Welcome to an Expert Panel Discussion hosted by the criminal law and procedure Practice Group entitled opioids, the crisis in 2022 and beyond. My name is mike. I am the former United States attorney for the Southern District of mississippi where i witnessed firsthand this worsening crisis and the effect it had on our communities. Unfortunately, this topic is more relevant today than even just a few years ago. The u. S. Apartment of health and Human Services declared that the nation has myths of an unprecedented Opioid Epidemic with Drug Overdose deaths having quadrupled since 1999. According to the cdc, there were an estimated 107,000 Drug Overdose deaths in the United States in 2021 with approximately 75 of those deaths or 80,000 coming just from opioids. That is a rate of almost 220 people dying each and every day from opioids. Today, we have an incredible panel of experts who have looked at this issue in depth to discuss what has happened, how we got to where we are today, and what we can do hopefully to dig ourselves out of this crisis so let me introduce our panel first. We have the Senior Legal Research fellow at the heritage foundation. He writes on a variety of legal issues including policies. He has had numerous positions in the federal government, among them being at the u. S. Department of justice and counsel to the Senate Judiciary committee under chairman senator orrin hatch. He is serving as a senior fellow at the Shaver Center for Health Policy and economics at the university of southern california. He served as domestic policy advisor in the white house and before that, he was associate director for Health Policy at the office of management and budget and he served on the white houses covid19 task force in the first critical months of the pandemic and he has also worked in the Health Care Industry and served in Significant Health care in the administration of thenpresident george w. Bush. He holds a bachelors degree and law degree from the college of william and mary. Last and not least, we have trevor, a Research Fellow in the Cato Institute robert a leavy center for constitutional studies and editorinchief of the Supreme Court review. Thank you, gentlemen, for being here today and joining us in this important discussion. Each will have five minutes to make an Opening Statement or otherwise introductory remarks. Paul, we will start with you. The floor is yours. Thank you very much. And i want to thank the Federalist Society for holding this event and for inviting me to be a part of it. Im honored to be here on the panel to talk about this very important Public Policy issue. In my five minutes, id like to make just two points. The first is this debates like this at an intellectual level are extremely valuable. We should decide what the law should be on drug policy based on debates over what the law best does in this area, whether its on the supply side or the demand side. But the problem were facing right now is a matter of life and death. As you heard, thousands and thousands of people are dying from fentanyl and most of the fentanyl that comes into the United States comes from mexico, regardless of what you think about the immigration laws, they are on the books and they are not being enforced because the president doesnt want to offend the trotsky ict wing of the democratic party. Trotskite wing of the democratic party. The result is people are dying from from fentanyl, that is being smuggled over the border, regardless of what you think about the immigration laws, regardless of what you think about the drug laws. These laws are on the books and they should be enforced. It is truly as you heard, and as i said, a matter of life and death and hes just not doing it and theres no good reason for that. Some people will be saved if he enforces the law at the border. And thats worthwhile. Said how many people has to have and thats worthwhile. The president has never said how many people has to have to die before he addresses this problem. And i personally would like to hear him answer that question, but hes not going to because he doesnt want to offend people in his party. And thats a tragedy. It leads not only to deaths that leads to cynicism about government as a whole. Now, what else is the problem of what were doing right now . Its a question of hypocrisy. If a private company were importing from mexico or anywhere else for that matter, a drug or some product that killed 100,000 people, the federal government would sue him civilly and prosecute him criminally. If the governor of one of the four states on our southwest border, decided just to wave everybody in the way the president has done, the federal government would either civilly sue the state or the governor or other people in the administration or in extreme cases, even bring a criminal prosecution for this. But the federal government wont do this because its the federal government that is responsible. So ill just give a little bit of Historical Context in where we are now. When nixon declared the war on drugs in 1971, there were about 7000 americans dying of overdoses. This compares, as you mentioned, 207,000 that weve got. Now, that was a rate in 1971 of about 3. 3 per 100,000 americans were now at around 28 per 100,000 americans during the Trump Administration. When he declared a Public Health emergency in 2017, we were at 68,000 deaths. What you saw with his declaration and an all of government approach a crackdown on the border. Uh, a weekly meeting with the heads of Law Enforcement agencies and immigration agencies, as well as Public Health agencies, was a turning of the tide. And we saw a drop in Overdose Deaths in 2018 and 2019. But then covid hit us, of course, all that attention was diverted. But more importantly, the economy shut down and critically enhanced Employment Unemployment benefits kicked in from the federal government and some people were being paid to sit at home. And the covid epidemic exacerbated a Mental Health and addiction crisis in the United States. And again the trend line when almost parabolic again, were at 100 and 7000 for last year and its probably accelerating. Uh could be wrong about that, maybe its moderating. But some of the anecdotes that i hear from state Health Officials are very troubling. So both nixon and thad success in devoting resource to this, focusing on law and order. Um getting Public Health, Public Health officials focused on it and um and making it a big public issue. Now, one other very disturbing trend thats occurred in the past few years is this sort of, is the crossing over of the disproportionate amount of deaths from white americans to minority to the minority community. So theres a perception, i think still out there because the overdose epidemic was driven by prescription opioids uh in the last 20 years beginning at the end of the bush administration, beginning of the Obama Administration that this was quote unquote a disproportionately working cland class and problem for white americans. And that was true in the beginning because it was driven by prescriptions. But then when the Trump Administration clamped down through medicare, uh, prescribing rules, Law Enforcement crackdowns and encourage pharmacists and Insurance Companies to clamp down on prescription opioid abuse, we see it being driven into the illicit market. And now, youve got a disproportionate number of minorities dying principally driven by fentanyl. Now, there could be a couple of reasons for this historically. And the data on this is really well, uh, is very well documented. Africanamericans are disconnected from the Health Care System and their pain pain their pain is not taken seriously by physicians, so they were not given as many prescription opioids. Um, and then once it was clamped down on and you saw more fentanyl coming on the market through mexico. As paul said, uh, many of the incipient ingredients from china. You now have this flooding of American Cities with very cheap , uh, substances that are extremely powerful and are killing large numbers of americans. Uh, finally, i just say were at a real crisis and i would suggest were failing across the board are the way we intervene across the board. The way we intervene on treatment is a disaster. The way we are intervening with law and order, or frankly abandoning law and order in this environment is a disaster. And as paul said, the border is a disaster. We need a fundamental rethinking of what were doing here. And it does not involve frankly walking away from any attempt to try and limit the number of people overdosing or experimenting or using illegal substances. Thank you. Thanks, joe. Trevor. Well, thank you, mike, thank you, joseph and paul for the conversation and thank you to feed stock. I might expect we have a different view on this subject, the federal drug war, but for the countenancing of slavery is the most evil thing that the federal government has ever done. Let me very clear, this is not a death, an overdose crisis that is caused just by the presence of these drugs. It is caused by drug prohibition. The fentanyl crisis which has spiked as joseph pointed out, especially in the last 10 years, is a direct product of prohibition. Why is it a direct product of prohibition . Because well, im sure none of the upstanding people watching this have ever tried to smuggle alcohol into a football game. But i bet if you did, you would not choose a 12 pack of beer, you would choose a flask of alcohol. And of course we saw this during alcohol prohibition when alcohol prohibition came in, beer and wine essentially disappeared from the shelves, the shelves and it went up about 700 in price and everyone was drinking hard alcohol. But this would be bad alcohol policy. We would not want this for alcohol and thats sort of a stunning thing. Right . We know alcohol prohibition didnt work. And im a of course the radical here saying there should be no federal drug lord is one unconstitutional to its a bad idea. Our drugs should be legal in some way and what we should be doing is treating our fellow human beings who use opioids in different ways for Pain Management or even recreationally as human beings and we should treat them like we treat alcoholics, no one thinks that alcohol is the best thing we should be drinking. We know that 20 of users of alcohol are problematic users who have Severe Health complications from it. But we also know that people enjoy alcohol. We do not go back to prohibiting alcohol in the name of the 20 of people who are problematic users of alcohol. We are literally killing people with our drug war and there is no way to enforce our way out of it. Im sometimes getting a strange kind of just, you know, eternal recurrence groundhog day situation here, when we have people talking about prohibition being the more prohibition being the solution and conservatives and libertarians are prone to say like how many times the socialism have to fail before someone says, hey, look at all the way its failed. Drug prohibition does not work, it does not work in any possible way, and especially does not work when the manufacturers will beat the Law Enforcement agencies and with fentanyl whose potency is about 50 to 100 times more than heroin. And again, as i said, the reason its fentanyl is because the smugglers, they prefer higher potency versions of a drug when enforcement goes up and there is no way to stop this, there is no, there are not enough Law Enforcement officers on the planet. There is no way to stop the amount of fit and you could put in an envelope and sent across the border. What we have to do is treat these people like human beings and what that means is that it is possible just like being an alcoholic, we treat alcoholics like human beings. It is possible say were not going to make sure you have tainted goods, were gonna make sure you know whats on the label, whether youre drinking whiskey or ever clear or beer and if you need help, were going to be there to find it and were not going to try to stop alcohol your alcohol use, which might be very harmful to your health via prohibition. That we realize that alcohol is good that we havent realized that with the drug war and were still having the same conversation. Like were back in the reagan era is frankly stunning. What we have to do is re conceptualize how we think of our fellow human beings who might use opioids recreationally, much less the pain patients and we get into the pain patients and the crisis of cracking down on doctors for overprescribing when we treat them like human beings, we say, look, you have a substance that you are chemically addicted to, you use it for various reasons, you probably shouldnt be doing that. But before you decide youre gonna get off that substance, we are going to make sure that youre not going to die of tainted goods and its entirely possible for people to take heroin for very long periods of time to take it all for very long periods of time and do not be endangered by it. You can take fentanyl safely. Its prescribed thousands of times a day in, in hospitals throughout the country. You can absolutely take it safely if you know whats in it. If you know how much youre taking, what is killing people is that theyre theyre supplementing fentanyl into the heroin, unbeknownst sometimes to the low level dealer and definitely to the user who uses the same amount that they usually use. But its 10 ethanol and theyre dead. The first thing is to stop 100,000 people from dying. And if we legalize in some way and i say legalize it. And what that means about prescription to to compulsive users. We can talk about some sort of access if we legalize in some way, we would say 50,000 people next year, bar none. And then we can talk about how to get people off of these drugs. But the first thing is to stop people from dying and to stop our policy from killing. Thank you. Thank you. Trevor. Thank you gentlemen. You know, the first question i was gonna pose to the panel is really how we got to where we are today with 107,000 people dying from Drug Overdoses. Overall. You guys have laid out, i think pretty well how we got where we are today. So let me jump to the next question, which is kind of where are we going joe you alluded to . This is and and paul as well, i mean, it doesnt look like its getting any better. It doesnt look like its moderating at all. So where do you think our nation is going . Where do you think the Opioid Crisis is going . Do you think we will have more deaths in the coming years . Well go first. I mean, yeah, i dont see it moderating. I think the way trevor laid it out um it was very compelling to me at one point in my career, to be honest with you this idea, i have strong libertarian instincts. But the problem is you see a mass a wave of human degradation, chaotic cities overdose and addiction and Mental Health crisis in this country. And it is an incontrovertible fact that the overdose and addiction crisis got worse with the promulgation of powerful prescription opioids, loose prescribing habits and frankly subsidized opioids through the part d program. So he can talk about legalization. But in many parts of the of the country, its affectionate, its effectively legal anyway. And there are people doing. I mean, the law is not being enforced. People are doing drugs without overdosing in parks all over the place. And the question is, how long are the American People going to put up with it. I imagine whats gonna happen is the same thing that happened after, you know, the counterculture revolution and the and the first big bump up in over overdoses which sparked nixon in the first place. Its a law and order crackdown and the country is setting up for that because i dont think the country is really fired up to see the border like this or americas city parks like this and these homeless encampments, ad infinitum and thats where we are right now. Let me just make, oh i was gonna say allowing people to use thats where we are right now. Let me just make, oh, i was gonna say allowing people to use addictive and potentially fatal drugs without any restraints whatsoever is like saying we should allow people to play russian roulette because they have five chances at a six of surviving, were going to have a known number of people who get addicted. And it is not small because weve seen this with heroin. Uh yes, there are chippers, people who can use it now and then, its a very small number. And as far as the argument that legalizing a drug is going to prevent a black market from growing, just look at the evidence we have from california. Once you legalize a drug, people in the legislature are gonna tax it like crazy because they see it as being a new source of free money. And once you do that, the black market is always going to be able to under price any legitimate market thats whats happening in california, which legalized Recreational Cannabis a long time ago. Theyve had to go back to the legislature and ask for relief from regulations and taxes because they cant compete with the black market. So as an overall matter, what we have to do is look at it not just as whether we should uh prohibit anything or permit anything, we have to look at the costs and benefits, but at the margin, okay, you dont look at it just in terms of we cant stop it and therefore its not worth trying. We have to look at it what it would be if we didnt try to stop it through the criminal law. And if we didnt try to use the criminal law to try to stop it, we would be in a far worse situation. Id like a few points. One of josephs point that it is absolutely controversial that whether or not the prescription overprescribing which again has no actual definition and no doctor or even the cdc can define. But its absolutely not true that that is the sort of main cause of the Opioid Crisis, which again is also a misnomer. Its not an Opioid Crisis. We dont know how many opioids should be used. The federal government pretends. The dea tries to put caps on how many opioids should be used. This is one of the most medically useful drugs on the planet. And there are many, many people who use it, yes, recreationally in the same way people use xanax, they use it in a harmful way, they use it casually. Unlike pauls point, it is absolutely its just true that most people who use heroin are the 8020 rule applies, heroin or other opioids. Um, the 20 of the users are problematic users and 80 of the users are not necessarily problematic users. That applies to alcohol too. And so the question here is whether or not were going to do the same thing that we dont do with alcohol and take 20 of the problematic users and try and stop 80 of people who are not problematic users in a sort of quixotic attempt through Law Enforcement to enforce people from doing something that helps them in certain ways that they perceive. Now, of course, we do this with alcohol. And the question i posed to my fellow panelists is why do we treat alcoholics different than opioid users, even compulsive recreational opioid users, aside from pain patients . Different question, why should we i mean, were gonna get back to alcohol prohibition. Do we need to get back on the on on the prohibiting alcohol . Because its paul said on the margins, drinking did go down during prohibition. We know this from data. People were affected by Law Enforcement and just saying whether or not thats an analogy, good thing as opposed to all the harmful effects of prohibition. And on another point of paul point that paul made just being addicted to something is not a per se wrong. Uh, this is this is a very important point, because we understand this with cigarettes. We think you should get off cigarettes. We dont think you should be addicted to these things. If thats the choice you want to make, it definitely with alcohol. And many other things, people who take xanax every day are chemically dependent upon xanax after a few months, and its very hard to get off. So, being addicted is not a per se wrong that therefore needs Law Enforcement. What it needs is care and attention and making sure that were not killing them by tainting the supply. Being added to cigarettes. We were, yes, theres a crackdown, theres a silly crackdown on vaping, but were not putting tainted cigarettes out there and say were gonna stop you from being addicted via these tainted cigarette. Thats not how you help people at all. And clearly, look, prohibition drug, deaths. I mean, these are kind of moving in parallel with each other. Uh, and i, you know, there are things we can talk about. Were on the margins. What should we do for how should how should we make these little how should we supply access for people who are compulsive users of heroin or fentanyl, and how can we do that . And what sort of regulations should exist around that. But its like, im not the radical here. The radicals are the people who think that we can do this in a different and better way it is time. I mean, at 100,000 deaths, is it time to think differently . And of course, yes, libertarians have been saying this for years. But like, when is it time to think differently . And to mikes question, where is this going . Well, after i think the Mental Health crisis with covid and everything, we will hit 100 50,000 Overdose Deaths before the before 2030 and i have 2019 and i missed it by a year. Its not going to stop and Law Enforcement cant stop it. Thank you. Let me ask this. You guys have all been kind of beating around the bush, addressing this next question to some degree. But i want to get straight to this question, which is how do we fix it . 107,000 Overdose Deaths, 80,000 related directly to opioids. How do we fix this and prevent any more deaths occurring from opioids and drugs . Trevor. Trevor. And youre passionate about this. Im gonna let you go first. It has to include some sort of safe access. When we first started the drug war, and it wasnt nixon, it was the harrison narcotics act of 1914, which window 1915. Opioids were available on the shelves. And there were many, many people who were addicts who were compulsive users, but they had a supply and whether they want to get off when we shut down that supply via the treasury department, we created the heroin market, we created the cartels and weve now created the fentanyl market. Decriminalization is not enough. It has to feature safe supply, how that works. One of the big things with the harris narcotics act is whether or not a doctor could prescribe fentanyl or heroin or some other opioid to a compulsive user in order to mitigate the effects of their compulsive use. Whether that was a valid medical purpose, thats a good place to start, heroin should be as legal as fentanyl, right . And thats an important point. Heroin is a schedule one drug is scheduled to drug is prescribed all the time. Heroin and fentanyl and other opioids should be prescribed herbal very bare minimum. This is a form of legalization by doctors to compulsive users who go to doctors and say, you know, i cant get off this, but i need a safe supply. Safe supply has to be part of it. Prohibition doesnt work. My mistake. You know, in terms of safe supply, you can get a safe supply of methadone, you can get a safe supply of deacon or friend supply of a different drug or for those deal with the problems of physical withdrawal. By the way, theres a difference between being physically dependent on a drug and being addicted to it. If youre physically dependent, youre going to go through withdrawal. If you are addicted to it, your entire life is focused on, on obtaining that drug. Youll commit crimes, youll do whatever disgrace yourself in the process to get the drug. And society has for years tried to help people and when they cant be helped, use the criminal law to address it. I mean, alcohol has been socially accepted since the time of noah, who was the first vintner. Uh and its just as a matter of history, impossible to prevent people in the United States from using it. We tried, it hasnt worked. You dont have the same social acceptability of heroin or of illicit fentanyl and other, uh, chemical analgesics. So you know, where you cant just automatically say we allow alcohol and therefore we allow, we should allow everything. I think we need to approach it from every possible perspective, supply and demand. On the demand side, we need to educate people. We need to educate them not to use some of the drugs theyre buying because they are tainted with fentanyl. You know, interestingly, fentanyl is oftentimes a supply driven problem rather than demand driven problem. Yes, there are people who want fentanyl because it gives them a better kick. But a large number of people are dying from fentanyl because it is put in because the people who are manufacturing the packages arent using the same, you know, sanitary and safe procedures as the normal pharmaceutical companies. So what you have is people who are unwittingly buying it, okay, educate them get them off of these other drugs provide more treatment to help them get off of these drugs for the people at the bottom who are either addicted or physically dependent, we should try to help them. We should exhibit charity. But for the people who are at the upper end to are profiting off the misery of others, the criminal Justice System is the way to address them. Oh, im addicted to nicotine and i have this and i have these things and i havent committed any crimes or any ability to try and get them. So its a really strange definition of addiction. Well, in italy, they did try just outlawing cigarettes back in i think the fifties or sixties when they didnt have either left right hand or your left hand devices. And they found out that people were robbing trains, uh, that had cigarettes on them, read john kaplans book, the hardest drug, heroin and Public Policy. He talks about this. So i understand, yeah, people will do whatever they can to get them. And there are ways of trying to treat these people. But fentanyl doesnt permit any mistakes. Its a drug with fangs. You have a little too much of it in your history, we need to stop that from happening. That sounds like a really good argument for legalization, joseph. So if you some of the data shows that as many as 70 of the people who want Addiction Treatment cant get adequate Addiction Treatment. I dont know how many, uh, people you know, your family or friends, who have had somebody that they love and either try to go through treatment themselves or try to get somebody into treatment. It is extremely difficult to figure out what is a good treatment center, where it is , how to pay for it. What are their measures of success . Are they good for me . Are they the type of addiction that i have . And i think we need and we are spending billions and billions of dollars on treatment in this country, uh, couple that and the fact that we have a lack of adequate Treatment Facilities. And in large part due to the fact that Treatment Facilities are set up in such a way as dictated by federal resources and state resources and are not flexible enough. Dont innovate enough and are not frankly meeting the needs of those people who need services. Uh, you also had the deinstitutionalization for Mental Illness and addiction in the 1960s. So, there are some people for which institutionalization, maybe even for a brief period of time and stabilization is necessary. We looked at institutions for those with mental disease in the 60s, and coalition of liberals and libertarians said, this is not humane. Weve got to get these people out of these institutions. And the problem was we didnt replace them with anything. We just push people onto the streets. That is what is inhumane. And we should repeal the prohibition on using medicaid dollars for those who are suffering from serious mental disease to get people stabilized for a period of time. Those people who need in inpatient Addiction Services, regardless of income, should be able to get the resources they need to get stabilized in sober. And then we should go to a voucher system, frankly, uh, to allow people to find Addiction Services that they need to to get sober. Thats the biggest problem, frankly, i mean, well be having this discussion about prohibition or not, ad infinitum and you will have as trevor showed with the vaping product, you will have innovation where it is allowed to go. I would argue that those companies developed innovation as an alternative to cigarettes because of the increased taxes on cigarettes and the cultural shift that occurred about cigarettes and the emerging science side. Unfortunately, now we are in an arms race against illegal drug traffickers who are innovative, innovating nonstop and bringing new drugs. And now theres competitors to fentanyl on the street and finding its way into drugs and the legal system. The legal drug and pharmaceutical industry is being one sued as they were when they developed in the aftermath of opioids and to they have to go through the food and Drug Administration, which takes far too long. So were gonna need to figure out how were gonna get more non addictive painkillers and more powerful over the reversal agents out onto the street because if were gonna turn this tide. But i agree with trevor. I think this is, if anything, its accelerating and were gonna were gonna hit 150 before we know it in in 150,000 before we know it in 150,000 Overdose Deaths. Excuse me for a second. So, for my addiction to nicotine, now, i remember you telling me, did you tell me once that you smoked cigarettes at one point . Yes. Yes, i had. Well, thats the interesting thing is that youre right and joseph is correct, methadone and people often we need to expand access. Theres many, many reforms on the Mental Health side, joseph pointed out many, many good things, but i remember getting off cigarettes where there are different ways that help different people. Uh, patches maybe work for some. This time using as like kind of a loss in these kind of things for getting off of cigarettes and vaping with those ability to have those products available to you because everyone is different. And what we know from wes in europe and many other countries like switzerland and increasing in canada one of those options that would be useful to compulsive users is heroin assisted treatment, for example, which would be a form of legalized heroin as i point out that maybe a user who has a pretty severe chemical dependence would need safe access to heroin for part of their trip out of the kind of dark hole of being a compulsive user and that dark hole is also created by prohibition. And i also want to second what joseph said that yes, like cigarette taxes, they have an effect. Cigarettes are 40 a pack in australia, which is crazy, but they have an effect on smoking rates. What did more for smoking was the social change about smoking and when you do the same thing for users of opioids, right . We had a social change about alcoholics. They are people who need help, not cages. We had a social change about marijuana, which was that cheech and chong movies did more to legalize marijuana than any policy paper written the Cato Institute . Because we no longer thought of them as psychopaths. We need to think about people who use opioids categorically different because right now we think about them in an inhuman way at a societal level. We think about them as junkies. We think about them as people who are living in the gutter and not living Productive Lives. And because of that we want to punish them for that. We want to make it even harder for them to live Productive Lives and ask why are you using this drug . Why are you compulsively using this drug . What is happening in your life and how can we help you out . Im all for that. That is thats totally untrue that i want to dehumanize societally. No, i think you said very good things. I mean societally we do dehumanize them. Like no, i think you said very good things, like but we have to think differently about how we treat these people well. I would agree with that. I mean, i hope that we i hope that we could agree that non addiction is better than addiction and that addiction really inhibits the ability of human beings to flourish. And there is a connection between homelessness and overdose and chaotic personal lives and addiction. Now you can go through different gradients of that. Im not particularly offended by the fact that youre addicted to nicotine. It doesnt really bother me. It would it would irritate me if youre sitting next to me in a restaurant smoking a cigarette. It irritates me when the the uh it irritates me when the, uh, you know, im walking down the street and theres an incredible smell of marijuana in the streets of any major city now or even driving down the street. I mean, that offends me and frequently, im starting to get its gonna be just a matter of time before people start complaining about like nausea and headaches from the constant smell of these things, but it is an invasion of other peoples space and frankly it is degrading to people and its degrading even to the people that are using to have our cities have their public parks taken over by addicts and those people suffering from Mental Illness right now, like we have. And frankly this idea about , prohibition or non prohibition, these people are getting arrested now. You have a flourishing market taking place for drugs in the United States and there are very sophisticated purchasers out there getting high constantly in many ways. The illegal drug trade is a freer market than what if youre having to put a drug through the food and Drug Administration and seek reimbursement from either cms or an Insurance Company . So this idea about prohibition or non prohibition, its i find it to be somewhat ironic when you can walk into any major city and buy drugs in open air markets. Let me to respond to that. I mean, you said we shouldnt be noting that, uh, you know, opioid addicts or others are, are living in squalor in the gutter. They are, theres a lot of people who spend their lives in those circumstances. Look also at the homeless camps that have grown up in places like seattle and portland which enabled drug use. You have people who are using meth and are slowly wasting away and becoming like the walking dead, thats not good for them and its not good for the rest of society. Why should the rest of society have to give up large portions of the, some of the nations metropolis is just so that metropolises just so that people can be homeless on the streets and business communities or rural areas or whatever. Its not as if theyre doing this in the privacy of their home. Theyre doing this out in public and they are either physically dependent or addicted to it. And society is entitled to say weve had enough of that. A question that joe brought up and his answer, which was the Regulatory Regime is the bureaucracy is the federal government regulatory machine causing the Opioid Crisis . Is it contributing to the Opioid Crisis . Is it averting or helping to um diminish the Opioid Crisis . The what effect is our Regulatory Environment having crisis . Well, joseph is correct. Uh well, first of all, we still have a regime of prohibition even though correct that it can be de facto decriminalization in many cities there is no safe supply, which is why the first thing has to be the safe supply. But we have bad regulatory policy on Addiction Recovery is just joseph pointed out, we have the x rule for being an orphan, deepen our friend we have methadone. Getting methadone as a compulsive user requires going to a special clinic. Normal doctors can prescribe this, this has worked in other countries, all these things have to change. Absolutely. And to pauls point, i guess there are absolutely people in the gutter and all those things are kind of thing. We treat other policies of prohibition right . I agree with everyone. Like we talked about drinking in parks and we like have we talked about where you can smoke and things that we are not pro and have other policies with them. We can do things to say, get out of the park, go over there and get your safe supply. We can we can make our city safer and make these people safer from the tainted drugs that theyre supplying. I mean, i agree. This is i am not supporting drug use, especially opioid use at all. Like im just saying that people will do it and the first rule is to make sure theyre not dying from tainted opioids as they easily can do. Yes, respond to the safe supply point. There are two responses to that one is essentially, youre never gonna get rid of a black market. Look at what happened in california. Once you legalize a drug, youre going to have politicians regulated and tax it. Regulate it and tax it. And there are always going to be people who can undermine the legal price because theyre not regulated and theyre not being taxed. So you you cant get rid of a black market. Plus there are always going to be some people that dont want to out themselves as using a previously illegal drug by going to a cannabis dispensary or you know, a meth warehouse or whatever you wanna call it, you know, and thereby make it publicly known that theyre using that drug, so they will buy it on the black market. There will always be a black market if there is a rationale for people to go to it and there will always be reason for people to go to it because its cheaper and its private. On the regulatory tiein, i think david is pretty clear that the creation of the program and subsidizing prescriptions help drive some of this. Fda proved some powerful opioids in the 2000 and prescribing has changed and cms, started to adopt Pain Management as one of its quality measures and allowed patients to complain about possibles if their pain needs are not being met. All of these help drive the prescription opioid overdose epidemic. When we came in in the Trump Administration and clampdown on that, i think trevor makes a good point, there were people that were addicted, and couldnt get them anymore, and they start illegal sought illegal avenues to feed their habit. Also during that time, there were innovators occurring in we got a lot of stuff drug with from china. Then, we started to get progress. We were shutting down the border, as materials were getting created in mexico. We have abandoned all of that in the Biden Administration. That is why we are in hyperdrive. Let me ask you one or two more questions before we get to questions from the audience. One question is the cdc reported that there has been a massive increase in Overdose Deaths, particularly in alaska, while some other states have seen decreases in opioid deaths. Or Drug Overdose deaths. Hawaii saw a decrease of 2 . I know some of you mentioned having looked out or spoken with state officials, do you see Different Solutions occurring in our states . Are there any lessons we can learn or pitfalls we can avoid for our state . There is a live a lot of variety. Some of those varieties are Prescription Drug moderating programs in terms of how much those are been cracked tacked on. A compulsive user of opioids, you would have a less medically approved oxycontin pill than unknown purchases from the street. Some of those policies have changed that in terms of Overdose Deaths. Alaska is a good example. A lot of the reasons i am thrilled is on the opposite of pauls point, alaska is a dreary place with a lot of isolation. Those are often a bad solution situations that put people in that Substance Abuse situations. One of the things we can do is help people come out, on these bad situations and say, you dont have to be, embarrassed so much about those because theres all of these possibilities of getting safe supply. Some of these highly rural states we see higher rates, the President Trump talked about, those are all bad things. Prohibition is adding another conviction for the inability to get drugs. It doesnt help people in these hard in places that are expressing difficulties. Expensing difficulties. Im not sure how legalizing methamphetamine and heroin, which are very addictive for the vast majority of people, is going to help those people overcome the problems they have finding jobs. Lets face it, people are not going to hire meth or heroin addicts. Where theyre going to get their income to buy the drugs . I just dont see that legalizing drugs that are addictive and devastating like those is going to help the people you are talking about. Paul, are you seeing anything in the states that have worked . I have not. But i havent gone and done a vast a complete survey of what the states have going out there. One thing that the states have done that has been greatly helpful is allow for narcan to be widely used. In fact, the state of virginia has an equivalent of the u. S. Surgeon general, that person authorized anybody to go into pharmacy and purchase narcan, so that he or she would have it they come across somebody. This was in the precovid era. I dont know. Weve had a change in government, whether theres a new person in that position in virginia or virginia has changed its policy. At the time, that was a rather useful way of trying to deal with the problem, after it happened, and when it became most acute. Because someone was overdosing. Thats very helpful. At the front and, i think we just have to try different matters and at the intermediate end, what youre talking about his treatment, is the problem there. Treatment is going to fail for more than it works. You are not going to get very many politicians who are willing to go to the floor of the senate or the house, or state legislatures and say, we should spend millions or billions of dollars on a policy that is going to fail more often than it is effective. Youre not going to get people to do that. Thats a shame because we need to spend money to enhance the opportunity for people to get treatment, even though it is going to take them multiple times. In order to succeed. Yeah, i mean, look the Government Funds failures constantly. Maybe we just need to message it better. We cant leave these people to their addiction. The fact that weve got such terrible success rates and as i said, 70 of people want treatment, they can get treatment services. It is a tragedy. We have to make a commitment to these americans who need help and dont want to be addicted anymore. Frankly, we need to make a commitment to those who want to be able to use our parks again and be able to walk down the street and not be accosted by somebody who is having some type of mass induced psychotic episode. It is intertwined with our Mental Health problems in this country and the fact that we dont have adequate treatment for that. Trevor is right. A lot of these people are selfmedicating. The answer to that in my opinion is not to self medicate themselves into numbness, unless they are in extreme pain and need that for short period of time. The answer to that is to get that stabilized and get them moving in a positive direction for future. I hate we should not watch our fellow citizens be wasted. Some level of alcohol use or Substance Use can be tolerated but being perpetually wasted or addicted should not be an acceptable state for our family members, friends, or fellow americans. Last question before we get to the q a part. Trevor, prohibition is going to stay in place or or paul the thing prohibition is going to get done away with. We still have this problem of china and other countries were going to it or import fentanyl and other opioids that will kill our citizens. What do we do about International Actors . I sound like a broken wickard. Broken record. It is prohibited in some way. Is not available without a prescription. But we cant stop china. There is not enough agents it cant be stopped, so we have to stop say, to minimize the black market. There will always be a black market. But of course the black market in the prohibition was a different thing than people selling alcohol, they were doing moon shining. We can minimize the effects of the black market. China is feeding the black market. We have to minimize the effects of it. It has to be part of something on the table to allow safe supply in order to shut down harmful blackmarket. Paul . I think there are several things we could do. We may in fact be doing some of them. One of the steps we can take is to increase our ability to find out where precursor chemicals for fentanyl come from and going to mexico. We now know that most of the fentanyl coming into the u. S. Comes across the border from mexico. What is happening is, as the dea has told me, the cartels are building massive labs in mexico to manufacture fentanyl from the precursor chemicals. So what we need to do first is find out in whatever way we can what precursor chemicals are being shipped from china or india, or other places, to mexico, and what happens to them once they arrived at the port . There is a major port on the west coast of mexico, the pacific coast. That is where most of it comes through. Although there are plenty of other places too. We need greater intelligence work to find out what is happening, where it is coming in, etc. But, as i mentioned earlier, we have to change our border policy. If it is coming across the border, we have to make that more difficult. And we have to do our best to stop it. At a minimum, we need to do that in order to educate the public that were trying to do something. Maybe theres something were doing right now, but it sure doesnt look like it. Doug . It needs to be a priority for the president and the state department. On those who represent our countries overseas to hold these guys accountable. The agenda for trump when he met with xi, we had problems with fentanyl coming into the country, xi with say, look, we have the Death Penalty for fentanyl production in our country. But trump put them on a report. A lot of fentanyl started to flood from mexico to be produced there, because the chinese didnt want to send it directly to the u. S. Anymore with trump at the table. But he made it a priority. Mike, has a portion in his book which he mockingly says that trump brought up bombing, and fentanyl labs in mexico. Well, great, ha ha. And made the president look stupid in this passage but wise and at a huge priority for the United States when we meet with mexico . We send the millions of dollars in aid, we have opened our border and we allow tons of manufacturing and products to flow across the mexican border. I dont understand why the Biden Administration was devoted, six attends mine in the most recent budget to Climate Change as it did to the Opioid Epidemic. I dont understand why they dont call the Mexican Government and say, this needs to stop and were going to Work Together to stop it, we will close down the border or control it for more aggressively. But you have to have a president who cares and secretary of state who cares. All our diplomats and professionals need to make it a priority. Paul or joseph said, cartels switch to fentanyl, which is more potent, to make their operations more clandestine and kill more people. The policy of the mexican president , is hugs not bullets, its not working, its not working for us and not for people in mexico. You read the most recent issue of the economist that says theyre still thousands of people who are among the category of disappeared ones, that people no longer hear from, and they have no idea where they went. Its not working. We need to tell mexico everything that joseph just said. Make this a priority. Right now we spend more time on Climate Change or woke subjects than we do on matters that has killed thousands and thousands of americans. There is good excuse for it. I would like to hear joe biden say what number of people have to die before he will do something about it. Some of our questions, tom palmer says, he thinks there is manned, if there is demand there will be supply that no one can prevent. Is there a solution of Illegal Drugs if potential users are in charge of seizing the safety of drugs . The question for the panel is, should the government allow people to take drugs, choose to take drugs, not to drugs, or not have any say so or interest in the wellbeing of people . The short answer is yes. But not for the wellbeing. But changing the addict Addiction Treatment, how we treat alcoholics. The federal government are not at all they are not doing prohibition. What a novel idea that is worth trying. To answer your question, no. We shouldnt just give up. Look at all of the secondary problems. People are going to use drugs, psychoactive drugs, they will get behind the wheel of a car. Theyre going to cause a crash. People are going to be maimed or killed. They didnt choose to be maimed or killed. It is done by somebody else. There are all sorts of costs like that that come with the increased legalization of drugs. We have only talked about some of them here. Yeah, im a free market guy. I believe in markets where you will have demand, you are going to have a market or people trying to meet the market. But the price could go up with enforcement for those selling it. For those dealing it. And for those using it. We could make it cheaper for people to get treatment services. We dont suspend the laws of economics to supply and demand in this market. We are not enforcing the drug laws. Drugs are extremely cheap. Ive said before, when we put additional Unemployment Benefits in peoples pockets during covid, that extra 600, you can see at one point, trump stopped it, they got restarted again in august 2020. You started to see a pickup again. You have people with extra cash in their pockets and they were using drugs. This is a static this is not a static environment where people are the only thing they are purchasing is drugs. The only thing there thinking about is drugs. They can get pushed in one direction or another. As trevor said, there are other substances you can choose to use or not, but it would be great if we can have an honest discussion in this country. We would like our Law Enforcement to pursue crimes when they are committed, including violent crimes, often by those who are using drugs or pursuing money to purchase or deal drugs. We are abandoning law and order and our cities. This has been an incredible discussion. I apologize for the audience. We had some Great Questions we didnt get to. I wanted think our panelists thank our panelists. We can agree to disagree. But we can do it professionally. We can do it honorably. You have shown that. I want to give a shout out to the person who put this panel together. Thank you for hosting this event. On cspan, President Biden signs a bill to expand Health Care Benefits for veterans exposed to toxic burn pits during their military service. That is followed by House Speaker nancy pelosi discussing her recent trip to the in the Pacific Region which included a stop in taiwan. Later, the House Rules Committee considers the Senate Passed a bill to address Corporate Tax policy, Prescription Drug cost and Climate Change. The legislation will be debated by the full house on friday. Coming up thursday on cspan, the former director of the congressional budget office, joins the Bipartisan Policy Center for a discussion about what a potentially Republicancontrolled Congress would look like and areas of a bipartisan agreement. That is live at 10 00 a. M. Eastern. At 1 00 a. M. , Health Commissioner speaks to the Washington Post about the rise of monkeypox cases and what the cities doing to stop the virus from spreading. At one 30, Election Officials from arizona and vermont discuss how misinformation is affecting the work of election administrators. That is from the House Oversight and reform committee. 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