're trying to get more into the pipeline? guest: for opioid use disorder,

there are three f.d.a.-approved medications. there's two with the most research, science-based that reduce overdose deaths and help people enter recovery. for alcohol use disorder, trexone is a medication that is available. it's not as often used, but it is available to treat alcohol use disorder. we also have cognitive behavioral therapy, continued management. so, you know, we have treatments that work. we just haven't made them as available to people, and we need to continue to remove the barriers. so anyone who wants treatment can get it. host: let me pause there, bring in some callers, especially folks on the line impacted by drug addiction. eugene, oregon, good morning. you're on with regina labelle. are you with us? caller: yes, i am.

host: go ahead. caller: go ahead what? there's no answers to the problem. we dealt with drug addiction on a daily basis. there's no treatment facilities down here that someone can walk into. there's no program. they're pretty much homeless. you don't go in and seek treatment here in our hospital in eugene, oregon, and you'll be chucked out right back on the street. how are you supposed to get well when you're homeless? most of the drug addicts here are homeless. there's nowhere for them to go. there's no treatment. guest: yeah, so thank you for that. oregon obviously is facing a crisis like every other state in this country. a couple of things that she said that are really important. emergency departments, hospitals in this country, traditional way to treat addiction, unlike other conditions, has been what's called treating and streeting.

so basically stabilizing the person and sending them out on their way. at the o'neill institute, we actually put together a model piece of legislation for states that provides for care, connecting people to care in hospitals, in the emergency room, so they're not just being treated and streeted. so emergency department can be an avenue to connect people to the services that they need, and so that's one piece that's really important. host: how long do you keep them in the hospital after that treatment aspect? it's not like you have the capacity to continue to keep these people in the hospital. guest: right, you stabilize them. you can provide methadone or morphine, either in the emergency department or you refer them to a service. but it's connecting people to care. that's what people are doing. there are states around the country, rhode island is a good example. there are states around the

country that are addressing that, that connection to care, so the emergency departments don't become basically the housing stablization place. and there is a nexus between homelessness and overdoses, as well as substance use disorder. the homeless issue is one that is a much broader issue determining social determinants of health, making sure we have adequate housing, recovery housing, and recovery support are also part of that solution. but again, we to build the infrastructure, and it's going to take a while. host: for those who have been impacted by drug addiction, this is steve from maryland. good morning. caller: yes, i looked at drug addiction, my son was addicted and is still addicted from a heroin. he's overdosed 10 times or more and i've had to bring him back with narcon, pump his chest, ambulances and the works.

i look at this as i look at the immigration issue in this country. i see that it creates great jobs for those that like to support this. i look at it as a jobs program for the federal, state, and local government, which is why i don't think there's going to be a reason to ever solve this problem. it creates way too many jobs for people all across the country to think behalf they're going to do to solve the problem. the problem is, once these programs run out with medicaid and medicare and such, they're right back out on the streets, he's been in a year program, year and a half programs, here and there, gets the job, does the work, and then ends up always going back and turning back to the drugs. so as a parent, that was back years ago. i just booted my son out and said you're going to have to figure this out on your own, if these are the choices to make in your life. in the end, drug addiction is a

choice. it is a choice, choice, choice. and that's up to the individual to make that choice to say, you know, this lifestyle just is no good. living in the street is no good. doing these programs for a short period of time and thinking you're going to get better, as soon as that medicare card runs out, as soon as that runs out, guess what, you're kicked back out on the street. even when he completed the program with flying colors, boom, always ends up going back to the drugs. this is the same way as immigration, it is a great jobs program. we're not going to stop defending all. they're not going to stop the immigration because it creates jobs across america. you guys have a nice day. host: regina? caller: thanks, steve, and my sympathies for what you have gone through and what your family has gone through. there are two things i want to point to. first, the importance of naloxon. it's a life-saving drug that can

reverse overdoses. it's now, there's one version that's available over the counter. the cost is still too high, but in places like washington, d.c. and other cities, you can get it either delivered to you or you can access it through syringe services programs. secondly, for parents who are struggling with a child with addiction, a partnership for drug addiction, the partnership to end addiction has a lot of resources for parents. to figure out how to get treatment, to figure out what kind of services their child might need. i work with people every day who have recovered from substance use disorder, from addiction, so i know that recovery is possible, and it's within reach, there are 20 million people in this country who are in recovery, who celebrate their recovery every day. so i know that that's possible. but my heart really goes out to

a lot of parents, like steve, who really suffer from their family's illness. host: we're not going to stop the fentanyl. i wonder if you can comment on this headline from the associated press, china's agreement expected to slow the flow of fentanyl into the united states, but not solve the overdose problem. what's the agreement that china has come to? guest: china has agreed to basically monitor, i mean, do a couple of things, but one is to monitor the flow of precursor chemicals that are going from china. china has the largest chemical industry in the world. so they've promised and opening up the door to monitoring the precursor chemicals that are going from china to mexico. host: precursor chemicals? guest: the chemicals that go into making illicit fentanyl. the drugs of today and tomorrow are not going to be crop-based. they will be synthetic, which means the chemical industry and

chemists will become a lot more significant players in the drug trafficking world than farmers. but the really important piece about the fentanyl issue is that these are, you know, international trafficking organizations, and it's not just, they don't just traffic in drugs. they traffic in a lot of other products. so that's where, you know, enforcing the rule of law, illicit finance, all of that is also part of a plan that the biden administration has put forward to address the issue. host: come back to test strips and how they're used when it comes to fentanyl. guest: sure, so if you -- syringe services programs in many cases will hand them out. people can use it to test whether or not the drug that they have contains illicitly manufactured fentanyl, if it contained illegal fentanyl. and then the person will have

more knowledge about whether or not that drug, if they've never used it before, might kill them. that was really significant about four years ago. now i think everyone who is getting their hands on a street drug, if it's supposedly heroin, it's usually fentanyl. it's still significant for purchases a pill, they might want to know what's in it. we have to assume today that if you're buying that you think is heroin or a counterfeit pressed pill, it probably has fentanyl in it. host: jonestown, pennsylvania, good morning, you're on with regina labelle. caller: everything i hear right now seems to be more of a band-aid than a long-term

solution. we're talking test strips, injection sites. that's actually not solving the problem to bring addiction down. the biggest issue we have to figure out is why is addiction increasing in our country. my thoughts are, number one, we do a terrible job of mental health in our country. we don't teach people how to deal with stress in their life. we teach a good job of education. the second thing is family structure. i think if we break this down a little bit more and look at family structure and the breakdown of the family in this country, you would see that i guarantee the majority of these are coming from broken families that are dealing with addiction and just not being able to cope correct well that. i would love to hear your comments about those situations. guest: thanks. i think the prevention piece is really important, and unidentified mental health conditions in this country and the lack of mental health treatment is very important. that's something we have to address, particularly for young

people who are seeking out counterfeit xanax. that means that they have a mental health issue that they need to get addressed. i do think that the entire continuum of care, so preventing youth substance use is obviously important, and identifying risky substance use that might indicate a broader problem, a bigger problem, and all of those social determinants have helped. lifting people from poverty, making sure that adverse childhood experiences are addressed, trauma, all of those things go into addiction and substance use disorder. but i would say with over 40 million people in this country who have some type of substance use disorder, it's not a partnerral fault in those cases -- it's not a partnerral fault in those cases. addiction affects every family.

it affects intact families, people who come from divorced families. but focusing on prevention is very important as well. host: on addiction and youth substance use, this is a nbc news story from earlier this month. it cites that nationally the median monthly deaths among 10 to 19 doub the second half of 2021, according to the c.d.c. and media monthly deaths involving illegally made fentanyl nearly tripled. most of the adolescent the did not have a history of opioid use, meaning addiction wasn't the culprit here. guest: yeah, so there's some gaps in our knowledge here. but we do know that there was an increase in overdose deaths among adolescents, and a shocking increase as you said. most people were going online

buying what they thought was a counterfeit, what turned out to be counterfeit pressed fentanyl. host: thinking it's what? guest: they thought they were getting xanax or something else. again, it goes back to what christopher was talking about with untreated mental health, and also, you know, the availability on social media of some of these drugs, press the pills, counterfeit pressed pills in particular, yes, those are people who might, young people who are not, who don't have a long history of substance use, but are getting them online, and so we have to look at data to see if any of the things that have been put into place are helping to address that issue. host: in about 15 minutes this morning, we're going to talk about another issue here on c-span. it's a hearing on gun violence in the united states. that's where we're going to go going after this program. it's happening before the judiciary committee.

stick around for that discussion. but if you want to talk drug addiction, the fentanyl crisis in this country with regina labelle, our guest this morning, the phone lines are as follows. if you're in the eastern or central united states, it's 202-748-8000. if you're in the mountain or pacific region, it's 202-748-8001. if you have experience, if your family has experience with drug addiction, 202-748-8002. john has been impacted by drug addiction, kansas city, missouri. john, thanks for waiting. caller: thank you for taking my call. this is my first time calling in 25 years. i listen to you every morning to get my news. the purpose of my call, i was addicted over 25 years, and i've been clean and sober for 25 years. my choice of opioid was crack. and i would like to point out how this drug crisis is being

handled as opposed to what was done in the late 1980's and 1970's with crack. i remember bush bush bush sitting at the white house with a big back of crack cocaine, and that was basically the beginning of the war on crack. now, don't get me wrong. i was addicted. crack devastated our communities. i mean, devastated. and the heavy-handed police presence that was put in communities sent a lot of people to prison for small amounts. now i see fentanyl coming through, and it's coming through the red states, rural communities. in my hand, you're having the same issues that i had back in those days, where it is devastating the communities. it's devastating your families. what my problem is how each was

handled. there is no narcan of people addicted to crack and going through the crack epidemic. there was none of this, you got programs and other. our program was a jail cell and drug court pretty much. so i have empathy and sympathy for people in the red states that are going through this epidemic. but one thing that you must understand, nobody forced nothing in my mouth. nobody forced nothing in my vein. it was myself, my personal responsibility that got me in and got me out of it. it's not fentanyl at the border. it's in your home. one thing is this. people who are on addiction to get that drug if they want it that bad. it's not a policy thing. it's not a government thing. it's a personal thing. so i like what you're saying. i like how you're bringing this

up. i just wish that and hope this goes into all communities. don't sit there and say, oh, look at that black community, oh, they got the drugs or any other brown community. i'm watching families be destroyed, just like mine were in my community. host: thanks for sharing your story and hope you call in down the road. going to let regina jump in. guest: first of all, congratulations on your 25 years in recovery. it's people speaking up and talking about their stories that's really important. but i do want to emphasize the importance of what john said. our policies have changed over time, and the policies that were in place during the crack cocaine epidemic were jail first, prison first. and we've seen that how it's acommunities. i was looking at washington, d.c. data, overdose data this year, for the last year.

d.c. has one of the highest rates of overdose deaths in the country. they are primarily deaths occurring among black men who are 50 to 60 years old, west of the anacostia river in the fifth, seventh and eighth wards. host: for folks who don't live in d.c., explain what that means. guest: it's basically the eastern part of the city, which is primarily black men who are dying. so this is an issue, it did start out primarily in red state appalachia. it has expanded over time to affect every community. that doesn't at all dismiss the truth of what john said. we changed our policies quite a bit. we're much more empathetic, much more acknowledging of this as a disease today than we were in the 1980's. host: john said our program was the jail, our program was the drug court. are there still drug courts

today? guest: yeah, there are about 2,500 drug courts nationwide. they started in miami. they've been around since the 1980's. for some people, they work to help them enter recovery, sustain their recovery. the one thing that we work quite a bit on in jails and prisons is to get people who are incars nature, evidence-based treatment, that they don't have to go in and be forced off of medication or withdrawal from medications and not get treatment. and then the highest, one of the highest rate of overdose, risk for overdose, is incarceration. so getting people the treatment they need in jails and prisons is critically important, and there's legislation on capitol hill that would expand access to treatment. host: and that's outside the support act? guest: it's outside the support act. i mean, it could be inside the support act, but it's outside. host: do you know the name that have? guest: it is the reentry act.

host: john is next, good morning. you with us? caller: yeah, good morning. i appreciate this conversation. i think the last caller said a lot of good things. my name is john, and i'm 10 years clean. my drug of choice was heroin. i think that this fentanyl that's going around right now is, i don't know. like, i used to think that, you know, drugs are bad, right? but the fact that any time you choose to get high, you could possibly die is pretty crazy. and yeah, that's pretty much my only comment. guest: thanks, john, and congratulations on your years of recovery. and again, when people talk about their recovery, it shows that recovery is possible. and that's something i obviously

really want to emphasize. we know that our supply is dangerous. and because of these synthetic chemicals that are going into drugs that are becoming more and more powerful, that's why harm reduction services are so important to keep people alive, so that they can, you know, reduce their use or enter treatment in they need it. -- if they need it. but reduce overdose deaths is one goal, but also help people live fulfilling, healthy lives after entering treatment and recovery is important as well. host: how much time do you spend the idea of going after the drug traffickers and maybe not even going after them in the united states, but going after them in mexico, in places where these drugs are coming across the boredder? guest: sure, so i think certainly when i was in the administration, i spent more time than i do currently on that. however, i think looking at this

issue, these are tans national criminal organizations. and if we focus solely on the border, it's too late. these are criminal entities and looking at illicit finance, going after the source of their funding, those are all pieces of the puzzle that are really important as well. host: this is a call from virginia, good morning. caller: yes, thanks for taking my call. i'm familiar with drug treatment, because i had two dear friends who are actually clean, and they were clean from a salvation army, which is probably one of the best in the d.m.v. area for those recovering from drugs and alcohol. they have a very stringent program, and i suggest anyone to go there. second, narcan. we have to realize that we do have a drug problem in this country. we distribute the covid test. why don't we distribute the narcan nasal spray throughout?

everybody should have it at their residence. they need to distribute those, you know, at bars, at schools. and then the schools should talk about this. i mean, i remember going to school. i went to school in d.c., actually grew up there, so i'm familiar with the drug issue. but we have police officers come in and talk to us about drugs. that was in junior high school, at p.t.a. meetings. so it is a crisis. we need to do something about it. the solution is having centers like the salvation army throughout the united states. number two, distribute narcan nasal spray to everyone. you know, bars, schools, hospitals, every resident should have narcan nasal spray. we have one. we don't have anybody that used it, but we have it just in case. so that needs to be distribute. we can do that. host: thanks for the call from virginia. guest: thanks.

narcan is the brand name, and it's one type of naloxon. it's a life-saving drug. it prevents and can reverse overdose deaths. in washington, d.c. and other areas of the country, you can get it over the counter by going to your local pharmacy and your drugstore. and you can now buy it, it's $45. you can buy one of the types of naloxon. you walk into your drugstore. in some cases it's behind the counter. it should be in front of the counter. so if you have $45, you can do that. you can buy it. no questions asked. there are naloxon distribution programs in every state in this country, and i totally agree that every family should have this available in their home. host: before we get too close to the end of our program, let me mention, the national help line, 800-662-help.

exain what the help line is designed to do. guest: sure, samsa is an agency within the department of health and human services. you can call that number or go online, and you talk to them or you look for the type of treatment that you might need or a loved one might need. you can look to see what type of services they have. it's a finder. it's a treatment locator so you can have your questions answered if you call about the type of treatment that's available in your area. ve treatment availability.., you if you're in more rural areas, you have to rely on telehealth, and the good thing is currently you can get treatment via telehealth. host: i should note, in washington, d.c., samhsa is the substance abuse and mental health services administration. samhsa.gov is where viewers can

go. time for one or two more calls as this hearing on gun violence in the senate judiciary committee is going to get underway pretty soon. let's go to mark in south carolina as we're waiting. good morning. caller: good morning. i just want to share that i had been in recovery for over 30 years now. and i'm now licensed as a professional counselor in three states. recently, they passed the legislation regarding l.p.c.'s able to see medicare, particularly medicare resilients. that was a barrier for a long time, and i just want you to comment on that a little bit if you don't mind. guest: thanks. mark, congratulations on your recovery and forgiving back and serving your community by being a licensed professional counselor, which is what a

l.p.c. is. one of the big issues we have, we don't have the type of trained workforce that we need. so most people go to primary care physician, that individual may not have ever received any training in addiction. so making sure that people have access to trained counselors like a l.p.c. is a way that we can expand that workforce and having reimbursement for that through medicare or medicaid is important. host: come back again, we can continue this conversation certainly an important one. rejeep allabelle is with georgetown's o'neill >> now to live treub butt to first lady rosalyn carter who passed away last week at the age of 9 #. service being held at the glenn memorial united methodist church on the campus of emory university, atlanta. live coverage here on