07/24/16 Tim Kaine

US Senator Tim Kaine talks about states as laboratories of democracy, and asks whether marijuana legalization has impacted heroin production; Senator Ed Markey talks about overdose deaths, and asks whether the administration has been ignoring Fentanyl coming in from China and Mexico; and Senator Marco Rubio speaks sensibly about alcohol, other drugs, and drug addiction.

Program: 
Century of Lies
Date: 
Sunday, July 24, 2016
Guest: 
Tim Kaine
Organization: 
Senator
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CENTURY OF LIES

JULY 24, 2016

TRANSCRIPT

DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century Of Lies. Century Of Lies is a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

Back in May, the Senate Foreign Relations Subcommittee on Western Hemisphere, Transnational Crime, Civilian Security, Democracy, Human Rights and Global Women's Issues held a hearing on drug cartels and heroin addiction. One of the senators at that hearing was Tim Kaine, the Democrat from Virginia. Kaine has been in the news this week because he's apparently going to be the vice presidential nominee for the Democratic Party this cycle, so I thought it would be a good time to go back to that hearing and hear what Kaine has to say about drugs, Mexico, and marijuana.

The next voice you hear is Senator Tim Kaine. The witnesses testifying in this part of the hearing are Kemp Chester, the Associate Director of the National Heroin Coordination Group for the Office of National Drug Control Policy, and Daniel L. Foote, a Deputy Assistant Secretary in the Department of State’s Bureau of International Narcotics and Law Enforcement.

SENATOR TIM KAINE: I want to talk, Mister Chester, about your written testimony, I'm sorry I didn't get here for your entire oral testimony, but, on page one, there are several principal factors contributing to the current nationwide heroin crisis: the increased availability of heroin in the US market, the availability of purer forms of heroin that allow for non-intravenous use, its relatively low price, and a relatively small percentage of non-medical users of opioid prescription drugs transitioning to heroin.

I'm trying to unpack that statement, and I'm wondering if your statement puts the -- enough of a finger on the prescription opioid problem. I have heard it stated, through Michael Botticelli and others, that 80 percent of those who OD on heroin in this country, not fatal ODs, total ODs, 80 percent of those who OD on heroin started their addiction to opioids by being addicted to prescription opioids and then transitioned to heroin because they could get it for a lower price. Is that an accurate statement?

KEMP CHESTER: No, Senator, and I'm glad you asked that question. Of the numbers of individuals who non-medically use opioids and then transition into heroin, that number is actually relatively small, it's about 3.6

TIM KAINE: Non-medical use.

KEMP CHESTER: That's correct. So the non-medical use of a prescription opioid like OxyContin, and kind of the traditional got it from the medicine cabinet, got it from friends or family members, the percentage of those individuals who transition to heroin use is relatively low. It's about 3.6 percent. But conversely, of individuals who are non-treatment users of heroin, 80 percent of them actually abused a prescription opioid in the past, so while there's not a direct causation between the two, the non-medical use of opioids is a strong risk factor for eventual heroin use.

TIM KAINE: And even the medical use of opioids can be a risk factor for eventual heroin use, correct?

KEMP CHESTER: Yes, Senator, that's right. So, so, you know, an opioid in and of itself, and its affect on the body, obviously it's a very addictive drug, and affects the body in unique ways, as an opioid. So those individuals who take opioids, whether they get them from a doctor or whether they get them from a friend or a family member for non-medical reasons, are at risk for eventual opioid addiction, if not used properly, that is correct.

TIM KAINE: And, you cite in the testimony, it's the relatively low price of heroin, and that's relatively low compared to past trends, but also compared to the cost of opioid based prescription drugs, correct?

KEMP CHESTER: That's correct. So, the street price of a gram of heroin compared to the street price, if you will, of an opioid pill or an Oxy pill, or something of that nature, that's correct. That was -- that's what we consider to be one of the contributing factors, and, so it's the availability and the general low price, and then the purity, that have all been contributing factors to the current crisis that we're in with heroin, that's correct.

TIM KAINE: Mister Foote talked about, you know, the work that we've done in this body and we're trying to harmonize with the House in this recent CARA, Comprehensive Addiction Recovery Act. We really believe it here, and I think it's now bipartisan, we're seeing it in all of our states, that if we don't get ahold of the culture of overprescription of opioid based prescription drugs, you know, we're just hollowing out communities, rural, urban, suburban, rich and poor, and this was a drug addiction that came out of the medicine cabinet, in many instances it was somebody, a trusted professional in a white coat, that was handing somebody this prescription saying this is going to do you good, and it's not going to do you harm, driven by, you know, inadequate science, driven by, frankly, marketing scams, and that is inextricably related to this heroin issue, and so I think it's kind of hard to deal with the heroin issue in the abstract without talking about this culture of over-prescription, that hopefully we are working together to reel in.

Last question I want to ask, and it's probably too early to know this, but, in terms of the growth of the number of hectares of poppy production in Mexico, do we have any evidence to suggest whether that is at all connected with marijuana legalization in the United States? I actually kind of like this notion of the states as labs, and they can experiment, and we can see what happens. But, I've heard it said, and I don't know whether there's any evidence to back it up, that the legalization of marijuana in some states, that has allowed marijuana to be grown, has taken hectares of land that were used for marijuana cultivation and, well, we don't have a market for our marijuana anymore because there's competition, so we'll switch to something like poppies to produce black tar heroin. Is there any evidence of that?

KEMP CHESTER: We've actually looked closely, kind of at the crop transference to see if there's anything there, and I can tell you that we, at this time, whether it's too early or whether it doesn't exist, we can't definitively say that farmers have decided to switch from one crop to another in Mexico. We've, we can't say that with any degree of authority at this point.

TIM KAINE: But, that's something that you're going to continue to monitor?

KEMP CHESTER: It's something that we do watch, yes.

TIM KAINE: Great. Great. Thanks, Mister Chairman.

SENATOR MARCO RUBIO: Just to interject on that point, it's my sense, and you're both experts at this, that very few people wake up in the morning and say I'm going to go shoot heroin just for the first time. There is a gateway to the heroin use. A lot of it is being driven by people that were prescribed prescription opiates, they now have become physically dependent, the prescription opiate is cut off, they're going through severe withdrawal, and the only thing that addresses that withdrawal, if they're not in treatment, is access to heroin, and that brings all sorts of problems.

Absent that, what is the other gateway? How are people, how does someone get dependent on heroin, minus the prescription drug gateway, which we've already discussed?

KEMP CHESTER: Senator, it -- and that's -- it's a difficult question just because you're dealing with a number of variables down at the individual level as to the reasons why people engage in the behavior that we do. We do know a couple of things, that heroin in general terms is kind of at the end of a trajectory of long-term drug use, and that a high number of heroin users are actually poly-drug users. And so they're not an exclusive heroin user, they get the drugs that are available to them, and because of the high availability of heroin, a lot of times that's heroin.

The other thing that we look at, and we do a number of surveys to look at this, but what we realize is that youth behavior, from the ages of about 13 to about 18, is a very strong factor in terms of risk taking behavior, in terms of, you know, underage drinking, tobacco, marijuana, things of that nature, in shaping youth attitudes eventually that they carry with them for the rest of their lives in terms of risk taking behavior for using other drugs. So, I think if we're -- what we can't say is that we can put a finger on this or that particular reason why a person does something, but we do know that the availability of drugs in society obviously increases the chances that an individual who's inclined to use them is going to intersect them at some particular point, and I think that's one of the, the discussion we had about the availability of heroin being the driving factor.

MARCO RUBIO: So, just to understand your testimony, we understand the pill problem that leads to that, but what you're basically saying is, if someone, especially at some point early -- earlier in their life begins to use a substance. Alcohol whatever it may be, an intoxicant of some sort. There now starts a potential trend where the next thing is, well, what's out there that's better? What's out there that's stronger? Once you've crossed that barrier, it could unleash this cycle of basically a set of dominoes that ultimately lead you to the heroin point.

KEMP CHESTER: Yes, and it's not, you know, and again, it's not direct causation, but it certainly is risk taking behavior.

MARCO RUBIO: Right, in general.

KEMP CHESTER: And, you know, and patterns of behavior, and that's why the prevention strategies, particularly through programs like the Drug Free Communities Program that ONDCP manages, are incredibly important because they're locally based, and they allow trusted individuals to be able to speak to people at very, very young ages about things just like that, and their attitudes about drugs and foreign substances in the body and things of that nature. So, they're able to, through evidence-based prevention strategies, be able to talk to people at those young ages, when they're vulnerable and shaping their ideas about drug use that they carry with them for the rest of their lives.

DOUG MCVAY: That was Senator Tim Kaine, Democrat from Virginia, speaking at a hearing of the Senate Foreign Relations Subcommittee on Western Hemisphere, Transnational Crime, Civilian Security, Democracy, Human Rights, and Global Women's Issues. They held a hearing in May of this year on drug cartels and heroin addiction.

Senator Ed Markey, a Democrat from Massachusetts, raised concerns that the administration was paying too little attention to Fentanyl, the extremely powerful synthetic opiate that's implicated in a growing number of overdose deaths. Here's Senator Markey questioning ONDCP's Chester and State Department's Foote.

SENATOR ED MARKEY: This issue of Fentanyl is, to my way of thinking, kind of the most important threat that we have to families in the United States at this time. I'll just give you some numbers. In Massachusetts in 2015, 57 percent of the opioid related overdose deaths in Massachusetts had a positive screen for Fentanyl, specifically of the 1,319 individuals whose deaths were opioid related in 2015 where a toxicology screen was available, 754 of them had a positive screen for Fentanyl. So we can talk about prescription drugs, we can talk about heroin, but Fentanyl is now the issue. And we, that is, New England, we're at the epicenter of it, it comes up from Mexico to Lawrence, Massachusetts, and then it goes out into New Hampshire, other states, but Massachusetts as well.

So, the pathway is China, into Mexico, then into Lawrence, Massachusetts, and into Ohio, into Virginia, into Florida. And when it's over half of the deaths now in Massachusetts, it's clearly a looming threat that's a preview of coming attractions to every single city and town in our country. So that's why this hearing is so important, because it gets to the question of what is Mexico doing in partnership with China?

We'll start with that, Mister Foote. What is specifically Mexico and China, at the highest governmental levels, doing in order to interdict this new synthetic formula that is lacing heroin with a drug 50 times more powerful than heroin? So powerful that the DEA doesn't even let its dogs any longer sniff for Fentanyl, for fear that the dog will just die with the first sniff of Fentanyl. That three grains [ed's note: that's actually milligrams], three, equivalent of salt grains, okeh, to kill a human being, if they gained access to it. What is Mexico and China doing in cooperation with you in order to interdict that drug?

DANIEL L. FOOTE: Senator, first, I'll touch on Mexico and China's bilateral relationship on this. With our support, Mexico and China are meeting and discussing Fentanyl regularly, every year. They are both involved in the multilateral side of things. Just last month at the UN General Assembly Special Session on drugs, they were both there. China, their minister of public security, led, the conclusion statement, they were fully on board, and they are a member, both countries, to the three international drug conventions. We also sponsor in the United States two annual Fentanyl and precursor chemical conferences with Mexico and China, and --

ED MARKEY: So how successful is this effort so far?

DANIEL FOOTE: That's a good question, Senator. Fentanyl is a new problem for the Department of State, and INL, and it's one where we are applying lessons we've learned with other substances in other crime areas over the year, and at this point, we're working as hard as we can to have success, but I can't quantify success.

ED MARKEY: Has it been elevated to the highest level, in other words, with human rights and copyright infringement? Is this issue now at the highest level of negotiations with the Chinese government and with the Mexican government?

DANIEL FOOTE: It is. Mister Chester went down in March with our folks and spoke to a large inter-agency group headed by the Attorney General in Mexico on this issue. We regularly engage with China, our diplomats are going to China next week, at a very high level, diplomatic engagement where they will raise it. We raise it regularly in the joint liaison group on law enforcement, which has a counter-narcotics working group that meets throughout the year. And we've actually seen some positive signs from China. Last year --

ED MARKEY: What is the evidence? If you were going to convict them of doing something, what would the evidence be to convict them?

DANIEL FOOTE: To convict?

ED MARKEY: Convict China of actually doing something, to block this from coming into Mexico and then into the United States. What would the evidence be to convict them of doing good?

DANIEL FOOTE: Of doing good. Last -- okeh. We've seen encouraging progress. There's still plenty to do. Last year, their ministry of public security officially controlled 116 new substances, including several analogues of Fentanyl, and they have expressed high receptivity in continuing to receive information on new synthetic substances to us, to efficiently control them. So they are doing something, there is more that can be done, obviously.

ED MARKEY: Clearly. We have the evidence in 2015 in Massachusetts, and it's going to be worse this year, in 2016, that -- there's slim evidence that this thing is being slowed down, in fact, it's very clear that it's intensifying, and it's going to kill, it's going to kill ultimately tens of thousands of Americans every year. Every year. There's no other threat to our country that even matches that. Every single year, Fentanyl's going to be able to do that. So if we don't stop it, it dwarfs every other issue. Every other issue will be a footnote compared to the magnitude of the impact on American families.

Mister Chester, can we just go to Mexico. What is the level of cooperation that you are getting from the Mexican government in interdicting Fentanyl coming into the United States. We know it's El Chapo, and his gang, that's responsible for the traffic that comes up to Lawrence, Massachusetts, but pretty much for the whole country. What's your success level with the Mexican government, getting them to understand the magnitude of the threat to the American people?

KEMP CHESTER: Senator, I would tell you that I personally have been down there twice, and then have dealt with the Mexican Embassy here in the United States. I will tell you that they understand how seriously we take this issue in the United States. They understand that this is our top illicit drug priority, and they also understand that it's not just heroin, but it is heroin and it is Fentanyl. In a meeting down there in February, I put Fentanyl on the table, and I won't say that it was first heard for them, but they weren't really familiar with the -- with how seriously the issue was in the United States. By the time we'd gone down in March -- later with Director Botticelli and Ambassador Brownfield, that was part of, part of the problem set that they agreed to work with us, moving forward, on.

So I will tell you that the Mexicans are -- understand the importance with -- that we place on this issue. They're very engaged on it, and they are willing to conduct joint planning with us on the issues not only of poppy eradication, which addresses the heroin issue, but also lab identification and neutralization, specifically on issues of either Fentanyl creation or the milling of Fentanyl with dilutants and other inert matter, as it's transported across the border.

ED MARKEY: Well, it's a little bit disturbing to me, if, from your testimony, it's a case of first impression for the principle law enforcement officials in Mexico, that they're just hearing about Fentanyl, and it's just getting on their radar screen, and it's February of 2016.

DOUG MCVAY: That was Senator Edward Markey, a Massachusetts Democrat, grilling officials over the administration's response to fentanyl use at a Senate Foreign Relations subcommittee hearing in May of this year. You are listening to Century Of Lies, I'm your host Doug McVay.

The chair of that Senate subcommittee was Marco Rubio, the Republican from Florida. Let's hear from Senator Rubio. In the second half of the hearing, the witnesses were Teresa Jacobs, the mayor of Orange County, Florida, and Steven Dudley, co-founder and co-director of InSight Crime. The next voice you hear is Senator Rubio.

MARCO RUBIO: I want to share with you an anecdote. This weekend, I have a personal friend who's a police officer in Miami-Dade County, and he recounted a story, that he pulled up to a car that was kind of pulled over on the side of the road, and there was a woman in the driver's seat. She was kind of slumped over, and it caught his curiosity, so he pulled over and knocked on the window. This was a nice car, by the way, obviously this is a person of financial means. Knocks on the window, and the person immediately pops to attention, and he can see that in her arm there's a needle. She was basically shooting up on the side of the road in a luxury vehicle. Knocks on the window, rolls down the door -- sorry, knocks on the window, she rolls down the window, they begin to interact.

Obviously he's -- has a decision to make about how to treat her. This is someone who said ten years ago he would have arrested her and taken her in as a criminal using drugs in the street. Today, his perception has changed because he's had several interactions, including this interaction, with a person who by the way is a member of the Florida Bar, is a successful, functional attorney, whose husband apparently also has a problem. The fundamental challenge he faces, he doesn't want to take her to jail, he doesn't view her as a criminal. He views her as someone who has a disease, and is in need of treatment to overcome it. And by the way, her gateway into heroin was the use of a pharmaceutical painkiller for a surgical procedure six or seven years ago, when she lost access to the medicine and this is what's happened.

And so the concern that I have is two-fold, and perhaps you can both opine on this. Number one, if today, you are dependent upon an opiate substance, irrespective of how you got there, but let's say in the case, this person because of the use of a pharmaceutical that led to this point. There is still an extraordinary stigma associated with it, as if you are a bad person who's doing a really bad thing, and needs to be punished for it. And second, even if that stigma were to change so that we can get more people into treatment, and accepting the fact that I am a, you know, dependent, physically dependent on this substance. In many communities, there is nowhere to take them. The only place you can take them potentially is to a jail, where you hope their withdrawals are managed, but may not be, and in essence, there's nowhere for them to go.

We have many places, we just don't have the capacity to meet that reality. Which leads to the third problem, and that is the number of people who end up in a jail cell for 15 days, go through withdrawal, do not realize they have lost their tolerance, even in that short period of time, and when they fall off the proverbial wagon they go back to using the levels they were using before they went through withdrawal, and it kills them, because they lost their tolerance for an opiate.

So, given that perspective, I'm sure there are hundreds if not thousands of cases like that. What are the impediments to getting someone who faces this now, who, I don't think so, but could be watching C-SPAN at this very moment, not very many people watch C-SPAN, but are watching this or hearing us talk about this. What's out there today, or what is missing for someone who needs this treatment, and just doesn't know what to do about it next? Because there -- especially for the uninsured, there aren't very many options from my understanding.

TERESA JACOBS: Thank you, Mister Chairman, and, I think that is a key part of addressing the demand side. Part of it is to educate people and help them make the right choices to avoid over-use of prescription drugs, but the other part is how do we provide the resources to treat people that are addicted? And the treatment options are very limited. For the uninsured, as I pointed out, 26 beds for 2.4 million people. Our jail alone, one out of four jails in the region, we have on average 200 people that we're treating for withdrawal symptoms, and offering them a treatment program when they leave. We need more treatment facilities. When you asked me the question, are traffickers, are dealers preying on people coming out of treatment centers, the reality is we don't have enough treatment centers to prey on.

MARCO RUBIO: You said in your testimony, I don't want to interrupt, but you said in your testimony, you believe that Florida was specifically targeted because they knew we had the pill mill problem, and once that was cut off, these folks were going to need.

TERESA JACOBS: Exactly. That's what I believe, I don't have empirical evidence. What I have is the evidence of the increase in the flow of heroin, and the increases in deaths related to heroin, at this, in correlation to our cutting off the pill mills. Let me also say that while we were dispensing more oxycodone than the rest of the country combined out of Florida, most of that was leaving our state, and most of these pill mills, you could drive up and you could look in the parking lots, the parking lot would be full, and only a small percentage of those were local license plates. So, it, the cartels may have misjudged the appetite, but they, no question, have flooded us with very, very cheap drugs, and the number of youth that I have seen that are struggling with addiction, and have turned the corner and have been able, have had the good fortune and the money to find treatment, the insured portion of that population, to see that there actually is life after heroin addiction, is very encouraging, but what's very discouraging is that most people that are addicts have no idea there's life, and most people that are addicts have no opportunity to get to those treatment centers.

MARCO RUBIO: The -- just to fill in the gaps on those who may not fully be aware of the Florida pill mill problem, we had these facilities, you just basically pulled up and said my neck hurts, or my back hurts, and by routine they would give you a package of prescriptions, it wasn't just, by the way, Oxy, it was, they also put some other stuff in there, and people knew this, and you would have busloads of people actually come in sometimes. It was a huge problem, the Florida legislature closed that loophole that was allowing this to happen. So, just to be fair, these -- we're not talking about the prescription, the Oxy prescriptions being driven by doctor at his hos -- his or her office, it was these specific facilities that drove it. Did you want to add something on the treatment part of it, because I had one more question, I know that Senator Kaine does as well.

STEVEN DUDLEY: Just very quickly, I mean, this is obviously framed as a law enforcement debate, and certainly I was asked to talk about the criminal organizations, but as you rightly pointed out, this is a public health issue. I mean, this, at the heart of it, this is a pharmaceutically driven epidemic, and it's a public health issue. And that's really the difficulty in facing up to this, is that it isn't necessarily a strictly law enforcement, we're not talking about throwing people into jails, you know, we need to be talking about how to get them better treatment.

MARCO RUBIO: And, my sense on the, on the human side of it is, I don't believe anyone wakes up in the morning and says today's the day I become a heroin addict, or an opiate addict. There's no one, that's not something somebody wants to happen. You just see growing evidence, people don't realize the power of this, there's no responsible way to use this. And it's impact on everybody's a little different. We know some people are more sensitive or susceptible to addiction than others, but it basically restructures the brain's chemistry, in a way disease would, and it has to be treated as that.

I look at these statistics, the -- for example, in Florida, just as an example, Orlando has 83 heroin deaths in 2014, significantly, other communities have large numbers, West Palm Beach at 51, Miami at 60, Sarasota at 55, but that number pops out at you, as a place that's been specifically targeted, and then you see the rise in deaths, and the kind of the spike we've seen in, because, across the country, in heroin and opiate deaths, where the real, where the take-off point has been, is the introduction of Fentanyl, which, as we've already seen from testimony today, is an incredibly powerful and lethal substance, which in fact, from my understanding, is not prescribed outside of a hospital setting to begin with, on the pharmaceutical side, and is now being laced into, and I want to go to Senator Kaine, so I wanted to leave with this thought.

I read the other day a report where one, someone who was a former, he's now a recovering, addict, was asked about this, and said, you know, when you hear that someone has died from an overdose, that was sold by a particular dealer, it makes you want to buy from that particular dealer, because you know what they're selling is the strong stuff. That was, now maybe that's just one interview, one line somebody said, but it just kind of tells you the point we've reached here, where it's, it is a very difficult and debilitating condition that we have to -- try and to understand here, and I think one of the keys is to remove the stigma associated with it, and I think many of us would be very surprised at the number of people we interact with on a daily basis that at some level have a dependence problem. Maybe not to street heroin, but of some sort, as a result of what we've seen happen in this country, and hopefully we can make advances in pharmaceuticals so that we can draw the line and we'll be able to treat pain effectively in this country without putting people at risk.

DOUG MCVAY: That was Senator Marco Rubio, Republican from Florida, chairing a hearing back in May before the Western Hemisphere and Transnational Crime subcommittee of the Senate Foreign Relations Committee. They were mostly discussing drug cartels, fentanyl, and heroin.

And well, that's all the time we have today. Thank you for joining us. You've been listening to Century Of Lies, we're a production of the Drug Truth Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org. You can follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty minutes of news and information about the drug war and this Century Of Lies. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.