To the topic of opioid addiction and before we get to it i want to ask about what you wrote on your blog. You said theyre writing about heroin is another way about writing about america, who weut are and what we have become. Can you explain that . I began to occur to me as i write in the middle of the project and i began to wonder why it was that this problem was affecting appalachia and why it was affecting charlotte and salt lake and indianapolis in places that did well over the last 2030 years. What was the common denominator. I began to understand that the common denominator was our own isolation and that you are writing about much bigger topics then Drug Trafficking. My background is as a Crime Reporter and im wrote a book about Drug Trafficking from mexico and marketing from a supermarket and thats part of the story but i think beyond that it gets into who we have become. We become isolated, fragmented and weve done enormous amounts to destroy community in this country. The dreamland title comes from a Swimming Pool in the town of portsmouth, ohio on the southern ohio river that once was the thing that held the town together. Its a place where everyone came together and formed a communitya and we could stand by jobs in a good downtown but once that wen, away, there was like this savaging of the societal immune system and left places vulnerable. That took place in a destruction of community but in wealthier areas and suburban areas everyone so isolated and architecture was designed for that. Technology while he connects us superficially does a lot to separate us. These are some of the reasons i thought about writing about heroin because. As we have this conversation this morning we want to ask our viewers to join in. If you been affected by opioid addiction we want to hear your stories as money. Call in or send a tweet as well. 2,027,488,000 is the number if you want to call in. You can tweet at cspan wj. If your medical professional, phone number for you is 202 7488000 and all others want to join the conversation as well. You mentioned dreamland in the in portsmouth ohio and what dodo viewers know about the mexico. Guest part of my book deals with the guys who first figure out the heroin traffickers first figure out that theres a very aggressive push to promote a pain pill prescribing among ther doctors and doctors binding to that idea. Eventually it led to a vast new heroin market and the guys that i write about want to figure that out and saw that first emerging in columbus, ohio in the areas around cincinnati, wheeling, West Virginia, places like that and these guys had developed a system by them in the west coast where all the markets that they broke into had a static number and they were all from the same town. It played an Important Role on the name of the town was in thes state of. [inaudible] they figured out a retail model of selling heroin by a tenth of a gram similar to the delivery. You call, youd order, they sent a driver to deliver and hit some heroin and these guys with their model initially developed it on the western side of the United States for the number of addicts were static and they became master marketers and they couldnt kill each other because they were all from the same town and they knew were each others mothers lived when they competed they couldnt eliminate the competition the way the people in the underwood traditionally could so they had to become master marketers. Thats where they became. It was way of discounting and giving stuff away free, giving dope away free to guys who just got out of jail and you bring them five new customers will give you 50 free balloons of heroin. There were key moments that came from when they jump to Mississippi River for the first time. One guy in particular jumped thf Mississippi River lands in columbus and just as a massive new push is underway by pharmaceutical companies and pain specialist particularly in the area of southern ohio, West Virginia, kentucky to promote narcotic pains by get in, percocet is a new medicine for pain. This created a new measure of addicts and they are there then to service those addicts when they can no longer afford those pills and they are looking for something cheaper. Host you have a story of town like portsmouth, ohio and you have drug traffickers and what should viewers know about Purdue Pharma. Guest it was crucial in forming what we have just met primarily, oxycontin was crucial in all this. For two reasons, one was atto Purdue Pharma used a very aggressive form of marketing to doctors, giveaways, similar to the marketing technique from the mexican boys Purdue Pharma used to convince doctors that these pills were no longer addictive and it was no longer addictive and they be fine it prescribing it to their patients and they gave away stuff. They gave away cds called swing in the right direction with oxycontin and we have a swing band tune they tried to convince doctors that this was fine to do. Oxycontin did not contain abuse to turn for the first 14 years. It took addicts people would get addicted and it their tolerance of two very, very high levels and then they would be looking for a chief potent alternative inherent proved to be that. Particular, the heroin initialed from the mexican brands. Host this is a chart from 19822016 and it rises greatly in the United States. In 2016, when is your story that you talk about in this book taking place. What years . Ni guest the mid 90s about those years where you are seeine i was writing the book i was a longtime Crime Reporter and i knew the most innovative and quick fast changing part of our economy is the underworld and is always morphing into something new. I knew that part of the storyic would involve after the book came out and thats also what happened with retinol as an additive to the drugs people are using. Host the book is dreamland, the author sam quinones is with us for the next 45 minutes to take your questions and comments. David in denver is up first. Caller good morning. This is dave in Denver Colorado and i hear every day how my granddaughter is an attic and its heart wrenching but every day we talked about solutions and will put them on this drug or that drug and when you hear it on cspan they talk about how they are getting all the states where marijuana is legal, suicides have dropped 30 . Overdoses have dropped 30 . You never hear the mention that. Its always when they are scared to face that marijuana is a cure and they just dont want to admit it. Host lets give him a chance to talk. Guest im sorry to hear hostt your granddaughter. This is a story thats going on across the country and its crushing, torture to so many families all across the country. I think that there are early signs that this is one way of transitioning people off of the medical marijuana. We rushed into a medical marijuana a little bit so we need to be more cautious and humble about the potential uses of this. In fact, the potential what might happen should be legalized marijuana. Certainly, all kinds of marijuana nationwide. D marijuana varies widely nowadays. Its very different from when i was a kid growing up in Southern California marijuana was mild back then. Now its extraordinarily intense and theres a big question of whether what kind of marijuana is good for medical purposes. The marijuana that makes you most high takes very high of phc for my reading is not always the one that contains the medical benefits, the cbd elements and marijuana that are what have the medical benefits i would be a cautious. A massive amount of legal drugs were based on the country and they had nightmarish conferenc conferences. Host marilyn, a medical professional. Good morning. Caller i have a question i want to ask the young man. Id like him to address three areas. The first area is poverty. Can you please explain how poverty plays a big role in this system when it comes to rural areas and urban areas. I live in baltimore but i work in dc. The other area i want you tove address is the easy availability of prescription drugs. If you walk through the streets. Of baltimore and you walk through the streets of washington dc you can get percocet in differentt y prescriptions in the streets. 510 a 5, 10. The criminal Justice System needs to be addressed. A lot of these people go to jai1 for Different Things and when they come out they cant find jobs. Because of their records and what they accumulate from drugs or whatever it follows them and as a result you create a population that cannot find jobs so they resort to the samefollon measures. They go back to using drugs because they are frustrated and we have to deal with the situations everyday. Host before sam addresses her question, what medicalea profession are you . Three, cancer and i have a degree and. Guest first of all, this ise certainly started in poverty and stricken areas, in rural areas primarily ohio, kentucky, West Virginia, virginia, eastern tennessee, western pennsylvaniar in those areas are roughly where it is from. That would be my ground zero. Yes, i think those are areas that were ripe for this and there were a lot of places where doctors have become solutions not just for people physical pain but to their economic pain as well. Doctors were the people you hadd to go to if you wanted to get workers comp or ssdi or Social Security supplemental disabilitl insurance. Ssi is another one that you needed a doctor to sign off on. These are areas where the doctors were acutely aware of the pain people were suffering physically and as well as economically. This is one of the reasons why pharmaceutical Companies Went to those areas first and promoted in those areas because i sawco that these were areas where doctors were already prescribing a lot of pills and were amenable to this approach. They were acutely aware of how bad things were in these areas. I would say, however, is for them to understand that today that is not always the case. Mosley i would say its in welltodo suburbs where youre fining this problem. This is not necessarily only appalachia, this is charlotte north carolina, salt lake, minneapolis, indianapolis and all over the country. The common denominator is not economics it is, i believe, race. While it is common and it is true to say that drugs do not discriminate, this is almost entirely a white persons problem. This is very rarely that you find a large number baltimore being an exception to that rule but across the country youre fining mostly white people, native americans to a certain degree as well. I would say in answer to your other question yes, this is a supply generated problem. I used to believe when i lived in mexico that demand was the problem that we have created demands here the motivation for people to sell drugs for mexico. I now believe Something Different on this book. I believe the crucial decimeter of these problems is applied, excess supply. Thats what we have with doctors across the country came to believe the idea that these personal were nonaddictive to treat pain and therefore it didnt matter how many of these bills they prescribed and for 20 years plus now all kinds of surgery, chronic pain, mainly acute surgery pain after was massively overprescribed and these pills are circulatingafter everywhere. Theres a lot of ways these bills have leaked out into the black market but were your scene in baltimore and other places is an effective that. Host the book is dreamland the true story of americas opiate epidemic. Sam quinones is here and the author. Guest im here to speak at the faith and politics institut speaking privately with some congressional staffers, Senate Staffers and at 7 00 p. M. Tonight in the Capitol Visitor Center theres a public talk, a panel with a couple of congressmen in a senator on this very issue which is so important nationwide. Host a busy day. Thank you for taking the time. Our caller is margaret in texas. Caller i am coming toward this in a different way. Im an 89 yearold and i see that so much in their lives now we are protected with the image that any pain or discomfort with the physical or mental is unnatural and that we need too take something to get rid of that. I used to be a competitive runner and i know the difference between discomfort and pain. A lot of people dont. They seem to think that any little discomfort in their lives is so unnatural that you have to take something to get rid of it. I seldom watch the tv and i was watching a program in everys intermission was a ad for three or four ads that gave the image of happiness without pain and without discomfort and if youth have any of these you better take something to get rid of it. You go to the doctor and you find and you asked the doctor for a certain kind of medicine so you will not feel discomfort. Now, i could go on and on with this but i wont but this to me is one of the big things in our. Lives. Host thanks for bringing that up. Guest you are asking earlier about how this is a reflective of larger issues cultural issues i think in our country. I think what margaret brings up is exactly one of those points. We, as a culture, have grew to fear pain. You can see this in all parts of life. You we are afraid of letting our o kids go outside, afraid to let them skim their knees, afraid they might feel emotional pain from not being chosen as the best player on the team so we give away trophies to everybody. Its part of our culture now. We treat our bodies like cars. And we use doctors as mechanics. Fixed me. Frequently, you can hear doctor stories very vividly on this point frequently when the doctor says the problem is you need to work out, you need to eat better and you need to quit smoking, walk more, swim more, whateverer and it requires our responsibility and we need to have a look at our own wellness and their approach it that way. L frequently our responses know, doctor, thats your job to me. I think across our culture today were seeing this way of no one is outside because theres a certain anxiety the parents have about letting their kids outside alone. E. There might be child musters behind every tree. We have hyper protected our kids to the point in our effort tod get them to avoid pain and iwe think we have deformed these kids in a lot of ways they are not prepared to work hard ate something and deal with the common ordinary pain that you might feel by living life. Host melanie has been impacted by opioid abuse. Go ahead. Caller i live in california and i have chronic pain. Im very debilitated. I depend on my medication because its not just a little bit of pain. Its a huge amount of pain. I dont use, i go to my doctorus regularly and were cutting back a lot. I understand theres a drug addiction problem but why us, the ones that are in Critical Care getting cut off because of the abusers. That is my question. Number two, how come no one is addressing the methamphetamine problem that we have. There seems to be more outrageous than the opioid a addiction. Guest with regard to your first question. Your first comment. Yes, i think one of the reactions again, weve seen the trouble of letting the pendulum ease into the middle somewhere and there are people who need opioids and need these bills who need the drugs and therefore they should not be cut off quote unquote. Unfortunately, this is been happening some areas. It seems like we go from one extreme to the other. We either heavily or massively prescribed or we want to cut them off entirely and i would say theres a role for really a nuance and getting back to again, the community care, the way the doctor and patient Work Together to find a solution to each patients pain. Its very important to practiceg medicine. Although im not a doctor. Host what about the meth addiction in this country is worse than the opioid. Guest its true theres a serious a problem with meth addiction in america but i dont think methamphetamine is to blame for 59000 deaths annually. That is not possible. Its a gruesome drug, its a torturous drug and i wish it on no one but i dont know that its actually at this point the preeminent threat. Host zack from minneapolis affected by opioid abuse. Go ahead zack. Caller i just want to say everyone who abuses starts from the doctor. They go into the doctor, they had a backache, their shoulder pain and they get prescribed oxycodone and before you know it they need more, their lying and stealing and its a gateway to heroine abuse. Heroine is cheaper. Eed more i noticed marijuana in the conversation earlier and no one has ever overdosed on marijuana, no one has ever stolen for norijuana, no ones sold their body marijuana is not the gateway to opioid abuse, its the physicians. Guest i would agree with that. Doctors have overprescribed and very, very aggressively prescribed for 20 plus years now and that has created a lot of people, doctors and dentists, dentists for example describe a huge amount of these drugs with a tooth extraction. That to me feels bizarre,ounts honestly. I would say absolutely. Absolutely right. What you are talking about is one reason why i think the ball is a gateway to heroine addiction because the ball is one of those sports where the sport creates the most injuries, i think. When you deal with injury through firing pills at it eventually lots of kids will get addicted. Thats what youve seen all across the country. Its a serious problem. The only difference today is that in the last couple of years this has actually gotten the attention it deserves. We have been watching this buster for 20 years and its now the last two years that its been a big deal. Host on that point, we wante to come to the story of the annual who you wrote about in your book from avon lake, oakitb from ohio and they mentioned his sons battle. Lake, from page 347, while noting theres some comical andis charismatic personality the parents of the 24 yearoldhe wrote that unfortunately, his fiveyear battle with addiction took over and eventually beat him though he spoke often before he died of the many friends that he lost two overdoses. K they face it takes a community to battle addiction. Talk about the parents talkingr. About the addiction and that changed. Guest absolutely. When i was writing a book what stunned me was the lack of the enormous silence. The lack of willingness to talk about it. Ho i had grown up during the crack years that was my first job was covering crack cocaine in a town of california. Back then it was really not hard people would come to you and write about our neighborhood, its undersea use with gangs and Drug Trafficking andif troubleshooting. With the story, i was stunned. Fr i cannot it was very difficult to find parents who wanted to talk about this. This was not so long ago, 2013, 2014, and i would go to them but they would tell me off the record that please dont do that, dont write anything and this is one of the reasons why it spread because people who would ignite interest were parents of this appointment, lacerating story to tell that only they can tell werent telling it. They did not want to tell it. L they actively try to hide it and theyd make up in the obituary a died of a heart attack, died suddenly at home. It was like the aids epidemic that in the mid 80s where people would make up lies for the obituary, fabricate things for the obituary. What has changed in the last twl years is ignited the interest in this topic, i believe, parentste now found a common cause. They are coming out of the shadows to talk about this in a very open way and tell the story n a way only a grieving parent can. I know the power of the medium and thats whats changed, i would say in the last few years. Now youre seeing the obituary and put them up on my facebook account because i want to encourage his parents. Its healthy for them, not to sit in a room crying and being all alone, but its healthy for the country. Host bonham, pennsylvania, medical professional, bob. Caller the question i have is do you know how the duplex tablet is and that much could kill two or three people if that was spent in all. The small dose of conventional can be so disruptive. That is what they are putting in to heroine. It is like 50hundred times more addicting than regular heroine. The ones who make that sentinel is coming from mexico and max mix it with heroin and they think would be more addicting and they buy more for us and get it at the price if they are selling it then let them bee moe responsible. If they have made money on it, take everything away. They can never own anything in the United States. On guest getting to the part of fentanyl this is absolutely nevr true. Fentanyl is a new wrinkle that is extraordinarily scary. Its scary for users and scary for family members because the death toll is largely do to conventional is a very dangerous for Law Enforcement who have to do deal with overdosing or maybo in drug busts because they dont what is or fentanyl is very dangerous for those folks as s ll. I think about them a lot. You think in fentanyl as the last wrinkle, latest wrinkle in the underworld as it is adapted to our overprescribing of these pills. And then that is why. Kentucky you have been impacted by this. Caller i want to agree with what he said the people that use these ion in my seventies i had to retire earlier than i would like to i have done all manual labor and the only time i took them but if they do of a urine test for a blood test that you are cut off. There is too many people and not to say i have paul letter from my doctor by have been fighting cancer five years and now my doctor sent me a letter saying i am cut off now have to go to the pace Management Center this over 100 miles away and they will put me through the of ropes to stick needles in your back into the mr i and it is a money thing i cannot understand with the Opioid Epidemic most of it is young people with the needle heading out of there or marco why go after the people in their 70s that have worked all their life and need this to normally function . I have never had a problem but i do need them to survive. This is part of theon problem that we have a distorted view where drug czar used as the answer so when they also create a problem and ensure you are no lot of people in the area have predicted that does not change your problem. I understand the medicine is used to firing pills. So doctors have to learn howhe to find the new bonds and the middle road to work with you personally over a period of time to find that proper approach. Maybe they are a big part of it but getting away from that that is a more personal uso but then to be treated as a production line. House will come in and about 20 minutes. So to abandon the health care but then taking your calls and also in kentucky goahead. Caller good conversation today i live next door to a notorious dealer. Not so how minipill mills are there in America Today . I cannot wait to read your book but i can tell you that just like my neighborhood we live in a very nice neighborhood in a beautiful city. Risen just pour it isnt just the pork. With 1 million home. If youre carrying 20 pounds of heroin there is nothing that they can do. Of belleville the Pain Management clinics that the doctor never installed a reasonable diagnosis just to sell prescriptions for cash. At West Virginia and kentucky ohio. K then that spreads to other areas so now what you are saying not just like the pill mill like the long lines and people from out of state but what you are finding there is a lot of doctors. So to pay patients that turns out to be a curse their scruples whither away day in and day out they got used to that cash and so what you see now is sporadic doctors here across the country with isolated cases nevertheless where they are over prescribing god are the days of the wild west pill mill apple asia and they pop up vocationally but now he lost his weight honestly with this. So what about the crack epidemic rather than locking the people of . Je i was a Crime Reporter. A couple of things but first of all, the end because of that it has affected the political discourse. Contacted the state legislators said mayors and congressmen to have a political fact speaking very bluntly. And that is what has been created in the red areas of radical changes it is no longer throw away the key. S bein we need to treat them so they dont have a felony thcord. The back of the crack epidemic there is one big difference between this epidemic most of the dealers that i saw were black the users were of every race. But it is almost entirely white people but the other big difference that that epidemic of shootings and carjackings in my town there bulletecord homicide levels every year i was in stockton covering this problem. So the focus was one of the reasons that the black community was very intent for these dealers that were all over their neighborhood. There was no focus on expanding treatment capacity. To have none of the of public violence it would be very hard for me to imagine with this type of treatment approach and those that can live through that so that crime problem is awful. He you really touched on something about 50 years ago i was told by a doctor they yea are refusing to write prescriptions for powerful painkillers. Octors for the health and wellbeing of their patients who are nfl players and a lot of it had to do with a valuable players plaguing their injury during a game and i remember to concentrate on the running back bns bid a vicious game to play through their injuries did you really hit the nail on the head. Ki i do have to say that what struck me was football was a gateway. In 2009 they disintegrated under the pressure leading to win because the school just build a new stadium and then also the first ring getting hurt second straight b was not up to the job dominical church to use pain pills and basically destroyed half the team half of them were addicted theyi quarterback died of a heroin overdose a friend of mine from ohio they also died of an overdose this haser affected highschool and College Sports massively football is the extreme example but also lacrosse and baseball and others. [applause] just a comment and question. I suffered from chronic pain over decades to to workrelated injuries and also by the Opioid Epidemic it is a complicated problem but as a chronic pain sufferers has he ever suffered from extreme pain . Or a ruptured disk . Know i had a hernia when i was an intern. Host fisher common. Caller and has not been my personal experience of decades pushing pain killers. Far from a. Now i know there are doctors doing tests but it has not been my personal experiencefrom. Just like the previous caller that you cannot get a prescription for a controlled substance from a general practitioner anyll more. They will not prescribe those. If you suffer from a f degenerative disk disease kore history of back surgery or nerve damage and suffer from any event your out of lot. This is part of the problem as a country with the inability to find that, happy middle ground. What it comes from is our system has the production line quality that nobody treated at the time with the attention that they needed. So the doctors overall cigna will not prescribe any of those. But on the flip side of that if you go in for the appendix operation and then you are given 30 days worth of pain killer for a patenturev that might only last two days. Some doctors do this but that is the opposite. And then they say we confine them on the street for 5 will that is why because that is what is happening. S depending on the doctor and the region where you are indianapolis goahead. Caller as a registered nurse well try to remember the joint commission ofne hospitals but there was an impact, hospitals and the survivors. And there was a huge focus on prescribing and taking those that needed to be comfortable bed dont blame the providers but then you have the providers but those up pop up afterwards. There were enormous pressures on doctors to prescribe in this way but then to come up with the idea to be called the fifthct vital size . Pain is not a vital sign. You can live with a not a polls but in order to get them aggressively to liggett pain look at paid and attack that they came up with this idea so there is the idea if you are not aggressively treating pain youre feeling in the mission or you could get sued were the patient was given day dr. Valuation if you had a bad evaluation if they got too many bin that p could be effected economically. Me and to push them over that objection then replenished that pendulum and using that to vote massively of frequently as it ceases to exist and that middle ground catherine has been impacted by this i know youre running at a time as the parents and family members need to get involved and when the police chief called me and said theyth looked into the doctor records she was given extremely high doses of antidepressants its just like he put the ball in the gun but we were all in shock. Gun. Not that she was sick there were multiple emergency room visits with more drugs to control her paid because she would not allow was in to her doctor visit said we were not told her she was aking or why. Seniors sometimes dont realize with those who remembers as they are involved in the medical decisions there is nothing we can do and are not narcotic painkillers if they know that there is abuse going on and i will listen offline. Thanks for sharing your story. I am sorry to hear about your mother. Using pills for every problem i was not your mothers doctor but it does seem that we focus so much on the use of skills with that will this rubric i have to say with this book i thought i need to be the chief gen want to see so i stopped drinking sugar ta at soda i stopped buying all food advertised on television. I began to work out more andd i have to say this is one of the lessons to take from this experience we all need to be owners of row wellness and then looking get the labels make sure we dont eat too much processed sugar. Caller i am a doctor of chiropractic and acupuncture i have been dealing for a long time with people with opioid because they have the page 90 to come to the chiropractor to get your back fixed. Is and Acupuncture Works better. But the real situation also to get the Central Nervous system to work better. It is all about the immune system there are all kinds of studies out there will look them up on the internet i am not an expert the chiropractic medicine but it does seem to be the overal point pain specialists are working toward that holistic idea with the mystery of human pain and a narcotic pain pills sucked up all the oxygen. Hat so i am hoping that we can once again get back not that they dont have a role absolutely they do of modern medicine but in what the doctor was alluding to is it Insurance Companies we should make use of them all. Toa and pay very close attention to our own well listen what we put in our bodies. And talking with members of congress. A talking about how we got into this and why with some solutions as far as i see that my mind advocate yournd, y inactive this but trying to talk with policymakers where they might go perhaps. Is there a followup . Possibly i am now trying to write about the drug cartels. Author of the book dreamland. We appreciate your time. The insane co pay. We can get into a leader with became insane but it is harming of a companys and employees and it is terrible for the economy and one of the principal drivers of increasing of economic equality in this country. So we pushed back on the morbidity on the claim that it is dangerous so those that call those within the agency as human beings to make those decisions [inaudible conversations] in. Good morning i president dan cero the United Council the director of the Latin America Economic Growth Initiative had the piece published in the national