Can hear host appreciate you joining us. Sounds like it is a busy practice for you. Well get one more view on the governments role. Barbara is in pennsylvania, on the others line. Guest good evening, caller good evening, i was in an accident, and i had five different doctors, and the last doctor just left me two months ago. Pain. N morphine for my and she is cutting me down, this new doctor, for two months, has and more i and more am in bed because i cannot walk. Host she has you down in terms of the amount of the prescription . Yes. R i have 27 days, and that is it. I had over 30. Now, i asked her to look up because in pennsylvania you have to show your license, even though the nurses know you, show you the license, and if you look my clipboard, you will see the day i take them up is always a weekend that have to two weeks later. Meds, butverdo my when i need a med, i needed. Host we want to remind you all on video we are showing you the program tonight is on www. Cspan. Org. To heroinll take you abuse summit held back in january, in a program that includes members of the National Institutes on drug abuse and Substance Abuse and the Mental Health services administration. The most Important Information reminds us of the deaths associated with drugs of abuse in general, the painkillers, restriction opioids, almost 19,000 t deaths in recent data from 2014. Data has some messiness in it. Deaths look at how certificates are coded. There are an awful lot that are coded as Drug Overdose generally, and dont specify whether it is in opioid or even heroin. It is prescription opioid or even heroin. There may be even greater numbers specified in the National Death data. Is the increasing rates of prescriptions that have given so many in this country a taste for an opioid. That means their brain has been exposed to it at some point. Or the communities are exposed in a way that these pills can be diverted and misused and taken nonmedically by so many around the west aruound the u. S. As the number of prescriptions go up, the number of deaths increase as well. A fourfold increase in the deaths associated with these we would painkillers. That strokes like oxycodone, hydrocodone, all of these narcotic opioid pain relievers. Witheason i am starting prescription opioids that is the upstream, driver of the recent heroin epidemic. That seems to be the deciding factor that exposed so many to opioids and let them towards that pathway into a heroin addiction. The brain does not distinguish between different types of opioids very well. The brain sees them almost all as not quite identical, but very similar. Heroin as a street drug, has pretty much the same impact on the brain as oxycodone or hydrocodone. In controlled laboratory studies, people cannot even distinguish when you give them one or the other. As those rates of prescription drugs become available, we seen a corresponding increase in heroin. We believe these are related in important ways because of the availability of heroin in so many communities. As youve already heard alluded to, the number of those misusing heroin has skyrocketed in the last five years. Overdose deaths have seen a corresponding increase. Its almost an exponential increase in the last few years. As an epidemiologist, it concerns me. We like to see a curve venting and eventually coming down. We dont know where this curve will end. Its still on the upswing. There have been increases everywhere. If i only showed you the south and west, we would have thought it doubly was a terrible scourge. But look what is going on in the midwest and northeast, somewhere between a four in sixfold increase in Overdose Deaths. All the different major ethnic, racial, and age groups. But particularly, nonhispanic whites of young and lh youing and no age seeing the sharpest young and middle age seeing the sharpest increases. It shows these new injection drug users tend to be younger, more equally male and female. That is a novel change. We think of most drug uses being more common in males than females. That is not so true in the new injection drug users. Thats another concern with the epidemic. Why do people abuse things . They abuse them because these drugs have an impact on the central reward circuitry. They make you feel good by rewarding and relaxing. That is a basic principle from much neuroscience, that i will go to in detail. That is the underlying feature here. These are habitforming, not for everybody. That is a conundrum here. Some people take these pills or drugs and find it extraordinarily unpleasant. But some really like it. And they are the ones at risk for doing it again and keeping on doing it. Im very pleased that our secretary of health and Human Services may do this one of her keynote issues. Shortly after she was confirmed and took office, she convened a small group within the department to help her address this in a proactive, consistent way. Weve developed three priorities. These are not the only things we are doing in opioid epidemic, but three priorities relate to prevention. Lets change how many prescription opioids are available by focusing on prescriber practices. Lets focus on saving lights immediately with the use of no locks on in greater numbers. Greater access to the lifesaving overdose treatment martin. Lets focus on treatment. Medicated assistant therapies as the proven treatment for opioid addiction to reduce the likelihood to increase the likelihood of those going on and recovering their lives. Im going to focus on the first two. When it comes to prescribing there are guidelines for prescribing opioids that plane that pain clinicians use. Those sources have been inconsistent. Some of them are outdated. Some are not without their conflict of interests. As an alternative, the cdc has undertook the development of prescription guidelines. We expect these to be released to assist in the proper prescribing of longterm opioids for noncancer, not endoflife care. When it comes to the overdose, we are pleased on working with one of the pharmaceutical industries and with the fda for the recent approval of an intranasal. Instead of the only fda approved formulation being an injection, there is a nasal spray. As soon as it was approved in november, it should be on the market shortly. Lets get to the main issue, medications. There was a study in baltimore couple years ago that showed us that as they increased the availability of methadone, they showed a corresponding drop in heroin Overdose Deaths in the city. We see this as a populationbased example how you can save lives by increasing Treatment Access any large population. Ive already mentioned methadone. That is in opioid substitution treatment. Methadone is in opioid agonist. That is a fancy way of saying that it wont work as another opioid. What do we mean by that . Lets take a quick lesson in cellular chemistry. When a chemical is administered were taken, it works by fitting into a receptor. Think of it like a key going into iraq. Into a lock. When morphine or heroine agonists go, opioid into the brain, they go into the receptor and produce a lot of activity. Kind of like turning a lock, and the templars move and the door opens. And tumblers move and the door opens. Morphine is like a dummy key. If sills the keyhole it fills the keyhole, prevents other keys from getting in that locke. A full agonist like opioids we have and in between agent that is somewhere in between the two. Is a partial agonist. But therns the lock, door only opens partway. That is a quick way to think of these classes of medication. A blocking agent is one of our tools that can be given in a longacting form. When people take it successfully, they dont get high if they use heroin or other opioids. The same thing happens with methadone. When they take those successfully, and they might slip and use heroin or other drugs, they generally want get any high. Wont get any high. The key is a learning experience. That is a short version of what history is. Melinda will go into this in more detail. We have focused on extended relief medications. We focused event on medications and have been pleased to partner in the release of a longacting naltrexone. Weve finally been developing vaccines as another way of keeping drugs out of the brain. One of our new medications is a longacting beeper northing. People will take these medications, but there is an issue. My patient has to make a decision everyday whether they want to stay clean and sober, stay in treatment, take medication, or if they want to not do that and had back into a path towards relapse. Sometimes its a conscious decisions, sometimes not so much. They need to make that decision every day. With a long acting injectable form, they may not need to make that decision quite as often. In particular we are interested in this idea of an implantable device. A longacting implant that only needs to be implanted once every six months. Means someone only needs to make a decision about their life and turning things around about once every six months in some fundamental way, rather than every day. Patients are more likely to be compliant when they take this, certainly producing greater abstinence. That is one of the hopeful possibilities. This was submitted to the fda in september. Review,er an expedited so we expect an answer from the fda and whether the data supports its actual use by clinicians within the next couple months. The next area is promising vaccine development. For drugs to have an impact, they have to get into the brain. They go from the blood system, across the capillaries into the brain. Vaccines attached to those drugs, so they create a protein binder to those drugs. They keep them in the capillaries. They keep them in our circulatory system and not in the brain. That is the theory. There is quite a bit of Preclinical Research with animal models. There is now some emerging Human ResourceHuman Research that suggests this to be effective. But we have a ways to go before we have vaccines to be useful and administered on a regular basis. I remind you that our job is to support what we can do today and to always be charting a path forward tomorrow even better. Is last challenge implementation. Weve had these medications like methadone for about 50 years. Had naltrexone as an oral medication for 40 years and in injectable for the last couple years. What is going on . Not very many people are treated, even when you go to specialty care. This is a major gap for us. People are more veiling themselves of us. We have been pleased to try novel trials. A group at yellow university a group of Yale University noticed they were seeing the same people with either an overdose or problems related to heroine and other opioid issues. She said, maybe we can start them on it here in the emergency permit. Why dont we act as their primary care physician . They found they were much more likely to be in treatment. They were also less likely to be using drugs when they were reevaluated weeks later. This is just one center, a topnotch center. We dont think everyone else can do it as well. We think that is very promising and are working on testing this in a number of other centers. Butevery place should, those that see a lot of opioid addicts might want to do it. Saddened by the story representative custer relate about patient who died shortly after being released from prison because they cannot get into treatment. This speaks to the important of linking our kernel justice and Public Health effort. Our criminal justice and Public Health efforts. I have issues with high attrition. People drop out of this readily. With prison, they have recidivism and problems with mental activity and drug use. But working together like the drug court models, extensive work with probation and parole, we can do a better job using the best pieces of both. Whether thats a close provision that provision and parole can provide, the treatment that providers cna provide. Even incentives for people to turn their lives around through modification. These models have been shown to work for 20 years. We dont see them in white enough usage. These combined efforts seem to be an area where theere can be improvements. Even medications can be used in this setting. A study coming out of baltimore took vendors about to be released longterm with a history of heroin addiction. This was in withdrawal. Wasnt withdrawal. They are the referred them to methadone actively, which means they actively made that referral and tried to engage them in treatment after release. Or they started them on methadone a few weeks before release. Those where methadone was started prior to release had a better outcome, less criminal activity as well as less drug use. At least over the first few months after release. This speaks to the importance of being practical and thinking through what happens. When people get out of prison, they are not usually thinking about getting treatment. There are other motivations they are paying attention to as their first goal when they are released. Starting treatment on the right foot could be important. Thanks very much for your attention. I will turn it over to melinda from sampson. If i could have congresswoman custer make the introduction. Thank you very much doctor. Welcome the current medical officer for the office of pharmacologic studies at the Substance Abuse and Mental Health services administration. She is a position Board Certified in family medicine, with additional credentialing in addiction medicine. Thank you for being with us. Its my pleasure. Before i get down to the business of my presentation, i want to thank you. Sam is supporting a new round of grantssa to improve access to highquality medication assisted treatment. And funds to Overdose Prevention thanks to the budget you work hard to pass. Similarly, i want to thank you for setting aside the block of time to together more information about Treatment Options for opioid disorders. I cannot begin to fathom the number of equally Critical Issues you are faced with. We will go live to the Brookings Institute from the turkish president recep tayyip who will speak about thega challenges facing his country. News agency has said n explosion has gone off in a bus terminal in southeastern turkey. Ur people were killed. We understand there were a number of protesters outside this event. [captions Copyright National cable satellite corp. 2016] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] live pictures from the brookings institution. They are hosting remarks from the turkish president recep tayyip erdogan, who is expected to talk about some of the challenges his country is facing. He will address challenges they face. Also here in washington, president obama is part of a Nuclear Summit taking place at the Washington Convention center. He said more has to be done to rid the world of nuclear weapons. He is calling on russia to reduce its nuclear stop file. He said the u. S. Will continue to stand up to north korea. World leaders are meeting in a Nations Capital for the fourth Nuclear Summit the president has hosted. President of the republic of turkey, recep tayyip erdogan. Good afternoon, everybody. Welcome to brookings. Welcome to our forum. Our speaker and our guest of erdogan, is innt washington at the invitation of president obama to participate in the Nuclear Security summit. Dogan is kind enough to be with us because it is part of our tradition and mission to invite World Leaders to address the issues of the day. It is a particular pleasure that the first lady of turkey would be with us once again as she was back in 2013. These discussions are intended to be in the spirit of informing the Global Public and promoting stability of debate and respectful, constructive, and candid public discourse. We need as much of that as possible in the case of u. S. Turkey relations right now. Ankey has long been especially important american ally, critical to American Foreign and security policy. It has been an ally for 65 years. This is especially a difficult for turkey as it is for much of the world. Turkey faces internal and external challenges, which all of us, whatever our perspectives and concerns, hope will be resolved in a way that contributes to regional peace, strengthens bilateral ties between our two countries, and upholds the Democratic Values of the transatlantic community. We look forward to hearing from the president his perspective. Colleague will conduct a conversation with the president followed by an opportunity for him to take a few questions from our guests. President , thank you once again for being back at brookings. And now, erdogan directors of the brookings, i would like to greet you with respect. Celebrating its centennial this year. It is a pleasure for me to meet you once again in this very reputable think tank. I would like to start my words by reminding you of the fact that there has been a terrorist attack targeting our Security Forces. I denounce this. We have regrettably lost Seven Members of the Security Forces who have lost their lives, and we have 14 injured, officers i would like to convey my condolences to those who lost and those who were injured. I am very sorry about these attacks, but those attacks will never keep us from fighting terrorists. The terrorist organization shows its acts. To make sureined that terrorism is no longer an obstacle inonger an our country. Terrorists unfortunately keep attacking our country. We cannot tolerate this anymore. European countries and other countries, i hope they can see the true face of terrorists of these attacks. I am meeting with you to discuss the global problems and my opinions about the approach of of those challenges. Achieved humanity has a point in history in terms of science, technology and other fields. Quite a wide way of interest ranging from the sophisticated mechanisms including the internet, that makes lives easier. But it brings in challenges, including security, for example. Poverty, hunger, migration, and terrorism are common problems that have an impact on the entire globe, and are related to each other. They are equally important. Communityational needs to discuss how we can find a solution for the global. Roblem the International Community turkey is located in the intersection of the most specific geographical faultlines. We are in 300 kilometers of the iraq. We are surrounded by troublesome territories. Not deviated us from our humanitarian approach, and will not deviate as from our approach. On the contrary, a humanitarian approach is a must in order to custody stability and peace stabilityo establish and peace. We have made particular achievements. Century,ginning of the i am sureipient brookings has data in its archives. Humanitarianin our aid and we are the first in ratio to our gdp. If we can do any help, we always use our means to help people in need, even in distant geographies, like africa. We are perceived as an honest partner. We believe for more welfare around the world, we have to pursue. There are gentlemen, groundless allegations against turkey. I regretfully follow those allegations. I would like to share with you a few examples, or a few facts. Years, our 13 citizens from all segments in have been benefiting. Rom comprehensive reforms in 2010, we had the referendum and had the constitutional amending 26duced by articles of the constitution. It not only offered new rights to our citizens, but also introduced Additional Mechanisms for the protection of Constitutional Rights. This strengthened the role of state in turkey. Officetituted ombudsman and human rights communities in turkey. They are conducting their activities in defensively. We have put in many reforms. To institute the fundamental practices, and we also drafted new regulation to improve human rights, and the freedom of expression. Reform to make sure that we can respond to the needs of our citizens belonging to different states and sects. If you believe that this is about the marketization, it means we have a very serious problem that has got nothing to do with us because on one hand, we have some people who live with strong Constitutional Rights and resorted to very restricted measures. This has not been the case in turkey. Target ofnot a common the bloodiest of all terrorist organizations in the world. Despite all of this, we are not compromising on human rights democracy or rule of law and are fighting against terrorism. When we look at all of the it is facing,ats you cannot find any country that pursues high standards in human rights and democracy like turkey. We want to be treated fairly. The turkish American Partnership if used effectively, is a partnership that can produce very positive results. There is a crisis we thought along the same lines as the United States, and we follow the same lines today, and we believe we have to keep this relationship always dynamic. There may be differences of topics and ittain is very normal that this this that this is the case. Relationsh american is strong and deep enough to resolve disagreements through dialogue. We also believe that today we use toground we can reinforce our relationship. The United States, there is and we election process, are keen on following up on this president ial election in the United States. We believe it is one to be very to see what the outcome will be, but we will continue our relationship with the United States based on our common interests like we did in the past and respect the choice of the american people. However, it is important to see how our positions work in the current issues. Have aan we humanitarian and security crisis currently. Usse are Top Priorities for and we had been very sincere and very selfless in our approach in this crisis. The 6 million syrians who had to leave their es because of this crisis 2 million syrians took shelter in the last six years. We have 300,000 iraqis taking shelter and refuge in our country, but we never closed our gates to them, and never let them suffer their fate and to die. 280,000 of them are now being housed in container camps, and are in our towns and cities in the raise parts of the in variousd cities parts of the world. A lot of other countries are closing their gives to the refugees. There are some there are many who died at sea because their bonuses were punctured. But the coast guard saved hundreds of thousands of lives in the sea from certain death, and they have fulfilled their humanitarian duties, according received, e according to the data, we 400,000 400 million. This does not include the assistance by our local government. It including their assistance, i moreve we have spent 50 than 10 million. We have more than 150,000 syrian babies born in turkey. The number on its own is much more than the Syrian Refugees accepted by many European Countries. When we admitted the syrians, we never checked their origins or their faces. Their humanitarian problems are being ignored thinking there is a country taking care of them, and this is very unfair. And weumanitarian issue require the enrollment of the entire humanity. Specifically European Countries and other countries, are more concerned with the regular migration process. E are doing our best believe it isnt right to build everything on security measures. It cant eliminate the humanitarian crisis and security that these people are facing. There are people on the journey boat towards europe. The person responsible is the president of syria who uses his power. 500,000 people in syria have been killed since the beginning of this crisis. There are some people who are completely ignorant of how countries are ruled and still have these questions. Organizations that. S the product of the regime other elements of the regime are exposing Syrian People with unprecedented violence and cruelty. Those people who flee syria are trying to get away from terra and the are try to look for a Better Future for themselves and for their children. Europeare traveling to on makeshift boats and we have people losing their lives and innocent babies washing ashore. Aree are things we regretfully watching a spectators, however, on the other hand, we also have apart byfamilies torn bombs from the regime. Terrorist organizations are going to get bigger and stronger in syria as long as we keep the regime there. Turkey is a country that feels the pain of the crisis in syria, the closest of all regions. Security, peace, quiet, and order in syria immediately. However, this is not the case. Thinking about a rock, unfortunately picking about iraq, unfortunately there is no stability. Iraqess against i. S. Is a small model of the middle east and serves as an element of imbalance. One third of all of the iraqi byritories have been invaded terrorist organizations, freely roaming in the northern part of iraq. Have some ofnt their subgroups under different names. In some parts of northern. Erritory of iraq unfortunately, no one is buying the fact that the subgroups dont belong to the pkk. They are only following its own agenda. These are just lies. And pkk is exploding the tragedy. That they are surrendering to terrorist removeations in order to the terrorists from there. We have to coordinate in unity if we want to win a victory. We are trying to encourage our iraqi friends to do it. Stability and security depend heavily on Eastern Europe. Unfortunately, Eastern Europe is disputesng kurds with way need to be settled in a. , theirritory of Ukraine Security needs to be taken into account in those settlements. After the fighter jet incidents with russia on the 24th of november, 2015, we have been facing challenges in our relations with russia. We had developed good relations with them after the cold war. Lso, the russians government is suffering. Unfortunately, their reactive policies that were employed by the russian government after the fighter get incident in november 2015, our relations are suffering. Despite all of that, we keep calling weak calm because turkey and russia have had interaction for several centuries. Our common interests require our relations there. We will assess our relations from that point of view. Another issue is cyprus. We are determined to ensure a lasting and fair sentiment with cyprus. First and foremost, we have to guarantee the human rights of the people of cyprus and we need to introduce a comprehensive settlement by the end of this year. In may, we are going to be start negotiations and we hope this will mend the turkish cyprus communities. They put forth their desire for a settlement. If the greeks also respond favorably, we will be able to achieve a settlement on the island. If we can achieve that, then we will have many important opportunities that we can make use of, including energy projects. October, the turkish project is a project that is a clear indication of turkeys sincere approach to the settlement. Applies to the entire island. After we have a fair and lasting settlement community, we will be able to benefit from the project. Watchers project, i call it because the southern part of cyprus still receives watchers supplies on tankers. However, they could receive supplies from northern cyprus. I have not changed my position since. My expectations from the International Community is that sincereo offered support for the efforts. We have one more important issue israelregion, which is and palestine. Brothers and sisters are suffering under the unfair treatment of israel. We have always been in support to them for lasting peace in the middle east we believe the invention of the palestinian terminatedhows to be. After the few tell a incident after the incident come our expectations from israel were expressively stated to them. Prime minister Benjamin Netanyahu called in and apologized. After that, we started our negotiations. Specificallyma took initiative and placed a to Benjamin Netanyahu, and i heard the apology through the call. It is in progress and it will be the result without any problem. Attackl, there was an that cost the lives of three country,isitors in our and we have communicated our regret and condolences to the Israeli Government and their families. Thesehave specified that acts isnt only targeting israeli tourists. We continue to intensively fight against their operatives and actions. Israel communicated their gratitude to turkey for our efforts, and we are in communication, and we have also expressed our feelings for cooperation. We believe we are going to ensure positive developments and improve our relations with israel. Palestine isint, facing energy problems. If we can have a Power Generator anchored on its harbor, we will be able to provide gaza with electricity. This will facilitate the lives of the people. This is something we had been communicating with israel, and they know the government, they are facing a water supply problem. Situation improve the by desalination and drilling artesian wells. Andave placed our requests desire to move forward. We are ready to help in their need for school and hospital, and we also have applied for systems in kind, like food supplies, or construction materials. On these through our negotiations. I believe that the parties are as a to reach an agreement result of these negotiations. Young unemployment, social that we aree issues going to face in the future. Are one of these problems destructivet have consequences, and they can act as triggers to new challenges. Migration irregular are the main threats caused by these problems and no country is isolated from those problems. No matter where you are in the world, we are all exposed to the threats caused by these problems. And when we are facing those challenges, regional and international organizations, need to work on ways for solutions to these challenges. Out king for ways humanitarian missions should be funneled by every country, and every country is facing terrorist threats. There isnt any country that doesnt face terrorists threats anymore. Succeed if we are ncere in our efforts. U. N. And all the International Laws we have drafted so far. Terrorisming to fight , and terrorism can easily , by thiss identity disinforming and by using pretexts that terrorism does not have any more values. Act on these basic principles. The most important principle is to be determined in our fight against all terrorist and distinguish between one or the other. Aday we consider daesh terrorist organization. It is active in syria and iraq. Ypt is a gang of terrorists. Is fightingp goodst daesh so they are terrorists. This is unacceptable to us. There are the organizations that auxiliaries of the pkk. If that is the approach, i would is a terrorist organization, so fighting against daesh. Itn we have to also consider a Good Organization . Considerse we cannot good terrorists or bad terrorists. We have to cooperate as Coalition Forces in our fight against terrorist organizations. Our shabbat is an organization that we fight the same level of sincerity. We also have to fight against daesh because it is a threat to the entire region, including the United States of america. Our partners are required to offer us their support. This is how we have to operate all together. We have to present the foreign prevents the foreign fighters from entering the fighting ground, and turkey is the country that has taken measures against that, against some terrorist organization or even being supported to others, but it is not reflective of how the International Community t. Ould act for th organizing,e are funding meetings, and are getting arms to those organization. As the attacks in ankara that and conducted in february, in march, were conducted by changing the and also in istanbul, the daesh was realized with the support of the pyp organization and members. Those facts are the same as the attack in brussels or in paris. We informed them we had captured the terrorists. Despite a report, it was robust by it was released by officials in belgium. Also have to apply to elgin four terrorists who assassinated a very important businessman in turkey. It has been 10 years. We asked for this person to the extradited, and the person has not been extradited since. Each time we meet them and we respond to us by saying they are the savor of freedoms. How about the person who was is going to, who defend the right of the victim . What kind of freedom is this, and they are trying to convince us this is freedom of expression. You are working in company and you are killing your employer because you are an assassin. This is something that we all have to fight against. Those people do not recognize any humanitarian values or moral foundations, and those people have clearly demonstrated to us that they had no principles. Principled is a more approach and position from other countries that terrorism does face,ve any nationality, or race. Unfortunately, we are facing a tendency like associating the religion of islam with terrorism. Since the beginning of my office as Prime Minister, i have clearly indicated that i am against but i expect the same approach also from the west as they should also have to state that islamophobia is a crime of humanity. Of islam as a lim, i denounce all these with the fact that any religion should be associated with terrorism. Terrorism is violence that distinctively. This has no place in any religion. An can a religion endorse ideology that says you can kill park . En playing in a fun is inhuman, and associating terrorism with a causesn or a nationality humanvelopment of an in human ideologies like racism. We need the cooperation from the islamophobia and racism are not right, and they an obstacle to human development. In 2005, my spanish colleague and i of the alliance of civilization. Group is a very Wide Organization that has 118 and 26 international organizations. And this also requires not only the elimination of terrorism, but also the ground where terrorism is fostered, because you cannot get rid of miscues by killing them. You have to make sure that you dry the wetlands where they grew. So we have to make sure that we have a strong, Sustainable Growth thatawful includes all the countries. And i believe that this also is a moral liability. Global trade is also being , as the transatlantic trade and Investment Partnership which was negotiated between the u. S. And following this process. In cooperation with alignu. , and we have to the their trade agreements, freetrade agreement of the union, which has a direct impact on us. Enforced, ites will have a negative impact on turkeys trade balance. In order to prevent that, we want to be included in the negotiations and also in the scope of this agreement. The support by the eu and the u. S. U. S. As i have stated at the beginning of my presentation i said that we have become a that has been very 2023,sful so far, but in the turkish republic is going to celebrate its centennial in order to make sure that we can. Elebrate the centennial while we have set targets for ourselves, in terms of the politics, we want to improve our social economy and political standard in order to the Global Community with the. Upport of the american friends we are trying to achieve our target that we set for the centennial of our republic. I would like to thank once again the Brooking Institute for giving me this opportunity. Thank you very much for your kind attention. Thank you very much, mr. President. While listening to your marks, i had two reactions. One, it is competent. Have to glad i do not deal with the problems that you do. [indiscernible] thank you very much, mr. President. I am very grateful that we have time for a few questions. , what itened to you heard was that you are hopeful in the effortough to normalize relationships israel,palestine and also that your relations are turning a page with europe as a result of the agreement you struck on the handling of visas and the opening again of negotiations for accession. I was wondering whether this can be characterized as a s foreigng of turkey policy. Is this a turned back again to the approach that you had pursued when you were first Prime Minister, in which in the ways you look more to west and the mediterranean rather than the middle east where the troubles are some any and the problems are so difficult to resolve. President erdogan thank you. Let me start by referring to the cyprus issue, as you so rightfully suggested. The cyprus question, the southern cyprus and the northern parts of cyprus are required to adopt a very positive approach to these talks. The u. K. Happens to be a little bit more of a passive country, but turkey and greece countries. Portant when i took over the office of Prime Minister for the first we got together with kofi davos, and that was the time i requested kofi annan to help me. That he took an initiative three times in order to solve this problem and he was afraid of taking another step forward and yet again failed. And i said that the turks will be one step ahead of the greeks, and i promise you that will be the case. I told him to give me some time, and without further ado, mr. Annan said we could initiate a new process and we could start our talks. Our ministers got together, we started seeing each other again, in the initiative was under way again. And the most important detail is in switzerland, we got together for what you could call a camp for four days, and we were part of that union, and i was the Prime Minister then, as i said, and the initiative was underway. We invested tremendous efforts and we were on the brink of. Eaching a consent consensus. But right before we put our signatures underneath that agreement, right then and there, the Greek Cypriots said they were not going to be able to sign this agreement. And kofi annan said that he gave a promise and he was involved in these talks at the beginning. E. U. Wasson of the andinted of these actions, after almost everything was therete, kofi annan said was no going back and we need to sign this agreement. The signatures were put, and then we went our of ways, and referendumk later, a was decided to be held here at and what was important about that referendum is at the end of the referendum, the greek and the turkish super it said yes. The Greek Cypriots were admitted into the e. U. , but the northern cypriots were not. Right next to that there were certain Financial Support that the northern cypriots should have received, but that never happened, so that has been the case since then. 2013, we reached a certain consensus between the Greek Cypriots and the turkish administration, and a draft text was produced from and we asked each other if we could reach a consensus and continue positively. Both of the parties agreed, but something happened, some evil intervened, and things started falling apart again. That again we are back to square one. Were taking positive steps forward. And i amcommitment, always telling my friends and my colleagues that they will be on the Positive Side of everything that is going on. In may there will be general elections in the Greek Cypriot part, and i hope and pray in the aftermath of the elections the process will be proceeded with as positively as it has been. With regard to your other and i believe all my friends in the audience know this for a fact, that we apply to become an e. U. Member state in 1959, but the official application was amended in 1962. Since then we have been living at the doorstep of the e. U. , and we have been waiting. When i was Prime Minister, when there were only 15 member states, we were always invited to the leaders summit. Was the president of france at the time, and chancellor schroeder from germany was always attending these leaders summits, and as a triparties, we were always positive toward one another, and all throughout our celebrations we thought things were going on quite positively. But that was the time we saw tendencies amongst the chapters which are being opened and being closed. There was a possibility for us to open chapters, negotiate them, and close them. Chirac and schroeder left their offices, the new president s and chancellors in france and germany had a different approach to turkey. The chapters would be open, but they would never be closed. And the new thought emerged as a and weged partnership, never knew when this Privileged Partnership idea was coming from. And everyone was blaming one another. Doing everything we could and everything was becoming more obscure, and everybody seemed to have lost their way. See, chapters were closed, and the process in question is stagnating. Everything is going on very slowly. Our friends are very patient. Im very patient. There going to proceed with process as promised. I hope and pray that in the wake of these new developments and in the aftermath of these refugee crises, our friends in the e. U. Will appreciate the fact that turkey is becoming well being. Mr. Irdyk you mentioned in your speech the importance of politicalyour country standards. Therare turkish journalists for are facing prison terms carrying out their work as journalists, in some cases criticizing you, that has generated a lot of concern in the United States about the prospects of a free media in turkey. Can you address that question that Many Americans are now asking about your commitment to a free media in turkey . President erdogan i am glad i. M prepared we are receiving questions from our friends abroad continuously. Cases andfront of folders of this scale, and we are improving our position every chance that we get. Who believe in allegations in light of information provided them by those that are trying to defame turkey. If you want details of this, i will be more than happy to share with you. This is the brief that i have. Allegedlyare the incarcerated journalists in turkey anden subject to there verdicts and sentences are pending. These people have already been connected because of terrorist actions and being involved in terrorist organizations. Four have been sentenced to various terms of imprisonment, and their cases are pending. There are only seven journalists in prison in turkey who are ofrnalists, and only two those journalists have their credentials in place with the yellow press card. Journalistsseven are allegedly member of the pkk terrorist or position, and three of those journalists have been tried because of having been a member of the terrorist organization. Let me elaborate on what this terrorist organization. They have been incorporated within our National Security it is a terrorist organization engaging in illegal actions with illegal and illegitimate to skies. Disguise. Another aspect i want to share with you has something to do with giving into journalists. Inside the turkish prisons, there are no journalists incarcerated due to their due to theirr freedom of expression. I have some people shouting on the streets outside. They do not know what is going on back in turkey. Freedom of regulations in the turkish constitution, where the president was allowed to be elected, i was receiving over 50 of the votes. Y are pretending as if legitimacy. Ofave garnered the support my people. Me onlyest candidate to receive 34 of the votes of the people. I am talking a 17 difference. The second runnerup received by having been supported by political parties. I am the first elected president of turkey elected by the people. I was selected because of services i provide it for my people and for my nation and my country, whether it be social services, with infrastructure and superstructure. I was the elected president. If you do not invest in every chapter, if you do not increase the Living Standards of your people, if you do not raise the standards in these realms, people will never appreciate and people will never be supportive of you or your actions. That is what i believe. The will of the people shall prevail. People never make mistakes and they did not make a mistake back in turkey. Mr. Irdyk in our country our president is regularly criticized, and he faces criticism from the press, the opposition, from president ial candidates. It gets quite nasty here. That is part of a free society. Is a democracy. Do you have a problem with people, with journalists criticizing you . President erdogan i am sure you have chosen this expression specifically. In terms of criticism, i have no problems with nobody what server, but in terms of insult and defamation, of course i have issues. I will take every one of those theyriticize me, but if were to insult me, my lawyers will file a lawsuit. What criticism would stand for and lead to insult is not humane, but criticism is a part of our nature. The criticism will lead us to the right direction and renders that is why i wish i would have been criticized more frequently, but i have seen such insults involving my family, involving my children, relevant, elevant, harel insults gate insults, case cascaded down the to the channels. And we have a judiciary in if you have documentation, take it to the courts. If you have proof, take it to the court and do whatever is necessary to do. A terroristly organization was very prevalent within turkish history, at a time when they could file a lawsuit whenever they wanted to, and that is what they tried to do. They tried to hit me using that had of my intelligence agency. But despite all these developments, and in spite of all these