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President Trump's Commission on Combating Drug Addiction and the Opioid Crisis issued a preliminary report this week calling on the president to declare a state of emergency over the opioid crisis. The report says that "with approximately 142 Americans dying every day, America is enduring a death toll equal to Sept. 11 every three weeks."
On the DEA's mission
"[Our] biggest priority, simply stated, is the fact that 60,000 Americans died last year from a drug overdose. That's an astonishing number, and we have to do something about it, and we have to do something about it fast."
On stifling prescription drugs' supply-demand relationship
"It's not necessarily easy to reduce either, but there are a couple ways that we think about it. For instance, we know that four out of five new heroin users started on prescription pills, and we know that there's a huge prescription pill problem in this country. So we have to be smarter about how we prescribe, what we take, what we put in our bodies, but also we have to clean out our medicine cabinets. The DEA runs a national take-back program two times a year, where folks anonymously and safely can drop stuff off with us, no questions asked, and we incinerate it. If we can get pills out of people's homes, we can break that causal connection between pills and heroin."
On where the problem begins, and the role of prescriptions
"We have to change the culture. And I've said this many times publicly: We're not going to enforce or prosecute or incarcerate our way out of this problem. Changing the culture means talking about this stuff, treating this stuff, treating addiction as a public health crisis, but also changing behavior, and again, both prescribing behavior and consuming behavior. We have to start with kids, we have to talk to them all the time. You know, we've changed the culture in the United States with respect to seat belt use, we've changed the culture in the United States with respect to smoking, we could do it here, too, it's just very, very hard. ... There's a couple of things they can do. They can prescribe lower doses, they could prescribe less, meaning rather than coming home with 30 opioid painkillers, you come home with five, or there are non-narcotic pain treatments. So there are plenty of options out there."
"We're not going to enforce or prosecute or incarcerate our way out of this problem."Chuck Rosenberg
On fentanyl use
"Fentanyl is a big, growing and terrifying problem. ... It might even be the case that the low-level suppliers don't know what's in the stuff that they're peddling on the streets. Here's the math: Heroin times roughly 50, in terms of potency, equals fentanyl, and fentanyl times roughly 100 equals carfentanil. Fentanyl's not the worst of it, as bad as it is, fentanyl's not the worst of it. We're seeing even more powerful and deadly substances on our streets, and you're right; people do not know what they're putting in their bodies. ... From a supply perspective, it's cheaper, easier and quicker than heroin. You don't have to cultivate it or harvest it, you just make it in a lab and cut it into your product. From a demand perspective, it's also cheaper, easier and quicker. Folks don't know what they're getting, but if they build up, let's say, a tolerance to heroin or to another opioid, and something comes along that's more powerful, more potent, it's a better high. That's what we call 'chasing the dragon,' and that's why so many people end up dead."
On the accessibility of fentanyl
"It gets here primarily in two ways. First, in larger quantities from China to Mexico, and then north, across the border, through traditional drug trafficking routes. Second, and I don't recommend this, folks can order it easily off the dark web. You can sit down at your computer and in a couple of key strokes find any number of illegal sites, and order it up and have it delivered through the U.S. Postal Service to your home. Those would be smaller quantities, but remember, fentanyl can be deadly even to the touch at the two-milligram level, and so very, very small amounts of the stuff can kill you, and I worry about it all the time."
On changing attitudes toward marijuana
"Some people think lots of different things. The Food and Drug Administration is responsible for making a scientific and medical determination about the efficacy of, among many other things, marijuana as a medicine, and their conclusion over and over and over after decades of study is that it's simply not a medicine, and it's not good for you. And we are bound by their scientific and medical determination. That said, I go back to what I have told our special agents in charge: Focus on the most significant threats in your jurisdiction — the violent crime that attends the trafficking of drugs and the number of folks dying from heroin, fentanyl and other opioids. That's where we focus our time and energy."
On gauging success in combating the opioid crisis
"There are a couple of hopeful signs on the horizon. One is that we see more and more prescribers and physicians using the Prescription Drug Monitoring Program. In other words, being more careful about what they prescribe and to whom they prescribe. Second, we've seen over the last three or four years a decrease in the number of opioids that are being prescribed by physicians. And so if I'm right, that there's a causative and correlative relationship between opioids and heroin, and heroin and addiction, and addiction and death, and the amount of prescriptions are going down, then maybe over time we'll see some good news on that end. I'm hopeful."
This segment aired on August 2, 2017.
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