Transcripts For CSPAN Newsmakers 20161127

Along with other officials, he works on it uniform Health Officers representing the United States in 800 offices around the world. Thank you very much for being here. Vivek murthy glad to be here. Susan we are here because you just released a report on addiction in america. We are going to talk about the message there. Me to reduce the reporters who will be asking questions. Lauren is from the associated press. Sarah is from the hill. Lauren this report on opioids and other forms of addiction was anticipated. What do you feel is most Important Message for a country that has already been dealing with opioid addiction. Why issue it now late in the , Obama Administration . Vivek murthy the decision to Commission Report on alcohol, drugs and health was a decision i made at the beginning of the tenure. It was the first major decision i made in december 2014. These reports take several years to produce. We did it on the quickest timeline possible. We knew there was a great need for this report. I am issuing a call to action for our country to take on the Public Health crisis of addiction. I am doing so recognizing there are 20. 8 Million People in america with Substance Abuse disorder. What surprises people, that is similar to the number of people with diabetes in america and it is 1. 5 times the number of people with cancers. Despite this heavy burden of illness, only one in 10 people are getting treatment. Thats what we have to change. Born how does the report do that . Vivek murthy in several ways. One comment lays out clearly the scope of the problem, which is one that everyone necessarily understands and races and on the priority list. Number two, it also lays of the evidence for prevention and treatment strategies when i. When i travel the country and talk with families, many dont realize that we have evidencebased methods to treat their family members. We have a need to expand her treatment facilities, but people should not think there is not treatment that is effective other because there is an relay of the Prevention Strategies that work. What is remarkable is they are also costeffective. For every one dollar we invest, we save four dollars in healthcare costs, seven dollars in criminal justice care costs and with the prevention programs, we have found they are so effective they returned 64 for every one dollar invested. Those are investments worth making. Finally most challenging, the , report issues a call for our country to make a cultural shift in how we think about addiction. Cultural shifts are the hardest to make. They require each of us to stop and think about how we think about addiction and recognize that it is not a moral failing. It is a chronic disease of the brain. In the report, we layout the latest science about the biology of addiction that helps people understand that addition affects the brain circuit in specific areas that control decisionmaking and impulse control. They help explain why it is so hard to manage addiction and so easy to slip back into relapse. Sarah i want to talk with you about how you see the role of government in this problem. Some of the advocates with this who are trying to get the government go further and they want mandatory training for doctors and a larger role for the federal government. I know you recently sent a letter to many, thousands of the thisns doctors addressing issue. I wonder if you talk about how far the government needs to go if this is the time for a mandatory policy or any kind of stricter guidelines for working with doctors on this. Vivek murthy one of the key points i make in the report is the only way we will address addiction in america is if everybody does their part. That means policymakers invested in treatment and clinicians ensuring that they have the training necessary to diagnose and treat Substance Abuse disorders. In the last chapter of the report, we lay out a call for many other sectors such as law enforcement, teachers and families and local leaders. When it comes to government, believe the government is an important player here. Many times in history the government has played a role in some of the logo the report on on a Public Health crisis. Tobacco did that. In the late 1980s, there was a similar report around hiv. My hope is this report will help kick off and accelerate our work in this area. The government has a role to play in that respect. We know the government can play a powerful role in investment and the expansion of treatment s and the expansion of treatment and prevention programs. When it comes to treatment, particularly for opioid users, we have a lack of treatment. When it comes to open we had specifically, we have 2 Million People who need treatment and less than one million who are getting treatment. That is a gap we have to close. The Obama Administration has taken many steps to Fund Expansion of treatment as well as to fund work to sharpen prescribing practices, including a recent set of guidelines the cdc issued for prescribers. From my office, we issued a letter to 2. 3 million healthcare practitioners from the country. We did this because you wanted to call them to action, we canzing that while book recommendations in place, we really need to professionals to step up and to take a larger role in ensuring it is training the current and rising generation of health care practitioners. Sarah one of the key stakeholder when we are talking about, congress, fda looking to guidelines on this issue is the Drug Companies themselves. What do you think the government needs to do in working with the drugmakers, how much scrutiny do you think needs to be here is you were to address this growing epidemic . Vivek murthy i think if we look back with the lens of history, for use are retrospective skull, as we used to call it a medicine, what we see is there certainly rolled in from the cynical companies played in the development of this crisis. There were a number of people who played a role in the development of the crisis. We did not have enough investment. We also had pharmaceutical companies that were marketing these medications heavily to clinicians, often without the emphasis on the harmful effects and the addictive intentional. Potential. We could go back in history is something we should change. Looking forward, what that means is we have to be very careful about the marketing of medications in general to patients as well as to clinicians. We know that every medicine, whether it is an antibiotic or an open. As a benefit or a risk. That is true even of tylenol. It is important that patients and clinicians understand the risk. I would love to see Pharmaceutical Company step up and play more of a role in the training the extension of treatment because we know we have a huge problem on our hands. We have to extend treatment. I would like to see pharmaceutical Companies Pay much more attention to their marketing practices because we know that those messages can be very powerful when people see them in advertisements. As a doctor myself, i have had patients come to me and ask about medication they have seen advertised on tv. They are led to believe are harmless and will cure many of the problems. It is often not the case. It presents an added burden to doctors and nurses when you have advertising that is not entirely accurate or doesnt tell the full picture, is imbalanced. You have additional risk and work for doctors. Lauren that brings up an interesting point because you have the patient coming in and say, would like his medication i saw but there is also a lot of people that are paying attention to the news about the opioid addiction, and saying, what i really want to take regardless . One there is a lot of science on the narrow biology of addiction but theres not a lot of science on the possible risk factors, why some people suffer abuse disorders and not others. What makes people vulnerable . If your doctor is saying you need medication, what the you say that helps decide if this is the right choice for you . What is there that you can look for to say, this might be trouble . Vivek murthy what is it that determines if someone is prone to developing a Substance Abuse disorder . We know that somewhere between 40 and 70 it is through june next and the remainder is related to your environment. What were you exposed to when you were growing up . In the cases of alcohol and cigarettes, people drinking heavily or smoking around you . We also know that your exposure constitutes a risk factor. When it comes to prescription pain medication, particularly, there is a need for Public Education. I have found as i have traveled that many people assume that because the medication is prescribed by a doctor or a Nurse Practitioner that it must be safe. Usually like i said, medicine should boost prescribed with the waiting of the benefit weighing the benefit and the risk. One of the key points that i have found is important to share with the public, they are addictive. That simple message is one that has not fully penetrated. When i was training in medicine, many clinicians were taught that opioids were not addictive if they were given to someone with legitimate pain. I was in florida a few months ago, having dinner with a colleague and i said to them can , you believe we were actually taught this in medical school . He put his for Donaldson Company mean that is not true . This is a man that is incredibly bright and well trained at the best institutions, but there were errors and how many clinicians were actually taught and trained. There is any for Public Education among clinicians and patients. Efficient out there that is prescribed in opioid medication, to have a discussion with your doctor or Nurse Practitioner about the risk in the benefits. Ideally they would bring it up with you but in case they do not, i would ask them proactively. Lauren is there any research, Promising Research done to treat pain other than chemically . We may be moving away from this idea . Vivek murthy that is a great question. One of the things we called for in the report and i have spoken about on the road what is about the need for us to invest more in research on alternatives to opioid medications. The truth is, we have a limited material of tools. It is broader than just opioids but more would be better. Even right now we know that in addition to nonsteroid ,edication like ibuprofen physical therapy can be effective when it comes to reducing pain. We know that Cognitive Behavioral Therapy has shown to be helpful with pain. We know that the veterans , acupuncture, acupressure as methods to treat pain. The more we look, the more we find there are alternatives to using medications like opioid but we have to do that research and that is going to be an important part of us Going Forward and treating pain safely and effectively. Susan speaking of resources that are needed. A lot of lawmakers have talked about 920 budget dollars that they want to see in a comprehensive addiction and recovery act earlier this year. Some are still hopeful they may see that in this study before the end of the year. If that does not happen, im curious if you think it will, if you have seen any signals on that, what are you thinking about the next administration coming in, have you had any conversations with incoming President Trump about what his plans are since he did not released that much detail about this specific issue . Vivek murthy that is a good question. I have not had any conversations with the administration of other legislative plan, but what i do know is everywhere i travel, it is clear that addiction does not discriminate, it impacts people of all economic classes and people of all political perspectives. I have been very proud and happy to work across the aisle on the issue of opioids with both parties. I plan to continue doing that. This is an issue that is really come up with bipartisan support. You saw that in work that was done in opioids and my hope is that that will continue because the truth is, this is impacting all across america. My hope Going Forward as we can not only work on funding that will expand treatment but also be mindful of how we think about addiction because one of the things i have seen, there clearly is coming even if you have Treatment Centers available, you need people that want to go to them. You need them willing and able to step up and say, i need help. As i travel, i find city after city, there were people that did not feel comfortable even coming to talk to me if there was a camera nearby because they worried that if somebody found out that they were struggling with Substance Abuse disorder they would be ostracized by their friends, maybe fired from their jobs or that their doctor might even look at them differently. On the one hand, we have to address the policy issues, which are largely serenity investment in prevention and treatment programs, but we also have to work on the cultural shift. You cannot legislate shift in attitude. That has to be something that we model ourselves. It has to be a change to come from the grassroots up, people sharing their stories and talking differently but addiction. Do think the nearly 1 billion that would go toward expanded treatment, do you have any hope that could still be achieved in 2016 or are you looking at 2017 . Vivek murthy i do not know if it will be achieved in 2016 or will come later but i do hope that it comes as soon as possible because i will tell you that we cannot wait. Families have waited too long and too often in the shadows, unable to feel comfortable coming forward and talk about their illness. They are desperately in need of treatment. We are at a point where we have treatment that works, when we know how to help people, we know and to reduce the risk of relapse in overdose, it seems tragic that we have not been able to expand this further up until this. We have made progress under the on administration, but what we have illustrated in this report is theres much more progress for us to make. By the way, im always open to working with anyone to do what i can to make sure that we have the support and the information to make the case for expanding treatment. I believe it is desperately needed. Isren part of the issue payment. Resident elect trump has campaigned on the notion of repealing the Affordable Care act, which did make Addiction Treatment essential health benefit. What happens if that goes away . Vivek murthy the coverage is a key part of this equation. I had the privilege of practicing medicine in massachusetts before and after Health Care Reform was implemented. I saw what a difference having Insurance Coverage made to my patients and their ability get care and the level of stress and anxiety, not having to worry that they would not have coverage if they were to get sick. When it comes to getting Substance Abuse treatment services, yes, Insurance Coverage is an important part of that and the protection or benefits that came with the Affordable Care act act were included under the benefit package. That has been important. My hope Going Forward is as the new administration looks for ways to improve and build on our health care system, that we find ways to not just maintain but to expand our coverage because despite the progress we have made with 20 million more people enrolled in coverage through the Affordable Care act, we know there are millions more who are uninsured. We still know that we have a parity law in place. This has advanced our ability to adequately reimburse them for Substance Abuse services, but we still have to ensure that this fully realized, the fully fully implemented. My intent is to do whatever i can with the next administration to make sure that our coverage expansion continues. Its going to be an important part of ensuring people with addictions can get care. Lauren with President Trump coming in and talking about ripping out the Affordable Care act, what do you say to providers and state Health Officials who are on the ground and worried about the uncertainty that may be preventing people from enrolling and rethinking their current coverage. This could be a major Public Health problem for millions of people that have the coverage right now if there are no changes in that and if they do not have options. What is your strategy, your to your strategy for looking at this and what do you tell the providers at the moment . Vivek murthy times of change are hard for everyone. Harder us as we have made in some rounds of health care, we know there are other gaps to fill and during this time of change, people are wondering if we are going to keep the gains we made, Going Forward, going backward . I do not have a crystal ball so i cannot fully predict the future. Im gorgeously for the next administration to, with this policy proposal, and like i said, im willing doing the remade in two years to work closely with them to see what we can do to ensure people can get the care they need. I think that is the most important thing all of us can do, make sure that our needs are being voiced. I have realized working on both sides of the aisle in a Opioid Crisis that we have a lot of good people in washington that want to provide help on this issue, the want to address andid abuse in disorders they are helped by hearing from the constituents in the public about what it is. I have found unfortunately many of the people i have spoken to on the road have incredibly poignant and heartbreaking experiences dealing with addiction, but they have not really shared those with others. I understand why they have not because theres so much of the acceptable stigma. This is the time we need more people to share what their needs these with the elected leaders and media as well. One of the things that has helped to turn the tide in the opioid issue has been people stepping up and telling their stories and making it more acceptable for others to do the same. Susan i know you have some of the topics you want to get into. , to segue over to medical marijuana which was on eight ballots this election. You brought up in the report that there are some concerns that research is raising about marijuana usage in general, medical or recreational. What is the publics attitude about marijuana . Publicurthy i think policy is outpacing science when it comes to medical marijuana. There are two points i want to make. One is what we do know in the other is what we do not know. One is that marijuana is addictive. This will come as a surprise to many people, 9 people overall use marijuana will develop marijuana use disorder. That number is even higher if you start in your early teens, closer to 17 . Marijuana is in fact addictive. We know that it has an impact developing the brain. Theres also a we do not know about marijuana. We do not know at this point, high quality evidence that tells us in fact marijuana is both safe and effective for use for medical purposes. That is the standard we used to approve any drug or medication by the fda. My belief is we should hold marijuana to the same standard because right now, if you asked somebody, what are the guidelines, what does and what frequency and what type of strain of marijuana, etc. To used to treat the certain condition, whether that is lower back pain or nausea related to pregnancy or related to cancer diagnosis. We do not have a specific guideline that are evidencebased. You may have people prescribing all kinds of doses at different frequencies based on their best judgment, but that is generally not how we want to operate in the universe where we care about the safety and efficacy. My belief is we need to accelerate the research on marijuana so we can understand more fully what the benefits and what the arms are, and that is why i am glad in this administration that they were making steps to make research easier to the Public Health Service Review trusses, increasing the amount of research on marijuana available. There has also been hundreds of millions of dollars put to work on research from over 100 million and over 250 studies funded by the government to better understand the impact of marijuana. Susan one more topic. I want to pivot to a different epidemic. But others have talked about gun violence is a Public Health crisis, and again, what president obama prepared to leave office shortly, i was wondering if you could point to any antigun violence or mental executivevisions, actions, programs under the Obama Administration you believe will have a lasting effect if we do so some of these rolled back and eczema and ration, which is possible. What are the things that are working right now that you think should continue . Askk murthy well, let me you to zoom out a little bit when thinking about gun violence. Gun violence is a problem any parts of our country, i do not think anyone would disagree with that. I do not think there is anybody that wants to see that continue. I think all of us want to come together and address gun violence. Unfortunately, this is a debate against polarized very quickly. If we really want to address gun violence in america, i think what we need to do is we need to have commonsense laws in place. We do need a focus on gun safety education. We do need an investment in the to Health Services that is actually something with Public Health as well. We need to ask the deeper question to what contributes to the violence in the first place. Not everyone engages in violence has a diagnosis. The majority, but theres something they is giving rise to violence which is why we need to ask ourselves, how can we improve our Emotional Wellbeing in the communities, especially communities under high degrees of stress, whether that is due to poverty or existing violence in the communities for other reasons. The good news, we do have programs that are being developed and implemented in different parts of our country that are focusing on improving wellbeing in schools and some of them are having a striking impact on reductions in violence. , andf them is in chicago which one year, when run as a controlled program a child is able to demonstrate a 44 . Eduction in Violent Arrest there are others as well. My hope Going Forward as we can actually focus on investing in Emotional Wellbeing programs and research and understand which ones work in the investment to scale up on programs that have demonstrated to be effective, and that is an area that i intend to continue focusing on. Susan we are out of time. Dr. Murphy, want to close on that point. Your term ends two years in the trump administration. Would you like to serve for President Trump . Intent hasy my always been to continue serving as long as i feel if i can make a contribution to the Public Health of our country, and i feel i can still do that. I have a lot of ideas about how to fill some of the needs we have, not just around Substance Abuse and addiction but Emotional Wellbeing and other areas. Look, i recognize from the beginning that health is something that matters to all of us. It is not inherently political issue. A reason to come together to work on health. There are many areas of shared concern among parties in our country, Substance Abuse being one of them but there are others as well. My intention is to continue working with the next administration to do everything i can to advance the Public Health of our country because we have the challenges, but i do believe that we are up to the task. Susan thank you very much for being the guest. We appreciate your time. Vivek murthy great to be here. Isan cspans newsmakers back after our conversation with attorney general of the United States. Our two reporters. Health and policy. The new report from the Surgeon General on facing addiction in america, which he hopes will be as impactful as the early report on smoking in america, you both asked about timing. We are going through a president ial transition, lameduck congress. You know this town. What is likely going to happen with this work . Probably not a lot in this particular time because are so many other things going on that unfortunately do take precedent over Public Health matters too frequently. Dr. Murphy did make the point that addiction is a problem of no clinical persuasion. I am sure it is something that will come back to but the question is when . The fact of the report is coming up some and months after the bill was passed, we do have an upcoming spending bill that there could be some money involved with that. The head of the House Appropriations committee is a very strong advocate coming from a bigky with this is problem. There could be money at the end of 2016 but this is something democrats are worried about. Dr. Murphy spoke about the need to reeducate the insurrection. Be surgeons General Office is a bully pulpit, that is primarily what it is. His call to action probably has the effect of orifice and 80 throughout country been necessarily on congress, which knows the problem and has debated the problem. If you can get a doctors attention and you can get other groups attention and also just raise this idea of stigma that really people should not be afraid to seek help. Susan two government walks such a fine line on this mandatory requirement, any kind of mandatory training is not seen well by the medical american association. We have seen signs from the fda and cdc and the recommendation which are nonenforceable, but there are signs that say, this needs to be a bigger priority for doctors as they are getting trained and even in their day to day life. Some go years without additional training on this, but as we heard, what changes, the research comes to fruition and some doctors may not be aware of the update. We just saw video from president elect trump or one of his 100 days pledges of some regulatory reform. That is for every new regulation has to be rescinded. For the environmental question, we are in such a state of flux, could you see those kinds of could you see those kinds of mandatory policies Going Forward in a certain environment . It is not likely. Incoming President Trump has said he wants people with opioid disorders to be able to seek treatment. He said he wants to help people on this issue, but we have not seen a lot of details on this, unlike the plans we saw from secretary clinton, which were very detailed and got a lot of reception on capitol hill and a lot of groups. He might take on after he saw the reception of her policies, her policies were so well received we might see some of , those carried out, but we have not seen them yet and there is still so much going on. Im not holding my breath. Especially in terms of how the country has approached this, opioids are legal substances. Do they fall under a criminal justice area . It is a Public Policy issue because despite the problems with opioids, there are many instances where prescription opioids are truly the appropriate treatment. And so, there has to be enough education our there for both doctors and patients to know how to get the balance right. You both spent some time with this report. What is the takeaway you have from it . Where the numbers in a surprising to you both . Were the numbers and it surprising to you both . I think we know these numbers. They have been hammered home for so many years. The message of stigma also. Sometimes, the public needs that sort of bully pulpit to bring this to them. I agree that we have seen the federal government trying to say this is a social problem, something from the grassroots that Everybody Needs to be aware of and needs to help others. Others they see who need counseling or addiction services. That has been a large part of this report and 400 pages is very extensive for any branch of government to put out this much material. It does show a commitment and that the Obama Administration wants to leave a mark on this. That is one takeaway. Thanks to both of you for being with us on on this thanksgiving weekend. Thanks. If James Madison is the architect of the constitution, then George Washington is the general contractor. If you ever build a house or put an addition on, you know for some it looks more at what the general contractor has in mind that the architect has in mind. Talkshor Edward Larson about president George Washingtons role in unifying the country and ratifying the First Federal government in his first book George Washington nationalist. They wanted to recruit washington in as the coup detat. This democracy stuff is never going to work and you are going to have to be our king, but washington was proand believed in republican government. Tonight, on cspans q a. Next washington journal, Lieutenant General stephen townsend, commanding general of the Iraq Combined Joint Task force joins us from baghdad to discuss the fight of isis in mosul. The president of the department for Public Service talks about donald trump preparations to take office in january and former nato secretarygeneral anders looks at relations in a trump presidency. We will take a cause and you can join the conversation on facebook and twitter as well. Washington journal, live at 7 00 a. M. Eastern on cspan. Now, advocates for opioid recovery founders, newt gingrich, patrick kennedy, and van jones discuss why they joined forces to fight drug addiction. This is about one hour 20 minutes