ANNOUNCER: IN RECENT YEARS, THE RAPID INCREASE IN RATES OF ADDICTION TO OPIOIDS, BOTH THE ABUSE OF PRESCRIPTION MEDICATIONS AND ILLEGAL STREET DRUGS INCLUDING HEROIN, HAS BEEN CALLED AN EPIDEMIC AND A NATIONAL EMERGENCY.

WITH OPIOID OVERDOSE DEATHS NOW SURPASSING DEATHS FROM CAR ACCIDENTS IN THE UNITED STATES, IT'S ABSOLUTELY CLEAR THAT THIS IS A PUBLIC HEALTH PROBLEM OF GREAT URGENCY.

BUT WHAT HAS CAUSED THE SURGE IN ADDICTION AND ITS CONSEQUENCES, AND WHAT CAN BE DONE ABOUT IT?

THIS EPISODE OF "THE WHOLE TRUTH" WAS MADE POSSIBLE BY THE MILL SPRING FOUNDATION, THE DORAN FAMILY FOUNDATION, AMETEK, AND BY... FOR HUNDREDS OF YEARS IN ENGLISH-SPEAKING COURTROOMS AROUND THE WORLD, PEOPLE HAVE SWORN AN OATH TO TELL NOT ONLY THE TRUTH, BUT RATHER THE WHOLE TRUTH.

THE OATH REFLECTS THE WISDOM THAT FAILING TO TELL ALL OF A STORY CAN BE AS EFFECTIVE AS LYING IF YOUR GOAL IS TO MAKE THE FACTS SUPPORT YOUR POINT OF VIEW.

IN THE COURTROOM, THE SEARCH FOR TRUTH ALSO RELIES ON ADVOCATES ADVANCING FIRM, CONTRADICTORY ARGUMENTS, AND DOING SO WITH DECORUM.

ALL OF THESE APPLY TO THE COURT OF PUBLIC OPINION, WHAT JOHN STEWART MILL CALLED THE MARKETPLACE OF IDEAS.

THIS SERIES IS A PLACE IN WHICH THE COMPETING VOICES ON THE MOST IMPORTANT ISSUES OF OUR TIME ARE CHALLENGED AND SET INTO MEANINGFUL CONTEXT SO THAT VIEWERS LIKE YOU CAN DECIDE FOR THEMSELVES THE WHOLE TRUTH.

WE TURN TODAY TO AN ISSUE NOW BROADLY SEEN AS A MAJOR NATIONAL CHALLENGE-- THE SURGE IN OPIOID ADDICTION AND RESULTING ILL HEALTH AND PREMATURE DEATHS.

DOES THE RISE OF OPIOID ADDICTION AND ALL THE RESULTING NEGATIVE CONSEQUENCES IN THE LIVES OF INDIVIDUALS AND IN THE LIFE OF OUR COUNTRY STEM FROM A DOWNTURN IN ECONOMIC OPPORTUNITY AND MOBILITY IN AMERICA, REFLECTING A KIND OF DEMORALIZATION OF PORTIONS OF OUR POPULATION?

OR IS IT PRIMARILY A FUNCTION OF A FAILURE OF RESPONSIBILITY ON THE PART OF THE NATION'S MEDICAL COMMUNITY OVER PRESCRIBING POTENTIALLY ADDICTIVE PRESCRIPTION DRUGS AND FAILING TO MONITOR THEIR DISTRIBUTION AND DIVERSION WITH AT BEST A BLIND EYE TOWARDS THE ABUSE OF THOSE DRUGS?

AND WHATEVER THE SOURCES OF THE PROBLEM, CAN WE BEAT IT?

CAN WE SEE THROUGH THE MANY ADDICTS AMONG US TO RECOVERY AND PREVENT FOLKS FROM GOING DOWN THIS TERRIBLE TRAIL?

HERE TO DISCUSS THIS IMPORTANT QUESTION WITH US TODAY ARE DR. DAVID HERZBERG, ASSOCIATE PROFESSOR OF HISTORY AT THE UNIVERSITY OF BUFFALO, DR. MICHAEL PANTALON, PSYCHOLOGIST AND SENIOR RESEARCH SCIENTIST AT THE YALE SCHOOL OF MEDICINE, DR. BERTHA MADRAS, PROFESSOR OF PSYCHOBIOLOGY AT HARVARD MEDICAL SCHOOL AND MEMBER OF THE PRESIDENT'S COMMISSION ON COMBATING DRUG ADDICTION AND THE OPIOID CRISIS, AND MRS. REGINA MARCHETTI, CERTIFIED RECOVERY SPECIALIST AT CROZER-KEYSTONE HEALTH SYSTEM.

LET ME BEGIN WITH YOU, REGINA.

I UNDERSTAND THAT YOU ARE A RECOVERING OPIOID ADDICT NOW WORKING TO HELP RECOVER OR GUIDE OTHER GUIDE OTHER PEOPLE THROUGH RECOVERY.

WE APPRECIATE YOUR BEING HERE AND YOUR WILLINGNESS TO SHARE YOUR STORY.

COULD YOU START OUR CONVERSATION BY JUST TELLING US ABOUT YOUR EXPERIENCE IN THIS, HOW THIS HAPPENED TO YOU AND HOW YOU RECOVERED AND HOW YOU GUIDE OTHER PEOPLE TO RECOVERY.

ABSOLUTELY.

SO MY ADDICTION TO OPIOIDS STARTED THROUGH A WELL-MEANING DOCTOR.

IT WAS A GENERAL DENTIST EXTRACTION.

IT WAS NOT AN OVERPRESCRIBED, BUT THE SECOND I TOOK IT, IT WAS MORE THAN I COULD HANDLE.

BUT IT WAS EVERYTHING THAT I WAS LOOKING FOR.

IT FILLED A VOID.

IT GOT RID OF ANY FEAR THAT I HAD ABOUT LIFE OR ANYTHING LIKE THAT.

IT TOOK AWAY ANY ANXIETY THAT I HAD.

I WAS A VERY SOCIALLY ANXIOUS PERSON, AND IT TOOK ALL THAT AWAY.

EVENTUALLY WHEN THE PRESCRIPTION PAIN MEDICINE RAN OUT, UNFORTUNATELY I WAS ADDICTED, AND IT TURNED TO HEROIN USE, WHICH OF COURSE IS MUCH CHEAPER.

AND IT TOOK OFF FROM THERE.

I WAS ADDICTED FOR ALMOST 9 YEARS.

I'VE HAD A DAUGHTER THROUGH ADDICTION, BEEN TO MULTIPLE INPATIENT FACILITIES...

MULTIPLE OVERDOSES.

I WAS ONE OF THE FIRST IN DELAWARE COUNTY TO SURVIVE A FENTANYL OVERDOSE, WAS INVOLVED WITH THE CRIMINAL JUSTICE SYSTEM THROUGH DRUG TREATMENT COURT, AND WAS INTRODUCED TO TREATMENT AT CROZER-CHESTER, ACTUALLY.

I WAS AFFORDED MULTIPLE OPPORTUNITIES FROM INTENSIVE OUTPATIENT DROPPED DOWN TO OUTPATIENT, MULTIPLE SPECIALTY PRACTICES, PSYCHODRAMA, EMDR, CBT, DBT, AND I'VE BEEN CLEAN EVER SINCE.

AND AT THE END OF MY TREATMENT IN OUTPATIENT IS WHEN THE CERTIFIED RECOVERY SPECIALIST POSITION BECAME AVAILABLE AT CROZER.

AND THE DIRECTORS OF THE PROGRAM CAME TO ME AND SAW SOMETHING IN ME THAT I DIDN'T SEE IN MYSELF AND ASKED ME TO APPLY FOR THE JOB.

I WAS THE FIRST RECOVERY SPECIALIST HIRED WITH CROZER AND HAVE BEEN THERE EVER SINCE.

WHAT IS THE SCALE OF THIS PROBLEM?

THIS IS--YOUR STORY IS SO COMPELLING BECAUSE THIS IS SUCH A BLINDSIDE.

I DON'T THINK THAT AMERICANS REALLY SAW THIS SITUATION COMING, AND SUDDENLY IT'S HERE.

WHAT'S THE SIZE OF IT?

WHAT DO YOU SAY, DAVID?

YOU KNOW, I CERTAINLY BOW BEFORE THE WISDOM OF PEOPLE WHO HAVE STUDIED THE PRESENT DAY EPIDEMIOLOGY MORE THAN A HISTORIAN.

I CAN TALK ABOUT WHEN I BEGAN TO TEACH THE HISTORY OF DRUGS AND ALCOHOL IN THE UNITED STATES, I USED TO TEACH THAT IN THE LATE 19th CENTURY OUR HIGHEST RATES OF OPIOID ADDICTION WE REACHED IN MAYBE 1892, 1894, AND THAT WE HAD NEVER OBTAINED THOSE LEVELS AGAIN, THAT THEY HAD BEEN EXTREMELY HIGH.

AND IN RECENT YEARS, I'VE HAD TO CHANGE THOSE LECTURE NOTES AS THE EXTENT OF THIS PROBLEM HAS BECOME VERY WIDESPREAD, CERTAINLY FOR OPIOIDS UNPRECEDENTED IN OVER A HUNDRED YEARS.

EISENHOWER: UNPRECEDENTED IN A HUNDRED YEARS.

WELL, THE ABSOLUTE NUMBERS ARE DRAMATIC.

THE INCREASE OF OPIOID USE DISORDERS HAS MATCHED THE INCREASE OF PRESCRIBING OR PRESCRIPTION OPIOIDS, SO 4 TIMES THAT OF WHAT WE SAW IN 1999.

UH, THESE--4 TIMES?

4 TIMES.

4 TIMES.

WOW.

THESE NUMBERS ARE STAGGERING, BUT THE THINGS THAT I TALK TO OUR TRAINEES AND STUDENTS ABOUT IS THAT THE SEEDS OF THIS EPIDEMIC WERE SEWN IN THE FERTILE SOIL OF A BROKEN TREATMENT SYSTEM, THAT WE DO HAVE PEOPLE LIKE MRS. MARCHETTI WHO'VE DONE DRAMATICALLY WELL, BUT MANY OTHERS HAVEN'T BECAUSE OUR SYSTEM DOES NOT FOLLOW THE EVIDENCE-BASED TREATMENTS, SOME OF WHICH SHE MENTIONED.

YOU KNEW YOUR DOCTOR WHO UNWITTINGLY EXPOSES YOU TO THIS, WHO IS DEALING WITH YOU AS AN INDIVIDUAL.

THIS IS NOT A SITUATION WHERE PEOPLE ARE SCAMMING PRESCRIPTIONS AND SO FORTH.

THIS IS SOMETHING THAT JUST HAPPENED.

I GUESS THE STATISTIC THAT STICKS IN MY MIND IS THAT MORE PEOPLE ARE NOW DYING OF OVERDOSES THAN DYING ON HIGHWAYS, WHICH I GUESS IS A WAY OF-- THIS BRINGS IT TO NATIONAL ATTENTION AS A KIND OF CRISIS.

BERTHA, WHAT IS THE SIZE OF THIS FROM YOUR PERSPECTIVE?

FROM OUR PERSPECTIVE, THERE ARE CLOSE TO 12 MILLION PEOPLE CURRENTLY MISUSING OPIOID DRUGS.

AND THIS IS AN AMERICAN PROBLEM.

WE PRESCRIBE 5 TIMES MORE OPIOIDS THAN THE AVERAGE OF 30 OF THE HIGHEST PRESCRIBING COUNTRIES IN THE WORLD.

THAT'S NUMBER ONE.

AND WE HAVE--OF THOSE PEOPLE WHO ARE MISUSING, THERE ARE APPROXIMATELY 2.4 MILLION PEOPLE WHO HAVE AN OPIOID USE DISORDER AND AT LEAST 600,000 PEOPLE WITH A HEROIN USE DISORDER.

THE PROBLEM IS THAT APPROXIMATELY, AS IN YOUR CASE, AND YOU ARE JUST A REMARKABLE PERSON.

80% OF THE PEOPLE WHO ARE CURRENTLY ADDICTED TO HEROIN TRANSITION FROM PRESCRIPTION OPIOIDS.

THIS IS A DIFFERENT PHENOMENON THAN THE PAST.

ALL RIGHT.

THIS IS NOT JUST SOMETHING THAT IS JUST HAPPENING ON THE STREET.

THIS IS SOMETHING THAT IS REALLY GROWING OUT OF OUR MEDICAL SYSTEM IN AMERICA.

ITS ORIGINS ARE IN THE MEDICAL SYSTEM.

AND THE ORIGINS ARE VERY SIMPLE-- TERRIBLE SCIENCE FOLLOWED BY PATIENT ADVOCACY, FOLLOWED BY PHARMACEUTICAL COMPANIES, FOLLOWED BY DECLARING PAIN A FIFTH VITAL SIGN AND SO ON.

I ASSUME THAT THIS HAS A MEDICAL DIMENSION, AND IT WOULD HAVE A SPIRITUAL AND A MORAL DIMENSION, AND THAT IS RECOVERY, PUTTING PEOPLE BACK ON THEIR FEET.

HOW ABOUT THE PHYSICAL SIDE OF THIS?

WHERE IS THIS ADDICTION LOCATED AND WHAT CAN YOU DO ABOUT IT?

SO I CAN SPEAK TO THE IDEA THAT THIS IS A MEDICAL DISEASE.

IT'S NOT EVEN AN IDEA.

OUR SCIENCE SUPPORTS THAT THIS IS A BIO, PSYCHO, SOCIAL DISEASE THAT NEEDS A TEAM OF PEOPLE-- PSYCHOLOGISTS, ADDICTION MEDICINE FOLKS, PSYCHIATRISTS, RECOVERY COACHES.

SO WHERE IT STARTS IN THE BRAIN IS JUST THE BEGINNING OF IT.

IT AFFECTS EVERY ASPECT OF AN OPIOID USE DISORDER PERSON'S LIFE.

WE HAVE TREATMENTS THAT WE KNOW THAT WORK.

AND A LOT OF THOSE TREATMENTS ARE DISCUSSED IN THE COMMISSION'S REPORT, WHICH I LAUD, BUT I DON'T THINK WE GO FAR ENOUGH TO MAKE TREATMENT-- BY TREATMENT, WHAT DO YOU MEAN?

THIS REDUCES CRAVINGS OR IT REDUCES-- SO WE HAVE MEDICAL TREATMENTS, MEDICINES LIKE SUBOXONE THAT REDUCE CRAVINGS, BUT THAT ALSO NORMALIZE BRAIN FUNCTION AS SOMEONE STAYS ON IT 12 MONTHS OR LONGER, THE RIGHT LEVEL AND TYPE OF COUNSELING.

SOMETIMES IT'S VERY BRIEF MOTIVATIONAL AND BEHAVIORAL COUNSELING THAT A PHYSICIAN CAN DO AS HE OR SHE PRESCRIBES SUBOXONE.

SOMETIMES A PSYCHOLOGIST OR SOCIAL WORKER USING COGNITIVE BEHAVIORAL THERAPY IS NEEDED.

WE ALSO NEED EVIDENCE-BASED RECOVERY SUPPORTS, A RECOVERY COACH THAT IS AWARE OF THE EVIDENCE-BASED TREATMENTS, AS WELL AS THINGS LIKE SMART RECOVERY, A SUPPORT GROUP THAT FOLLOWS EVIDENCE-BASED.

WELL, OBVIOUSLY THERE'S MUCH MORE TO THIS THAN JUST SIMPLY PHYSICAL BECAUSE IF YOU HAVE A SUBOXONE OR YOU HAVE SOME SORT OF PALLIATIVE TREATMENT, THAT IS NOT ADEQUATE.

IN OTHER WORDS, THE WHOLE PROCESS OF OVERCOMING ADDICTION IS SOMETHING THAT... JUST TERRIFIES AMERICANS, I THINK.

TO THINK THAT THEY ARE BEING-- THAT PEOPLE THEY KNOW OR THEMSELVES ARE BEING EXPOSED TO SOMETHING THAT WOULD BE SO VERY, VERY DIFFICULT TO HANDLE.

IN ADDITION--OK, WHERE DO YOU COME IN?

AS A RECOVERY SPECIALIST, WHAT DO YOU THINK IS THE MOST IMPORTANT FACTOR THAT YOU TRY TO ACTIVATE THAT IS GOING TO HELP SOMEBODY RECOVER FROM THIS?

SO TO ME, THE MOST IMPORTANT FACTOR IS THAT IT IS AN ENTIRE LIFESTYLE CHANGE.

THERE'S, OF COURSE, MEDICATION THAT YOU CAN TAKE, BUT IF YOU DON'T CHANGE SIMPLE THINGS-- PEOPLE, PLACES, THINGS, YOUR ATTITUDES, BEHAVIORS, IT UNFORTUNATELY DOESN'T WORK AS WELL, WHICH IS WHY THERE'S TREATMENT AND INTENSIVE OUTPATIENT AND OUTPATIENT AND ALWAYS RECOMMENDED TREATMENT WITH ANY KIND OF MEDICATION.

BUT IT IS, IT'S A WHOLE LIFESTYLE CHANGE.

WHAT TYPE OF PERSON IS TYPICALLY CAUGHT UP IN THIS?

IS THERE A--IS THIS A EQUAL OPPORTUNITY CRISIS, OR IS THIS FOCUSED IN CERTAIN ETHNIC GROUPS OR CERTAIN TYPES OF COMMUNITY?

AHEM.

WHEN YOU HAVE MAJOR PUBLIC HEALTH CRISES RELATED TO PHARMACEUTICALS, IT'S IMPORTANT TO REMEMBER THAT THEY BEGIN IN POPULATIONS WHO HAVE A LOT OF EXPOSURE TO PHYSICIANS AND WHO ARE ABLE TO-- THAT PHYSICIANS ARE WILLING TO PRESCRIBE PSYCHOACTIVE DRUGS FOR.

AND, YOU KNOW, THERE ARE PEOPLE ON THE PANEL WHO WILL KNOW THIS EVIDENCE BETTER THAN I, BUT I KNOW THAT PHYSICIANS HAVE HISTORICALLY BEEN LESS-- THEY HAVE RECOGNIZED PAIN IN RACIAL MINORITIES LESS THAN IN WHITE PATIENTS, AND THEY HAVE BEEN LESS WILLING TO PRESCRIBE DRUGS FOR THOSE POPULATIONS BECAUSE THEY'VE BEEN ASSOCIATED WITH THE PROBLEMS OF ADDICTION IN THE POPULAR AND EXPERT MIND.

AND SO WE HAVE A LOT OF DISCUSSION QUITE APPROPRIATELY ON THE SOCIAL STRESSORS AND DIFFICULTIES FACING MANY DIFFERENT COMMUNITIES IN AMERICAN LIFE RIGHT NOW.

IT'S ALSO IMPORTANT TO REMEMBER THAT PRIVILEGED ACCESS TO THE MEDICAL SYSTEM IS ONE OF THE RISK FACTORS, OR WAS AT THE BEGINNING OF THIS PARTICULAR CRISIS.

HOW WAS IT HANDLED HISTORICALLY?

IT IS A PROBLEM THAT HAS A LOT OF HISTORICAL ROOTS IN A NUMBER OF WAYS.

NUMBER ONE, FOR OVER A HUNDRED YEARS, AMERICANS HAVE HAD A VERY HIGH RATE OF USING POTENTIALLY ADDICTIVE PHARMACEUTICALS.

IT HASN'T ALWAYS BEEN OPIOIDS, BUT THERE'S A HIGH ENDEMIC RATE OF USE OF THESE DRUGS, AND THAT'S NOT NECESSARILY IN AND OF ITSELF A PUBLIC HEALTH CRISIS.

HUMAN LIFE INVOLVES A LOT OF SUFFERING, AND THESE DRUGS CAN ALLEVIATE THAT SUFFERING AND DO MANY THINGS THAT ARE BENEFICIAL.

AND SO THERE'S NEVER BEEN A TIME WHEN I WOULD SAY GOVERNMENT POLICY HAS BEEN DESIGNED TO STAMP OUT USE OF THESE DRUGS.

SO THE QUESTION IS, WHEN DOES THAT ENDEMIC USE EXPLODE AND BECOME A PUBLIC HEALTH CRISIS OR COME INTO EPIDEMIC USE?

AND SO THAT FIRST CRISIS THAT YOU'RE TALKING ABOUT, THE LATE 19th CENTURY, THE RESPONSE WAS TWO PARTS-- TWO PARTS ON THE PHARMACEUTICAL SIDE OF THE LEDGER.

ONE WAS TO INCREASE REGULATION OF LARGE MARKET ACTORS, IN OTHER WORDS, THE COMPANIES THAT WERE MANUFACTURING AND SELLING PHARMACEUTICALS, EDUCATE PHYSICIANS TO CREATE A SMARTER SUPPLY, NOT JUST TO GET RID OF THIS DRUG, WHICH IS VERY VALUABLE, BUT TO MAKE SURE THAT IT'S GOING WHERE IT NEEDS TO.

AND THEN THE PEOPLE WHO HAD BECOME DEPENDENT ON MORPHINE USUALLY AT THIS TIME, THEY WERE MOST OFTEN CONTINUED TO BE MAINTAINED, OFTEN INFORMALLY, IN SOME CASES ILLEGALLY, BY PHYSICIANS THAT-- BY THEIR OWN PHYSICIANS.

NOW, PEOPLE WHO BECAME ADDICTED OUTSIDE THE MEDICAL SYSTEM IN THE LATE 19th CENTURY FACED A VERY DIFFERENT SITUATION.

THEY WERE CRIMINALIZED.

THEY WERE POLICED.

THEY WERE JAILED.

AND THEIR OUTCOMES WERE MUCH WORSE.

I THINK THAT'S A VERY IMPORTANT POINT.

I THINK BACK THEN, THERE WAS LESS OF A STIGMA ON FOLKS WHO WERE USING THESE MEDICATIONS.

EISENHOWER: LESS OF A STIGMA?

AND DOCTORS WERE WILLING TO TAPER THEM OFF.

WHEREAS NOW, AFTER ALL THIS TIME, OPIOID USE HAS BEEN STIGMATIZED EVEN MORE SO, AND DOCTORS WHO FOUND THAT THEY WERE DUPED BY PHARMACEUTICAL COMPANIES AND DIDN'T TAPER AND ABRUPTLY STOPPED THEIR PATIENTS' OPIOID PRESCRIPTIONS, THOSE FOLKS WERE MORE LIKELY TO PROGRESS TO HEROIN.

AND WE HAVE THE SAME STIGMA NOW, I BELIEVE, ON SUBOXONE AND METHODONE, AND IT'S MUCH HARDER FOR PEOPLE TO GET THOSE MEDICATIONS-- SO THERE'S AN UNDERSTANDING ISSUE HERE.

THAT IS FASCINATING.

NOW FROM A--I WOULD SAY FROM A NATIONAL POLICY SETTING PERSPECTIVE, HOW MANY FRONTS ARE THERE ON THIS WAR?

IN OTHER WORDS, FROM A SOCIAL RESPONSE?

I WOULD SAY THERE ARE MORE THAN 10 FRONTS.

10?

MORE THAN 10, EASILY.

THERE'S, NUMBER ONE, SUPPLY REDUCTION.

AND SUPPLY REDUCTION INVOLVES REDUCING PHARMACEUTICAL PRESCRIBING.

AND THAT IS--THAT CAN BE BROKEN DOWN INTO PHYSICIAN REDUCTIONS, FOLLOWING NEW GUIDELINES FROM THE CDC IN TERMS OF PRESCRIBING, ACCESSING WHAT'S CALLED THE PRESCRIPTION DRUG MONITORING PROGRAM, WHICH IDENTIFIES DOCTOR SHOPPING AND HIGH DOSE PATIENTS.

THAT'S ONE COMPONENT OF SUPPLY.

THE SECOND COMPONENT OF SUPPLY IS CLEARLY REDUCING THE INFLUX OF FENTANYL, WHICH IS DEADLY AND HAS CREATED AN ENTIRELY-- IS THAT HOMEGROWN OR THAT IMPORTED?

WHERE DOES IT COME FROM?

CHINA.

CHINA.

CHINA.

WOW.

PRIMARILY.

AND SOME OF IT IS FILTERED THROUGH MEXICO, BUT MOST OF IT IS CHINA.

THE OTHER THING IS THAT WE RECOMMEND BESIDES PHYSICIAN EDUCATION ON PROPER PRESCRIBING AND ACCESSING DATABASES IS PATIENT EDUCATION, BECAUSE MANY PATIENTS ARE UNAWARE THAT THEY'RE GIVEN OPIOIDS.

AND THEY'RE UNAWARE THAT A 30-DAY SUPPLY IS UNNECESSARY, AND THEIR TEENAGERS MAY GO INTO THE MEDICINE CABINET AND REMOVE THEM.

SO THE SUPPLY COMPONENT IS WHAT I WOULD CALL IN THE DOMAIN OF PREVENTION.

AND THEN WE HAVE THE TREATMENT COMPONENT AND THE RESCUE.

AND THAT IS CRITICALLY IMPORTANT BECAUSE PEOPLE, WHEN THEY OVERDOSE, THERE SHOULD BE TREATMENT ON DEMAND.

I'M THINKING OF ANALOGIES.

I'M THINKING OF THE WAR ON DRUGS, THE LONG-TERM WAR ON CIGARETTE SMOKING.

I'M THINKING OF OUR CAMPAIGNS AGAINST ALCOHOLISM THAT RESULTED IN PROHIBITION, OTHER THINGS.

ARE THERE ANALOGIES THAT COME TO MIND HERE IN A WAY THAT AMERICANS WILL BECOME CONSCIOUS OF THIS PROBLEM, IN A WAY THEY WILL TRY TO PREVENT PEOPLE FROM FALLING INTO IT, AND IN A WAY THEY WILL TRY TO ADDRESS THE PROBLEM THAT WE FACE RIGHT NOW?

ARE THERE ANALOGIES THAT YOU SEE?

I MEAN, I THINK THAT IT'S IMPORTANT AT THIS POINT TO BRING RACE INTO THE CONVERSATION, BECAUSE ONE OF THE, YOU KNOW, STRIKING ASPECTS OF THE OPIOID CRISIS, AT LEAST IN THE PUBLIC EYE, IS THAT IT'S SOMETHING THAT TAKES PLACE AMONG WHITE PEOPLE IN RESPECTABLE COMMUNITIES, SO TO SPEAK.

AND THIS HAS BEEN PRODUCTIVE OF AN EFFORT TO TRY TO THINK ABOUT THIS AS A PUBLIC HEALTH PROBLEM OR AS A CONSUMER PROTECTION PROBLEM.

AND ONE OF THE-- THIS ACTUALLY CONTRIBUTES IN A WAY TO HOW YOU SWITCH FROM AN ENDEMIC USE, WHICH MAY NOT BE A PUBLIC HEALTH CRISIS, TO AN EPIDEMIC SITUATION, WHERE YOU HAVE A REAL CATASTROPHE.

I'D SAY HISTORICALLY, THIS IS THE THIRD OF 3 MAJOR PUBLIC HEALTH CRISES RELATED TO ADDICTIVE PHARMACEUTICALS.

AND IN EACH CASE, THERE'S TWO PRE-CONDITIONS AROUND BEFORE THEY BEGIN.

ONE IS THAT IDEAS ABOUT ADDICTION, METAPHORS ABOUT ADDICTION ARE WARPED BY SOCIAL PREJUDICES.

ADDICTION IS THOUGHT OF AS SOMETHING THAT HAPPENS TO RACIAL MINORITIES OR THE POOR.

AND THEN LINKED TO THIS, BECAUSE ADDICTION IS SOMETHING THAT'S SEEN AS--THAT HAPPENS BECAUSE OF PEOPLE WITH INNATE, PROBLEMATIC QUALITIES, THAT THERE'S LESS OF AN INTENSITY TO THINKING ABOUT HOW YOU MANAGE CONSUMER MARKETS FOR PHARMACEUTICALS, WHICH TRADITIONALLY HAVE BEEN SOLD TO MORE PRIVILEGED, WHITER, MIDDLE CLASS PEOPLE WHO SENSE THEY'RE NOT MUCH AT RISK FOR BECOMING ADDICTED, YOU DON'T NEED TO POLICE THAT MARKET AS CAREFULLY.

SO THOSE TWO THINGS ARE RELATED, AND THAT'S HOW YOU CAN HAVE THESE PRESCRIPTION DRUG EPIDEMICS.

AND I THINK THAT THE RIGHT METAPHOR IS THINKING ABOUT CONSUMER PROTECTION, BECAUSE AS A HISTORIAN I CAN SAY WE'RE NOT-- THERE'S NO EVIDENCE THAT YOU CAN EVER END THE AVAILABILITY OF PSYCHOACTIVE DRUGS FOR A MILLION DIFFERENT REASONS.

AND SO YOU MOVE TO THE NEXT STEP OF THINKING, HOW CAN WE MAKE THESE SAFE THE WAY WE MAKE OTHER PRODUCTS SAFE?

JUMPING OFF OF THAT, JUST LIKE WE CAN'T STOP THE PRODUCTION OF THESE COMPLETELY, HUMANS HAVE BEEN USING DRUGS FOR 8,000 YEARS, AND I DON'T THINK THEY'RE GOING TO STOP BECAUSE OF SOME EVEN REALLY SOPHISTICATED CAMPAIGN.

SO WHAT WE NEED TO HAVE IS NOT JUST THE KIND OF EDUCATION THAT PREVENTS NEW PEOPLE FROM DEVELOPING THESE PROBLEMS, BUT THE KIND OF EDUCATION THAT HELPS THOSE, ESPECIALLY THOSE WHO ARE DISENFRANCHISED, WHO ARE ON THE PERIPHERY OF OUR SOCIETY, TO STAY ALIVE.

AND THOSE ARE, FRANKLY, SOME OF THE THINGS THAT WE'RE NOT ADDRESSING IN THE TREATMENT SYSTEM.

HOW DO WE KEEP THOSE WHO ARE AT THE HIGHEST RISK FOR OVERDOSE FROM DYING?

ONE QUICK EXAMPLE IS THERE'S PEOPLE WHO ARE COMING OUT OF 28-DAY, TRADITIONAL REHABS.

ANY ONE OF OUR FAMILY MEMBERS HAS AN ADDICTION, WE'RE GOING TO THINK INTERVENTION AND REHAB.

BUT YOU'RE AT TWICE THE RISK OF OVERDOSE DEATH WHEN YOU COME OUT OF A REHAB BECAUSE 90% OF THEM DON'T PRESCRIBE SUBOXONE AND DON'T OFFER EVIDENCE-BASED TREATMENTS.

SO THAT'S WHERE THE ACTION IS AT FROM MY PERSPECTIVE.

TALKING ABOUT DYING IN THE DRASTIC END OF THIS THING.

WHAT IS THE, I WOULD SAY, THE CAUTIONARY TALE?

YOU SOUGHT TREATMENT, DID YOU NOT?

WHAT IS YOUR LIFE LIKE?

NOW?

IN A SITUATION LIKE THIS.

IN OTHER WORDS, WHAT ARE THE CONSEQUENCES OF THIS THING, THE ECONOMIC, THE SOCIAL CONSEQUENCES, THE PERSONAL CONSEQUENCES?

WHY STAY AWAY FROM THIS?

SO THE CONSEQUENCES JUST FOR ME PERSONALLY, I LOST CUSTODY OF MY DAUGHTER IN ACTIVE ADDICTION.

I BECAME INVOLVED IN THE CRIMINAL JUSTICE SYSTEM.

TO ME, THOUGH, EVERYTHING THAT I'VE BEEN THROUGH HAS GOTTEN ME WHERE I AM TODAY.

I WAS FORTUNATE ENOUGH TO GET THE BEST TREATMENT AVAILABLE.

I WAS ONE OF THE ONES WHO DECIDED TO CHANGE MY LIFE, BUT THERE--I MEAN, PEOPLE LOSE EVERYTHING WITH THIS DISEASE.

THEY LOSE THEIR CHILDREN, THEIR FAMILIES.

MOTHERS AND FATHERS ARE LOSING THEIR SONS AND DAUGHTERS.

THEY LOSE THEM BECAUSE THEY CAN'T FUNCTION ON THE DRUGS, RIGHT?

THEY CAN'T FUNCTION OR WHAT DOES IT DO?

SO JUST FROM MY OWN PERSONAL PERSPECTIVE, WHEN I WAS IN ACTIVE ADDICTION, I COULDN'T GET OUT OF BED IN THE MORNING WITHOUT IT.

I WAS 100% DEPENDENT ON THE DRUG.

I COULDN'T LIVE WITHOUT IT, WHICH IS WHERE INPATIENT TREATMENT CAME IN, TREATMENT AFTERWARDS CAME IN, AND I FOLLOWED THROUGH WITH THE ENTIRE CONTINUUM OF CARE, AND THAT'S WHAT FOR ME SAVED MY LIFE.

WE'RE IN THE PRESENCE OF PEOPLE WHO HAVE STUDIED THIS PROBLEM, WHO HAVE DEALT WITH THE PROBLEM, AND I WOULD LIKE TO KNOW HOW CHALLENGING THIS IS GOING TO BE.

HOW HARD IS THIS GOING TO BE TO COME TO GRIPS WITH THIS?

I'D LIKE TO GRAB THAT ONE.

I THINK THAT REVERSE ENGINEERING THE MEDICALLY-INDUCED ADDICTION, THAT COMPONENT IS NOT AS CHALLENGING AS THE PEOPLE WHO'VE TRANSITIONED TO HEROIN AND FENTANYL.

I THINK THAT WITH BETTER EDUCATION, PRESCRIBING GUIDELINES, THOSE THINGS CAN BE REVERSE ENGINEERED IN A MATTER OF TIME.

IT IS HANDLING THE PEOPLE WHO HAVE PROGRESSED TO THE ILLICIT DRUG MARKET THAT I THINK IS MUCH MORE PROBLEMATIC.

AND I THINK THAT THAT IS-- WE HAVE TO RECOGNIZE.

I DON'T THINK WE CAN ARREST OUR WAY OUT OF THIS.

I DON'T THINK WE CAN TREAT OUR WAY OUT OF THIS.

I THINK WE HAVE TO PREVENT OUR WAY OUT OF THIS EVENTUALLY.

AND PREVENTION HAS WORKED IN THE PAST.

THERE HAVE BEEN WAVES AND WAVES OF SURGES OF DRUG USE AND RAPID DECLINES OR SLOW DECLINATIONS.

AND WE HAVE TO LEARN THOSE LESSONS ON WHAT WORKED AND WHAT DIDN'T IN TERMS OF PREVENTION.

SUPPLY IS A KEY PART OF THIS, BUT ANOTHER KEY PART IS EDUCATION OF THE AMERICAN PUBLIC.

WE'VE BECOME A NATION OF CHEMICAL COPING AND CHEMICAL REWARD.

THAT IS NOT A GLOBAL PHENOMENON.

ALL RIGHT, WELL, THIS HAS BEEN VERY ILLUMINATING.

AND I WOULD SAY THE DIMENSIONS OF THIS ARE STAGGERING.

AND I THINK WE'RE ALL-- I APPRECIATE YOUR PERSPECTIVES VERY MUCH ON THIS ISSUE, AND I'M SURE WE'RE GOING TO BE HEARING A LOT MORE ABOUT IT IN YEARS AND YEARS TO COME.

THANK YOU VERY MUCH.

YOU'RE VERY WELCOME.

UNLIKE MANY OF THE MOST VEXING QUESTIONS OF OUR TIME, THE OPIOID ADDICTION CRISIS IS CLEARLY A PROBLEM OF OUR OWN MAKING, WHETHER ONE CREDITS ECONOMIC CONDITIONS, MISTAKES ON THE PART OF THE MEDICAL COMMUNITY, MORAL LAPSES IN OUR CULTURE, OR OTHER FACTORS.

THIS IS AN AFFLICTION TAKING THE LIVES OF FAR TOO MANY OF OUR FELLOW AMERICANS, WHICH WE HAVE VISITED UPON OURSELVES.

THERE ARE, HOWEVER, PATHS FORWARD.

FROM REFORMS IN THE PRESCRIBING PRACTICES OF DOCTORS TO REFORMS IN THE CRIMINAL JUSTICE MANAGEMENT AND MEDICAL RECOVERY OPTIONS FOR ADDICTS, THERE IS HOPE.

ONCE AGAIN, FOR "THE WHOLE TRUTH," I'M DAVID EISENHOWER, AND I THANK YOU FOR WATCHING.

ANNOUNCER: THIS EPISODE OF "THE WHOLE TRUTH" WAS MADE POSSIBLE BY THE MILL SPRING FOUNDATION, THE DORAN FAMILY FOUNDATION, AMETEK, AND BY... AND BY CONTRIBUTIONS TO YOUR PBS STATION FROM VIEWERS LIKE YOU.

THANK YOU.