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tv   Public Affairs Events  CSPAN  April 25, 2022 6:16pm-7:01pm EDT

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>> tonight watch a debate among the democratic candidates running for senate in pennsylvania, live coverage starting at 7 p.m. eastern on c-span online at or watch full coverage c-span now are free video app. >> c-span brings you an unfiltered view of government, our newsletter word for word recaps a day for you from the halls of congress to daily press briefings to remarks from presidents. state -- scan the qr code to sign up for this email. subscribe today using the qr code or visit to subscribe anytime. >> the associate director of
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the research center. welcome back to c-span. guest: -- the biden administration releasing the new policy. what is the purpose of such a thing? guest: it is a congressionally mandated document. every year the administration puts one out. this is touching upon many different areas related to drug control policy. things like jurisdiction at the border, domestic law enforcement , treatment prevention and harm reduction. >> as far as the approach that you -- that the administration took, the doctor wrote this, saying we are changing when it comes to drug use by meeting them where they are. we are moving their years.
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we are also striking drug trafficking organizations in their wallet by disrupting the operating capital that they need to sustain their criminal enterprises. guest: these pillars are pretty standard. what is not is harm reduction. that is new. we have not really given any thought to harm reduction. this is the first time that the reports have actually reduced harm reduction. it counteracts and reduces some of those deaths. those things have been there, going back 34 years. host: can you tell us what that looks like? guest: people will use drugs,
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especially those with a substance use disorder. there are long-term harms. they are not worried about contracting aids or having an addiction problem. they are worried about today. i am experience withdrawal so i will do everything i need to to overcome that withdrawal. they recognize that they will continue using drugs today, but let's make sure they are not doing it in a way that is harmful to themselves or others. we want to make sure they are not transmitting blood-borne diseases. he will allow them to test their drugs. those are things like harm reduction. it can link people in the throes of substance use disorder. it is a low threshold way to take the time to recognize that they have a problem and address it with methadone or other social service programs. it is a low threshold way.
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host: does the harm reduction path work? if so, how would you demonstrate that? guest: it can take a lot of different forms. these are programs that people can go in, get clean syringes, use their drugs and return them to the needle exchange program. they can get low threshold treatment for things like addressing infectious wounds at an injection site. those things are what is done. research on that shows that they do reduce hiv transmission in many places. there are other harm interventions. these are very cheap and easy to deploy. strips allow you to determine whether fentanyl is present in the drug. if you have a powder mixture, it will allow you to determine that fentanyl is there. the science is still emerging,
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but there is early evidence adjusting that people do use -- change their use profile. it will maybe not use the whole bag. they will take the proper precautions to reduce their death risk. there are some ways in which harm production can shape user behaviors and ultimately reduce the things that we care about. is it give -- host: is it given to the states to handle? guest: this is the first time it has been done -- others have been funded with federal dollars, but this time, there is a pillar. we are going to fund some money towards this. it is a drop in the bucket compared to the federal drug control policy. but it will allow for them to
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purchase test strips. there will be other interventions used outside that this administration is suggesting warrants for further research. morphine treatments -- these are other therapies that are being used to attract individuals that are not using methadone or they have not had much success using methadone. we are trying to reduce overdose deaths. host: we will talk about this from the mn station, when it comes to drug control policy. we have divided the lines regionally. for those in central time zones, (202) 748-8000. for those in the mountain time zones, (202) 748-8001. if you know someone who struggles with rug addiction or
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you struggle yourself, call (202) 748-8002. what is the potential as far as reducing harm on that front? guest: test strips have been the one thing that they have put a lot of money towards. they said the emerging research suggests that they may be useful, but there are limitations and people need to be aware that there will be -- it is like a pregnancy test. it determines whether fentanyl is present. if you are a drug user in the market, everything contains fentanyl. that is what we are seeing in the market. you already know that fentanyl is there. for a cocaine user that does not want to come into contact who has no tolerance, it could save their lives. if you buy a powder in a baggie,
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you can test it with a test strip and if it shows positive, you may not take that baggie. for some users, it may work, but others -- there are other things that they can do to try to increase the numbers in counties that are affected by overdose. that is fine and it seems like a valid thing to do, but it may not have a direct impact. they are designed -- that said, it may serve as an early threshold. for those coming off the street, they may be able to get access. those types of interventions may result in provision systems, so that is good, but there is a lot more that can be done.
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canada has been opening up. other places have been offering more access to treatment. there are things that can be done, but this administration is just dipping its toe. host: what is the perception of this type of approach? guest: the reality. host: you explain that before. guest: the perception depends on who you ask. they will come down one way or the other on harm reduction. more in the middle, but people are generally adverse to harm reduction programs or abundantly welcoming to it that there is a little bit of blindness towards it. there are some people who initially are not in favor of harm reduction, especially in localities where they have been looking --
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a lot of community members did not like these ideas, but over time came to realize that they had some benefits. the public drug use that leaders were concerned about happened behind doors. it reduce the social disorder in that area. that was a benefit that community leaders warmed up to overtime. the research on some of these interventions has shown that they reduce the transmission. early research on some of these that address fentanyl -- they show some positive benefits. they are trying to expand. it will probably not have much of an effect. again, everything contains fentanyl. you want to know is how much fentanyl. there are no other testing mechanisms that can be used. there are programs and services
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where you can take part of your drug off the street and had it tested in the scenes using a machine with a more robust and quantitative means. it will allow the user to know what dose they should be taking. host: our first caller from tennessee. go on with your question or comment. caller: it seems like this question has been asked more. i was calling in -- host: are you there? go ahead. you are on. go ahead. caller: the question is what should our parties be doing? are we talking about something else? host: we changed the segment for that. let's hear from henry from
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massachusetts. in morning. caller: good morning. how are you? host: good. go ahead please. caller: thank you for taking my call. way back, before the military with issues with my body, i have been taking painkillers for all those years which has helped me anyway that medication has not. three years ago, they started withdrawing the medications because they were worried about the opioid problem. i can understand. i understand why they worry, but when i go to a doctor now, they have dropped. i'm called a drug addict and i
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have been called a drug-seeking behavior and stupid by my doctors. i do not have time to go out into the streets to look for powder and fentanyl. i'm just looking for help to take care of my physical ailments that my body needs. when i go to a doctor, i'm not going there to seek drugs. and going there to seek help. host: thank you for sharing that. guest: this is the concern that some drug policy folks have raised some issues with. with opioids in particular, it is tricky because you have to taper people down slowly. some chronic pain users can benefit from long-term treatment with opioids, but it is a small amount of the population. in this case, there is a concern
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of tapering too quickly. they have said maybe we should not have done this too rapidly. we need to do this more slowly. that is when they come into contact. that is a serious concern. host: you talked earlier about markets. is it urban, suburban or rural? guest: this problem is largely regional. but we are seeing fentanyl showing up everywhere now. it started showing up and parts of the and antic. in other forms and other markets -- it is pretty much everywhere. this is both a suburban and an urban problem. it is easy to ship. you can ship it by mail. it is easily done. with that said, this administration recognizes
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limitations and being able to offer some of these services. they are looking at low threshold means. you have methadone provision centers. these would be useful. it is hard for people to go get their methadone every day. it is stigmatizing and hard for people who may not have a vehicle or a means of transportation. it will be increasingly difficult to reach out and meet people at their needs. we recognize the limitations that might be put into place. reducing availability of doctors who can prescribe morphine. there are policies put in place that may prevent some of these efforts to reach people. host: eric is in las vegas. in morning.
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caller: good morning. you are the best. help me. i have a blind spot. i see these now. it is approaching the opioid crisis as a health problem, but growing up. it was always a law and order issue. i see all the help being given out. i am all for it. please, help everybody. it seems like -- i am an american of african descent. it seems like when it was mostly people who looked like me, let's put them in jail, but now that it seems to have crossed the street and affected people that do not look like me, now it is a health problem and let's help them.
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do i have a blind spot there? guest: that has been a recognized point. that metric has shifted in a large part, due to the emergence of opioids. the opioid problem really saturated many markets, not just these are prescription drugs and people who had access to health care were going to the doctor with legitimate issues, but then it became a substance abuse disorder. they developed problems with drug use and some cases were cut off. the overdose problem associated with that -- some people traded down to air -- heroin. it is more of a public health approach not only because we have more white folks more than rural, but decides it showing that treating this through the
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public health approach is the best approach. we have that stigma associated with the colonel justice system really contributes to elevated risks. they have lost tolerance. there are a lot of harms. but eric is right to point out that those dying are also driving this. host: russell is from new jersey. hello. caller: good morning. thank you for coming on this morning. my mom died of opioid addiction. later on in life, when my doctors all started handing the opiates, i knew better and i saw alternative treatment. but i have noticed in the years since my injury, when i talked to other people, they say they
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are still being handed opioids left and right. i do not see a change and i want to know if it is due to the fact that it is so hard for normal spine doctors to prescribe epinephrine or that they do not know better? guest: that is an interesting question. it is in opioid -- sometimes, they push something off of it. it is interesting that way. it acts both ways and it can be used to treat pain, but it can also be used to treat substance abuse disorders. they are cap at how many. doctors do not want to be seen as dope doctors.
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there is a little bit of stigma from that. many pain patients are being saddled with something else. i'm not a medical doctor, so i do not know to what extent those decisions are being made. it has kind of a ceiling effect and more traditional like methadone. host: those on twitter asking, is it true that most illegal drugs, including fentanyl and heroin enter the u.s. through ports of entry active guest: yes. the data shows that they do occur near ports of entry. those are the main ports of entry for all sorts of drugs. host: it includes the targeting of activities of criminal organizations and reducing the supply of drugs smuggled across the borders.
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what has been successful? guest: it is very limited. we need to recognize that they are moving more difficult. it will be increasingly difficult for law enforcement to do this. the supply reduction efforts can shape markets. traffickers will find a workaround and markets will stabilize in other ways. there has been some effort put into that, but largely temporary reduction. host: charles is in new jersey. go ahead. caller: i have dealt with people with addictions. i was in a worship group and we used to deal with addiction every wednesday night. i would see one guy after another, after another, dying.
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my thing is, the money should be put where it will cut the head off. that is where they should throw their money at. places like china and we cannot bring all these people -- sentinel comes through -- sentinel comes through -- fentanyl comes through our borders. you have to cut the head off the snake. guest: there has been billions of dollars funded towards intervention, including ports of entry and be thing of security efforts there. working with china to reduce the flow of chemicals. trying to improve corruption
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efforts in mexico. this is nothing new. they have spent billions of dollars on these efforts with some modest gains. there have been efforts that happen from time to time, especially with fentanyl. it really changed the way in which it was manufactured. again, the overall flow -- it just shapes the supply in different ways. it does not really in the problem. there are too many ways to get sentinel into the u.s. host: what do you think is shaping their approach versus other administration's approaches? >> it is laid out front and center. that is new and historic. in addition, looking at the federal funding request, it has been 50-50.
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this administration is requesting a little bit more, about a 60-40 split. recognizing that efforts are going to be limited. we will have to change. this is not plant based drugs. this is manufactured in a lab. you cannot send marines out of a helicopter. you need to tackle this in different ways. they recognize that more needs to be done on demand reduction. they talked about methadone and trying to increase the number -- getting them onto methadone. they are in the system. it will come down to the states. they are not in-state homes.
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they are at recovery houses. it will come down to stay efforts. the federal government is working towards trying to improve access. host: does that mean working with pharmaceutical companies? guest: there is some discussion about expanding the reimbursement mechanisms for people on medicaid or private insurance to gain access. if you are someone in a state that did not expand access, what are you supposed to do? they recognize limitations that needs to be overcome. these are barriers that the federal government cannot quite
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compel the state. they can start dangling things. but they can gain access. things like that. but there are things that need to be addressed. host: what is the typical? guest: with opioids, it depends. there are people who get into this for legitimate reasons. working in a coal mine for 30 years -- they become -- those people, 55 plus. then you have people who are long-standing heroin users. for decades, even when they had a prescription opioid problem. those are largely older black man who have died.
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then you have other folks like a more western phenomenon, people around 25 buying a, what they think is a legitimate tablet. these contain a few milligrams of fentanyl. they look like the genuine product. they buy these thinking it is a genuine xanax by. that said, the age range of 45 to 50 are the ones who are dying of overdoses. host: this is media in california -- mia in california. caller: thank you for having me. i'm a little nervous and i have a question -- couple questions. the epidemic, the drug epidemic
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is really out of control. we have to start within the community. i do not want any politics to come in between us. if you want to be a politician, come straightforward to your community, at the city halls and everything. we cannot have police -- we need to have community activists involved. big pharmaceutical companies -- you guys started this. you gave us these pills and now we have people addicted. i do not want to get too deep because i can get way more detailed. host: he said you had questions. what are they? caller: i need to know, what is he going to do to get the pharmaceuticals out of here and
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to get rehabilitations for everybody? a ghost of fentanyl. -- like fentanyl? guest: there are some things regarding pharmaceutical drugs. there are kickbacks. they are trying to encourage -- this is a strategy that they put out every year. there are limitations to what they can do and implementing this is the next question. if you get a 90 day prescription , you can mail back the rest if you only take three tablets. you want to avoid your kids going into your cabinet and getting access. there are things that the administration realizes need to be done. reducing barriers are crucial. during covid of the regulatory
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agencies reduce access. during covid, you could not go anywhere. you could not go to your methadone clinic. those things, we hope will be made permanent. there are other things, really opening up more treatment facilities that they are offering, but implanting this is the question. host: what country best handles drug addiction? guest: that is an interesting question. the problem is made more difficult with regards to health care. we were told by pharma that these were non-addiction producing substances. it was a well intended policy. we started to aggressively keep
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them alongside polls, heart rate , temperature and respiratory rate. pain is subjective and nobody else can understand my pain. adding patients to do that is impossible. because be focused on treating pain and levels of reimbursement , everything started to focus on treating pain problems, people were prescribed very quickly, prescription opioids. we were settling people with them to get things like tooth extraction, then back -- chronic pain patients, but not that many. most people that get opioids and are exposed for a long period of
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time can develop opioid dependency and addiction. static to constrain access. to some of the people who had addictions switched to heroin because it was cheaper. that started this second wave of the illegal opioid problem -- problem. a large part of this had to do with the health care systems in the country. once you have an addiction, it is hard to get addiction therapy in many places. what are you going to do if you have -- if you do not have access to private insurance? host: you mentioned canada several times. guest: it is easier for policy.
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we are talking about a very fractured system, different states and different models. the federal government is very constrained and what it can and cannot get -- cannot do. we have housing problem that compound this. it contributes to people using drugs chaotically on the street. there are other associated problems that are typical of this. there is a book that i like the recommend called the american disease. our addiction problem make it more difficult. you have public transit.
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you have universal health care. you can take the bus to a methadone center. you can go to your doctor. there are different things that you have access to. host: let's hear from kathy in pennsylvania. caller: thank you for having me. i wanted to ask, where is he getting his statistics about chronic pain patients? i am a chronic pain patient and i am not addicted. there are a lot of people like me that are able to function with the pain medication. now it is being taken away. i would like to know where you are getting your facts about everybody who takes pain medication becomes edict -- addicted because it is not true. thank you.
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guest: that is correct. there are chronic pain patients who benefit from long-term treatment. that is that said, there are those who become exposed come who should never be exposed. a 19-year-old who gets a wisdom tooth extraction should not be subscribed -- prescribed opioids. the cdc has recognized this as a very tricky group of patients because they are people -- you need to be cautious about tapering down, if they choose to taper down. there are other people who should not be exposed to opioids. this is a big part of the problem is because we overdid it by over treating. host: what is the impact of
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legalized cannabis in the u.s.? guest: so far, this guy did not fall, but there have been different effects. we have seen children going to the er for accidentally ingesting cannabis problem -- products. those numbers have gone up in states that have legalized cannabis. we have seen increased car accidents, but it is a little mixed. it depends on how you peel the onion. some are looking at insurance claims versus fatalities. you can see people, the fatality is decreasing. others are getting into accidents. things like we have seen state revenues include -- increase from the taxation. there has been a benefit from that. in legal markets, -- there.
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mexican drug contrails -- cartels -- they recognize that it is not viable for them. they do recognize it as an increasing problem. there has been a mixed bag, here and there. it will take a long time to suss out what is happening. we have seen the use rates for certain cohorts increase. this is for those individuals using cannabis or reporting cannabis use. the numbers in the midrange from young adults 18 to 30 -- we have seen the number of individuals increased her medically. about half of them reporting.
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that is something that has dramatically increased. have seen a flattening. host: where is the federal government? guest: the federal government has had no take on this. there've have been several bills put forward and we will see if that gains traction. so far they have taken aback see. -- a back seat. host: joanne is in reading, pennsylvania. caller: i'm coming from a different point of view. i had a couple friends have been in your fatal car crashes with drunk drivers and another friend of mine had triple bypass surgery. they did not want to be on any kind of drugs.
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went to two different enters and the ones who check into a center for addiction, you basically cannot get out unless you are on methadone. both of them went to have help to decrease what they were on and go on with their lives. and basically almost held hostage. you have to take this. you are not allowed to leave. why do they push methadone unless -- instead of trying to lean people off of things? other people have been prescribed things that they initially did not even want to be on. i just felt so bad. i could not even get my best friend out of the place because
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they would not let her leave. you have to take methadone. they said -- she said they treat you like dirt. is that the long-term game plan? host: thank you for the call. guest: this is an important conversation to have. stigma is a huge problem in terms of individuals that need to get onto methadone and cannot or individuals who are on methadone and they want to get off. doctors do not want to prescribed morphine in some cases. similarly here, it is true that you have some people who want to walk off and they are being told that they cannot because it is harmful. it can create a chemical dependency.
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long-term repeated exposure can change the way the brain operates. you develop a chemical dependency that requires you to taper off. methadone patients, there are those who successfully live with methadone for 40 to 50 years loan amounts and notices, and they are fine. pushing those off is probably not a good idea, but if somebody does want to taper off, they should try to find some kind of center. it just these to be managed in a way that is safe. if you taper off too quickly, you can create compulsive cravings that would resort and individuals seeking drugs in the market. there needs to be caution there. host: we're are almost done with the program -- program. caller: i have been on opioids since the early 90's.
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i blew out my c 32 and my neck. went through a whole rigmarole of being in pain. they sent me to a nut doctor, saying it was only my head until they figured it out. now i have a cervical pain in my spinal cord. people do not realize how much hassle, people in chronic pain and have hurt themselves have to go through all these loops to get things accomplished. it is not just the pharmaceuticals. it is the doctors. it is all the hoops that they have to jump through to prove that they are in pain. it is ridiculous. the other thing about the fentanyl, if we closed the southern border, maybe we would not have this problem as bad as we do. thank you. guest: closing the border is -- again, fentanyl was easy to ship into the u.s. before.
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it was coming through mail. closing the border will not have much of an effect. can shape these supply patterns in a variety of ways, but it is too easy to get through. to her point on prescription opioids for long-term chronic pain patients, there is a legitimate concern. by tapering people or cutting them off too quickly, you can cause more harm. there is a segment of the population that needs to be managed carefully. they should not be cut off. long-term -- rather than cutting off their medication and them seeking out heroin from the illegal market, that is much more harmful for them and society than managing their pain long-term with opioids. with that said, trying to avoid starting people is crucial. we recognize that, but we also need to focus on other areas. host: our guest is the associate
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director. >> including the pennsylvania cable network we bring you live coverage of the debate here on c-span.


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