With opioids in the u. S. From washington journal. Joining us as the chief medical advisor who previously served as the deputy secretary for health. Good morning to you. The president sent out a tweet earlier this morning taking a look at what he wanted to talk bout with the Opioid Crisis. At 3 00 in new jersey. This stems from his commission that takes a look at the similar topic last week putting out calls from him calling it a National Emergency. Can you tell us what you see from these events and what it says about the administrations concerns . This is a very important issue. I think this is one of the most important Public Health issues of our time. Over 30,000 americans are dying every year because of opioid overdoses. There are 2 million americans who are addicted to opioids. The president issued an executive more order. A final report will be due in october. That report by the commission has a recommendation that the president should invoke a National Emergency. This has been done before, usually after a significant Public Health event like a hurricane. Dollarsdes additional and waiting regulations. They didnt specify what exactly a National Emergency invocation might do. People say it could bring more toicaid dollars to states fight the opioid epidemic. It might be a way for states to better Public Health access. I think one thing is certain, most people think this is a good idea because it will raise the nations consciousness about the epidemic. I dont think most americans understand that 92 million americans in the last year used opioids. What is astounding is that opioids are really not firstline treatment for chronic or acute pain. If this can raise the consciousness about the epidemic, invoking a National Emergency will be a good thing. Pedro who is affected most by this crisis . Certainly, if you look at geographic reasons regions, the New England States have the levels. Levels people who are poor and undereducated. There are two problems here in this country right now. Many prescriptions for opioids and they are unnecessary. Longigh of a dose for too of a duration. This is not only heroine coming from mexico, and now there are synthetic opioids coming in from countries like china. This is a twofront battle. One is to curb unnecessary prescriptions. The second is to curb the illicit supply coming in overseas. Those are where we are with the epidemic right now. Treatment is critical for the 2 million americans who are addicted. Pedro he will be here until 9 30 if you want to ask him any questions on the Opioid Crisis. You can call us. 202 7370001. You can also tweet us. When you talk about the curbing of the prescription of drugs, that seems to suggest a hopeful change for the medical industry. How do youthat make that change . Myself weres like introduced to a new class of pain relieving drugs called opioids. We were told these have no Addictive Properties. There was a Health Care Quality movement trying to elevate pain as a vital sign. This led to more prescribing and overprescribing in addiction. What needs to change is the culture among Health Care Professionals. Guidelines specific to make sure were only prescribing opioids for chronic pain. Should in turn opioids turn to opioids as the first drug. There is a lot of education that needs to be done. Most of this education is being called for voluntarily. What the commission has called , we have now called for mandatory prescriber education. Before someone gets a controlled substance license, we should have some sort of mandatory prescriber education. Large to goc is too any other routes. Pedro there will have to be a change in mind to help manage pain. Absolutely. That leads to another important point. We need more options. Opioids cannot be the only option out there. We need to provide them options to help treat chronic pain in a way that is much more effective than opioids. There are other options out there. Well tomore research as identify chronic pain treatments. Pedro when it comes to this issue, if you want to talk to our guest give us a call and we just. Thereviously served as former assistant secretary of health during the Obama Administration. Did you see this happening in the Obama Administration . How in his administration help to curb it . The Obama Administration did a very good job raising the alarm bell. The center for Disease Control and prevention did a good job. They started to identify ways to increase treatment and treatment capacity. They allowed more providers to provide assisted treatments. I think he really moved the ball forward. Had bipartisanss side the 21stama century obama signs a bill that is being implemented. There is bipartisan movement forward. The final report is due in october, but i think the commission is looking at some of the right steps. That is all just a plan and of course, people want action. Of my i look back to some colleagues at health and human services, a lot of the agencies are taking an active role in this crisis. Back in april, the National Institute of health launched a partnership to try to increase the number of medications for Addiction Treatment as well as chronic pain. The food and Drug Administration voluntarily asked and opioid manufacturer to take the product off the market because it was linked to an Infectious Disease outbreak. They issued an important report highlighting opioid prescribing is coming down. There is still a variation around counties across the country. I think federal agencies continue to be front and center and very involved. I am pleased with what the Obama Administration did. I think this is a bipartisan issue in congress. The Trump Administration is also doing a great job. Pedro robert calls from pennsylvania. i have been prescribed opioids for the past 17 years for a few back injuries at work. I dont see the side that is pushing for opioid treatments here. I dont see them doing anything to cover the people who actually have legitimate pain problems. I have tried different pain remedies and pain clinics. The opioids work in my case, and they keep my pain at a manageable level. Without the opioids, i cannot function. I would be bedbound and not able feet. K more than 10 or 15 you are not offering any solutions for the people who have a legitimate pain issue. You are just saying, everyone is abusing opioids and we need to stop dispensing opioids. I would like to know, what answers do you have for people who are actually helped by opioids . Thank you for the question. I was involved in developing the National Pain strategy. Certainly, chronic pain is also an important challenge in this country. I think there are two solutions. One for people who are currently being prescribed opioids, having torpatient relationship. Tailoring opioids for the conditions you have is critical. The key point is to prevent addiction. If one goes down that road, to intervene. I think there are many other americans who their chronic pain is not being addressed by opioids. We need more research in the public and private sector. When are those interventions that could be very helpful . Have tried many interventions and they didnt work. For many others who may be predisposed to an addiction disorder, it is very well worth trying other therapies. Hello. Lisa, iller i wanted to point out used and opioid after an ear surgery. I have had different surgeries in the past. I never found it to be addictive, maybe because it was not prescribed at too high of a dose. System was was my gi completely shut down and i ended er and have been anscribed and opioid opioid. I told my pharmacist it is now becoming part of their continued that patients are not informed what to do with prescriptions like that were there will be a gi issue. Thank you for that. Constipation is one of the main side effects. Pharmacists are coprescribing with the issues that will likely result from opioid use. I think surgeons and dentists are Health Care Professionals where the word is increasingly getting out often times after surgeries that opioids are prescribed. Too many opioids are as prescribed for a lot of days. After you get past five or seven days, it does increase the chance of potential addiction. I think that is one of the things we need to work on with Health Care Professionals who are prescribing these medications to ensure they are prescribing only the amount that is absolutely necessary and not too much. Pedro rhode island is next. Richard, hello. Questions. Ave three i think we are tackling this problem a little too late. These problems we are talking about for the Pain Medicine have already occurred now. The pharmacies and everyone involved were able to cash in, another government is putting strict rules in. For the people that are really on it, now they need the medication and you are singling out them. Is now that everyone can get the pain medication on the streets so they are going to heroine. That is a totally different animal now. ,or the people on Pain Medicine they are prescribed it properly and they needed. The people you are now picking out are the ones that are going to get even stricter laws. Pedro we will leave it at that point right there. I think it is an important point. There are americans out there who are suffering from chronic pain who are properly being prescribed opioids. The opioids are keeping their pain at bay and there is a relationshipt there. I think that is tremendous. Unfortunately, that is not the case for all of the 92 million americans out there who said in theilized opioids last year. Lesswe need to do is single people out and more so educate americans about the benefits and risks, the potential for addiction. We need to educate Healthcare Professionals to ensure the doctor and the patient have the toormation they need prescribed the most therapeutic intervention. Pedro what is the success rate of those overcoming opioid addiction . Guest it takes time. There is a lot of evidence for medicated assisted treatment. These are partial opioids in conjunction with behavioral therapy. This is something you have to stick with. It is a chronic condition. Addiction is really a chronic condition that you can relapse if you dont focus on it. The good news is there is an evidencebased treatment available and there are thousands of americans who are currently on it and overcoming their opioid addiction. Pedro from washington state, this is chris. I think one of the problems is Insurance Companies are often not willing to look at all the alternatives. I have a chronic neck problem from an accident. For the last 20 years, i have managed the pain through acupuncture. It has been at least 15 years since my state mandated the insurance paper. Once i had medicare, i found out it is out of pocket. I think a lot of people who get longterm,pecially might get relief from alternative medicine. That is something that should be encouraged. Representede reason is that Pharmacy Companies have lobbyists. That is a very important, you made. I couldnt agree with you more. This is something Insurance Companies can do in this country. They can offer alternative treatments for chronic pain. Massage,re, yoga, that can berapy, the intervention they need to tackle their chronic pain. Sometimes, you have to jump through a lot of hoops to get Insurance Companies to pay for these. We are trying to make it as easy as it is to get a bottle of medication. I think that could go a long way to better address chronic pain. Marijuana is ays good alternative. Any evidence . Guest there have been an increasing number of studies that have looked at places that allow Medicinal Marijuana and have looked at opioid overdose. Opioidy of the states, prescribing has been down. That is a correlation, not a causation. We need to do more research on the marijuana side. This is about the public and trials sectors to hold and see what marijuana is doing for chronic pain. We need to do Clinical Trials so the fda can come in and say, yes, marijuana is safe and effective. So they can have physicians be a short when they prescribe marijuana. I think we have a ways to go. We need more and more research. Pedro calling from florida. Army, when i was in the i was in a training accident and her my lower back. After i got out, my pain was really bad. What i used was crystal meth. I used it for over three years and it was the only way to take my pain away. But my girlfriend, she gets opioids. She cant even function. I think she needs surgery, but i dont think your insurance is going to cover the. Guest thank you for your service. I think it goes to the larger point that we are all different. Our bodies respond differently. For certain individuals, certain interventions will be better than others. I think we have to understand the epidemic that is ongoing right now with opioid overdose. They areindividuals, particularly high risk for overdose. I want to ensure they have other means to treat their chronic pain. Pedro what are the programs to help them get over the addictive process . What is available . Places oute many there. There are hotlines. Are federal grants going out to states. Medicaid is an important funder from a public insurer perspective. Medicare, as well, but less so than medicaid. There are federal providers out v. A. To thethe Indian Health service. Stop the to help prescribing of medication. There are a lot of options out there. From the states perspective, there needs to be more. I think the commission referred to several of the possibilities. The Bipartisan Policy Center put together different recommendations. You talked about some of them. Are you able to talk about these issues . Guest thank you for asking that. We have a Governors Council made up of five former governors. This is a Bipartisan Group that felt that their experience with this issue they really wanted to weigh in. Three of the five are sitting governors, so they really felt a need to address this issue. They came up with for critical fourmendations with critical recommendations. They stop heroin deaths increasing by 20 in a year. We need to do a better job curbing this. Make sure need to they are not being unnecessarily prescribed. The will need to have and compassion in this country to treat the americans with this addiction. Of people with the addiction are being treated right now. Fourth, we need to educate americans. Those are the four steps a recommendations. I think the governors were quite pleased to see the Commission Incorporated many of those recommendations to President Trump. Pedro greg from massachusetts. I have one basic question. Now i have been in your constant pain. The only thing that would touch this is the oxycontin. I took it for seven years and it kept working. When it wore off, i was in massive pain. I stood up under a plane in the marine corps and part of my vertebrae broke off. Know, i aming you getting pain in every part of my body, my hip, everything. I have tried acupuncture and spinal stimulators. Every drug you can think of under the sun. None of them worked. They dont come close to it. I was never addicted to it. I was dependent on it, but i was not addicted. My pained to tell me was being brought on by the opiates. Its took me six months to get off of it and i was in constant pain the whole time. Timeestion is, most of the you will have a governor or someone saying the same thing. We have to make sure we are taking care of the people who egitimately need the stroke. Guest thank you. I think this is overarching that we dont need to have the federal government completely get rid of opioids. We need to prevent addiction. I dont think a lot of federal government to get in between the doctorpatient relationship, but we do need to understand the Addictive Properties of these types of medications and do what we can to prevent addiction and overdoses. We need to accelerate research into other medications and other opioids. Ves to this is for the millions of americans today who have chronic pain. Pedro he said he was not addicted but dependent. Have you know when you have crossed over . Fort there are definitions misuse of opioids. If you dont have a prescription or if you are not taking the prescription as you are supposed to. These are clinical definitions. You go through withdrawals, it interferes with your home life, you could have trouble with the law. There are very clinical definitions that differentiate misuse. Abuse as well as pedro one more call. This is eric. Caller good morning. I appreciate you taking my call. Is is going to go out to everyone who is having a problem with the addiction. I have been on them and have had a really bad accident. There is nothing that can be done about it. I took them for years and really was addicted to them. I understand that everyone is different. This is going out to the people who are addicted. You can get off of these and get your life back. You can be yourself. That is what i really wanted to say to you. Ctor and everyone listening, i want to send my love out to you. Guest thank you so much. Pedro as far as the Trump Administration going forward, what would be the best advice you can offer . Guest we will wait for the final report in october. I think we hope to see continued efforts from scientific agencies fda to move forward. I think ensuring that medicare and medicaid are facilitating treatmentassisted will help. There was some concern there that cutting medicaid funds off could certainly prevent that. I think it will be very important that we continue to focus on the science and allow our agencies to work with these recommendations we will get in october. We want to prevent as many opioid overdose deaths. Treatmenttimately, will be critical to fight this epidemic. It will essentially be prevention to help us be this epidemic. Is preventing addiction in the first place. Serving as their chief in 1979, cspan was created as a Public Service i americas Cable Television companies. It is brought to you today by your cable or satellite provider. Up next on cspan, a look at recent u. S. Policy in the middle east. Then President Trump talks about the Opioid Crisis and the situation in north korea. Later, conversation on oil and Gas Production and government corruption around the world. Journal,s washington live every day with news and policy issues that impact you. Coming up on wednesday morning, a look at escalating tensi