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Prescription Addiction: Dead in the USA. Aired 9-10p ET

Aired May 11, 2016 - 21:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


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[21:00:15] ANDERSON COOPER, CNN HOST: Welcome to the "360" town hall "Prescription Addiction Made in the U.S.A." We're here to talk about an epidemic that kills 78 Americans every single day. That's one death every 19 minutes from an opioid overdose. We don't know yet whether if it was a prescription drug problem that killed the artist Prince. According to a source, prescription opioid pills were found with his body.

As we reported in the last hour, the investigation now includes a doctor who saw him twice in the weeks before his death, and went to his home in Paisley Park on the day the singer died. Now, those facts, spare as they are that due raise crucial questions. Life and death ones that are becoming all too common.

In the last 15 years have seen an explosion of addiction, overdoses and death for prescription pain pills in America.

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UNIDENTIFIED MALE: Rescue units for a medic at Paisley Park. Person down not breathing.

COOPER: This type of drug called "opioids" reportedly found on Prince at the time of his death and they driven drug overdose deaths to the highest rate in our nation's history.

The epidemic is uniquely American. The U.S. makes up 5 percent of the global population, but consumes 80 percent of the world's opioids. So how did we get here? The late 1990s, a push within the medical community to better manage pain led to laws passed making it easier to prescribe pain pills.

Coupled with that, aggressive marketing for some pharmaceutical companies directly to doctors to prescribe their drugs. In the years since, a frightening pattern has emerged. Sales of prescription opioids quadruple. What else quadrupled? Deaths from overdoses of the same drugs, and the rise of pain pills has lead many to cheaper and even deadlier opioids. Like heroine and black market fentanyl.

Today, 2 million Americans or dependents on or misuse pain medication. Everyday more than a thousand of people go to the ER for misusing pain medication. And every day, 78 people died from overdosing on opioids.

(END VIDEO CLIP)

COOPER: I want to welcome all of the people here in the audience tonight, to those of you watching on CNN and people around the world tuning right now on CNN International.

Our goal tonight is really to dig into what's going on with prescription opioids in this country, pain pills. You've already heard some statistics, and they're important. But tonight we want you to hear from the people behind those numbers, the real lives that have been lost and forever changed.

We want you to hear the voices, and see the faces of what these crises actually looks like. We'll also talk to the number of experts who have been on the frontlines of this, each in their own way, I'll be joined on stage for the hour by my co-anchor Dr. Sanjay Gupta. And for the first part of the program Dr. Leana Wen, who's the Health Commissioner Baltimore, Maryland, and an ER physician. As the health commissioner in Baltimore, she declared opioid overdoes a public health emergency.

Want to thank you both for being with us. Sanjay, let's start with you. I mean, have we ever seen anything like this in the United States?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: I don't think we've seen anything quite like this. This is a public health epidemic. But it is completely man-made. So, it is a manufactured epidemic. We've seen other infectious disease epidemics, but this is man-made, completely by us. And, you know, it's been preventable sort of all along.

We've known that this problem was sort of festering for decades now, and we've even had some solutions over time, but now it is the number one cause of preventable death in America today.

COOPER: And so much of it is prescribed initially by doctors, then sort of spirals out of control. Why are they so addictive?

GUPTA: Well, what's interesting, it really has to do with the way these things affect your brain. I mean, when you take these types of medications, opiates, you're going to keep in mind, that first of all your body is already making opiates, these endorphins. So, when you start to taking these pills, for example, you will shut off your body's own supply. Your body says, look I don't need to make it any more. So you see how these chemicals are sort of coming in, they're flooding those receptors over there. After awhile, those receptors get sort of blunted and they want more and more to get the same effect.

But what's interesting, if you stop taking the pills, no more of those opiates in your body, and your body hasn't been making any of its own opiates, so you crash. You feel awful, you're sick, you're nauseated. And what do you want? You want to get more pills. But it's interesting you want more pills not to get high, but just to feel normal again. So that's really what dependence sort of is like. COOPER: We got a lot of folks in the audience who have very personal experience since in all of these. I want you to -- everybody is watching, to meet some of them and they'll can be asking a questions to Sanjay and Dr. Wen.

I want everybody meet Jennifer Toy. She is the mother of a recovering addict. Her son became addicted to opioids when he was 16 years old. A doctor prescribed them 180 vicodin pills for a leg injury. That led to heroin a constant battle with addiction. She's got educated about the crisis. She seems help place 33 kids into treatment. I know Jennifer has a question for Dr. Wen.

[21:05:14] JENNIFER TOY, MOTHER OF RECOVERING ADDICT: Yes, thank you. How can we get the doctors and hospitals to stop over prescribing these addictive drugs?

COOPER: Dr. Wen?

LEANA WEN, BALTIMORE HEALTH COMMISSIONER: One hundred and eighty pills for one injury it's not acceptable. This is a problem by drug companies. It's also a problem by doctors as well. And doctors have to own the problem. And we have to be careful ourselves about prescribing medications. There are new federal guidelines issued by the Centers for Disease Control and Prevention that doctors have to follow. We're starting in medical schools. We have to do, we have to get all doctors to follow these guidelines. But we also have to get patients involved, too.

I urge for all patients to ask your doctor every single time, do I need this medication? What are the side effects? What are the alternatives? There is a culture of excess I'm sure you says this Dr. Gupta, it's not just in -- it's not just what doctors are doing but also patients expect the pills for every pain.

COOPER: But you know, I was in the hospital I'd surgery and I got great cared, but the doctor at the end said do you want 34 percent or 90? And I was like, I'm not sure I should be the one determining this. I don't know anything about this. I went for 30, and then soon as I took 34 percent, I kind of wished I took 90, but and I'm glad I didn't. Because God knows what would have happened. But these guidelines you talked about, the CDC my understanding is they just put out these guidelines this year. Why is it taking so long?

WEN: This is medical culture. It's taken so long because of all that marketing by drug companies and I feel badly now, I mean, I'm an emergency physician, I prescribed so many patients, so much opioids without thinking about what that could be doing to them in terms of causing overdose stats, in terms of causing them to be addicted. I wish I could take it back. But that's why we have to start with doctors, you know, with patients working together to stop this culture of excess.

COOPER: I mean Sanjay, and has the medical just been far behind on this?

GUPTA: I think they have been far behind, and there's lots of different reasons why. But what I think is sort of amazing is that many -- much of this started about 30 years ago back in 1986 with a single paper, a small paper of just 38 patients. And that paper -- before that time, people were more judicious about using opioids. After that paper it sort the belief became that you could prescribe this and discriminately that the risk of addiction was low, that the risk of overdose was low. And I think that's what Dr. Wen, that's what myself, I know Dr. Drew Pinsky is here, we all learned that in medical school that they're really wasn't a proceed harm from this.

Insurance companies loved it because it was cheaper to prescribe a pill than for people through physical therapy and other things. Pharmaceutical companies loved it because they were selling more pills, and the doctors I think as Leana said they bought into this. I mean, we much of the blame is on our shoulders.

COOPER: You know, Jennifer talking about limits. Would you meet somebody else in our audience for whom at one point there were no limits. Ray Lucas is here with us, Ray's a former NFL quarterback who at one point was taking of this up to 1,400 opioid pills a month. Is that right?

RAY LUCAS, FORMER NFL QUARTERBACK: Yeah, that's correct.

COOPER: That's incredible.

LUCAS: Yeah, started from a football injury, didn't have insurance, 300 turns into 600 before I knew that 1,400 pills a month, and I was doing TV at that time doing all the jets stuff. I was a functioning addict.

COOPER: You could function?

LUCAS: Functioning addict. The day before I will go on TV, I would stop taking the pills, do the show and I could swear as soon as my producer was in my ear saying five, four, the pain would rush back. So I would go downstairs, and I would take 15 pills right away. And before I got in my truck to go home and I live in New Jersey coming from New York, I would take 15 more pills. I mean, at my worst, I had taken 80 a day at one point, 40 a day, I mean, this was my life and the funniest thing about the whole I won the MVP that year.

I mean, in reality, I mean, this is what I did on a daily basis for a year. Bankrupt my family, put my wife and kids through hell. And I tell my story, and I'm not ashamed because I think opiates has changed the face of what people think are addicts.

COOPER: Right.

LUCAS: I am an 8 year NFL player, veteran graduates from Rutgers University, but I'm an addict and I will always be that way, so again ...

COOPER: Even now that you're not using you still using?

LUCAS: Oh 100 percent. And I don't wear it as, you know, like I'm supposed to be ashamed of it. COOPER: All right.

LUCAS: The worst back because I survived and I overcame my addiction, and I tell my story to make sure people know out there that they can overcome it.

COOPER: It's incredible, I mean, I think a lot of people don't really think about a functioning addict.

GUPTA: Right, yeah, I mean, Ray, it's good to see you. I mean, you look well. But I think you would probably agree that you probably had windows where you were functioning.

LUCAS: I mean, like I said, the day before ...

GUPTA: Right.

LUCAS: ... stop taking the pills.

GUPTA: Yeah.

LUCAS: As soon as the show was over for the next three days before my next show 40 a day, 50 a day easy.

GUPTA: But the rest of the time, you know, there's denial, there's probably hiding of pills.

LUCAS: The funniest thing with me was, I used to walk past the mirror, and, you know, be the quarterback. We really liked to look good, and you know, be sexy and stuff. But, I couldn't shave because the guy I looked at in the mirror wasn't the guy I knew.

COOPER: All right.

[21:10:12] LUCAS: So, that -- like you said functioning at various but a lot of times I would just be nasty. Not want to shower because I couldn't walk past the mirror.

GUPTA: Yeah it's an interesting term, functioning addict. But, you know, you still so much of the time is spent thinking about pills. You wake up in the morning, you're thinking about pills. You go to bed at night, you're thinking about pills. You're thinking about how you can continue.

COOPER: And you need more and more.

GUPTA: And you need more and more because they're not giving you the same effect that they used to get. And also, again, it's not at some point about getting high anymore, it's about not feeling awful.

COOPER: I want you to meet Maureen Morella and her son Jessie, they're right here. Twelve years ago, Jessie's experimental opioid drug use resulted in loss of oxygen to his brain, two cardiac arrest, irreversible brain damage, he can't walk and eat by himself or talk. Maureen thank you and Jessie thank you so much for being with us. MAUREEN MORELLA, SON SUFFERED BRAIN DAMAGE FROM OPIOID OVERDOSE: Thank you first of all to CNN for giving us a voice. Because to save a child is to save a family and this is beyond anything, the pain of the people that I have spoken to is beyond anything that we can imagine.

Dr. Gupta to my question is at 16 he began to experiment with opioids with friends and we saw nothing. He remained a clean cut, all American boy doing his activities. His GPA was high. So what are we missing is my first question. And secondly, is it inevitable that you become an addict if you experimenting with opioids?

COOPER: Great question.

GUPTA: Yeah. I'm really sorry for everything. You know, I have three kids myself. You know, you think about it all the time I think when you're parent certainly. I don't think you missed anything. I mean I'm sure that you think about that, and you question that.

MORELLA: All the time.

GUPTA: But these are things that, you know, that can be easy to miss I mean because opiate addiction, opiate misuse to something that's not always obvious certainly. And the developing brain, a brain that's not yet fully developed is going to be more at risk of actually developing a habit of misuse or abuse.

So 16 years old, obviously pretty young. It's hard to know what percentage of people become addicts. That depends on a lot of things, your biology, your environment, again, what age you start taking the pills? But the best studies show around 25 to 27 percent of people who take these could become addicts. In terms of how long it takes to become an addict, you know, within five to seven days, people can start to have withdrawal symptoms.

COOPER: Five to seven days.

GUPTA: Five to seven days.

COOPER: Which if you're prescribed this stuff, I mean you prescribed it, much more than five to seven days.

GUPTA: Yeah, I mean you got whatever number of Percocet, as Leana mentioned the new guidelines from the CDC say just a few days after an operation or after trauma or something that.

COOPER: You've seen that to people?

WEN: Right. And that's why it's so important for us to start slow and start from the lowest amount possible, not to give 180 pills, but to start with the lowest amount.

COOPER: Is this just been, I mean traditionally it's easier for doctors, I mean, I don't want to sound like I'm just going after doctors, but to just kind of write a prescription and move on, your busy got a lot of other patients to deal with? WEN: That's part of it, but it's also the expectation on the part of the patient too.

COOPER: They want something one now.

WEN: Yeah and if you fall down, and you bruise your knee, you might have pain, but you don't need opioids. Opioids are in the same class of drugs as heroin, which are incredibly addictive. And that's one of the reasons why in Baltimore for example we've said that, look we know that opioids are killing people, that there are more people dying every year from overdose than they're dying from homicide.

And so, we've made our antidote medication available to every single resident in the city, because we believe this is a life and death issue, and everyone needs to be able to save a life.

COOPER: I wanted to introduce everybody to Celeste Ciulla son, Celeste Ciulla is here, and her son is recovering addict, he started of using opioids in college, which then led to heroin. I know she's got a question for Dr. Wen.

CELESTE CIULLA, MOTHER OF RECOVERING ADDICT: Dr. Wen, why is America afflicted with the opioid epidemic so disproportionately to the rest of the world?

COOPER: It's so true. When you see the numbers, I mean, 5 percent of with the population, 80 somewhat percent of the opioids.

WEN: You wonder, are Americans really in that much pain that we need to consume that many more opioids. And there is a problem that we have in this country.

What we do expect a solution. You know, I go to schools in my city in Baltimore, I ask our high school students, do you think heroin is good or bad. Of course they'll say heroin is bad. But if I ask them are prescription painkillers good or bad, they won't know the answer. Because they see their parents and care givers taking anti-anxiety pills every time they have an issue.

And then themselves get prescribed a medication every time they're acting up in class. So we have this culture of giving a pill for every problem. This culture of a quick fix and that's something we have to change.

COOPER: Where was the FDA Sanjay in all of this?

GUPTA: The FDA is in a tricky spot in many ways Anderson. I mean in one hand, they're constantly pushed to approve more drugs to give patients more options. Oxycontin was recently approved for children and that's a remarkable thing and might as epidemic.

[21:15:04] Zohydro, another opioid analgesic also approved. So on one hand they say look we need to provide more options to people. On the other hand, they sort of admit that they have been acting very slowly. And they're starting to do things now, like put black box warnings on these medications. But as you mentioned earlier, that's just recently.

And another thing I just want to mention about this culture of consumption we have in this country. This statistic blew me away but 91 percent of people who overdose and survive are given another prescription for those opiates typically by the same doctor that gave it to them in the first place. We're not only not making progress in that regard, we are turning a blind eye to the tragedy in front of us.

COOPER: I want everybody to meet Tracey Budd, she lost her son to an accidental overdose, he became addicted after being prescribed like within following a football shoulder injury. Tracy's daughter, she also struggled with opioid addiction, she's two years clean as of five days ago. And we've just heard so many stories of kids being over prescribed. You just talked that oxycodone for kids. I know Tracy has a question for Dr. Wen, Tracey.

TRACEY BUDD, LOST SON TO DRUG OVERDOSE: Dr. Wen, actually I was wondering how you think that opioid prescriptions should differ for adolescents and adults.

WEN: A tricky question. And this is why medicine is both an art and a science. There's no one size fits all solution. We have to tailor treatment to each person, depending on their age, depending on what it is that they have. If an adolescent were in a bad car accident, they might need opioids, and I want to clarify that too that there are appropriate usages of opioid in medications.

And doctors for the vast majority of doctors want to do the right thing, and are horrified like myself when we know our own practices. That's why there are guidelines in place. We -- I believe that the guidelines should be even stronger in saying that we should be very careful about prescribing opioids and also getting Narcan, the anti- medication available to every single person who is at risk, which could be everyone.

COOPER: Sanjay, I read the statistic and I was blown away by in 2014, 168,000 kids age 12 to 17 had an addiction to prescription pills.

GUPTA: It is remarkable statistic in this, they're getting these pills in all sorts of different ways. As Dr. Wen mention sometimes, you know, for legitimate reasons, they're can be legitimate pain that warrants that prescription for a short period of time. And a lot of times they're getting it through the process of what as known as diversion. They're getting it from other people's prescriptions, either their parents or friends or friends' parents, whoever it may be.

And again, because it's a prescription medication, I think the level of awareness, the level of concern has been lower than it should be. You think well, this isn't heroin, it's not cocaine, how bad could it be. We're now seeing it.

COOPER: Yeah. We're going to get a quick break. Just had one of the phoniest issues of the cross of the deadly opioid epidemic. Doctors deeply divided or do whether to prescribe these powerful pain pills, somewhat strict limits. While other argue limits will be (inaudible) pain for people who have chronic pain conditions.

Plus, a solution that could save tens of thousands of lives every year, when "Prescription Addiction: Made in the USA" continues.

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[21:22:27] COOPER: Welcome back. The deaths from opioid overdoses have gone up 200 percent since the year 2000. It is certainly a sobering statistic of an epidemic and epidemic that Sanjay is pointing out that is completely man-made. Now is traumatic as those numbers are. There is a debate raging in the medical community and among patients.

On one side other people who say look, we need to put serious limits on opioids, and others say frankly they need these drugs to live a normal life to deal with their chronic pain. You're going to hear from them any moment.

But first, I want to introduce on the stage Dr. Mark Rosenberg, and our own Dr. Drew Pinsky. Dr. Rosenberg is the chairman of emergency medicine at Saint Joseph's Regional Medical Center in New Jersey. His is the first ER in the country to implement a policy that when patients come in with pain they're not immediately offered opioids. What reaction doctor do you get from people when you essentially kind of try to steer them in another direction.

DR. MARK ROSENBERG, St. JOSEPH'S HEALTHCARE SYSTEM: You know, I think it all started out, I'm a doctor, I trained to take care of pain and suffering. And for most doctors when they would open up the tool box, the medicine kit to see what medicines are available. Opioids were the primary drug that was there. So, the alter program added new medications, new treatments into this tool box, this medicine box.

COOPER: And there are other options?

ROSENBERG: There are other options. But when patients come into the emergency department, we have several patients who come in who are already addicted or have been addicted to opioids or heroin, and they come specifically to our emergency department because they know they won't have to get treated with opioids and heroin.

I have a story about a young man who came in who had back pain, and he had a kidney stone. He came specifically to St. Jo's because he knew he would get alternative treatment in getting opioids.

COOPER: Drew, I mean you have been counseling ...

DR. DREW PINSKY, HLN "DR. DREW" HOST: Small applause for that.

COOPER: Yeah, yeah. But I mean you've been counseling people -- have you ever seen -- I mean in terms of how do opioids compare to other drugs in terms of their hold on people.

PINKSY: They have the highest recidivism, they're the hardest to treat, they give people the most sense of desperation, they don't make it even through withdrawn many times. It's a horrible drug to treat. It's easily addictive. And, you know, it is something we have been dealing with. I have been calling the prescription drugs if there was a tsunami, I've saw the wave coming 10 years ago.

I spent the majority of my clinical life the last three to five years just taking people off opiates who had chronic pain. When you ask them what their pain was, the common say it's 18 out of 10, they never say 9 or 10 out of 10. I take them off the opiates.

The withdrawal is awful. The most doctors haven't seen people go through to withdraw. It's not that bad. A week or two weeks later, they will only talk about pain when provoked, when asked about it and they'd say four or five in a scale of 10. Just taking off opiates. There's not good science that says opiates are effective for chronic pain. They're effective for acute pain, but there are other alternatives.

[21:25:15] But there's actually no clinical evidence that they're useful in chronic pain. I'm not saying they should be taken away from people for whom it is working. But our science is there. And it's little like saying I've got a blood pressure medication, it doesn't work. So let's figure it out how to use it.

It sounds like, well, are you kidding? Yes it works for some people, OK those people should get it, and we shouldn't be taking it away, we should be dictating clinical practice for a patient.

GUPTA: And some people get actually worsening pain if they take it.

PINSKY: All it's a hyperalgesia, it's a dirty little secret.

COOPER: Let's talk about chronic pain. I want you to meet Kay Sanford, she's been in chronic pain for decades, she's been on prescription pain killers since where the mid 1990s. Yeah Kay has a question for Dr. Rosenberg.

KAY SANFORD, LONG-TERM OPIOID USER: Thank you very much. I've been on daily opioids that have given me a very full and productive life for the last 25 years and I'm very careful. I have never misused or abused my medication. I am fully aware that there are many alternative, non-opioid things that I can do, which I do. I walk a mile and a half with my girlfriends three days a week. I swim, I pay out of pocket for massages two or three times a month. You know, I'm trying to do it right. And yet what I know is that there are many patients like me maybe thousands, tens of thousands who have tried to do everything right.

COOPER: Let me ask you, what do you say to patients like this?

SANFORD: That's what I want ...

PINKSY: I would say good, fantastic. This is a situation no one would dream of interfering with her treatment, but that is a very tiny minority.

COOPER: How is it that she is able to not ... PINKSY: It depends on medics. Everyone is different, how they respond to medication, what they're potential for addiction is. How they respond the pain. The biology of pain is exceedingly complex. There's another piece in the story which is adverse childhood experiences that increase the risk for people pursuing opioids. We have an epidemic of that in this country too. And this recent pill epidemic may be related to that.

I want to say one more thing. As we spent a lot of time talking about opioid overdose, there's a lot to be said on this topic. But remember the most people that die opiates plus benzodiazepine.

COOPER: Benzodiazepine is what?

PINSKY: Ambient.

(CROSSTALK)

PINSKY: Now that I know you love Percocet.

COOPER: Well no. I had a legitimate cause and I stopped.

PINSKY: I'm just saying it. But the point being the benzodiazepine class with opiate class together is what is so fatal. And it's bizarre to me that doctors routinely prescribed opiates and benzo's together.

COOPER: So, Doctor, what do you say to Kay?

ROSENBERG: Well, we know that opioids are very good, they're powerful medications, and when you used correctly, they have a great role.

I'd like to tell a quick story though. I've got a patient of mine, who was 56-year-old woman who had cancer that spread throughout her body. And I got a call from her daughter who wanted to tell me that her mom is not doing real well. And she was having a lot more pain. And I wanted to make sure she was taking her opioids appropriately. And the answer was no, she's afraid to give them to her. Look what happened to Prince. Look what happened out there.

So as a result, she's suffering. Opioids have a real role in the management of pain. But sometimes you're able to prescribe and sometimes alternative therapies will do as well and sometimes even better. I'm so happy that you're doing massage therapy. Because that is an alternative therapy that can actually help you deal with your pain a lot better. So hats off to you.

SANFORD: There are wonderful alternatives. And I had acupuncture which is wonderful. But I think one of the key things that we can do as patients and physicians is work together more carefully and closely.

COOPER: That sounds like an incredibly good advice. I mean I think all the doctors here would hear it.

ROSENBERG: Education and communication. COOPER: I want to meet, I want everyone to meet Joe Putignano. Joe has been on my program before, he's a recovering addict, he's an accomplished gymnast, he was an acrobat perform in Cirque de Soleil. He's got the incredible story about being in the hospital after surgery, he was administered opioids even though on your medical chart it said you should not get them, right?

JOSEPH PUTIGNANO, RECOVERING ADDICT AND ACROBAT: Yeah. On my chart that I signed it said no opiates, seven years clean. And as I was waking up, the nurse game me fentanyl without my permission, I was kind of asleep. And immediately felt incredible and it triggered that desire, obsession to use more, to keep that high and not tell anyone about it. Luckily I have a strong program, I didn't relapse, but I had that obsession for many, many months after.

[21:30:00] PINSKY: Yeah I was going to say that usually when my patients are re-exposed to opiates, sometimes they have to be, right? The only obsession will as minimum of two weeks after several months after, since you have to plan for that in your program. You had made a lot of withdrawal symptoms, it's the wanting and the obsession and the obfuscating, and the whole disease process is activated. That's not about withdrawal, that's about the pursuit, the desire.

COOPER: So the Joseph's plan I mean Sanjay how does somebody like Joe face something like surgery without having access to access to opioids?

GUPTA: Yeah, I mean that there are some real strategies, and it takes planning, which Joe tried to do. I mean he was very diligent about informing his doctors about this, said I don't want to take this medications but for example, shoulder surgery, giving nerve blocks ahead of time, giving medications that not only help before the surgery and then during the surgery, but then the last for quite a bit of time after the operation is over as well.

That can help get through that sort of more acute period, giving things like anti-inflammatory. But another thing is, you know, one things that I find really amazing here, Anderson, is that there's been no studies looking at the long term effects of theses opioids, as much as we're talking of people taking them chronically, there hasn't really been a studies to look at what happens to the body. And Dr. Lawrence Epstein is here from Mt. Sinai here in New York City and he can could speak to that I mean -- I don't know doctors are why aren't these studies out there.

DR. LAWRENCE EPSTEIN, MOUNT SINAI SOSPITAL: This studies long term studies are incredibly complex and difficult to do, and very expensive. Pharmaceutical companies aren't going to pay for them because frankly the medications are already approved and have a market. So the non funded researchers they can't afford to do it. And there's an ethical issue about trying to study and give treatment to patients that we already have good data this there's incredible risk. And yet we have little belief that we're going to get different answer than the conclusions we've already come to, which is there's minimal efficacy in long term use. COOPER: Wow. I want again to introduce Kym Laube, she's a recovering addict, she runs a youth substance abuse program. I think she got a question for one of the doctors.

KYM LAUBE, RECOVERING ADDICT: Thank you, Anderson. As we well know addiction is not just limited to pills and opiates, and as the national conversation continues about the legalization of marijuana, are there any studies that suggest that early marijuana use can potentially be a gateway drug for an opioid addiction.

COOPER: Sanjay you looked into this a lot.

GUPTA: Yeah, well look I mean there's a lot of studies around this, a lot of people looked at this. And I think for a long time there was concern that look, is this a true scientific gateway, is marijuana a gateway. What we know is that there are a lot of people who have start with things like marijuana, and then move on to heroin or cocaine. And even earlier than marijuana, many start with alcohol or smoking.

So in that regard, smoking or alcohol could be considered the gateway. But the real question is does marijuana in some way change your brain or prime your brain in a way that you then need to have, crave something else, like a heroin or cocaine, and the answer to that really seems to be no. That's a myth it is a myth that's been propagated for a long time, but the idea that you take marijuana for a while, and now you need to have something more powerful. Scientifically just doesn't hold up.

COOPER: Dr. Drew, do you agree?

PINSKY: You know, when I treated marijuana addicts that are really into pot, the problem is it wanes over time, and they been try to find some, you know, some substitute it is a service substitution, not more than a gateway in my experience.

COOPER: That's somebody who's already the ...

PINSKY: Did marijuana and this is where small population get marijuana addiction but when they do it's can be rough.

(OFF-MIC)

COOPER: I want you to meet Teri Kroll, her son Timothy overdosed on opioids she was over prescribe the drugs by doctor who was also selling them for cash. He reported the doctor to the authorities, Timothy died just a few months later.

The doctor was arrested terminated her mission to seek justice for her son she attended the trial the doctor everyday. He was only sentenced get this to six months in jail. Thank you for being with us. I'm so sorry for what you've been through.

TERI KROLL LOST SON TO DRUG OVERDOSE: Thank you very much, I appreciate that. Dr. Drew I would like to know how do we make doctors who are responsible for these prescriptions more accountable? PINSKY: Programs like this, I guess, I mean I know the DEA is very active in that. The one thing I want to say though is that all of us, physicians and patients alike, if we're going to take an opioid or benzodiazepine for more than two weeks, I just say it's a rule just two weeks more thank two weeks there better be a very good reason.

It has to be done patient to doctor, understanding it is a high risk intervention, to go longer, there better be a good reason and you do it together. Really, I mean these things are designed for acute intervention not for chronic use and I know it's going more than two weeks, both doctor and patient better really think hard about it.

COOPER: Do you agree with that?

ROSENBERG: You know, absolutely I believe that we need to really look at physicians who are prescribing large quantity of drugs.

COOPER: And also selling these drugs for cash. I mean that's a huge problem.

ROSENBERG: And we need to come up with ways to prosecute these physicians and to really monitor them and to go after them. This is not what physicians are supposed to be doing, they're supposed to be relieving pain and relieving suffering. And this is criminal this needs to be legislated and managed.

[21:35:16] COOPER: Bridget Brennan is here. Bridget is the Special Narcotics Prosecutor in New York City. She is attacking the problem of prescription addiction at the source, doctors just as we're return a doctors who over prescribe the drugs. Bridget's office successfully prosecuted one doctor for manslaughter after 16 -- and this incredible of 16 of his patients died from overdoses. Thank you so much for what you're doing and for being here.

BRIDGET BRENNAN, SPECIAL NARCOTICS PROSECUTOR, NEW YORK CITY: We started looking at this when we found doctors who were acting like drug dealers. They were literally exchanging prescriptions for cash and the pills, the addictive pills were flooding the street corner markets. We found that there was really little effective regulatory agencies that we're looking at it. They didn't seem to have much impact. And it was a public safety crisis.

COOPER: So there's not I always while the DEA must be monitoring how many prescriptions a doctor is writing for pill, that's not really the case.

BRENNAN: The DEA might be monitoring yet, but that's not the end of the story. We found dozens of patients were dying and really when we did our investigations, we would find letters from the Health Department in the files warning the doctor. But the warnings had no effect. So, when we saw nothing else was having an impact as prosecutors, we were sort of the last line of defense and we stepped in.

ROSENBERG: There are three ways that we can really address some of these issues that were talking about. One is we have to just really decrease the amount of pills along the street. There are several states like Washington State and Massachusetts who started an Emergency Department Information Exchanges where information is exchanged throughout all emergency departments who prescribe 17 -- 4.7 percent of the opioids, 17 percent of the patients from the Emergency Department get a prescription. But also we need to legislate again the pill mills and those types of things that are creating this problem more and more.

So we have a real opportunity out there to make a change. But it really needs to start with keeping the pill countdown, legislating against it, and also having take back programs. Where can you take back your medication if you have -- if you used all you need, and where can you take it? Many of the police stations you can take it back to. But it should be the pharmacy where it is easy to bring your medication.

GUPTA: And I'm curious as well obviously Bridget, this particular case seems like an obvious example. But in a lot of cases patients and doctors who think they're doing right by their patients, I think that's where it gets thorny, right? I don't think they intend for their patients to overdose. When does it rise to the level of being criminal?

BRENNAN: When it rises to the level of being so egregious. For example, in the case we prosecuted, the manslaughter case, a doctor was literally exchanging the prescriptions for cash. He had signs all over his office, cash only. And the few would go up depending on the number of milligrams of opioid you would get.

Patients would come -- he would be called from the emergency room, told that a patient had overdosed. The patient would come back to him and get a higher opioid prescription. And so it was egregious contact. It was far beyond just mere negligence or maybe bad judgment. It was far, far beyond that. And he's not the only doctor we prosecuted. We've seen it happen. It's an easy way to make money for some doctors who are really just drug dealers masquerading, that's not most of the doctors.

GUPTA: Yeah. And that's obvious again obviously unscrupulous behavior. But I thnk there's a lot of sort of doctors in between who aren't necessarily taking money but the exercised poor judgment, who have not done right by their patients because they're handing out these pills.

PINSKY: We have a generation was raised under the cradle that pain says it is. Which was also the 90's nearly 2000. The patients could come in actually picks drug off a menu because they said that's what controlled it. There was a discipline, a professional discipline that had that at its core epistemology. And as a whole generation and still been infected by that. And we that criminals are creating 80 percent of the globe's opioids on this -- continent, it is the rest of us.

GUPTA: Yeah.

PINSKY: Be fair. GUPTA: And the undercurrent that of course was as you and I learned at that time we were in medical school, was this wasn't a problem. And, you know, that you can give the medications, people weren't going to get addicted, they weren't going to overdose, you could give as much as you need to give.

PINSKY: Listen I like screamed about it for a long time. People said I was cruel. And a lot of people sound for not like no, I want people to get well and look at the thrive.

COOPER: Right.

PINSKY: And you -- got you there's no worse seeing it. And a lot of them still aren't. I got to tell you.

COOPER: We got to take a quick break. Just ahead the simple shot that can reverse in overdose. We'll show the dramatic result as one solution to help encourage some of the told the epidemic.

[21:40:07] So, why isn't it more widely available? Find out ahead.

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COOPER: We heard some deeply personal stories now about the toll of opioid addiction, lives shattered, love one lost, man-made epidemic. Here is Dr. Sanjay Gupta called it this year alone who killed more than 28,000 Americans. Now it's obviously -- something it needs to be done. We're going to shift the conversation now to try to look at solutions. Were just sort of a little about narcan or nalox, naloxone?

GUPTA: Naloxone.

COOPER: Naloxone which Dr. Wen prescribes for all of Baltimore those who need it. Its antidote in opioid -- for opioid overdoses. Can you show people how --- this works are powerful?

GUPTA: Yeah. I mean it is an -- antidote. So it essentially can reverse someone when their already in the throws of an overdose. And we were able to actually get some footage to actually show it in progress turn injection. Take a look.

(BEGIN VIDEO CLIP)

[21:45:11] GUPTA: What you're watching is shocking. A heroin addict named Liz (ph) overdoses. That night she was with two friends who volunteer with the program in Greensboro, North Carolina that provides addicts with clean needles and Naloxone. Now, watch what happens next.

UNIDENTIFIED MALE: We gave her about 60 units of Narcan.

GUPTA: Narcan also known as Naloxone can reverse an overdose from heroin and other drugs like oxycodone. Another external rub another shot of Narcan.

UNIDENTIFIED MALE: (Inaudible) the rest whole CC.

GUPTA: And finally.

UNIDENTIFIED MALE: Liz?

GUPTA: Liz begins to come around.

(END VIDEO CLIP)

GUPTA: It's kind of remarkable, she wasn't breathing. She was essentially in to the throws of an overdose. The advice is you call 911.

COOPER: Right.

GUPTA: And then you can administer this Narcan, and it can reverse that. That was an injection you saw. They have this nasal sprays now. This is it right here. Even if someone is not breathing you can still put it in their nose and just go ahead and spray. And that's the medication that comes out. And within just a couple of minutes it can reverse an overdose. So this as Dr. Wen was talking about earlier is a life saver.

COOPER: This is what she has, she suggested for everybody in Baltimore.

GUPTA: She's raising at a standing prescription for it in Baltimore. Here in New York, you can buy this now over the counter. So if you go to any pharmacy you can buy this, you can have this in case someone, you know, of an overdose, you can give them.

COOPER: The drug is Sanjay is talking about is available. So just said to anyone who needs it in Baltimore, but also in Boston, Massachusetts. Leonard Campanello is the police chief there last year. He wrote on Facebook that the old war on drugs was lost and over. He started a first of its kind program. This has been headlines around the country where his police department is steering addicts to treatment instead of jail. Addicts can actually just walk into his police department with illegal opioids, hand them over, and say look, I need help and they initially they get it. Chief appreciate you joining us. What made you turn around on this, I mean what made you kind of start this whole new project?

LEONARD CAMPANELLO, GLOUCESTER MASS POLICE CHIEF: I think it was community response, first of all is that we had heard very loud and clear from the community, is that they didn't want their addicted people, the people in the community who are addicted to be further stigmatized by an arrest or conservations that they wanted law enforcement to help.

And I think that's one of the things that is overwhelming in this case is the self stigmatization and the stigmatization by society that makes people stay in the shadows. And in law enforcement, being on the front lines we have a very powerful voice to legitimize the fact that addiction is a disease. The war on drugs was really a war against addiction. And the people that were laughing was the people that laughing all the way to the bank. The deal is from street level right up to the pharmaceutical company.

COOPER: I went to in Chicago to a county jail and it was full of people who had heroin addiction, some form of opiate addiction. And if they had been able to kind of break that cycle earlier they wouldn't have been in and out of prison as long as they have in our jail as long as they have.

CAMPANELLO: The crimes that addicted person commits are crimes of desperation in order to feed their addiction. It's no different than any other disease, the pathology of it, cancer, diabetes, a long term disease. In this particular case where it intersects law enforcement is the fact it's an illegal drugs that's feeding this disease and that crimes are committed because of it.

COOPER: I want you to meet someone who I met I think it was 1996. I was looking back in the records. We're both much younger then Ric Curtis, a professor. He spent decades conducting studies on the effects of narcotics in America.

Ric, a study came out recently regarding the mortality rate for a very specific group, middle aged, white people, found it since the beginning of the epidemic, this group is dying at a higher rate. Why is it hitting this group so hard?

RIC CURTIS, JOHN JAY COLLEGE OF CRIMINAL JUSTICE PROFESSOR: Well, I think you hit on that earlier, Anderson, when you talked about the degree to which the pharmaceutical companies have been promoting the use of opiate products for pain relief.

COOPER: Directly to doctors.

CURTIS: Yes. And so, that's -- I think responsible for a lot of the increase that we seen among 40 and 50-year olds, people that have begun to get treated for pain related to jobs often, you know, minor pain that they should have 3 or 4 days of prescription and they get the 90 pills that you got, you know.

I think that something that's been missed though in the conversation is that the pain that the people -- pain relief that they're getting from the pills, it certainly treats the physical manifestations of their pain, but they have other pain also that it dulls. The psychological pain of unemployment for example, the, you know, the hollowing out of America that we seen. This is the population that is largely effected by this opioid epidemic. These are people who have been affected by global shifts in the economy or out of work. And, you know, or finding that opiates dull that pain that psychological pain, something that they want, they seek.

COOPER: I see a lot of people in the audience nodding their head on this.

[21:50:01] PINSKY: I mentioned that Ric childhood experience's earlier which is one of the set ups, the other is -- whatever kind of psychic pain people aren't aware sometimes that walking around this way but they are aware when they get the relief. They feel a lot better. COOPER: I want to introduce Alan Forte, he's a recovering addict and I know he's got a question for our Dr. Drew. Alan.

ALAN FORTE, RECOVERING ADDICT: My family was greatly affected by my addiction.

COOPER: How long were you using for?

FORTE: Six years. I broke my neck twice and had spinal fusion and was addicted to the percocets for six years and still fighting it.

COOPER: Yeah.

FORTE: But, when my family finally tried to address my addiction, it was chaotic.

COOPER: In terms of how they tried to do it?

FORTE: Yeah. By the time they actually got to the point, they were pretty much helpless. They didn't know how to the help me, and I think they were frustrated and scared and so on.

So, it became volatile. My most intimate relationships became destroyed. My family, you know, those who were still left, a lot of shame, a lot of blame and so on.

So, my question to you is for a family with a loved one suffering from addiction, how should they approach a love one who is suffering ...

COOPER: Dr. Drew?

PINSKY: Yeah. My basic advice is it's a complex issue like me as other issues we're talking about.

COOPER: But to so -- I mean, it sees by the so many emotions, there anger, shame, frustration, fear.

PINSKY: It's complicated. But, the one thing I would tell family members, is don't go it alone. Do not go it alone.

The, you know, the plant, "Little Shop of Horrors" that Audrey -- alone. What I do when I walk into room I do with patients with addiction. I was bringing my nurse with me, because I know it will suck me in. It's an interpersonal disease, you know, destroys family. And it's something that they cannot fight on their own.

And, by the way, they're not equipped to handle it on their own. It's a very complex phenomenon. And it's not your fault and it's not their fault, just as that they get any of their neurological disease, you need help. But for some reason, this one, we think we can do it alone.

COOPER: Are there warning signs I mean Sanjay do you ...

GUPTA: I mean, if you're looking at your loved one and you're concerned about the physical things that you could see. I mean, everything from, you know, peoples will be more pinpoint for example with opiates as opposed to other drugs like cocaine where they maybe more dilated.

PINSKY: I exclude it. I keep it some ways go. If you find yourself going, you're going to think it's just and you can't explain what's going on to take a good look on whether drugs oral are involved here. I mean, if you and do not minimize it, and if you are aware that they are using to give you a parent, it's far worse than you know.

GUPTA: Yes, there's many be hiding and then they'd be hiding drugs and it's all sorts of different things is.

PINSKY: And then opioids, like you find it early, you can walk around on opioids all the time and not of any idea someone thought it until the things starts to unravel later.

COOPER: Crystal Oertle is here. She's a recovering addict. We first met here to CNN presidential town hall in Ohio. Crystal, appreciate you, you'd being with us in that town hall.

Crystal was able to ask Senator Bernie Sanders what he planned to do about drug policies. What do you want to hear from candidates, Crystal?

CRYSTAL OERTLE, RECOVERING ADDICT: Well, as a recovering heroin addict that started out on the prescription pain pills. I've been to the cash doctors, Dr. Hopping, Pharmacy Hopping, until I got that prescription failed and it led into my heroin addiction.

What I would like to know is, is it possible to get a national database that would track opiate prescriptions nationally, so that there was no overlapping and doctor shopping.

COOPER: That seems like a no-brainer.

GUPTA: Right.

COOPER: I would have assumed there was, there's not?

GUPTA: In the sort of a jury rigged one now, where a lot of states, every state, in fact, except from Missouri has this state programs, where there is some tracking, there are some monitoring of this, but there's a couple of problems.

One is that the states do not talk to each other, two is that it's not mandatory in all the states. Like in Alabama, it's mandatory, in Nebraska, it's voluntary. And many times, even if the doctors know about these programs, statistics show only about half of doctors actually participate in it, actually input the data.

You got to input the data, otherwise, other people can't find it. So, it's sort of there, it's not national and it's not always -- people always compliant with it.

COOPER: Chief, just very quickly, when you started this program, did you get a lot of pushback from the community and people saying, what are you doing?

CAMPANELLO: We actually enacted as a result of the community.

COOPER: Right. OK.

CAMPANELLO: You know, where our job is to hold accountable those we have to, and to care for those that we can. And if we can intervene somewhere before the arrest process exacerbates a person with an addiction's problems already, then, I think we have a responsibility to do that.

[21:55:13] So, our community supporters led to the program being enacted, it seems to have crack fire.

GUPTA: And people came from around the country, right?

CAMPANELLO: They initially came from -- we were the only one doing it. We did have a lot of ...

COOPER: And people coming from other towns to you ...

CAMPANELLO: We have people from the California same from Massachusetts.

COOPER: That's incredible.

CAMPANELLO: And then -- and now, we have over 105 police departments in 24 states that when someone picks up the phone calls Gloucester PD. We have thankfully able to point them in a direction that isn't always right there on our little tiny haven.

COOPER: That's amazing. Claudia Ragni is here. She runs two addiction treatment centers on Long Island. I think she's got a question for the chief as well. Claudia.

CLAUDIA RAGNI, RUNS TWO ADDICTION TREATMENT CENTERS: Yes, hi. Thank you very much for taking this subject out of the shadows.

I find that the shame and the stigma is a huge blocker to patients and family seeking help. What can we do to move the culture, the attitude of addiction to what it is, which is a disease and not a crime and not a character defect?

CAMPANELLO: All right. I think that stigma goes to the heart of this issue, because you don't find stigma with these other diseases that are very well cared for. But, stigmatization about the public, stigmatization, self-stigmatization is what really drives us into the shadows and hurts people, and keeps people in addiction.

I think the voice of law enforcement has been bringing it out of the shadows. If we're -- if law enforcement is able to do different things, is able to approach addiction, which has always been a crime to us in a way that says, look, this is a disease, we have that sort of legitimate voice, and a voice that hasn't been heard from before in order to, hopefully, promulgate more people to go on to that view and get it out of the shadows. So, hopefully, we'll be seeing that coming along, I hope.

GUPTA: You know, it's a brain disease. Dr. Drew calls it a brain disease, Dr. Wen, it's a brain disease. And I think more doctor say that out loud, the more that stigma goes away.

COOPER: We've really just begin to scratch the surface on this. I hope you do more on this in the future.

Before we go tonight, I want to know that the Simcakoski family is in the audience. Jason Simcakoski was a marine who was killed by the over prescription of pain pills while he was a patient at a V.A. hospital.

And just yesterday, the family was on Capitol Hill pushing for Bill that would among other thing set prescribing guidelines for opioids at the facilities, after say that Bill passed unanimously. It will forever be known as the Jason Simcakoski Memorial Opioid Safety Act. We hope that it saves a lot more lives in Jason's name and in his memory. So, thank you so much and thank you for being here.

Also, if you or a loved one need needs help, there are resources you can find at cnn.com/impact, again, at cnn.com/impact for you or someone you love. Also, I would really recommend everyone go to cnn.com, read the essay Sanjay just posted on the issue that we've been talking about tonight.

I want to thank everybody here who's told their stories and all those who've come tonight, everybody on the stage and in our audience and those watching at home, good night.

"CNN TONIGHT" with Don Lemon is next.

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