tv Discussion Focuses on Combating on Opioid Abuse CSPAN November 28, 2016 12:50am-2:13am EST
see across -- the oxycodone types, percocet is the most common, the green is hydrocodone. most people know that is vicodin. medications,ther tramadol and things like that. interestingly, the red on the bottom, that is oxycontin. even though it has gone to play a role, a lesser role after it was reformulated and became harder to crash in 2010, -- crush in 2010, the actual amount of oxycontin is modest. slidecond point of the that is important is the fact it is dipping off. doctors are prescribing fewer pills. that is because there has been so much attention to this. hopefully better training in how to deal with pain, but we are just beginning that education.
also, protection monitoring programs have kicked in in 2010 and 2011. . pill mills were cracked down on. especially ohio, even of the prescribing is going down, the death rates are not. that is because people are moving to other drugs and other painkillers. ms., i am sure you are familiar with. i want to show that. >> this, i am sure you are familiar with. i want to show that. this is a rapid acting antidote. available by prescription in all states. in about halft up of the states without a prescription. a large part of those opiate --pdoses are due to kindles
hyntels. when it is out on the street, it is dangerous. sou can see from the relative it is 100 times as potent as morphine. most people do not abuse morphine, but they do abuse vicodin,d percocet and hr between morphine and heroin on the slide in terms of potency. fentanyl is 50 times as potent as heroine. , ite is a new drug around is 10,000 times as potent as morphine. that can kill very efficiently. the fda is probably going to increase the dosage of the antidote to compensate for that.
is about the medications we may talk about. we're not going to get heavy into it. >> can you go back to the last one? why was that made? where did it come from? sally: it is actually an animal tranquilizer. thank you. : is it the potency or the size? sally: it is the potency. >> to knockout in elephant it is to and thousand times morphine? now it is introduced in diluted forms. -- not even diluted, mixed, yes. it is coming from different areas.
>> are they cheaper than heroine? sally: they are cheaper because they are more potent. one could wonder, even if we managed to repress heroin availability, would fentanyl replace it? gingrich: with methamphetamine, how hard is it to manufacture these? sally: it is hard because it depends on a precursor. the dea tries to control it. it is not some the you can make in a lab. newt gingrich: that is a relief. i hope all of you have learned something. i guarantee you the three of us did. sally: when there is an elephant in the room, you know what to do. medicationse fda
that are approved. the reason i want to go over them is because this is what we are talking about getting more access to. the one you may have heard about the drug known by the name of suboxone. it is in a class of opioid replacement medication. it is a form of opiate. it is not as dangerous as an overdose as methadone. it can be prescribed by doctors. that is a great advantage. like a go to the doctor, regular patient, get a prescription, go to your pharmacy and get it filled. it comes in a film that can go in your mouth. there is another one that is until -- that is a pill. and another one was a proof -- approved implant
recently, an implant. it goes underneath your arm. that lasts six months. that is a great advantage for people who do not take medications regularly. there is the good old, methadone, since the 1960's. i work in a method in clinic. it is a great standby. you have to get it in a clinic. is another, it is an opiate blocker. one shows ther opiate molecule off the brain receptor, this one is a blocker. cellss on the endorphin and if an opiate molecule comes, it cannot bind. basically you take the medications for that if you are to get an opiate, it would have no effect. that is called mal t-rex.
it has been around for two decades at least in the u.s.. the pill is called revia. it comes in a monthly injection. complianceod for that a colleague was telling me before we started that some in maryland have used it. it has cut down on how many readmissions they have. they have injected inmates would be -- with the medication, with their permission, it has worked to keep them drug-free. and of my presentation. -- end of my presentation. let me explain what will happen. i will ask questions. we will have time for questions. let me tell you how these questions are supposed to go. you can read this. can ask these
questions. they appear on this device. it should work. if it does not, i will have to use live, human beings. as i mentioned, i work in a methadone clinic. ways that is a vantage point from which i will ask these questions. i will start with you. may i call you, newt? you three established the advocate for opiate recovery in june, how did you come together? unlikely bedfellows in some ways. newt gingrich: it is an interesting story how you can be pie partisan -- bipartisan if you allow it. 1999, 2000,n
patrick was invested in electronic health records. best pressthe conference we did, he and tim murphy, a republican, were hosting a press conference in the invited hillary and i. the press came to see hillary and i for the spectacle. it was a great event. we were working on those things. since he was in congress, he has taken a national leadership role in organizingce an annual conference and he invited me to speak. i have been looking at brain science. the natural pattern. and i gote time,van to know each other at cnn. we found that we had a mutual passion about criminal justice reform, something i worked on here at aei. .e were coming down the road
criminal justice reform in many ways overlaps with mental health and addiction. with the collapse of the mental hospitals and state hospitals, we often have may have 40% of the inmates more appropriately dealt with as mental health problems and, in almost every case, you have a substantial number of inmates with the addiction challenge. if you are ever getting them back into society, you have to have a strategy to deal with the addiction, otherwise you're putting somebody back on the street who becomes a problem again. place -- it is complex. into this,getting
you have to make people feel compelled with a sense of urgency places. in new hampshire, for example, it is the number one issue politically. it beats the economy, it beats terrorism. you name it. people are really frightened, because they're seeing their children die, or they are saying -- seeing their brother or sister die. so we decided -- and there is a second part of this intersection -- one is to say here is a problem. the thing that drives you crazy is we have pretty solid evidence, and you may want to buys into it at some point
because you are the technical expert up here, but we have pretty solid evidence that medication assisted recovery combined with cognitive retraining has a very high likelihood of succeeding, but it doesn't fit much of the medical profession's tradition, and it doesn't fit many of the medical and state bureaucracies. and so, you have this moment in time where you're losing 47,000 people. you probably, in theory, could cut that by 45,000 lives a year if you had the right kind of sophisticated approach to this whole thing. and so, you see, how many times in your life can you find an issue where you might potentially affect half a million people over a 10 or 12 year period? this is why we are talking about it, it attracts a level of attention that no one of us would get on our own. ms. satel: right. actually, that was one of my next questions. what can you do that other and -- other advocacy groups cannot? my other question was what are some of the agenda items?
mr. jones: first of all, i just wanted to say, it is really good to see this many people coming out. many of us, we live in washington, d.c., we deal with issues all the time. i think when you saw that graph, maybe just, let me back up here. the deaths, that is shocking. and those are not just little members up there. that is thousands and thousands
of people who have died. that's thousands and thousands of funerals, that is parents and children. there is some external enemy that has figured out to kill this many americans a year, we wouldn't be able to have a room even this size. we would have a stadium full of people trying to figure out what are we going to do. so part of the reason i am here is because i have someone i was very close to who died, and i did not see it coming at all. i did not see the signs or the signals. i carry a lot of guilt about
what could i have done? luckily, i know newt well, and knew he was collaborating, so i was able to get myself added to the band. and happily so. what i will say is simply this. it turns out, this is completely unnecessary. it turns out that there are two strategies that could get this number way down. one is, it is true people have to change their minds. they have to have some willpower. they also, because of the way opioids work, have to change their brains back. this is a biological thing. your brain is an organ, and once these doctors hand you these pills, this is about willpower, -- this is not about willpower this is not you are a bad
person, you have organ damage. this is what the doctor gave you. the stigma and all of the theology and all the ideology that says this is addiction, suddenly we turn our brains off and don't look at evidence and don't look at facts and don't doctors help people. the people they have initially her. this can be changed. -- hurt. this can be changed. this organization that we are a part of, we want go on the country and have meetings like this and create a situation where first of all, doctors stop overprescribing these opioids. if the doctor gives you something and you take it and your life falls apart, that is a bad sign. if you can't trust what a doctor hands you, that is bad.
we want for the insurance companies to pay for and give the medicines that correct this. and we also want for the government to speed up these approvals, because there are a lot more drugs in the pipeline that could make a big difference. lastly, we have the drug courts out there that have been doing a good job, but could be doing a better job. you can go to opioidrecovery.org and check that out. for me personally, a year ago, i was not thinking about this at all. it was not my radar screen at all. i did not think about addiction in any way except "don't do drugs," and "if you do drugs, get off of drugs, period." that was pretty straightforward in my view. my world got turned upside down like a lot of other people's. there's a lot more out there, and if we work together, we can do something about it. ms. satel: patrick, i know your group commissioned a study on medicaid. could you highlight some of the findings? mr. kennedy: thank you. i appreciate this opportunity with good friends i greatly admire, and it is so impactful to hear speaker gingrich talk about how this needs to be treated like any other illness. it is so powerful when van jones talks about how you can think one thing one year and then have
a totally different perspective after this is personally -- has personally affected you. the endgame here is we just want addiction treated like the disease that it is. that is the endgame. there are lots of things we can do today to help make that a reality so there aren't as many people dying of overdose every year who are dying simply because of our neglect. literally, it is taking time today to put in regulations. people are dying every day. literally today, fda is sitting on the release of medication that can also augment what is available out there for people with opiate addiction. people are dying every 90 minutes. this is about a sense of urgency. and it is about the fact that as van said, if this were any other illness, they would be marching
on washington right now and people would be throwing up their arms and sang what are you -- saying "what are you doing about this?" instead, we get a bill passed and no funding. the regulations on implementation that are not forthcoming. we do not require insurance companies to disclose their medical management practices, which is the insidious way where they deny access to treatment for mental illness and addiction. so this is not about not knowing what to do. you've got it. you could bury yourself in position papers, there are so many good ideas. it is about political will. and the reason we don't have political will is that we in our own lives are so ashamed of having these illnesses in our own personal lives or in our family's lives that we do not talk about. guess what? if we can't talk about it in our own lives, how do we expect the government to talk about it for us? unlike every other issue, there are not the advocates.
very rarely do you have someone puts their hand and say they are an opioid addict in recovery. yes, addiction has affected my family, and it is an important issue to me and i'm going to vote on it, and i'm going to advocate for it. so, i am just so excited having worked in this for some time, to see the beginning of the advocacy part of this change, and, you know, being able to work with very public influence thought leaders like van and newt is a real honor for me. ms. satel: thank you. just a little --
mr. gingrich: we did a study of medicaid variation, which is amazing. it runs from, i think, it is $4 in mississippi to $68 in vermont, to give you a range. there are very wide ranges in how easy it is to get access, very wide ranges in what they will pay for. almost no correlation of anybody stopping to say what is the outcome of that? this is a field -- i helped found a center for transmission -- health transformation -- we get involved in budgeting cycle is that don't have any kind of accumulation. you walk in and say "we have a medication program that also has combined with it training so that people are both training their brain and at the same time they are reorganizing their brain medically." that costs x number of dollars. the legislature will say that we don't have that kind of money this year.
so that person ends up maybe being a prisoner who doesn't fully recover, who ends up back in prison, so we pay 200 times as much money keeping them locked up as we would have paid. the prison money is over here and we have the prison money. the mental money is over here -- the mental health money is over here and we don't have the mental health money. we cannot figure out that doing the right interventions today --we did a tv show today this morning and they had somebody on thereby remote from another town who 13 years ago had become a recovering addict. all of you this business know
that you never recover, you are recovering. it is a lifetime journey. he talked about, four times he'd overdosed, and four times they brought him back. the fourth time, he finally got it. he went through the process, so he has now for 13 years held down a job, had a family, lived a full life as a citizen. how do you measure all of that? if you do it based on an annual budget, it is cheaper for them to die. actually had a director of the budget tell me that that there is a real problem with people living to long and it increases their costs. -- too long and it increases their costs. and i said never ever go on television. what we discovered the study -- in this study -- every governor and every legislature should benchmark themselves against the medically appropriate standard, and ask themselves how many of their citizens are they willing to have die because they don't want to go to the appropriate modern system? the numbers on that are very striking. i may get them slightly wrong
off the top of my head. but essentially, today, 80% of the people who want to be in recovery don't get treatment. of the 20% who do get treatment, only 15% of the total population -- only 3% of the total population seeking treatment gets a medication based, sophisticated modern treatment. if i told you that about diabetes or cancer or about kidney disease, you would say that is outrageous, but because we have always had a lagging indicator -- i think for very practical reasons worth thinking about -- for most of the last couple thousand years, we have gained more and more and more knowledge about every element of of the body except the brain. we have the capability now to watch living brains. prior, we could not look at it because the brains we studied were dead. this model of theoretically trying to understand what might be happening in your head without really knowing. now you have at the cutting-edge -- and sally knows about this -- these amazing breakthroughs, down to the level of study of which synapses are doing which things, and neurons, it's almost
magic. it is understanding that the brain is integral -- the truth is, the brain is at the center, the center of who we are. for example, depression is the most common single health problem in america, and a surprising number of health problems are a direct function of depression. now, because we are only beginning to enter the age of the brain, all of our political behavior and all of our bureaucratic behavior is still locked in an obsolete model that says i will spend anything to fix her cancer, but now this addiction problem you have, that is probably because you are a bad person, as opposed to, this
addiction problem you have is a biological function of how your brain has been reorganized around a chemical interface. >> perfect. ms. satel: you are talking about differential treatment at the level of the hospital and clinic. it is true, even medicaid in its various -- obviously, by state -- there are duration limits on how long you could be treated, the dosage maximum, and preauthorization. so, this takes up so much physician time which is time they should be spending with patients. the good news, on that last front, good news on friday, the big insurance company has now dropped its pre-authorizations.
this was under pressure from eric schneiderman, who is the attorney general of new york. so maybe there is a role for attorney general. mr. kennedy: there is a huge role for attorney generals as consumers and patient advocates, we cannot get redress for the violations of the parity law, denials of care and the like. but if we join together, we can appeal these denials to the attorneys generals in the various states who are really consumer protection folks. they are protecting the contract law aspect of this. people are paying for insurance that are not getting the coverage that they are actually paying for. we feel this is going to be the most expeditious way to advance the implementation of the mental
health parity. and addiction equity act. to this date, most think that we are going to get appeals one at a time. we all know the best someone can get is there care paid for, often when it is too late. a year or so later when all appeals finally -- you need to be a harvard phd/jd to understand how to do these bureaucratic appeals, and the insurance industry knows it and are counting on that. we need to have a public movement that takes our grievances directly to the attorney general of each of these states and let the ag take on the insurance industry on our behalf as consumers. when you add up all these families i am seeing around the country, the speaker and van jones, we are going to start a consumer revolution in this country, and i hope the insurance industry knows what they are in for, because we are going to start taking these stories to them and require that they not only follow the law, but they take care of the people
who are suffering from these brain-related illnesses as they are required to by law. ms. satel: van, for you. you mentioned drug court a while ago. actually, i worked at the d.c. drug court a while ago. for those of you who were not familiar with the drug court, they kind of bring the medical and moral model together and -- in that these are for folks who have been arrested and put into a diversion type program. if you complete it, your record is expunged. so stick with it. what happens in a drug court is the participants go through a treatment program, and they also are monitored pretty heavily in that swift, certain, but not severe consequences are administered if someone misses an appointment with their counselor or does not show up for some appointment, or gives urine that is positive.
but, as i said, the consequences are not severe. they may be, one day of community service. they do escalate with continued infractions. if there are continued infractions. that is behavior 101. you respond to some sort of event that you want to change behavior immediately. mr. gingrich: by the way, sally, -- mr. kennedy: by the way, sally, airline pilots and physicians have recovery levels over a five-year. that is because they have accountability and a lot to lose. ms. satel: but when i was doing it, that was the cocaine era, and there were no medications then. but now, with all of these medications, the drug courts and
the criminal justice systems in general, we have clinics in bc. every week, you go over the -- in d.c. every week, you go over the patients and you say they are all in jail -- that happens a lot. in the d.c. jail, they detox people. in virginia, they don't. some jails even keep people on methadone, which is very constructive, because you lower your tolerance in jail and if you use again, that is a prescription for overdosing. i should be letting you speak. what is the potential for all of these medications that we mentioned earlier in the crystal justice system? mr. jones: you know, one of the big myths about change is that change is about people learning new things, but honestly, most change happens when you unlearn the old things first. what is holding back a lot of this is an old way of looking at addiction, which we have touched
on. the good old 12-step model, the blue book, the idea that if you are addicted to something, it is because you have some moral failing and you need moral redemption. you have had a lapse of willpower and need to get your willpower together. you and a higher power working together can get you out of this. there is deep truth in that and people who can give testimony about the power of that approach. the challenge is, 50 years later, 60 years later, when you are not merely talking about alcohol but these very complex substances, it just turns out that that is passed. on the others -- that is about half. on the other side, until we get to the point where we see the biological side of it as shame-free, stigma-free, so that we can act intelligently, we are going to continue to stumble.
i remember back in the 1980's during the hiv/aids crisis, the government, we knew that this was a medical emergency, millions of people affected, but there was a slowness to response. public concerns were going up, up, up, but there was a stigma associated with hiv and aids that was rooted in homophobia primarily, but also just a lot fear and ignorance. and the lad time -- lag time killed millions of people. finally, we said enough is enough and people of all races and genders, from both sides of the aisle, said that america has just a lot fear and ignorance. and the lad time -- lag time killed millions of people. finally, we said enough is enough and people of all races and genders, from both sides of the aisle, said that america has to do better. pressure was applied and the fda and other -- and now, hiv is considered a chronic condition. there is medication available. there is certainly, nobody wants to have hiv, but it is nowhere near the way that it was. that is the pathway -- we have to unlearn a whole bunch of stuff in order to just treat this just like a disease. treat hiv like a disease without
all of the stigma. we are to have to have the same approach now. addiction, your children, your grandchildren, are being thrown out into a world where people apparently are bringing elephant tranquilizers to parties. that is not the world i drop in, that is not the world you grew up in, but that is the world now. in that kind of a world -- and
frankly, kids are going into your medicine cabinet and taking your leftover vicodin and everything else from your last dental surgery and taking that to parties, too. in that kind of a world where we are taking kids' brains and dubbing them into these students of chemicals and opiates that can really change their brains, we have got to have a different approach. you talk about the criminal justice system. there's similarly, up until very recently, it was if you do something bad, you should go to jail. if you break the rules, you should go to prison. turns out, it is a bad idea because what happens is so many
people have gone to prison that the stigma of going to prison in some communities is not even there anymore. 11 prison so many people. you look at prison, and it turns out a lot of people in their have mental health issues at addiction issues, so you have not solved the underlying issue, you have just spent a lot of money hurting people who are already hurt. my hope is going forward that the criminal justice system can start being data driven, evidence-based, outcome oriented. i would love to see wardens get -- and i was talking to newt about this -- i would love to see wardens get paid based on how well the people in their custody do when they leave. see, right now, you get paid based on how many come in the front door and stay with you. and if 20 more come, you get more money. if they come in with their best friends, you get more money. that is a bad business model. i would rather wardens get paid based on people are there, i gave good care, i don't with mental health issues, they did -- i did well with mental health issues, they did well. it's the outcome oriented. we have to rethink these systems. we have the technology to do so, the brain science to do so, we have to have the political will to do so. ms. satel: we can go back. i think this is kind of a challenging question. this scenario in some places takes place with the same person, that guy, maybe 10 times
in a three-month period. a lot of sheriffs and a lot of governors, one state senator from new york in particular, is so concerned about this, that he is thinking or perhaps has introduced legislation that would say pretty much if there is a consistent pattern of overdosing, someone has to step in. because you mentioned someone overdosed four times. well, it could have been he never got to four after three. again, they are seeing, seven or eight or nine. that is a lot, so what the state senator is considering, and i must say, as someone who has worked in all the criminal justice and treatment elements of this, there is something to this. he is thinking about arresting for possession, but diverting to drug courts, diverting to treatment so that that is what these people get, not going to
jail. it is a more paternalistic, aggressive strategy that one would not use with a regular, what we call, medical disease. to me, this seems kind of reasonable or at least something to think about. i would like to know how you see it. mr. gingrich: well, i got into a lot of trouble when i first became speaker. i've been influenced by someone who had been a member of congress and secretary of labor, and she had been in new york city dealing with drug addiction and she had described a woman who was an addict, and her boyfriend was an addict, and her boyfriend had abused her three-year-old, but the three-year-old had been returned because the presumption was that the mother was the best place. and then, the boyfriend got mad one evening and killed her. the question is, what do you do when you're faced with this? and i said very unwisely that we might have to seriously look at taking children in those kinds of circumstances and putting them in orphanages.
and of course the left went crazy and said gingrich wants to rip children away from their mothers. [laughter] mr. gingrich: that i forgot to go on the tnt and introduce boys down. hat is said later was that we need prep schools for the poor. if you are rich and you send little sammy to the prep school, nobody thinks that is an abuse. but if you are a three or four or five-year-old, in danger of your life, we don't have any good models any foster care system. now we come to this example. i am deeply anti-addictive drug use, and i am deeply anti-addictive drug use because i believe in freedom.
if you are an addict, you have given up your free will. so i start with a very strong bias. i don't have a great deal of sympathy for the civil libertarian argument that you're right to be saved 10 times in a -- your right to be saved 10 times in a row means that the rest of us have to pay for the ambulance to come once again to save you at the last possible second until the time we don't get there and you die. it does strike me that there has to be some ability to look at patterns of behavior -- and you could make a cautionary argument that, ok, you overdose once, that is a sign that you are truly stupid and we will give you a pass. but if you overdosed twice, at that point, you clearly are out of control of your life, and therefore, we have an obligation as a society to help you get back into control of your life so you can go back to being free.
now that is coercion. this is a very serious national dialogue we have to have and i am very cautious about it because of some of the issues we have had with homeless people. i mean, there are a significant number of homeless people who are homeless because they want to be. those of you who drive over by union station know that there is a homeless shelter, and for most of the year, if you drive by there, you'll see some are between 10 and 30 people who are sleeping on the street outside the shelter. they go to the shelter to eat and then, they go back outside because they don't want to be in the shelter. they don't want to be controlled by anybody. now, it makes you uncomfortable, but on the other hand, if you believe that as long as they are in control of their life and making a decision to be kind of goofy, i favor their freedom to be goofy.
a person who shows up like this to bring, 3 -- 2, 3, 4, five times, they have lost control of their life. this person has lost control of their life. this person is relying on society at large to save them. i think we owe them more -- and this goes back to the point about the brain -- we have to do enough that they can stand up to their brain that is still addicted. it will go back and overdose again. i would favor states exploring -- again, i keep this at the state level, because we need experimentation, not some federal law that is totally out of touch with reality -- we need local communities to figure out when they could get people to return to society as a complete person capable of being free. that is my bias. mr. kennedy: you know, i see it slightly differently in that i just don't have a good answer. i will say my bias.
mr. jones: my bias is that we should do what works, and if a coercive model does not work, if a coercive model is telling somebody that you are going to have to get clean right now on a government timetable because we are sick of you, if that does not work and makes things worse and drives people underground it makes people less blood to call -- less likely to call for help. we need to be attentive to that. but newt and i actually share some biases as well, and that i am 1000% against the use of addictive drugs. i grew up in a family in which all the men in my family are incredibly hard workers, but at least until me, hard workers, hard smokers, and hard drinkers. so, they wound up, all of them, with good lives, good middle-class lives -- my dad was a cop, in the military, and became an educator -- but also impacted by alcohol. and my father actually also died of lung cancer.
i made the decision when i was young that i was not going to drink or smoke. i can say at 48 years old, i have never had a beer, never had a sip of alcohol. i'm extremist in all regards. so for me, i look at any addictive behavior with some real horror, because i know my own family shows a very strong pattern of that. and so, i am not -- i live in california -- but i am not one of these prodrugs, drums our freedom, no, to me drugs or slavery.
they are the opposite of freedom in every way. my life is bad but i like my drugs, why not you stick your -- six your life? -- fix your life? in that regard, i think we are similar. i just worry that if you get overly coercive, you have unintended consequences. ms. satel: can i say the next question? we only have about 10 minutes. my plan was to ask this one last question, which is another tough one, but follows along. and then, as one of you to just sum up. there is a lot of talk, and i certainly understand it, about you know, reducing stigma. sometimes i wonder, and others have wondered, in a way, how realistic that is. i am thinking of that photo that
went viral last month in ohio, these two adults who were overdosed in their car with a four-year-old in the back and it was the grandson of the woman. the two adults were arrested for child endangering. you know, the way the debate has been set up as i watched it, and not as presented by you, but just by watching in general, is that we have brain disease on one side and moral failing on the other. no one wants to get on that team, the moral failings i, i don't want to. -- failing side, i don't want to. when you say brain disease, what that conjures up in many people's mind is that the behavior is completely involuntary, completely, hence no responsibility at all. people take responsibility all the time. patients coming to our clinic all the time because the wife is going to leave them, because consequence just got so much. it is a little more complicated than just having epilepsy or multiple sclerosis where, if i put you in a drug court with some sanctions, if you don't keep this appointment, i am going to -- you would not respond.
that is autonomous, it does not respond to consequences, but addiction can. i guess the way i would sum up that question is, is there a way to -- can social disapproval of addiction -- i'm not talking about individuals. i know everyone knows this is suffering and that my personal areas of the self-medication for misery -- but the point being that social disapproval of addiction coexisting with compassion and greater access to treatment. that is my question. mothers against drunk drivers has made great progress with
stigmatizing drunk driving. mr. kennedy: sally, i think you after how we frame this issue. my view is we have not made the progress we would like to make in eliminating racism and bigotry and prejudice in this country, but with the 1964 civil rights act, 1965 voting rights act and fair housing and employment, we had done our job to try to outlaw discrimination. so no matter what you think, you just cannot act in a discriminatory way. that is my view as to how do we move this forward on making sure we get people treated. because we are going to still be arguing, is this a moral failing or medical failing in another 10 or 15 years. i wish i could say i had greater faith that we overcome our biases and prejudices, and all of a sudden, that would mean insurance companies would pay and we would fund and treat is equally and integrate it with the rest of medicine. i don't think that is going to happen. i think we need to enforce the
law, and i think we need that we need that -- and i think we need that moment of clarity that those of us who have been suffering from addiction and have had some chance to get some sobriety have faced. and as society, we need a moment of clarity. we have, you know, 47,000 people dying of overdose, we have 42,000 taking their own lives every year. this is a public health epidemic. it is like "hello, where is our response?" we are collectively stuck in a time warp, where we are not understanding that we can do something about this. to your frame, i think we get away from having these debates and get about actually enforcing the law. if we enforce the law, more people will get treatment.
mr. jones: i want to be clear about that because i don't think people are as smart as you want us to be. just say one more time the law you want us to enforce and why that would make everything different. mr. kennedy: the law i want to force is the mental health parity act that says the brain is part of the body. you treat illnesses of the brain the same as other illnesses. inpatients, in network, out-of-network, outpatient. at the primary care, secondary and tertiary levels of care. in other words, the whole spectrum. today, we only treat addiction as a stage for illness -- stage four illness. how do we address that gentleman who needed it four times? you wouldn't in the future let that person get that are because they would have grown up in a household where you would have known their parents had addiction, depression, anxiety. you would have known they had exposure to violence, deprivation, other causes of trauma, and you would know that they ran a higher risk so we can
personalize medicine to them. the future is avoiding having to use the medicine because we are waiting too long. that is not the paradigm we should be thinking about. the paradigm is not how we're going to have more advanced directives and source of treatment, although i know today, having been guarded to my mom, there is a near-term reality. let's keep in mind, we moved upstream into the problem as stage one illness or people who are at risk for the illness and then you wrap it around. to your point, you are risk for this and your family, you had no help from your medical system, intervening and same tell us about your family history of our tolerance and addiction. you made in your personal -- we in the future need medical consulting to say, like cardiovascular disease and like cancer, what are you at risk of? let me see what i can do to curb the chances of getting cancer or having addiction. if i have that on my medical record, he guess we should not be treating this as a separate from medical care, which is what we do is keep them all separate, we have a chance of changing the course of the illnesses to the
benefit of our criminal justice system, our health care system, the whole country we live in today. ms. satel: ok. that is great. thank you so much. [applause] ms. satel: no wonder i couldn't see -- they are on here. ok. here is a question. we have until about 4:50 and it is about 4:30 now. anonymous asks, when parents are able to get into treatment
programs of their kids two thirds of them complete the program. shouldn't such programs be prioritized? i would just answer that and say yes. i'm sure you all agree. those kinds of treatment programs are excellent. they are expensive. there are not enough of them. mr. kennedy: insurance is complaining about all these rogue rehabilitation places that
dry you out, send you out and you are relapsing in no time. then put more evidence-based treatment programs in your network, mr. insurance program. right now, my fellows can get access to treatment in your narrow network. you cannot complain about how we have these fly-by-night, hang your shingle out and say you are for recovery when all you're doing is collecting the insurance premium. until you help us pay for what really works, you will be stuck paying for what doesn't work, which is the problem. mr. gingrich: let me at an example of a brilliant program for reform that was created under mary a cuomo. it was founded by former social workers. they contract with the state and they only get paid if the person that they help is still on the job six months later. if you aren't insurance contractor in this thing, you say, we will pay you a base rate
but you do not get a bonus unless the person is still drug-free a year later. you build in a huge incentive. this worked brilliantly. it is still around and doing great job. they may be the best program at taking hard-core unemployed people and moving them into jobs because everybody at america works gets the bonus when they are at work six months later. mr. kennedy: the problem there is that there is not any continuity. you have someone in patient, they refer, there is no connection to the outpatient, and we wonder why people fall through the cracks. they are in the er and are revived in get no aftercare. ms. satel: basically you're talking about incentives.
when we talk about drugs we are talking about sanctions and negative consequences, but positive are extremely helpful. there is literature that is called -- on what is called contingency management. the better they do they get rewards or more freedom, they don't have to report as often. in some cases, johns hopkins had an interesting program where people who were unemployed, but the better they did, the more they allow them to work in the workshop. they had wonderful results. these are expensive programs. they can be hard to replicate in garden-variety programs, but they can work very well. we use them in the methadone clinic.
it is a strategy that is important. here is a question from a real clear health editor. isn't there a risk for addiction to naloxone itself? mr. gingrich: the long-term goal would be to help the person initially be able to cope with the physiological effects of the brain having been rewired and then over time so through the process of cognitive change and eventually be weaned off. the current system where we detox you and think you will be ok, is proven to be a guaranteed failure. i would like to live in a world where nobody was addicted and
nobody needed this kind of help, but that world does not exist. the question is, can you find the medication support that enables you to then go through what may be a several year process. it may not be a six weeks or six month process. ms. satel: the medication is stabilizing. you have to actively participate. that is why it is so hard for private practitioners to prescribe. they don't have that kind of backup. mr. kennedy: the state of massachusetts adopted this mandatory coverage for two-week detox. you will see death rates rise in massachusetts. in other words, the science is not guiding the policymaking. it is happening all over the country. at the height of this crisis, we are not following what the
science tells us to do. we have another issue here of global warming and we don't appreciate it. mr. johnson: for those of us who were just thrown into this world, we think, if we had more detox centers, people could go and get detox and then they could go and get phd's and everything would be fine. you just need those couple of weeks. it turns out that is not true. in fact, people are at great risk. people are at very great risk. after a nor can shot, their brain has begun to heal a little bit and rewire a little bit, and yet, there they are back out there in the world and don't have aftercare or any other medicine that they can rely on. what tends to happen people too often is they go back and they say what was i relying on before and they take that same dosage
that before got them high and that same dosage now gets them dead. detox turns out to be a springboard into the morgue. we are not paying attention to the science. we have these theologies around 12 steps, but it turns out in a lot of these things, there is a 13th step. that is getting some medical support. ms. satel: this question is from alex. do you have any policies solutions you can offer to state legislators looking to respond? mr. gingrich: we have to appreciate the multiplier effect this has on when someone is ill and the costs -- mr. kennedy: and it has been a reduction of their disability.
i think what we saw in miami-dade with the judge that reengineered the system to in the devise stable housing, peer support, medication assisted treatment. recidivism has plummeted. and the county has more money. and people are doing better. it is like the trifecta. what do we do? we don't have that model easily replicable because no one is going around the country saying, here is the step-by-step process to get this changed. we don't have the aei of think tanks producing a road map for these state legislators. we need that roadmap and it needs to be available so they know what to do in order to make a difference in this issue. mr. gingrich: as an argument for optimism, you actually do see a
wave going across the country of criminal justice reform that is having a positive impact. people who are not violent criminals or a danger to society are being reintegrated back into society. a lot of it has been places you would not expect. georgia has been a leader, texas, south carolina, mississippi.
a lot of places stopped and said, what we're doing is crazy and it is breaking up communities by taking people who were not violent and turning them into criminals and taking them out of the community. the result has been encouraging. in that sense, if you can have a wave of examples like you just gave, you might well find a lot of state legislatures in the next few years who are prepared to do those kinds of changes in medicaid in particular that could be very powerful. ms. satel: somehow i think i've run out of russians on that. -- run out of questions on that. please stand up. you were with the v.a.? does someone have a microphone? sorry about that. >> this is a huge problem among veterans, suicide is related to homelessness. veterans can also show us the way to cure the problem. the second thing is, i want to ask a question. you talk a lot about the hyper
the kind of dialogue somehow between those who feel as you do, that this is a medical problem with medical solutions. and others who still feel it is a moral issue. mr. gingrich: i don't agree with anything you said. i think veterans are probably one of the centers of concern because of the combination of different impacts on their lives and because we're worrying about the suicide and addiction rate. at the same time, i am not quite sure how one has a dialogue. the point we were in terms of
addiction, and i would be happy to have a debate about this sometime, we have somebody who was just pointed out who is in their 10th recovery from overdose. i am fairly comfortable saying that's bad. maybe there is some really -- somebody who wants to say that is a morally exclusive experience and we shouldn't prejudge it. there is a difference between addictive drugs that take control of your life. there are certain things you take that rewire your brain. it is not like you are walking around saying you will make this choice, your brain is telling you that the choice has been made because you have been rewired and you have a genuine, desperate hunger. my version of being free does not mean being free except for your brain. i do think we need to have a national dialogue. i was going to go back, i thought pattern did a beautiful job of saying it. i'm very prepared to be very hostile to the idea of becoming addicted while at the same time being very sympathetic and open to a person who is trying to deal with their addiction. i want to encourage some buddy who is addicted to feel they can come out and say they have a problem.
but at the same time, i want discourage my grandchildren from thinking it is an acceptable gamble to see whether or not they would become addicts. i think that would be a horrible thing to happen. that is my bias. mr. johnson: this is some of the hardest stuff. what is the right mix of carrots and sticks? what i most appreciate about your interventions, patrick, is to try to help us think about it afresh. as a parent, as a grandparent, i don't think any of us are ever going to be convinced that being enslaved to addiction is a good outcome. that is something i will fight to keep my children safe from. at the same time, coming out of the society we have lived in that is so judgmental and so lacking in empathy, as you pointed out, there is some real learning that we have to do.
we are missing something. there is some new place we have to arrive at where we want people to live full lives and we are willing to fight for that, and at the same time we are assigning the right causal factors in genetics and medicine. we cannot escape it. this will get bigger and bigger. we are being dragged into a different conversation.
i can't tell you how much i appreciate both of you. you have 15-20 years of bipartisan cooperation on this. this is the one issue that when you guys had your primary as last time, and i saw your protege john kasich with tears in his eyes going around in new hampshire. and it wasn't from the point of view of anything but hurt and concern and a desire to help people, i said that opens all whole different door to bipartisan cooperation. i feel good about the opening of this being created, but i don't
feel strong yet in all of the concepts and the right way to get there. mr. kennedy: you pointed out veterans. four times more likely to die of opiate overdose. big challenges here. but they are not only dealing with the v.a. and trying to access care. most of them get their health care through their employer-sponsored health care. people don't know that. we need to make sure that the parity is out there for our patriots, because if they encounter their own networks through their employer and cannot get treatment for their signature wounds of war, ptsd, that's on all of us. after the phoenix v.a.
debacle, veterans started "the weight we carry," and they monitor v.a.'s around the country and how long it took for them to get their disability claims adjusted. we need to do the same for private insurance. we are partnering to get civilian soldiers to report when they cannot get access to their aetna, united, cigna insurance. so that we can tell the insurance industry, you are not just denying the run-of-the-mill person, you are denying those who served our country. that should get their attention. there is a certain moral hazard to the insurance company continuing to deny treatment and the way they would not do for any other illness. i appreciate you bringing that up and thank you for all you have done for our nation. ms. satel: we have to end now. i apologize. i wanted to thank all of you, your comments about bipartisan
communicators. rewrite will come with a requirement or framework for putting data into a central depository where people can have access and and can be searched not only on an individual basis but on a scale basis because we run 2.5 million songs through and we will get more every day. >> pandora general counsel on the issues facing the music industry over music services including copyright laws, ticket price inflation, and the competition between humans and bots for concert tickets. -- bots do buy tickets. they keep other fans out of the market. some fans really want to go to a concert and they can push
buttons on their computer all day long but they cannot be the b -- beat the bots. so they're left only with the opportunity to buy the tickets on the secondary market after andbots have gotten to them raised the prices. ask tomorrow michigan is expected to certify the ,esidential vote count certifying that donald trump one donald trump won about 10,000 votes. the deadline for a pennsylvania recount requested us tomorrow.
mark alliance announced the clinton campaign will participate in the recount spearheaded by jill stein. presidential candidate president-elect donald trump has said the recount and the future of the democratic party. comments from trump senior advisor elion conway. bernie sanders and ohio congressman tim ryan who is charging nancy pelosi as house of aquatic leader. >> why in the world can't the democrats except the election results? >> why did mr. trump say he will keep us in suspense. saysou say hillary clinton
on election night called donald trump to congratulate him and concede the election. i was standing right there. withrump was on my phone her. i did not hear him say, hillary clinton conceded but she said that that was only unless jill stein asks for a recount and raised money for that. votesump got 1.4 million there. that is like the number of tailgaters at a packers game. it is not a serious reason to challenge an election. why are they doing this? what does president obama think of this recount charade? he eight weeks left to finish out his term. i think it is quite small of jill stein and hillary clinton. president obama and president-elect trump meet
regularly. they spoke yesterday at length. they are trying to move on. did, high time hillary too. >> it is over. mr. trump will be the next president and democrats must opens on the realities of where we are. so are they wrong to do this recount? meigs the democrats are not doing the recount. >> the democrats are not doing the recount. aren't you aware was the green party? >> of course i am aware. what happens but the focus right now has got to be on doing everything we can to look at the real issues facing the working families of the country. >> is a time for hillary clinton and the clintons to just move on? >> secretary clinton has served
this country for 25 years. she got 3 million more votes than donald trump did in the general election. i think the democratic party has to assess where they are and they are not in a good place. to go on.ed revitalize the democratic party. become less dependent on big money. a lot of campaigns, big-money people have done a good job but they cannot -- we have got to open the doors. >> we have to figure out how to have the robust economic message and we are not communicating. people left us in droves. they either went for trump or state home. without a message that connects deeply with them, that their family talks about at the kitchen table, they are not going to come back. we need a leader that will go
into those congressional districts and pull voters back. energize those voters. >> nancy pelosi says two thirds have already signed up to vote. >> those are not the numbers we have. there is a lot of consternation and our caucus right now. we're making a hell of a run. we have a chance to win. people up and home with their families over thanksgiving and they are saying, look, this is been a change election. we want change. a lot of people are realizing we need to make a change. we are not winning. winners win. we need to put leaders in place that will give us the opportunity to get the house back. we are down 60 seat since 2010. live the smallest number in the caucus since 1929. we have to do something.
followed the transition of government on c-span is donald trump it comes the 45th president of the united states and republicans maintain control of the u.s. house and senate. watch live on c-span. watch on demand that c-span.org will stop or listen on our free c-span radio app. >> thank you all very much. [applause] >> now, a discussion on the future of traditional libraries as more people access information through digital technology and other methods. this was hosted by zocalo public square. it is just over an hour. [applause] >> i'm sitting next to librarians that i feel like i should behave somehow. there is a slight stigma.
i will try to behave. ok. >> you haven't so far. [laughter] >> you see? part of why we are here is to celebrate this library. this is coinciding with that. i want to start with the soft and fuzzy before i really try to go anti-library on these people. what? i told them, i warned them i hate libraries. one of the striking things i have been talking to is that people have wonderful memories, childhood memories in particular, of libraries. when they first got -- a favorite moment. i'm curious if we could start -- oh i have to introduce you. my goodness. to my left, the former director of the institute of museum and library services, the presidentially appointed, senate confirmed position. she is currently professor of practice and treasurer of the