Transcripts For CSPAN President Obama Remarks On Prescription Drug Abuse 20160330

We want to hear your story as well. [applause] mr. President , i will start with you. You have a lot going on. This is a significant commitment. You flew down here. Why this particular topic for user . It isent obama important. It is costing lives. It is devastating communities. I want to begin by thanking congressman rogers helping to put this together and to the leadership he has shown. We very much appreciate that. [applause] unite ano thank you N Organization that has been carrying this issue for a long time. Paneliststhank our especially hearing the stories and very personal terms of what this means to families and communities. Im looking forward to hearing from them. This is something that has been a top priority of ours for quite some time. Is to promote the safety and the health and the prosperity of the American People. That encompasses a whole range of things. E are down leaders of isil responding to natural disasters. Trying to promote a strong economy. At the staggering statistics about lives lost and productivity impacted and costs to communities but most. Mportantly cost to families this epidemic of opioid abuse. There has to be something that is right up there at the top of the list. To 20,000. Ed it is important to recognize that today we are seeing more of opioidled because overdose then traffic accidents. Think about that. A lot of people tragically died in Car Accidents and we spent a lot of time in warren resources to reduce those fatalities. That wevews is actually been very successful. Traffic fatalities are much lower today than they were when i was a kid. We systematically look to the data and the science and we developed strategies and Public Education that allowed us to be safer drivers. Here we got the trajectory going in the opposite direction. 2014 is the last year that we have accurate data for. You see the enormous ongoing spike in the number of people who are using opioids in ways that are unhealthy. Rise in theicant number of people being killed. I had a town hall in West Virginia. I dont think the people involved would mind me saying this. They are very open with their stories. The child of the mayor of of theton, the child minority leader in the house in West Virginia, a former state senator, all of them have been affected by opioid abuse. This is not something ms. Restricted to a small set of communities. This is affecting everybody. Young and old. Men and women and children. Rural and urban and suburban. News is that because it is having an impact on so many people we are seeing a bipartisan interest in addressing this problem. Not just taking a onesizefitsall approach. Just thinking in terms of criminalization and incarceration. Too often that has been the response to the disease of addiction. Weve got to stop those that are trafficking and preying on people. We have to make sure that our medical community and of thattific Community Individuals all of us are working together in order to address this problem. Im very optimistic that we can solve it were seeing Action Congress that his move the ball forward. Administration has taken a number of steps. Providing 100 million to Community Health centers so that people have more access to treatment. [applause] concentrating on physician education. In terms of how they prescribe painkillers. To prevent abuse. The treatment are more widely available to more people. The antidotehat for the means of preventing people once they have overdosed from entry dying. It is being carried by emts. Under resourced. I think the public doesnt appreciate yet the full scope of the problem. I hope that by being here today and hearing from people whove gone through heroic struggles with this issue. Hearing from the medical community. We can make a dent on this. People who are much more knowledgeable and are doing great work out the field. That when i show up the cameras due to. Provide a greater spotlight for how we can Work Together to solve this problem. [applause] you had a chance to hear some of crystals story backstage. Very comfortable talking about your story . Vicodin. Ed using what happened at that stage in your life . Crystal my path into addiction which eventually was heroin was pretty similar to a lot of stories. Knowing it can be used recreationally. That is what happened with me. Happened for a to meeting and throughout the week. Needing something to work. Eventually i needed something stronger than the vicodin. I was using oxycontin. It eventually led to me doing heroin. I was physically addicted and the higher milligram things like oxycontin are pretty much like heroin. Synthetic heroin. Almost as strong. Came to the point where i couldnt find those kinds of pills. I had to go to the streets to prevent my withdrawal symptoms. So i can participate in my daily life. Me going to work. Will you using heroin . Crystal at my home in the bathroom. While my kids were there. While they were at school. It was a part of my life. It is crazy to think about now. The things that i did. It was necessary or i would not enable the function. Who you call . How did you even begin . Crystal i tried a few times on my own and it didnt work. I couldnt get through the withdrawal symptoms. I couldnt tough it out. I know some people can. I couldnt do it. This last time has been the most successful recovery for me. Ive have been in recovery for about a year. [applause] thank you. I am unmedicated assisted treatment. What the Surgeon Generals talking about. That stands for urban minorities out of a hole outreach program. It is very intense. A lot of counseling. Group counseling. Other people that are in treatment. Talking to a doctor. It has really worked for me this time. Did you have interactions with Law Enforcement . Crystal quite a few times. Had to steal i have stolen from Department Stores to feed my habit. Ive been involved in drug busts couple times. When you talk about medically assisted therapy you are using one kind of medication. It doesnt give you the same euphoria to win you want the heroin . It blocks the receptors in the brain so you cant get high. You have tried this a bunch of times. What was it that works this time . Crystal i think this time i anded it more than anything taking that step forward along with the support that i get for my family. Advocating. Telling my story. Helping other people helps me. It makes a want to stay in recovery and keep doing what im doing. [applause] you are sort of at the frontline of this. Some of the stories that you share are pretty remarkable. You are a doctor. How did you get into this . Leana very similar story to crystals. I saw patient that i got to know over the course of time in the er. When you are a doctor, you know there is something wrong. This woman was in her late 20s. She was a competitive swimmer. She torry disc in her back. She started out with pain pills. She ended up with heroin. She loses her job, she wound up losing her kids. She wound up homeless. She basically came to us every week in the er. She knew that she needed help. She said that i need help for my addiction. It is one of the worst realizations as a doctor and one of the worst feelings to know that you cannot help them. Needed, whatient so many of these patients need is addiction treatment. But we could not give it. [applause] mean, we would never say that to someone who has a heart attack. Go home, andr say, if you have not died in three weeks, come back and we will treat it. [applause] faced. s what we i talked to her onetime about getting her treatment. We set her up with an appointment. It was not until two weeks later. She went home that day and overdosed and came back. We try to recessive tate her, but we cannot save her. I think about her all the time. She came to us so many times for treatment. Clearly a difference between how we treat her and how we treat everyone else. We need to realize that addiction is a disease. If we treat addiction like a crime, we are doing something that is not scientific, not humane, and frankly, ineffective. [applause] sanjay mr. President , you have heard these sorts of stories what theseing situations were like in the emergency room. The woman wanted help. What is your reaction . Pres. Obama it is heartbreaking. Long, we have viewed the problem of drug abuse generally and our society through the lens of the criminal Justice System. We are putting enormous resources into drug interdiction. When it comes to heroin that is south,hipped in from the we are working very aggressively with the Mexican Government to prevent an influx of more and more heroine. We are now seeing synthetic opioids that are often times coming in from china through mexico into the united states. We have to move aggressively there as well. Law enforcement officials [laughter] good job, dea. Cutting off the pathways for these drugs coming in, but what we have to recognize is that in this global mostmy of ours, that the important thing we can do is reduce demand for drugs. And the only way we reduce demand is if we are providing treatment. Thinking about this as a Public Health problem and not just a criminal problem. [applause] that began very early on in my administration. Drug is a reason why my not is somebody that came, from the criminal justice side, but really from the treatment side. He has been in recovery for decades now. [applause] something that we understood fairly early on. I am going to be blunt. Itaid in a speech yesterday, is your last year in office. You just get a little loose. [laughter] in West Virginia as well. I think we have to be honest about this. Part of what has made it previously difficult to over the treatment criminal Justice System is the fact that the populations affected in the past were viewed as or worse stereo typically identified as poor, minority, and as a consequence, the thinking is that it is often a character flaw of individuals that live in those communities and it is not our problem. We can just lock them up. [applause] things that has changed in this opioids debate is the recognition that this reaches everybody. Opportunity, not to reduce our aggressiveness when it comes to the drug cartels that are trying to poison our families and our kids, we have to stay on them. The recognition that the same way we reduce tobacco consumption, i say that as an exsmoker [laughter] in the same way that [applause] in the same way we have reduced traffic fatalities. My generation understands very clearly that you do not drive when you are drunk. You put on your seat else. Seat belt. We have instituted requirements for seat else and airbags and reengineered roads to prevent fatalities. It can make a difference. When i listen to crystal and i think, what a powerful story, i think for all of the crystals that are out there trying to make a change, that they do not wait three months. I agree that if all we were doing was dispensing the drug that is blocking your cravings opioid, but you were not also in counseling, it does not work as well. That int to make sure every county across america, that this is available. The problem we have right now is that treatment is greatly underfunded. [applause] its particularly underfunded in a lot of rural areas. Our task force, when we were looking at it, found out that america of counties in , there are just a handful or no Mental Health and Drug Treatment Facilities that are easily accessible to the population. If you have a situation where somebody is in pain initially because of a disc problem, they may not have Health Insurance because maybe the governor did not expand medicaid like they should have [applause] to a doctor one time when the pain gets too bad. The doctor prescribes painkillers. They run out. It turns out that it is cheaper to get heroin on the streets than to refill that prescription. You have a problem. For all the good work that the congress is doing, it is not enough just to provide the architecture and the structure for treatment. There has to be funding for the treatment. We have proposed an additional billion dollars for drug treatment programs across the country. My hope is that all of the advocates and families who are here and those that are listening say to congress, this is a priority. We have got to make sure that incredibly talented young people like crystal are in a position to get treatment when they need it. [applause] justin, you are 28 years old. This, for you, started at a very young age. Can you show us a little bit, when was the first time you started taking some of these drugs . Justin i started experimenting as a hole in the soul. I never felt good enough for like two i was or anything of that nature. Just being in my own skin was something that was very, very uncomfortable for me. That started around third or fourth grade. I was consciously disappointed with who i was. For those of you who have ever been a third grader, that is a stat statement that the future of our country at such a young age is so sad and hopeless. Thank you. ,he other side of that though it sounds a little bit like a broken record. Nt than whenporta that started, what that felt like, even though that is important to understand, is that people can recover. [applause] and millionslions and millions of people that can endure recovery. I am very fortunate to be up your to represent and be an example. I am not special or unique. I have worked hard and i appreciate that. I challenge others to work hard. Her others in recovery four others in recovery, that is an important part of this conversation. It is even less talked about and even more underfunded. People can recover. They do it and a lot of other ways that are extraordinary. Sanjay did you say third grade . Review starting to use these sorts of drugs at 7, 8, nine years old . My mom is in the third row, that is cool. Hi, mom. I was allergic to poultry. I learned at a young age that you take than a drill. Benadryl makes you sleep. If you cannot jerk deal with life, sleep through it. That was not satiating the hole in the doul. I literally could not sleep through all of life. Sanjay you started using other medications. How did you gain access to some of these other drugs . Very typical, for when i grew up. I grew up in a very rural community. Amazing parents and family. It is pretty common to have alcohol and other drugs in the home. My parents raised me exceptionally well. ,hat feeling of inadequacy searching for something to fill that space was pretty strong for me. Sanjay you eventually were in recovery. You were in and out of recovery seven times. Did you pursue it on your own the first time . Was it your family . Did they nurture you . Justin the first attempt at recovery for me, which was to no surprise when you have such an amazing family, was my parents and my pediatrician. They call me by my middle name. I was doing the sports thing. I was doing leadership stuff at school. Instead oft that water in there for tennis practice, there was bought cut in their. What are we going to was vod ka in there. What are we going to do about that . The understanding that there has got to be something bigger going on here before it gets to an epidemic. Was one of those very rare moments when i decided to be open and honest around some of the things i was doing. I am not a doctor, clearly. Im very much, almost without knowledge, there was nothing that dr. At that point in time could do other than to say, he is doing good in sports, he is doing good in school. I am sure this goodlooking young guy will be ok. Sanjay you were not ok. How did things get to you how bad did things get for you . Justin there were some things that i do not know if i could have gone through. What more so it was, how bad could it get . How many stories could i go into to articulate the suffering that my family went through . It was the reverse of that, the power of those stories when i did get well. Best man at myhe wedding. My father told me, because of what you have done, i want to be in recovery. He is still in recovery to this day. [applause] pres. Obama maybe i can just interject. Listening to justins story, when i was a kid, i was, how would i put it, not always as responsible as i am today. [laughter] was lucky, ways, i reason, for whatever addiction did not get its claws in may with the exception of cigarettes, which is a major addiction, but does not manifest itself in some of the same ways. Where wen a society medicate a lot of problems and we self medicate a lot of problems. The connection between mental , is powerful. Buse anxiety. Folks that are trying to figure out coping skills, we have an entire industry that says, we are going to help you self medicate. The line between alcohol, which is legal, and folks that are taking vicodin, and then onto , iser illegal substances not always that sharp, particularly among children. That wehe conclusions importants that its for our Health System to be addressing wellness in a way that prepares doctors, provides resources, insurance policies, all that can help with these issues as opposed to, if you have a broken arm, get some treatment. If you have significant depression, you may be masking through alcohol or opioids, you are not getting treatment. One of the things we try to do through the Affordable Care act was insist on parity through insurance policies. One of the steps we are taking in response to the Opioid Epidemic is to ratchet up the guidelines we are providing to insurers so if that young lady that we know is talking if she has insurance, if in fact that i ts treated as a disease and it is covered. And medicaid and medicare start taking parity seriously so that Mental Health issues and addiction issues are treated as a disease. [applause] can you give a little more detail on that . People talk about Mental Health and they say that has been around for some time. The impact has not been felt. What with the task force be able to do that has not been done . Pres. Obama the goal of the task force is essentially to develop a set of tools, guidelines, mechanisms so that it is actually enforced that the concept is not just an empty phrase, but as a practical matter, if you are trying to get it may orreatment, may not be reimbursed, but there is a consistency on how to approach the problem. When it comes to medicaid and medicare, there is some consistency because there that is a Government Program that we provide. When it comes to how we see the parity provisions in the Affordable Care act, we have to let the insurance carriers know that we are serious about this. Know the Public Education and employer education around these issues is important as well. 85 of these folk these folks still get their Health Insurance through their jobs or through their employer. Thatompanies to recognize they are much better off ch ecking and pressing their insurer to make sure that Substance Abuse parity does exist, they will save money and their workers will be more productive and they will be getting more bang for their buck. That is all part of the approach that we can take. Sanjay thank you. When we spoke earlier, you wanted to describe some of what you experienced any criminal Justice System. What you are talking about with some of the stigma you faced. I want you to describe some of your experiences and what that stigma felt like. Crystal well, the place i go for my counseling, i talked to a lot of people that are on probation. Treat thems dont and they have a disease the medication is something that is treating their disease. They do not want them to be on it. They do not understand. I do not think they have enough education. Hear theat to president on addiction. There is still a stigma. Ody me, coming care and nob here treated me bad or anything. It is in the back of my mind. Pres. Obama if anybody treats crystal bad, you guys talk to me. [laughter] the u. S. Armed forces. [laughter] dont mess with her. Crystal it is in the back of my mind. Like i am not worthy. Being really honest. Criminal justice parole officers, counselors . Crystal some doctors even. One doctor i went to. I talked to some people about the parity act. I do not have a problem with it now. Everything is paid for. Am on medicaid i have gone to doctors before that would only take cash. They have not been nice. I had a couple of nasty incidents with what a doctor said about other patients in treatment. What you are describing is so unfortunate, but it is so prevalent. Talked about the overdose of medication. There are people that would question about whether it would make them more likely to use drugs. We would never say that about someone who has a peanut allergy. We would not say that we will not give you an epipen because it could make you eat more peanuts next time. [applause] baltimore, stigma in where i am. Since coming up on a year the unrest in our cities. It is often tempting to look at what happened in our city as what is in front of us, angry young people committing acts of violence. We look one step further. We see what has resulted in the poverty and the disparities from our policies. Have a city [applause] if you look at the numbers in arrests, we have 73,000 made every year in a city of 623,000. Have a diagnosed mental illness. Six out of 10 use illegal substances. We are not giving them the reentry resources to get their lives back in order. Provide your own name as a doctor at all of the pharmacies so that anybody going in can get what they need, correct . Leana that is correct. We issued a Standing Order in the city [laughter] [applause] we strongly believe that everybody should save a life. Months, our Police Officers have saved the lives of 21 citizens. That is very important. We also believe that if it is true, that addiction does not discriminate, if it is true that anybody can die of overdose, i have treated 75 euros. These diseases can affect anyone. I issued a Standing Order. Now anyone that takes a very short training, they can train and public markets, in jails. They can get a prescription in my name. Of our cityents have access. President , the doctor brought up this point. Do people feel like i have got a safety net now . I can continue using heroin, for example. These service programs, are they more likely to enable continued usage of these drugs . These discussions come up as part of trying to pass these recommendations. Pres. Obama these discussions come up. The good news is that we base our guidance and policy on science. When you look at the science, there is no evidence that because of a Syringe Exchange that that is thereby an incentive for people to get addicted to drugs. That is not the dynamic that is taking place. This is a straightforward proposition. How do we save lives once people are addicted . Do they have a chance to recover . It does not do us much good to talk about recovery after folks are dead. When theysave a life are in a medical crisis, then we now are in a position where they can recover, so long as the treatment programs are available. Said withleana respect to our populations in ofson and the lack systematic programming for them and support when they get out is of critical importance. Gone toif somebody has jail for a nonviolent drug offense and they are not getting treated and provided with some baseline of skill and some handholding when they are released, they are going to get back into trouble. That is just human nature. Crimeare being smart on and not just thinking in terms of sound bites, this is going to be an area where we provide more resources. The department of justice is working very closely with our office of drug policy to find ways we can improve at the federal level, reentry levels, drug treatment, and so forth. Keep in mind that the vast majority of the criminal Justice System is a statebased system. The federal government is not responsible for the majority of the reentry how process works upon release. We model that practice based on evidence that more and more states will adopt it. The benefit is more and more cost. If you can reduce the amount of recidivism, then you are saving money. If an individual like a young man i met in kansas that was in prison for a drug offense for a decade comes out and gets treatment and support and gets training and is now an emt for state of new jersey [applause] taxes and paying supporting himself and potentially supporting a family, that is good for everybody. But that requires a certain ofunt of foresight in terms how we are looking at this problem generally. The same is true preventing people from getting addicted in the first place. [applause] as we are properly talking about recovery because we have heard stories from crystal and justin. Their stories are inspirational. I could not be prouder of them sharing their stories. We also want to make sure that the thirdgrader has support, t hat does not make him feel the need to engage in this kind of more destructive behavior. [applause] something, we have two doctors on this panel, so maybe they can address it. We have a Health Care System is a disease care system. We wait until people get sick and then we treat them. That requires a reimagining of how our Health System works. Opioids, the to training of doctors for pain and pain relief and how they help their patients manage pain, this is an area that i was shocked to learn how little time residents and medical schools were spending time just trying to figure this stuff out. It is not emphasized. It is not prestigious or trendy to think about how we are managing pain with your patients. Part of what we have got moving, we have 60 medical schools who have signed up who are announcing that they are going to make a relief a major part of their curriculums. [applause] sanjay that is really stunning, mr. President. It seems like for a period of time that pain relief was talked about a lot only in the context of giving out drugs. There was no concern for addiction. Every single time someone came into an emergency room for a nonpain related thing, they would be asked about pain and narcotics. En 80 of the worlds pain pills are taken in the united states. We are 5 of the worlds population. What do you think, dr. . How did that happen . Leana two things happened. Drug companies, very aggressively, they misled and marketed pain pills to physicians and patients. We then developed this culture of a pill for every pain. If i fall down and bruise my knee, i am sure i do not need opioids. We have said that our goal is to make people pain free. I have worked with many great doctors. I have worked with many fantastic people including our surgeon general. I know that doctors are trying to do the right thing. We are not trying to get our patients addicted to medications and to heroin later. We need the resources to help us. What are the guidelines issued by the cdc . What are the other efforts by our medical societies to assist us in making better decisions for our patients . To one of our students in Baltimore City and ask them if heroin is good or bad, a will say that hair when is bad. Are diagnosed with attention deficit disorder, they get a pill. They see that their parents are in pain or maybe they sprained parentsck and see their getting a whole month supply of oxycodone. Access thatlture of needs to stop. [applause] pres. Obama that is what i mean about us reimagining how we think about health. There is a good analogy to this. That is in the field of antibiotics. A lot of what im spending time cdc,my team at the nih and we have to worry about the fact that antibiotics, one of the great breakthroughs of mankind that saves billions of lives because of their existence, are becoming less effective. Because every time somebody has got a cold, i have been guilty about this as a parent. I do not like seeing malia or sasha sick. I go to the doctor and say im a cat we do something about this . It is a cold and an antibiotic will not do anything. It has led to increased resistance among the bacteria that need to be treated. So the doctor is right. We have to have a change in the medical profession and the drug companies. We as consumers and parents have to be more accountable in terms of how we approach keeping our ofilies well in terms preventing this massive gateway into addiction that can cause a real problems. Sanjay dr. Friedman is here from the cdc. The cdc has released new guidelines according to opioid prescriptions. Should not be a firstline treatment for chronic aim. That is not the way the medical coulter has thought about this for some time. The fda talked about black box warnings for some time. There is risk of abuse or even death with these things. There are some things that are changing as a result. Substance i want to ask you about that. We know how everyone in this room feels about addiction as a brain disease. It is still a hotly contested topic. Is there a component of moral failure . You counsel big young people in recovery in your organization . I am really glad you asked this question. I am not a doctor. I am not an expert. I try to be fully aware of what is going on in the way this happens and can relate to that personally. Anould consider myself expert in opportunities and hope. Question, i will start with one of the things that you said. This is good for everybody. This is not one of the things were talking about that will impact a very small amount of people. We are trying to help everybody that we can. Since we are not an expert when it comes to disease, not a disease, choice, not a choice. Separate myself from that conversation. It is not my role or my organizations role to have that discussion. The results that we have seen all over that country is that it has given the opportunity. This is something that i am very excited that i will be able to share this. I believe that if you have been a person, you can relate to this. Whether you may have made some choices that you were not proud of, those choices, maybe i should not have done that. Maybe something happened to you that was out of your direct control and influence. You can relate to that. If somebody gave me a real shot and an opportunity, i may not know how i got here. Whether i did this to myself. Instead of focusing on that were being able to medically speak to that, the real opportunity is what this country is supposed to be about. Resources thathe they need so that they can recover all over the place. To pick up on what justin said, i was lucky. I do not know why. Friends of mine battling addiction were not less worthy or morally suspect. For whatever reason, things broke that way. Justin is correct. How individuals get into these situations, and we do not know everything. There may end up being genetic components of how susceptible you are to addiction. Addictions may be different for different people. Is that therew are steps that can be taken that p people battle through addiction and get on to the other side. Right now, that is underresearched. Theree do know is that are steps that we as a society can take that will help young people adjust and adapt to a rapidly changing and sometimes confusing world in a way that is healthier rather than more destructive. It is affecting everybody. Poor,know that if you are you are more vulnerable. You do not have the same antibodies to protect yourself. You do not get the same second chances. Hopefully, goal, coming out of this conference is everyone,ds affect but speak to a broader issue of, how do we speak to addiction in general . We as a whole are paying attention to what is going on in ives and also l paying attention to children that have a lot less resources than your or mine children do. In an innercity in baltimore, it will not take long before those drugs find their way to a wealthy suburb outside of baltimore. I now have kids in high school. I am well aware that their ability to access legal or illegal substances is very high. Are just less likely to get in trouble and thrown in jail and have a permanent record than the kids that live in those inner cities. [applause] analogy, wee the care a lot about making sure that no children in america have tuberculosis. If a child has tuberculosis and point, they can give my child that is welltodo, tuberculosis. The same is true for addiction. It has an impact that can run andugh society as a whole that is where we have to pay attention. [applause] sanjay you are absolutely correct. [laughter] pres. Obama let me just say that i am in washington dc and that is rarely said. [laughter] [applause] i just want you to take note. Justin to continue to put a bill on the correctiveness, you are absolutely correct. What i have also found is that it is even more. What do we do . Calmly what to do for him. If we did this or that, with the result change . What the experts are telling us is that it is not an either or solution. It is time for the country to go all in on this. It is everything. Back k if i want to buy in. What are we doing with our members . What are we doing that is extraordinarily different . We are equipping them. What was that thing that changed . I was given amazing programs and treatment. The single moments in time that somebody looked eyeball to eyeball to me and said that you have value. Regardless of some of the choices that you made, whether somebody else did, you have value. You have got a lot to learn and you have got to listen and stop talking so fast. You have to know that you have value so you can give other people hope and help equip them and power them. Housing,through education, and other recoveryrelated resources. That is not unique to young people or people of any age or recovery pathway. Those are things that all individuals in this country need. When we start to have that conversation of that is how we net Recovery Housing and resources, we can do this thing together . [applause] i am soama sanjay glad you said that. It is a multidimensional issue. I want to ask about the next step. Mr. President , i know this is personal to you. Somebody has gone through recovery now. They are in recovery and they go to the hospital for something unrelated and they are given a prescription for narcotics, opioids again. They tell the doctors that ima drug addict. I cannot take this stuff. If i do, i could go into addiction again and i could die. That is what happened with jennifer. He stigma exists at all levels even within the medical establishment after somebody has been treated. You will be fine. I will give you these opiate pain medications. Pres. Obama this is where the training of the medical Community Comes in. There has been some discussion about making this education mandatory. I think that the medical community worries about their overregulationd of the medical communities. We have been getting some good volunteer efforts going. I applaud those. We have to see how good the takeup is. If the training is not sufficient, then we will have to look at the possibilities of mandatory training. With the federal government, for example, if you are going to treat somebody that is a federal employee or part of the federal Health Insurance program, you need to get trained. Medical of the timidity that treats employees, i was able to do that through executive action. I do not want crystal, if she is ready to get treatment and to do kids, i want somebody that is fully supportive from day one. I do not want somebody that has got an attitude. I do not want somebody who is misinformed. I do not want somebody who is not familiar with the best options that are available. I want somebody that is going to embrace her and say, lets go. Lets see what we can do for you. I want to make sure that those doctors and perhaps nurses as well, because in some communities, there will not be enough doctors. One of the issues that we have to address, i just happen to love nurses as a general rule. They are overworked, underpaid, and are just the foundation of our Health Care System. Want toproviders, i make sure theyre getting the resources and reimbursements to make sure they are part of medicaid or medicare to be able to do right by crystal. Because it is hard. When somebody is ready to make that change, i want somebody to be right there with them. [applause] leana mr. President , i would also add that we need people like crystal and justin and other people in recovery working as well. Specifically working with addiction inith baltimore. I am very proud to represent the Baltimore City Health Department on behalf of our mayor. We really care about addiction as a Public Health issue. We have individuals working at 24 Needle Exchange sites across the city. Statisticl you one that continues to really surprised me. It is also why we do the work that we do. The percentage of individuals with hiv from needle drug use has reduced from 64 in 2000 to 2014. [applause] these individuals who work on our needles are in baltimore recovery themselves. For them to save to their patients that you should think about quitting. We can help you with it. We can guide you through. That is so much more powerful than me as a doctor saying that recovery is impossible. We also believe that violence, just like addiction, just like other diseases, can spread. We have something that came from chicago where we hire individuals who were recently incarcerated, who were recently released from incarceration, who are asked to walk the streets of baltimore. If these people are true heroes and we pay for pure recovery specialists, the most powerful messengers [applause] you are also 100 correct. That excitement, that person that you described, esther president , when they are ready to get help, if i can encourage meet me one on your day of need and help, you meet other people on their journey, who better to do that along with as a professional. Fund massive amounts of them. One of our recent success stories, we said a long time ago, we decided to say that we would just put our money where our mouth is. We will be the solution until these coliseums change. What our chapter leaders have been doing, we have been helping build recovery schools and encourage recovery communities. That action has been able to attract enough attention because we are doing it. We are not waiting for things to change. Our leaders are changing the communities regardless of bias or straight up discrimination against their own population. What has happened is that Big Insurance Companies have said that we will literally pay you to further build out your own infrastructure to put chapters around our communities. Because thiswin is good for everybody. We will pay you to do what you were going to do anyway. We are saving a ton of money. Not like geico. Like insurance because we are getting money back. They are not going through that system again and again and again. If we equip and power and not handcuffed and jail people that are not well, that is part of the change. [applause] president , there are a lot of things that are going billionrt of this 1. 1 that are spent. Crystal describing how her life would change or to a future crystal, how her life will be different. Pres. Obama first of all, the 1. 1 billion has not yet been reallocated by congress. We havent able to reallocate some existing dollars. This is an area that is grossly under resourced. We will have to work with congressman rogers and other members of congress to support policies that they have already embraced. It is already affect reflected in legislation. Sometimes congress will say that this is a good idea, but until the money comes through, it is just an idea. It does not actually get done. Crystal, remind me where you live. Where you entered into recovery . Crystal ohio. Pres. Obama is it more of a rural area . Crystal yeah. Pres. Obama one of the things that would change, i do not know if it was easy for you to identify where you could get treatment and how long the ere, thewere, waits w basic thing i would like to see his greater coverage of the programs like justin is describing. Ind work that is being done baltimore. I want to make sure that there is sufficient coverage everywhere. Part of what is troubling about the Opioid Epidemic is that we are seeing significantly higher spikes in rural areas. Part of that is because there been a lot of under resourcing of treatment facilities, Mental Health facilities. There may be, in some of those cases, more stigma about getting help. If you are as in a small town and Everybody Knows you, you bay you may be more hesitant. If you are in manhattan and going to get treatment, people may be more familiar with it. Part of what our goal is is to make sure that in counties all across the country, have at least some resources that can get things started. As great as the work that he is doing, volunteer organizations are not going to be able to do it all. There is wonderful work eating done by the nonprofit sector. We applaud them. Faithbased approach is going to be critical to being able to get the wherewithal or the current to be able to get through this thing. Obviously, traditional recovery programs have emphasized the higher power. There is a lot of work that is being done. In churches and synagogues, temples and mosques all across the country on this issue. We got an amen. [applause] ultimately, if we are going to get coverage everywhere, then we have got to get government help. Immunity Health Centers are a very efficient way to do it. We have to make sure that local hospitals, medicaid expansion, are all part of this as well. Iis takes me back to why theed so hard for Affordable Care act. I know it has been controversial. I know the politics of it. Ake the main goal is to m sure that if you do not have Health Insurance on your job, which 85 of the American People do, but at any given time, someone that might previously have had Health Insurance on the are loses their job, or between jobs, or are going back to school, or are starting a small business. Those circumstances, you have some access to prevention. You have some access to doctors. You have the ability, if you have some pain, not to just rely pills,etime bottle of that a doctor who knows your health history. You know what, crystal, i have known you since you were x. I help you deliver your baby. Let me just give you some advice. You will be at her off. Off going through rehab on your shoulder instead of taking a pill. You have to have a wellness system. Gaps,are a lot of especially in rural communities, where that does not exist. System, whicha. Has coverage all across the country, typically, some of the biggest problems we have with v. A. Is in rural areas or you have to drive two or three hours to get treatment for any kind of medical problem. It discourages people from using it. They start feeling isolated and they start selfmedicating. We see a lot of veterans selfmedicating because they do not have easily accessible treatment facilities. Very rarely is money the solution alone. There has to be passion. There has got to be the stories that crystal shared, great dedication and professionalism like leana, but money helps. And without it, without the government without us collectively as a Society Making this commitment, what we will repeatedly end up with is being penney wise and pound foolish. It is so much more expensive for us not to make these front End Investments because we end up with jails full of folks who cant function when they get out. We end up with peoples lives being shattered. Folks not being as productive on the job. Children then suffering from some of the problems, parents who are going through issues. That affects their school work. That in turn has an impact on our economy as a whole. It is just smarter for us to do the right thing on the front end, and i hope that this conference will help underscore that. I appreciate everybodys great work and n highlighting it. Mr. President , thank you very much. Pres. Obama thank you so much. [applause] this week on cspan, were featuring programs on the increase of drug abuse in america as a situation of the Current Supreme Court vacancy. Wednesday evening at 7 00 p. M. Eastern, with the abuse of Prescription Drugs and heroin on the rise, we look at the governments handling on the issue. Comments from president obama d president ial candidate ted cruz. It is certainly not going to be washington, d. C. That steps n and solves these problems. Its going to be friends and family, churches, charities, centers. S, treatment people working to help those who are struggling overcome their addiction. Drug addiction is a disease. Pres. Obama i have made this a prort for my administration. Were not new to this. In 2010 we released our First National drug control strategy. And followed that up with a Prescription Drug abuse prevention plan. Were the weight to be given prevent drug use, reduce Overdose Deaths and helping people get treatment. Wednesday at 6 00, we look at what todays leaders have said in the past concerning the nominating and confirmation process of individuals to the supreme court. In my view, confirmation hearings, no matter how long, how fruitful, how thorough, can alone provide a sufficient place for determining if a nominee merritts a seat on our supreme court. The thought that senators should realize any benefits of barring an id logical opponent from the court are not likely to outweigh the damage done to the ourts institutional standing. Idological opposition to a nominee from one end over the political speck truck is likely to help generate similar oppositions on the opposite end. Rorn our next washington journal, well talk to joseph cirincion everyone. Then Daniel Klaidman will discuss Donald Trumps campaign. Then later scott lincicome. Hat is part of our spotlight series. You can join the conversation by phone, facebook and twitter. Americans hold 1. 3 trillion in unpaid student loan debt. About 121 billion of that is in default. Up next, well get a closer look at the u. S. Student debt. The Gerald Ford School of Public Policy at the university of michigan hosted this events. Good afternoon and welcome. Before i begin, i would like to thank the codirectors were planning our event today. I know you like me have been ooking forward to. I would also like to acknowledge the charles and Susan Gessner for their generous support of todays program. We are grateful for all of those engagements