MR. STEVE ROBERTSThanks so much for joining us. I'm Steve Roberts of the George Washington University sitting in today for Diane Rehm while she's away on vacation. Not too long ago, most people considered heroin addiction to be a terrible problem confined to poor urban neighborhoods. No longer. Heroin addiction and overdose deaths are devastating communities everywhere.

MR. STEVE ROBERTSJoining me to talk about the current surge in heroin addiction and what can be done about it, Dr. Leana Wen is Baltimore City's health commissioner, also an emergency room physician. Beth Kane-Davidson is director of addiction treatment at Suburban Hospital Johns Hopkins Medical Institute. They're with me in the studio. And by phone, from Great Barrington, Massachusetts, Marc Fisher, reporter for The Washington Post has written extensively about this issue.

MR. STEVE ROBERTSAnd by phone from Winchester, Virginia, Sergeant Jay Perry of the Virginia State Police who focuses on these issues from the law enforcement point of view. Welcome to you all. Thanks for joining us this morning.

MS. BETH KANE DAVIDSONThank you.

MR. MARC FISHERGood morning.

DR. LEANA WENThank you.

ROBERTSYou can join us, too, 1-800-433-8850 is our number. As always, drshow@wamu.org, send us an email. Of course, you can post on Twitter and Facebook. And I'm particularly interested in having some of you out there who have personal experiences with this epidemic to share your stories. We'll be happy to go to your calls later in the program. Marc Fisher, the Centers For Disease Control, the CDC, recently came out with a report in which it talked about heroin addiction, how number of deaths had actually close to doubled from 2011, 2013.

ROBERTSWhat's behind this trend?

FISHERWell, it's really quite severe. In fact, deaths from heroin overdoses have almost quadrupled in the last decade according to that same report so it's this enormous increase. I think two things are driving it. Number one, the federal crackdown on opiate pills. If you recall over the last decade or more, there was a tremendous problem in many parts of the country with over-prescription and then abuse of pills such as oxycontin and other pain killers that were originally marketed as non-addictive and turned out to be very much addictive.

FISHERAnd when the federal government cracked down both on those who were prescribing the drugs and on pharmacies and really tightened the supply of those pills and their distribution, the people who had become hooked on them found that heroin was actually easier to get, cheaper and a better high. And so there's been this tremendous migration of abusers from prescription pills to heroin. The second factor is the legalization and decriminalization of marijuana, which has changed the behavior of the Mexican cartels that are the main supplier for heroin at this point in the country.

FISHERWhen marijuana became much more liberalized in this country, the domestic growers and suppliers took over that market and the Mexican cartels shifted their product line to poppy and opium and, thus, heroin, which is obviously much easier to ship and cheaper to ship.

ROBERTSNow, Marc Fisher, from the Post, you wrote a lengthy -- several lengthy pieces from the state of Maine. You focused on a family, the McCarthy family in Falmouth, Maine. And one of the findings in the CDC report we just mentioned was that heroin addiction has gone far beyond the traditional communities, the traditional addicts that -- at least in myth and stereotype we believe in. And you focused on a high-earning family, very privileged, that reflected one important dimension of this trend. Talk about the McCarthys.

FISHERSo the McCarthys are a well-to-do family from a coastal community in Maine. The father is a lawyer. They moved from New York City for a slower pace of life. And they lived in this affluent community where the local high school was one that drew from many different economic strata and so you had kids of all different types there and one of the party drugs that was quite popular were these prescription painkillers and that followed the track that I described earlier, where a lot of kids moved from pills to heroin and moved from sniffing heroin to shooting heroin.

FISHERAnd in an affluent community, there's a great deal of emphasis on this stigma that surrounds heroin. It is seen as, in the sort of the popular mythology, as a drug of inner city strung-out druggies and it's not something people like to talk about and so even families that were themselves ravaged by this drug, found that this was not something they were willing to talk about publically and so it was only when kids started dropping dead of overdoses that this became a public issue in anything like the way that it's been in big cities for many years.

ROBERTSAnd one of the remarkable things, one of the reasons why you -- the McCarthy family was willing to talk to you at such length was in the obituary of their son -- they actually lost two sons to drug overdoses -- but they actually said he died of a drug overdose, which was really a breakthrough in terms of confronting this epidemic.

FISHERVery unusual and may not sound like it, but it really was a courageous act on the parents' part because so many of these overdoses, the families put out the word that the young one just died of natural causes or something like that. So this was an important step and they've -- there's been a tremendous rallying around this family and there is a change, I think, that's happening in a lot of places around the country where families are starting to speak out and because there is so little treatment available, even for those who have a lot of money, it is imperative that people realize the scope of this problem.

FISHERAnd so the more families step out as the McCarthys have, the more likely there'll be support for treatment. One slight correction, their second son did overdose, but he did not die. He's still alive and is actually doing quite well.

ROBERTSThanks for that. Dr. Leana Wen, you are now Baltimore City's health commissioner. You've been in this job for six months, have a lot of experience, emergency room physician. A report that you recently put out, a similar trend line from 2013, 2014, overdose deaths up 23 percent in Baltimore. Your reflection on what you're seeing behind these trends.

WENHeroin in Baltimore City has been a problem for decades, but the problem is getting worse despite our best efforts and using innovative evidence-based approaches, we do see it going in the wrong direction. We now have in our city with a population of 620,000 people, we estimate that about 19,000 use heroin. And last year, there were 303 people who died from drug and alcohol overdose, which is more than the number of people who died from homicide and is about one person per day was dying from this.

WENAnd it's so tragic because there is one medication called Naloxone, also known as Narcan, that can completely reverse the effect of an opioid overdose. And so as an ER doctor, I've used this medication Naloxone dozens, if not hundreds, of times. And I've seen how effective it is and how literally within seconds of giving this medication, someone who has stopped breathing will begin talking and walking again. And so I absolutely agree with Marc that we have to focus on providing treatment and reducing the stigma and showing that it really is anyone who can be addicted to heroin.

WENI've seen it in my patients from all different ethnicities and backgrounds and ages and I can say that the face of addiction is not what one might imagine. It really is something that effects our family and friends and therefore, we all have a duty to make sure that we focus on saving lives.

ROBERTSI want to bring in Sergeant Jay Perry from Virginia State Police because you, too, are on the street level here, Sergeant Perry and your take on what's behind these numbers we've been talking about.

SGT. JAY PERRYWell, I'd have to agree. Absolutely, the driving force behind the heroin addiction started with opioid pain medications. We started to see a sharp increase in heroin in late 2012 coming out into the rural communities. As it was stated, you know, earlier, you know, the stigma around heroin is, you know, it's a junkie drug. It's a, you know, it stays in the city and it's dirty and the back street allies and that's, like, absolutely not the case anymore. It is coming into the rural areas and, you know, any type of folks are using it, you know, rich kids, poor kids, it just doesn't discriminate at all.

SGT. JAY PERRYWe saw -- and I'm in the northern Shenandoah Valley. We cover five counties up here and we're very close to Baltimore, Maryland. They are our heroin source city. That is where the flow of heroin comes into our area. We have users network and we'll typically go up there, you know, we've seen them go two to three times a day to Baltimore to purchase heroin and bring it back into the area. Our overdose death numbers have gone -- we had one overdose death in 2012. We had 21 in 2013, 33 in 2014.

ROBERTSWhat's driving that, Sergeant Perry?

PERRYThe availability and the cheapness of the drug. When the price of opiate pain medications went to about a dollar a milligram of street value, you can imagine one oxycontin pill, 80 milligram, would cost you $80 so a prescription of 30 would be, you know, $2400. The price of heroin and the availability, the price has come down even since we've seen it increase. It used to be about $400 a gram in our area and now it's come down to about $200 a gram. And if you can envision how much a gram is, you're dealing with, you know, maybe a sugar packet holds about 3 grams.

PERRYSo that could be, you know, $6 to $800 worth of heroin in a sugar packet. So this is what we're dealing with. This is what, you know, folks are going to Baltimore to buy and bring back.

ROBERTSAnd is there -- just have a couple seconds before the break, and it's getting worse from your point of view.

PERRYAbsolutely. It's a, you know, as I said, the availability and the price, it just continues to decline and that drives the market up, you know. As you said earlier, you know, it's coming across the border of South America and...

ROBERTSRight. That's Sergeant Jay Perry from the Virginia State Police. I'm Steve Roberts. We'll be right back with your calls and your questions.

ROBERTSWelcome back. I'm Steve Roberts sitting in today for Diane Rehm. Our subject this hour, the surging heroin epidemic that is affecting communities across the country. It's documented by a new report by the Centers for Disease Control. With me this morning to talk about this: Dr. Leana Wen, she's the Baltimore City Health Commissioner. Beth Kane-Davidson directs Addiction Treatments at Suburban Hospital here in Bethesda, Md. By phone, Marc Fisher of the Washington Post, he's now in Great Barrington, Mass., has been writing extensively about this issue. And also from West Winchester, Va., Sergeant Jay Perry with the Virginia State Police.

ROBERTSAnd Beth Kane-Davidson, talk about this process of addiction as you see it. Heroin addicts people quickly. It's tenacious. Talk about what happens.

MS. BETH KANE-DAVIDSONYeah, I mean, what everybody's saying right now, on air, is exactly what I'm seeing in the field. I've been working in addiction since 1978. I've never seen anything like this, where our young people are dying every day from heroin addiction. And heroin addiction is like all other addictions: it's chronic, it's progressive, and it's potentially fatal. I see people getting addicted to heroin through what's already been called the back door, through prescription drug use and then they move on to heroin. Once somebody becomes addicted to heroin, they need professional help. They start, you know, seeking that drug no matter what else is in their life. They start avoiding the family.

MS. BETH KANE-DAVIDSONThey stop taking care of themselves. They spend money, they borrow money, they steal money. They become a different person in the eyes of their loved ones.

ROBERTSAnd from the treatment point of view, like so many of our listeners, so many Americans, I've had personal experience with this in my family. There's hardly an American family that's untouched by this.

KANE-DAVIDSONMm-hmm.

ROBERTSAnd my relative has gone through countless rehabs and it's never worked. Is there hope for people who are addicted? Are there proven treatments that can work?

KANE-DAVIDSONAbsolutely. And when you say "never worked," you know, as long as they keep going back to the treatment, they're seeking help. So I see people relapsing over and over again. And it is trying to get to, what treatment is best? There's no one treatment cures all.

ROBERTSMm-hmm.

KANE-DAVIDSONSo with heroin addiction, we do have the ability to do behavioral counseling and medications, as already has been mentioned here. But the main thing is keeping that person engaged in treatment over the duration. You know, it's not a three-day fix or a six-day fix or a thirty-day fix. The longer we can keep people engaged in treatment -- counseling, self-help groups, ongoing medication if necessary -- the better chance we have of that person staying in the treatment, you know, road, staying clean, you know, participating in their life. That's the goal.

ROBERTSYes, Dr. Wen.

WENBeth said something that's so critical that I want to highlight, which is that addiction is a chronic disease. We have to see it in the same way that we see other diseases as well. We would never say to somebody with high blood pressure, "Well, you tried one medication, it doesn't work. So we give up on you." We would never say to somebody who has congestive heart failure, who ends up in a hospital again, then, "Well, it's your fault that you're back in a hospital. You clearly didn't follow your diet and so shame on you." We have to see addiction in the same way. And yet, studies show that one in ten people who have addiction are getting the treatment that they need, which I find to be completely unacceptable.

WENBecause for what other disease would we find it okay that one in ten people have -- who have cancer get chemotherapy.

ROBERTSBut you must run into the problem that, from a political point of view, even from a moral point of view, there is a difference between addiction and cancer in the minds of some people, which is that an addict has chosen to go down that road. And allocating public funds is different than for other kinds of diseases. You must run into that problem.

WENAnd that is the great challenge for all of us in public health and medicine, as researchers, to use evidence and stories to show that it is not about choice. That people -- many of my patients, for example, first got addicted to prescription painkillers after having surgery or after having chronic pain. And then, as some of your guests have mentioned, started using heroin because it's cheaper. And so it's critical for us to change that mindset, to tell the stories of everyday people who have addiction and to say why it's important for us to focus on saving lives and getting people into treatment.

ROBERTSSpeaking of stories, I want to turn to one of our callers now. Stacy, in New Albany, Ind., thanks for calling and thanks for sharing your story with us. You're on "The Diane Rehm Show," Stacy.

STACYHi. Thanks for letting me be here. It's funny, I'm listening to this radio show and I have a syringe of heroin in my hand. And I got hurt in the military. And prescription drugs is how I got -- exactly like what you all are saying. So you get to this point where it's hopeless -- it looks hopeless. I know it's not. I have a college degree. You know, I'm not stupid. I won soldier of the year competition twice and I'm addicted to heroin. So what do I do now? Because I have these underlying issues where I have chronic pain. I have a messed-up back, a messed-up bladder, some other stuff from the military. What do you do from here? I have this addiction but, if I say I have this addiction, I can't get treated for these other issues that I have.

ROBERTSStacy, I'm going to turn to Beth Kane-Davidson, who runs the Addiction Treatment Center here at Suburban Hospital. Beth, your reaction to Stacy?

KANE-DAVIDSONAbsolutely. My reaction is thank you so much for calling. And you're absolutely right, that is the dilemma that people get in. And I would ask you to reach out to an addictionologist, a specialist in addiction that also deals with chronic pain. I don't know where you are but I would certainly ask you to...

ROBERTSShe's in New Albany, Ind.

KANE-DAVIDSONAll right. I would be happy for you to call me later this afternoon at 301-896-6608 and I will help you locate something local where you can, you know, contact somebody. I would also say, since you said you had a syringe in your hand, to please reach out to somebody right now to come over and help you through this crisis.

STACYRight. So then what everybody says that I know that has this same problem is, okay, that's great. But I'm to the point where I don't have insurance. I don't have a home. I don't have a car. I don't have money. I know it's funny because I can go out and buy heroin. But it's cheaper than painkillers or getting Roxies or tabs or Percocets on the street. I don't have money for this kind of thing. It's abhorrently expensive to somebody like me.

KANE-DAVIDSONAgain, I understand. And the most important thing right now is that you do get a connection to recovery within your community. And there are treatment locators through SAMHSA. And I understand right now, you know, I don't want you to have to be going through all the details. And that's what happens to people when they're trying to get treatment is they get overwhelmed with the dead-end roads and...

STACYYes.

KANE-DAVIDSON...you know, so what I'm saying to you is, reach out to somebody right now to help you not use. And reach out to me later or -- reach out to me later, please.

STACYYou'll be surprised, but I will.

KANE-DAVIDSONI welcome your call.

STACYThank you.

KANE-DAVIDSONMm-hmm.

ROBERTSThank you for -- very much, Stacy, for joining us this morning. We appreciate it. Marc Fisher, when you hear someone like Stacy, does this story sound familiar to you as you have made your journey through this world?

FISHERTragically, Stacy's story is quite familiar, quite common, all too common and that cry for help is not unusual at all. In fact, what we're seeing across the country is that addicts and their families are crying out for help in so many ways. And they're running into exactly the kinds of obstacles that Stacy has heard about and is worried about. And this is both a matter of economics and a question of politics. Because, as you said earlier, there is still this notion that addicts bring this upon themselves.

FISHERAnd that is driving the political discussion every bit as much as the increasing political consensus about considering this a health problem and stopping with the mandatory minimum sentences and, you know, starting to empty out the prisons of all the people who've been incarcerated for being addicts. So there's a growing consensus that that's the right approach. And yet we do not see the funding to back up that growing consensus hardly anywhere in the country. In Maine there's a particularly difficult political situation, where the governor wanted to zero-out funding for methadone because he opposes that, in part, driven by this idea that addicts bring this upon themselves.

FISHERIn other states, where you have Republicans and Democrats together on the side that this is a public-health issue, you still have an unwillingness to pay for treatment. So if Stacy makes the call today and she gets immediate help, she can probably get into a detox program and get some immediate help. But for that next step, for the longer-term rehab, she's going to find in most states that there's a tremendous shortage of treatment beds. That there are places that are actually closing down because of the extremely low reimbursement rates from Medicaid. So this is not a system that is anywhere near geared up for the level of problem that we have in this country.

ROBERTSSergeant Perry, another dimension of this issue -- in addition to that touching story that Stacy told us -- is the impact on communities, including the potential for crime, as people desperate for the next fix steal from their families and then from a larger community. Talk about the impact on communities, beyond an individual like Stacy, of this trend.

PERRYAbsolutely. Yes, the vast majority of property crimes committed in our region and I would dare say across the United States is driven by the disease of addiction, trying to get the money for the next fix. And the thing about heroin and opioid addiction is the withdrawals are so painful and last for so long that once that addiction takes over, you know, they need to get that fix every six to seven hours. And they'll basically do anything to get it. It affects the communities in many ways. Our EMS system is taxed to the max with running overdoses. Law enforcement is as well. When you take an addict to jail and then they have to detox in the jail for seven -- six, seven days, it puts a burden on the staff at the jail.

PERRYAnd then when they get out, they go right back to it because they have had no program or no treatment or anything while they've been in. We are working to get those drug treatment programs into the jails. We have a good program here but there's a waiting list. So not everyone gets in.

ROBERTSYou know, Marc Fisher made the point, Sgt. Perry, that financing for these programs is a question of allocation of resources and that when budgets are tight, the State of Maine being an example. Are you running into that, too, in Virginia, that you just don't have the beds, you don't have the facilities to deal with this problem as it descends on you?

PERRYAbsolutely. You know, we have no initial detox and I think that's one of the most important phases is getting the addict detoxed and getting them through the first step of getting over the withdrawals, and then getting them into treatment. But absolutely, you know, we're short on all those things. Valley Health Systems, in our area, has been instrumental in stepping up to the plate and trying to get treatment for people who want treatment. And I will say that, you know, when we encounter these people, they want treatment. They will tell you, "I want to get off this stuff. I just can't do it." So the people that we're encountering all the time want help. It's just not available.

ROBERTSI'm Steve Roberts and you're listening to "The Diane Rehm Show." Let me turn to some of our callers. There are so many people who are responding to this show and want to be part of this conversation. So let's turn to Sean in Indianapolis, Ind. Welcome, you're on "The Diane Rehm Show," Sean.

SEANHello. Yes, nice to be here. Good to speak with you both.

ROBERTSPlease go ahead.

SEANYes. I'd like to say that I've been clean for nine years myself but I've had lots of deep impacts with it. I found my uncle and his friend both with needles in their arms, dead, about 10 years ago. Also about 10 years ago, I lived in Mexico in Nuevo Laredo and I seen the scourge as it crept northwards at that time and I was able to see heroin being sold so powerful and so cheap that it was 50 pesos to get three shots of heroin. And that's equivalent of like $4 here, U.S. They're on the border. And I'd see, I mean, you'd see fathers selling their children in the street to get it. I mean, and I've seen it coming.

SEANAnd just here, recently, and within the last year, where I live here in Indianapolis, it's just become a surge and you can just see it everywhere. I mean (unintelligible)

ROBERTSSean, let me ask you this. We've been talking about -- Sergeant Perry just said, people he sees want to get off this drug, want to reverse their addiction, and can't do it. And we've talked about how difficult it is to cure and alleviate this addiction. How did you do it?

SEANCold turkey. I had separated myself from anyone that was ever around it, any of that. Actually, what did it for me, to be honest, I found out my wife was pregnant. And I, cold turkey, I disassociated myself from everyone. To this day, I don't have any of those friends. I don't talk to anyone, you know, around that. I can't -- because I still scare myself. Because I don't trust myself nine years later. I couldn't be around it because I know there is that underlying addiction there. So I just -- I cannot be around anyone like that or, you know, I mean, just thinking about -- hearing the program sends tingles up the back of my spine right now, from the years of addiction.

SEANBut, like I said, it was scary because I was one of the working addicted, so I always had money so I could afford my drugs. I didn't have to go rob and steal and that kind of thing, you know? And it was always available, once -- if you had money, no matter where you were.

ROBERTSWell, it took courage to share your story with us and we very much appreciate it.

SEANOkay. But, yes, I mean, there does need to be more programs around and things like that for the people. Because it is a disease that is there for lifetime. Thank you all.

ROBERTSThank you, Sean. Beth Davidson, as you listen, what's your reaction?

KANE-DAVIDSONYeah. My reaction is, first, wonderful, nine years clean. But I think his description shows how powerful addiction is -- that nine years later, he's getting a reaction just from hearing this show. I also want to say, he spoke of the people that he knows who have died of addiction. And I do want us to think about reaching out to the mothers, the fathers, the siblings of, you know, kids or loved ones that have died of addiction. I've been going to funerals since December for young people in Montgomery County that have died of an overdose.

ROBERTSAnd, quickly, Dr. Wen, one of the things Sean said was, it's not just the physical addiction. It's the community, it's the culture that he had to separate himself from.

WENThat's right. We know that heroin addiction is not just an individual disease. It's something that affects the family and something that affects the community as well. And what we've been doing in Baltimore City, as part of the mayor's task force on heroin, is to train family and friends on this critical issue.

ROBERTSI'm Steve Roberts sitting in today for Diane. We'll be back with your calls and your comments so, please, stay with us.

ROBERTSWelcome back. I'm Steve Roberts, sitting in today for Diane. Our subject this hour, the epidemic of heroin addiction and the deaths that have ensued as documented by the Centers for Disease Control in a recent report. Dr. Leana Wen is with me. She's Baltimore City's health commissioner. Beth Kane-Davidson, director of addiction treatment at Suburban Hospital here in Maryland. By phone, Marc Fisher of the Washington Post has been writing about this issue, and also Sergeant Jay Perry of the Virginia State Police.

ROBERTSI want to read a couple of emails and get a couple of reactions from you. Sue writes to us, my son has suffered from an addiction to heroin for about five years. He has recently started taking methadone. What is your opinion of this drug as a form of treatment? Once started, is it possible to get off this drug? And if so, how is it best to do this? Dr. Wen?

WENWell, I first want to thank Sue for sharing her story, as well. And we know that for heroin and opioid abuse, a number of treatments are effective and that the most effective treatment needs to be based on evidence and science but also has to be tailored for the individual. So methadone and Buprenorphine are two of the medications that are effective and have been shown by science and research to be useful and necessary to treating heroin and opioid addiction.

WENBut most of the time, it's not only medications alone that will be effective. We also need mental health treatment. We also need counseling, and patients may also need treatment for physical health and social services to connect them, as well.

ROBERTSAnd this is very expensive.

WENMethadone is actually not very expensive.

ROBERTSBut these larger services you're talking about.

WENThe wrap-around services are absolutely expensive, but they are...

ROBERTSWho pays for them?

WENWe believe, I believe, that the government has a responsibility to pay for these critical services, especially because the economic cost of not treating addiction is so great. The cost of not treating heroin addiction will result in crime, will increase that cycle of poverty and incarceration and violence. And so it's important for us as a society to treat this issue not only as a medical issue but as an economic imperative.

ROBERTSNow, one of the key variables here, Dr. Wen, you've written a lot about is the availability of this drug Naloxone, which as you've described from your experience as an emergency room physician can reverse the effects of addiction and save people who are headed toward disaster. But you've written about the pharmaceutical industry recently increasing the price of this. Talk about that variable in this vast arena of so many different issues, but talk about that.

WENI want to clearly separate the two issues because the first issue is that we have to save someone's life at the point that they're literally dying from an overdose. And then we have seconds to save someone's life, and that medication to save someone's life is Naloxone. The second issue that we had been talking about is what to do once that person's life is saved and what we can do with medications and counseling.

WENBut we cannot get to the second phase unless we save that person's life first. So in Baltimore city, we've recently, in the last year and a half, we've seen a quadrupling in the price of Naloxone. Now, Naloxone is a generic medication. It's sold by the pennies in other countries. It's on the World Health Organization's list of essential medications. There is no reason why this medication should be so expensive here because if the price is four times greater, that means we can only save a quarter of as many lives.

WENAnd so we need to make sure that we place people over profits and really start looking at how we can get this life-saving medication into the hands of everyone. We actually just in this year alone in Baltimore city, we have trained 2,000 people on how to use Naloxone, and now we have to get enough of this medication to put it into people's hands so they can use it.

ROBERTSBut you're finding the ability to do that limited by price?

WENAbsolutely. We are beginning to train police officers, we're beginning to train everyone who is in our jails and all family and friends of individuals in jails and other high-risk areas, and we don't have enough to be able to place into the hands of everyone who needs it.

ROBERTSLet me read an email from Elizabeth who writes, and Sergeant Perry, I hope you'll answer this because it's -- she says I live in a rural community in southeast Ohio, presumably with some of the same dimensions and conditions of your communities out there in Western Virginia. Heroin and other drugs are ravaging our community, she writes, destroying families, escalating crime. And then she says that extreme self-centeredness, manipulation and dishonesty, these behaviors are central to understanding addicts.

ROBERTSAnd she says, empathy for addicts is all good and well, but the families of addicts are the ones who are suffering terribly through no choice of their own. Your reaction, Sergeant Perry?

PERRYThat's absolutely true. And I feel for her situation out there. You know, what we're -- our goal is, in law enforcement, is to get the addicts treatment and to go after the dealers. We don't want to target someone who has the disease of addiction. And we, we decided several years ago that we needed a multi-faceted, community approach to this issue. It's not only law enforcement. It's not only health care providers. Everyone has to come together and work together towards the common goal of getting this under control.

PERRYThe Naloxone is a great first step to save a life. Virginia has recently passed legislation to make that available to people. We also passed a law earlier this year in July that gives an affirmative defense for someone who calls in a drug overdose. And that, that leads to, you know, encouraging people to call in if there is an overdose.

ROBERTSThank you for that, Sergeant Perry. We have an email from Laura, Marc Fisher. And she says, there is no discussion of Fentanyl. Why? Everyone I have ever known who has overdosed and died since 2006 has had Fentanyl in their system. You've written about this. Respond, please, to Laura.

FISHERShe raises an excellent point. In the reporting that we've done, somewhere in the order of a quarter of the heroin overdose deaths in the last couple of years have been addicts who took heroin that was laced or cut with Fentanyl. People may recognize the name Fentanyl. It's a drug that you often get at the hospital if you're coming out of surgery. It's used in anesthesia. It is a very strong drug. It is anywhere from 20 to 50 times more powerful than heroin.

FISHERIt's being used by low-level dealers to cut the heroin, make it go a little further to increase their profits. It doesn't make a lot of economic sense, and the DEA is very puzzled by this because Fentanyl in its actual marketable form is more expensive than heroin. So why would you cut a drug with something that's more expensive? The theory is that they're getting Fentanyl that's being made, bootleg Fentanyl from China that is coming in at a cheaper price and is being used to cut the heroin.

FISHERWhat happens is the addict knows about how much heroin they normally take. They take that usual dose, but they don't know that there's Fentanyl in it, which is many times more powerful, and so it's as if they're taking many times their ordinary dose, they overdose, and they often die. And so Fentanyl is an enormous problem. We're seeing it all across the country. It does not appear to be being used by the Dominican and Mexican gangs that are bringing the heroin into the country. It's being introduced at a much lower level along the distribution chain.

ROBERTSThank you, Marc Fisher from the Washington Post. Let me turn to more of our callers and Carolyn in Central Pennsylvania, welcome, you're on the Diane Rehm Show, Carolyn.

CAROLYNGood morning, thanks for having me.

ROBERTSPlease go ahead.

CAROLYNWell, I just wanted to relate my experience. You know, I can go through and relate a lot of the parallels between my story and a couple other of your callers. I've been dealing with a heroin addiction for the past decade, and, you know, I've tried multiple treatments. I've been jailed for it. Just now I, you know, was listening to your program on my way back home from my methadone clinic.

CAROLYNAnd it's -- it's really refreshing to hear that, you know, we're discussing this not as demonizing the addicts, you know, how things have been -- historically, addicts have been treated differently for having a disease, a lot differently than, say, if you had diabetes, you would go into treatment for your diabetes, and you don't get shamed for having diabetes. Addiction is also a disease, but it's often not recognized as one.

CAROLYNAnd to be treated, you first have to realize that this is not a moral thing, this is not a shortcoming of your family's upbringing. This is -- this is a disease. And I'm more concerned with, you know, what do we do to solve this problem? You know, there are a lot of different angles you could come at it from, but one of the things I found when I was incarcerated is that first of all, there's -- I mean, it's laughable that they would say that there's any treatment availability in the county-level jails. There is none.

CAROLYNThere was only ever treatment when you get to the state level. And that was actually quite beneficial to me, but my family, there was nothing for my family to use as a resource for them. You know, people talked about, you know, doing a 12-step group for them, but, you know, the families are the ones that are left in -- by the wayside because they don't have the tools to deal with this the way the addicts are given tools to deal with the addiction.

ROBERTSCarolyn, stay on the phone with us, and both Beth Davidson and Dr. Wen are nodding their heads as you were talking. Dr. Wen, your reaction to Carolyn?

WENCarolyn, I completely agree that we have to talk about addiction as a disease, and we have to make treatment on demand. Mayor Rawlings-Blake in Baltimore just convened a task force that release our recommendations about what to do with the heroin epidemic facing our city and facing the country. And one of our key recommendations is that people, including addicts but also their families, have to have treatment at the time that they need it.

WENYou know, I mean, you're a doctor, and in the ER, we often have people coming in asking for detox, asking for treatment, and we tell them, look, there isn't anything available for three weeks or even for months. We would never find that acceptable for any other disease to do so. And I also completely with you about having treatment in our jails. In Baltimore city, eight out of 10 people in our prisons have a substance abuse disorder, and four out of 10 have mental health illness or have mental illness.

WENAnd so it's critical for us to provide treatment for individuals in jail because these are our most vulnerable people, who, if they come out without having that treatment, are going to continue that cycle of incarceration and poverty and violence, and we have to break that cycle and get people the medical help that they really are needing.

ROBERTSCarolyn, do you have a reaction or response?

CAROLYNWell frankly, just to be part of the conversation today is a blessing. I'm grateful to be calling into your show today rather than listening to it on shaky jail radio. I'm so grateful for the opportunity to recover. You know, there's -- it's a bleak existence, and no addict wants to live that way. It's just hard to see a way out. And thank you for not giving up on us.

FISHERSteve?

ROBERTSThank you very much, Carolyn. Yes, Marc?

FISHERYou know, the jail issue is one that paradoxically a lot of addicts, especially in some of the states, we've been reporting in New Jersey, for example, a lot of addicts see jail as their detox center. And when proper medical services are not easily available, not insured, the jail ends up being the place where they can safely go through detox, go through the horrors of withdrawal. And so I've been surprised to see addicts referring to jail as their preferred detox.

FISHERIt obviously is no one's idea of how to -- ideal of how to treat addiction, but it is de facto the treatment center for many people across this country.

ROBERTSI'm Steve Roberts, and you're listening to the Diane Rehm Show. I want to go to one or two more -- one or two more callers if we can, and I'm turning to Nancy here in Sparta, Illinois. Welcome, you're on "The Diane Rehm Show," Nancy.

NANCYHi.

ROBERTSPlease go ahead.

NANCYI've been addict for many years, literally half of my life. I'm 60 years old. I've been in a methadone treatment program for 15 years. I see a counselor regularly. The doctor at my clinic is quite good and overviews our dosages. I also go to -- I have gone for many years to AA. It's a three-prong recovery with that, and without any of the three, I don't think it would be effective. I understand fully that methadone isn't a perfect solution. It's perhaps not even a good solution, but it's the only one that I can find at this point that's effective for me.

NANCYI don't have the cravings. It's made my life livable. Financially I'm able to survive at this point, and I'm not worried about the police coming after me because it's a legal form of treatment for me. I understand fully that I burned my receptors, serotonin (unintelligible) serotonin receptors. I've tried to go cold turkey and it just doesn't work. Long-term, it doesn't work. Even after a year of trying, I still -- an earlier caller mentioned dying years later. It's true, and it's probably the only drug that does that, that once it has you, it has you for a lifetime.

NANCYI appreciate the program and focus on the issue. It's a long time coming and very necessary. Thank you.

ROBERTSStay on the line for a minute. Beth, your reaction?

KANE-DAVIDSONMy reaction is thank you for mentioning the three prongs because what she talked about was a medication, counseling and a doctor that was supervising, and I hope Sue, who called in earlier, that has a son that is on methadone, heard that as well because it's a very critical point to have a combination of several different things that are supporting that person.

ROBERTSNancy, thank you very much for sharing your story with us. We very much appreciate it.

NANCYNot to interrupt, but I would say also that AA or NA is also ultimately important in that it's free. People talk about I can't afford treatment, they can afford treatment. AA costs nothing but getting yourself to a meeting, and in my experience it's been the best form of treatment available. It's just addicts helping each other or alcoholics, depending on whatever your problem is. But in the -- in the final analysis, the person that's going to help me is me. I can do and go to all the treatment I want to, if I'm not ready to quit, I'm not going to quit. Thank you.

ROBERTSNancy, one final question. Why have you found these meetings and NA and AA so helpful?

NANCYI believe because it's other people with the same issues helping each other, and no one understands addicts or an alcoholic like another addict or alcoholic.

KANE-DAVIDSONAnd I would just...

ROBERTSThank you so much, Nancy.

KANE-DAVIDSONI would just like to echo, you know, self-help meetings provide tremendous support for people in recovery.

ROBERTSThat's Beth Kane-Davidson. She's director of addiction treatment at Suburban Hospital. Also with me this morning, Dr. Leana Wen, Baltimore City's health commissioner, Jay Perry, Sergeant Jay Perry of the Virginia State Police, and Marc Fisher of the Washington Post. I'm Steve Roberts, sitting in today for Diane Rehm. Thanks so much for spending an hour of your morning with us.