(ominous music) - [Narrator] America is in the midst of an opioid drug epidemic.

Driven by escalating opioid addiction, drug overdoses are now the leading cause of death among Americans under 50.

- People are literally dying in the street.

They're dying in their parents' homes.

- [Narrator] According to the Centers for Disease Control, the opioid epidemic is fueled by prescription pain medications.

Michael Israel dreamed of becoming an architect.

In high school he participated in a video project exploring the architecture of his home town of Buffalo.

- These buildings have been here for such a long time.

- [Narrator] Michael didn't realize his dream.

Despondent over an addiction to prescription opioids, he took his own life at the age of 20.

- When Michael said I'm addicted, it was a big surprise.

The next question that came out of my mouth was, "To what, Mike?"

And he said his pain pills.

- The medical community has been overprescribing opioids, that's really the reason we're in the midst of a severe epidemic of opioid addiction.

- The doctor did prescribe the hydrocodone for your knee pain.

It's very important that you only take it as needed.

- I think some physicians don't appreciate how potent these drugs are, and don't necessarily appreciate how many problems they can create.

How did the pain killers work out for you, originally?

- Started okay.

Then I couldn't get enough.

- West Virginia has been ravaged by a flood of opioids.

- The epidemic we have in Ohio is fueled primarily by the pain med problem.

- [Narrator] The opioid epidemic has spiraled, as many addicted to prescription pain pills turn to cheaper and more available street drugs, like heroin and Fentanyl.

- So Cameron was my son.

He was wrestling and he broke his collarbone.

So he was prescribed Percocet.

I never in a million years thought my boy would be a heroin addict.

- There's a lot of blame to go around; patient demand, pharmaceutical companies, doctors that are easy with a prescription pad, health insurance came in that would pay for all this stuff.

- I can't imagine anything else that would happen in our community that would be associated with that many deaths.

I don't know where the outrage is.

- It's very hard to get over this image every day and every night of your kid taking his last breath.

- Michael was the child that could put the smile on your face, always.

When Michael passed away, we just started questioning, how did this happen and why did it happen?

- How did Michael get addicted?

What happened to Michael?

And then you find out we were all ignorant when it comes to addiction.

We don't know very much about addiction, because we never thought that it would happen to us.

- [Narrator] According to the Centers for Disease Control and Prevention, the number of drug overdose deaths in America has never been higher.

The majority of deaths involve opioids, including popular prescription painkillers like oxycodone and hydrocodone.

- The problem's huge.

The rate of death from prescription opiates has been exponentially growing, and that's only the tip of the iceberg in terms of how many people's lives are wrecked because of prescription opiates.

It's a huge problem.

- The most surprising element of this is how it's the legal, prescribed painkillers that get people hooked.

Our young people see prescription medications as something safe and effective; a doctor has given it, a pharmacy has filled it, so they feel okay about it.

- Michael was getting everything from our family doctor and two other doctors.

We didn't know that that was all addicting.

- He was taken his pills as prescribed.

- He was taking his pills as prescribed.

- People trust their doctor, and they think that the doctor is prescribing things appropriately and monitoring them appropriately, and they think that if the bottle says take it in such and such a way that it's perfectly okay to do that.

(phone ringing) Hello?

- [Narrator] Dr. Richard Blondell is Professor and Vice Chair for Addictions at the University of Buffalo and director of the National Center for Physician Training in Addiction Medicine.

- How did the pain killers work out for you originally?

- Started okay.

Then I couldn't get enough.

- That happens.

- Wanted more and more and more.

You keep taking more because you think more is gonna be better.

- And the more you take ... - The worse you get.

- The worse you get.

- And the more you want.

- The more you want.

I think the majority of the time it's just that doctors are trying to do a good job and fall into a trap and end up contributing to the problem.

Now, was that bothering you when you first got on painkillers?

- We've overexposed the U.S. population to prescription opioids.

- [Narrator] Dr. Andrew Kolodny is Director of Opioid Policy Research at Brandeis University and founder of Physicians for Responsible Opioid Prescribing.

- I think that the biggest problem has been well-meaning doctors who are intending to help patients with pain but who are underestimating how addictive these drugs are, and overestimating how helpful they can be when prescribed longterm.

- That's enough for 15 days.

- [Narrator] The opioid epidemic is the unintended consequence of the increased use and acceptance of prescription opioids.

It is made worse because many who'll become addicted to prescription pain pills eventually turn to cheaper and more available street drugs like heroin and Fentanyl.

- Before they're using heroin they're opioid addicted, and that addiction develops through prescription opioids.

The reason that we're experiencing record high levels of overdose deaths, the reason we're seeing heroin and Fentanyl flood into non-urban areas, the reason we're seeing soaring rates of infants born opioid-dependent or outbreaks of injection-related infectious diseases, the driver behind all of these problems is the increased prevalence of opioid addiction in the United States.

- [Narrator] Used properly, prescription opioids ease short-term pain from surgery or a broken bone.

They also manage severe pain for cancer and end-of-life patients.

But the amount of opioids prescribed in America greatly exceeds what is required for those uses.

- When Michael passed away, Avi was angry.

He was angry that it happened and it shouldn't have happened.

- There you go.

- Avi wanted a dog so badly.

And I said, "There's no way I can allow us "to have a dog, because Michael kept asking for a dog."

- We knew that Michael was in pain a lot.

And towards the end of his life, he really suffered.

- We were really terribly lonely.

So I finally gave in and, much to my surprise, this dog has given us such joy.

- Death changes you.

It completely does.

And you want to know, why did Michael have to die?

- [Narrator] At the age of 12, Michael was diagnose with Crohn's disease, a painful gastro-intestinal condition.

As he got older, doctors prescribed powerful opioid medications to treat his pain.

After Michael's death, his parents obtained pharmacy records that showed Michael was prescribed 185 pain pills over a one month period.

- I just couldn't believe that the doctors did this to him.

It's indefensible that they did this to an 18-year-old young man.

Changed him chemically forever.

- This thing takes a beautiful person and turns him into a monster.

That's my beautiful little baby.

You know, what happened to you?

You know, what's going on?

And you don't understand what's going on.

- The reason that the United States is in the midst of a severe epidemic of opioid addiction is because the medical community began to prescribe opioids very aggressively, and as the prescriptions went up, rates of addiction and overdose deaths went up right along with the increase in the prescribing.

- [Narrator] More than 240 million prescriptions are written each year for opioid pain medications, enough for every adult American to have their own bottle.

OxyContin, Opana, and Vicodin are among the most frequently prescribed and most commonly abused prescription opioids.

These powerful drugs can literally hijack the brain.

- The effects produced in the brain by oxycodone and hydrocodone are indistinguishable from the effects produced by heroin.

When we talk about opioid pain medicines, we're essentially talking about heroin pills.

- It is a very powerful drug.

It's a different addiction.

The course for opiate addiction is you fall of a cliff.

So there's no gentle slope downward with consequences and an opportunity to evaluate what's going on.

It is right off the cliff.

- With repeated exposure to a highly addictive drug, just about anybody can become addicted.

- We're acutely aware of the fact that it's broad and it's not just one subset of the population doing it.

It's kind of a problem that's affecting all age groups, all races, both sexes.

That allows it to become bigger, because it affects so many people.

- [Narrator] Unlike previous drug crises in the United States, the opioid epidemic impacts rural, city and suburban communities, and touches every socioeconomic group.

Opioid addiction is a 50-state epidemic.

- Wyoming County is a rural county, population approximately 23,000.

Very tight-knit, hardworking-type communities here.

The mountains are beautiful here.

I mean, the people are genuine and good people.

- Oceana is a close-knit community.

There's still good here.

But through the years it's progressively gotten worse, and it is getting worse.

- [Narrator] West Virginia has been hard-hit by opioid addiction.

It has one of the highest opioid prescription rates in the country, and has one of the highest rates of opioid overdoses and deaths.

- The majority of our kids are affected by drugs in their immediate family.

- [Teacher] Good morning!

- Good morning.

- In our career education class we've talked about what do you want to be when you grow up.

- We know that we have to meet their basic needs before they'll ever reach out to English or math.

We're gonna talk to each other, kinda be a sounding board.

What does this career really consist of?

- Primarily, we focus on keeping and making our kids feel safe.

And learning does take second to that.

If they don't feel safe, how can we expect them to learn?

(applause) - First of all, let me thank you so much for allowing me to come back to beautiful Oceana.

- [Narrator] Senator Joe Manchin visited Oceana Middle School in 2011 as a newly-elected Senator.

He came to talk about education and jobs, but the middle school students had other things on their mind.

- So when I came down five years ago, that's what we were talking about, about the jobs opportunities.

And then there were some students that wanted to talk to me.

They wanted to share the life that they were challenged with, living in an area that become truly overrun by drugs.

- [Narrator] Chelsea was a seventh grader when she met with Senator Manchin in 2011.

- He came to our small community.

And the conversation led to the problem with drugs in our community.

Oceana is a wonderful town, wonderful people, great place to live, but then there is the drug problem.

My mom and dad were divorced when I was in the sixth grade, and it was because of drugs.

My dad was in a coal mining accident.

He soon after became addicted to painkillers.

He started putting those medicines before us.

- [Narrator] Chelsea was in the audience when Senator Manchin returned to Oceana Middle School in 2016.

The Senator was hoping to hear more encouraging stories from a new group of middle school students.

He didn't.

- I think that what is wrong with our community, like the drugs in it, I haven't really seen a change, because I don't know how it was like before, but my parents and my grandma and my aunt used to talk how it would be safe at night and you could ... - Do whatever you want.

- You could walk the streets and you wouldn't have to lock your doors and have a doubt about anyone.

And now, everything is dangerous and you don't want to go outside alone even in the daytime.

- It's still that way here?

You're still seeing that?

- Yes.

- My stepdad did them.

He beat me an my mom.

Put a gun to my head, mom and me.

- What he want you all to do?

He wanted you to take drugs too, or he wanted your mom to take drugs, or he was just out of control?

- He wanted my mom to take drugs.

She wouldn't do it.

- Is he gone now, is he out of your life?

- He ... shot himself ... 'cause of it after he killed my mom by shooting her up three times with OxyContin.

He didn't want a divorce; she did.

- How old was your mom?

- 20.

I was five.

- But to have a child tell you that, "My mother ... "was shot with a needle with oxycodone "and the first shot killed her, "but the guy shot her two more times "to make sure she was dead," for a little 12-year-old girl to tell you that, now think about it.

You've seen the horrific effects it's had on your families.

You've seen death in your family at a very young age.

No child should go through what you went through.

- You know, this is life.

This is how it is.

Many kids don't know anything differently.

They don't know that ... another world exists.

To them, this is normal.

- I took away from that conversation just as another day.

I live that day in, day out from a lot of the cases that we have here.

Very sad stories, and I've heard just some horrendous stories over the years from this part of the state.

- You heard their stories.

They were worse than ours were from five years ago.

My story, it's sad.

But their stories were devastating.

Like it was ...

It was very upsetting to hear those.

It's unbelievable that it's just getting worse.

- Every day we battle this, the effects of the drugs.

We battle the addictions right here in school.

They're precious kids, and they all have special qualities.

We need to save their lives, we need to.

- I would just tell them that they have their future.

And I don't want to ever have to go through that with myself or my family that I will have in years to come.

We don't want this for our children, so maybe ... maybe we're not doomed.

- Children should not have to live like these children have had to live.

They didn't ask for it.

- [Narrator] Teacher Debra Davis fights the opioid epidemic at school and in the community.

- We are a faith-based organization.

We're a non-profit.

And we were established in 2005 because families had nowhere to go.

So how was your group of students?

- They did really good.

- So we started helping mothers and wives and children.

And wasn't long till we learned it was the community's problem.

I focus on what happens if I don't do anything.

For the longest time no one would take about anything.

It was hidden, therefore it continued to get worse.

So now everybody's talking about it.

Hopefully we can stop talking about problems and start focusing on solutions.

- [Narrator] The crisis of opioid addiction is a relatively new problem in America.

Prior to the mid-'90s, the use of opioids to treat pain was limited.

Two factors triggered the dramatic increase in prescribing opioids to treat pain: pharmaceutical companies began telling physicians that opioid pain relievers were safe, effective and non-addictive; around the same time, doctors were being pressured to treat pain more aggressively.

- There came out some new recommendation from professional medical organizations that pain is really supposed to be the fifth vital sign.

- In addition to your blood pressure and your pulse and your temperature, we'll also gonna ask you, "On a scale of one to 10, how's your pain today?"

And if your pain's a five or greater, then the physician feels a mandate to medicate that.

- The medical community begins to hear that we've been allowing patients to suffer needlessly because of an overblown fear of addiction, that the compassionate way to treat just about any complaint of pain is with an opioid.

- So there was a perfect storm of public demand for the treatment of pain, and the pharmaceutical industry right there creating a whole new generation of powerful drugs.

- [Narrator] Pain is the number one reason people visit a doctor.

Pain can be a challenging ailment for doctors to diagnose and treat.

But now doctors were being told they had a new way to treat pain that was safe and effective.

- Don't be afraid to take what they give you.

Often, it will be an opioid medication.

- [Narrator] In the 1990s, new opioid medications were introduced to treat pain.

Much of the information about these new drugs came from pharmaceutical companies.

- Some patients may be afraid of taking opioids because they're perceived as too strong or addictive.

But that is far from actual fact.

- The reason that the medical community started to prescribe so aggressively is that, in many ways, we were responding to a brilliant marketing campaign.

It was in 1996 that Purdue Pharma introduced OxyContin.

It launched a campaign to encourage the medical community to prescribe opioids for common chronic conditions.

- [Narrator] The marketing effort included paid trips for doctors to workshops on pain treatment, and visits from drug reps who often oversold the benefits and understated the risks of prescribing opioids to treat pain.

While OxyContin was the most successful of the new prescription drugs, other companies were producing pain killers and engaging in similar marketing activities.

The aggressive marketing increased the use of prescription painkillers to treat common types of pain, from toothaches and migraines to sports industries and back pain.

We start to hear that we shouldn't worry about patients getting dependent on the drug, that you can taper people off easily, and that this is the safe and effective way to help people with chronic pain.

What they were teaching was certainly wrong.

- I would describe that as one of the factors that contributed to the current crisis, and that never should have happened.

It's unfortunate that it did.

- [Narrator] Anne Pritchett is Vice President for Policy and Research at PhRMA, and organization representing pharmaceutical companies in the United States.

She previously served in the White House drug policy office.

- It's very challenging to look back at the history, and I don't think that anyone involved could have anticipated that we would be facing the crisis we face today.

Do I think that, if there's inappropriate prescribing and over promotion and that's for profit, that that needs to be addressed?

Yes.

Do I think that there was inappropriate behavior that contributed to the problem we're in?

Yes.

But do I think that that's the sole reason why we face the opioid crisis we do today?

I don't.

- The way that you can do well financially, the way that you can have a blockbuster drug, is if you can get the medical community to prescribe your medicine for common conditions, longterm conditions.

And if it's a drug that's very difficult to discontinue using, well then you've got a pretty good recipe for a blockbuster.

- [Narrator] As problems with opioid medications emerged, pharmaceutical companies faced increased scrutiny.

In 2007, Purdue Pharma paid $634 million to settle charges that it misled the public about the risk of addiction.

In 2017, several states filed suit against a handful of pharmaceutical companies, accusing them of conducting marketing campaigns that misled doctors and patients.

Despite the concerns, opioids remain one of the most prescribed drugs in the United States.

- My issue is: why is there all this surplus product?

I don't know why pharmaceutical companies are not held accountable to that.

If there's only this much pain demand but this much product, then obviously you know your product's being used for other purposes.

- [Narrator] Since 1999, sales of prescription painkillers in the United States have quadrupled.

During that same period, the Centers for Disease Control says there was no change in the amount of pain reported by Americans.

There are enough opioid pain pills prescribed in one year to medicate every adult American for a month.

- So, clearly, we have a disconnect here.

We have a situation where there's overprescribing, because it doesn't seem reasonable to think that, for every American, there should be a 30-day supply of a prescription opioid.

But how do we address that and still ensure that those with legitimate need are receiving access?

I understand and empathize with the incredible pain and suffering that these families are facing.

To blame the pharmaceutical industry as having the sole responsibility I think is misguided and wrong.

I don't think that any one factor has led us to the current opioid crisis.

It didn't happen overnight.

It's not going to be solved overnight.

- And the more you open up this Pandora's box, you find a broken system in this country, where there's parts scattered everywhere, and there's people who need help, and they're broken, and they can't get the help because our healthcare system is based on making money.

- That's always an issue, about who pays for anything.

We live in a capitalistic society, and our healthcare system is funded through payments, usually fee for service.

So there's always a discussion about who pays for what, and when.

- [Narrator] The Department of Health and Human Services estimates the economic impact of the opioid epidemic at $75 billion a year.

Much of that cost is borne by insurance providers, including government insurance programs such as Medicaid, Medicare, and veterans programs, and by private health insurers.

Public and private insurers confront both ends of the opioid epidemic, paying for prescription drugs for pain patients, and then paying for treatment when patients become addicted.

- And we were extremely troubled by all the headlines that everyone has seen about the explosion of opioid abuse in this country.

And we were mindful of the fact that often this starts out with prescription drugs.

- [Narrator] Dr. Harold Paz is Chief Medical Officer for Aetna.

He has an extensive career as a physician and healthcare administrator.

- Because of the addictive properties to these drugs and the fact that they're very effective at eliminating pain, the pendulum swung way out, but at a tremendous cost and in tragic ways.

We have to bring it back to the middle.

When a physician writes a prescription for a narcotic, we depend on the physician to make the appropriate decisions around does the patient need a narcotic.

So our role is not to sit in the room with the doctor and second guess those decisions.

But what we can do is look at the overarching patterns that exist.

- [Narrator] Health insurers collect information about the prescribing patterns of doctors.

Aetna initiated a program to contact physicians about their opioid prescribing.

- We really wanted to focus on physicians that are writing a lot of prescriptions for opioids.

We started with the top one percent, and we said to the doctors, "Based on this data, "based on the CDC recommendations, "you are an opioid super-prescriber."

- [Narrator] Along with the letter, Aetna provided a checklist for doctors to use when prescribing opioids.

But some question whether letters are enough to address the problem.

- We expect that our physicians are gonna be well-trained, they're gonna practice appropriately and professionally and ethically, and if they aren't, we have in our communities and in our states the mechanisms to identify that and make sure that those problems are corrected.

- Patients and prescribers really need to understand that opioids are highly addictive.

It doesn't mean that they should never prescribe it or that the patient should never take it.

It means we have to be very careful with these drugs.

We have to avoid using them when we can.

And for many types of pain we can avoid opioids.

We have alternative treatments.

- I'm treating the tissue in your neck and around your head.

It helps relax this area, help with pain too, okay?

- [Narrator] In 2016, the Centers for Disease Control created the first national guidelines for prescribing opioids for chronic pain.

A key recommendation encouraged doctors to use non-opioid approaches to treat most pain.

But changing doctor and patient reliance on prescription painkillers is challenging.

- I have a solution that will make this whole problem go away.

- [Narrator] Dr. Daniel Alfred is Professor of Medicine at the Boston University School of Medicine, where he directs an opioid prescribing education program.

- The solution is: if the insurance industry would pay for comprehensive pain management services - under one roof you can get massage therapy, cognitive immunotherapy, acupuncture, medication management, you name it.

I want patients to start demanding multimodal comprehensive treatment.

I want them to say to their doc, "I need something better."

And they should be calling up their insurers and saying, "Why don't I have access "to all these other treatment modalities?"

- Of course we need to continue to find more effective ways to treat pain.

And we certainly support every physician that wants to provide an alternative to narcotics.

Our problem is with other therapies, alternative therapies that are not clinically proven.

Until they are, we're not gonna cover it, because we don't have a basis upon which to say it makes sense to cover it.

What we have to look for are clinical studies that prove efficacy.

- [Narrator] Some alternative treatments are covered by insurance, but coverage varies from company to company, and state to state.

Insurers face pressure to pay for pain medications but are also challenged to control over-prescribing.

- The truth is most insurance companies will pay for physical therapy and some of these alternative treatments.

But the easiest thing for a primary care doctor to do is write a prescription.

If I've got 10 minutes to spend with you and you're complaining of pain, writing the prescription can be the ticket to getting you out of the office quickly so I can see my next patient.

- [Physical Therapist] Squeeze the shoulder blades together and reach the elbows back.

- It's a whole lot easier for me to prescribe a medication than it is for me to get a patient into physical therapy, into acupuncture, into cognitive behavioral therapy and all the other treatments that have been shown to be effective in treating chronic pain.

We still have a long way to go.

- [Physical Therapist] Does that feel okay?

- [Narrator] It is a daunting task to get doctors and patients to turn away from prescription drugs as the first step for treating pain.

- What's important is that 100 million Americans are suffering from chronic pain.

So we really need to screen patients better for addiction, decrease the amount of opiates that we're prescribing, and find non-pharmacological approaches to take care of our patients with chronic pain.

- [Narrator] At the University of New Mexico Pain Center, an interdisciplinary team works to manage pain, improve quality of life, and reduce use of prescription opioids.

- When you integrate care, right, when you provide as many things as you can under one roof, the outcomes are better.

- This interdisciplinary approach really offers that patient a co-located home where they can go and receive services all at once.

It also allows the clinicians to be able to talk all together about that patient.

If I can see a patient for the first time and I can tell them that their pain is real, I believe their story, they're being heard, and we have a team.

I'd love to hear about your pain story.

Would you tell me how you developed chronic pain?

- I had a lot of pain when I was working.

I was a veterinary technician, and I worked in a clinic at a zoo.

I've had pain for a really, really long time.

I'm almost 70 now, and I've been retired for about a year.

- It's very important to realize that there is an older group that's become opioid addicted as well.

These are people in their 40s, 50s, 60s, 70s and 80s.

The older group is developing their opioid addiction almost entirely through medical use, usually opioids prescribed for a chronic pain problem.

- I wanted to continue taking the opioids because they were the only thing that helped.

- [Narrator] The goal of the interdisciplinary team is to reduce reliance on opioid medications.

- [Patient] Dr. Dole has been really helpful in that respect, because he changes the medication.

- He changes it from one type of opioid to a different type?

- [Patient] Yes.

And in doing that, I'm able to take less than I was, overall.

- It's that communication that's ultimately gonna lead to better patient outcomes.

And I think that's what we're doing, which is so heartening.

- [Narrator] The interdisciplinary approach to pain management is fairly new and is more expensive than traditional pain management.

- It takes money.

We don't get reimbursed for some of our services, but I really do think that we have shown that we have a really good return on investment, and that patients are happier because they feel like they're being seen by a whole team and they don't really need just that one opiate.

I'll make that appointment for you.

How does that sound?

- [Patient] That sounds wonderful.

- [Dr. Katzman] I think you're doing great, Susan.

- Every time I or one of my colleagues writes a story on the opioid epidemic, we get responses from families, fathers, mothers who have buried children a week earlier, and they want to sit down and talk with us.

And sadly, it's the same story, it's the same tragic set of circumstance except for the names and faces.

There's just no end to these stories.

- In my job, you deal with a lot of people who suffer losses, and they're people who lose a loved one and they cannot move on.

There are people who lose a loved one and they turn around and say, "What can I do?"

That's what Jennifer was doing.

- So Cameron was my son.

He passed away five years ago of a heroin overdose.

I never in a million years thought that my boy would be a heroin addict.

- So like I said before, and I'll say it again, I love life, I love all of its fights.

- [Narrator] Cameron was a student and athlete at one of the top high schools in Albuquerque, New Mexico.

- He was wrestling and he broke his collarbone, and he had to have surgery, so he was prescribed Percocet.

He was injured about three months later, again, in a football injury and broke his other collarbone.

And he didn't require surgery the second time, but they gave him more painkillers the second time.

You're given 30 pills by a doctor and you think that they need to take all 30 of them, because otherwise why would they give you so many?

Didn't even cross my mind that is was something that was dangerous or addictive or anything like that.

- It's fairly typical.

Kids would get injured, whether they were in wrestling, football, gymnastics, suddenly they're on a road, and it's a fast track, and it doesn't take very long.

- [Narrator] Cameron's road to heroin addiction was paved with prescription painkillers.

Eventually he turned to cheaper and more readily available street drugs.

Nearly half of people who use heroin are first addicted to prescription painkillers.

- That wasn't his goal in life, to get addicted to opiates and then move on to heroin.

I didn't even know that opioids and heroin were related.

- It's not that there are young people out there who are deciding one day that heroin sounds like a fun drug to try.

Before they're using heroin, they're opioid addicted, and that addiction develops through prescription opioids.

The pills are very expensive on the black market.

They switch because it's much less expensive.

We've seen overdose deaths in that group rise very rapidly, because the heroin supply has become more dangerous; it has Fentanyl in it now.

- [Narrator] The migration from prescription pain pills to heroin has changed the demographics of drug addiction in America.

While heroin use has increased in most socioeconomic groups, some of the greatest increases are in demographic groups with historically low rates of heroin use.

- Every person I've ever talked to who ends up a heroin addict, they talk about how, when they were doing pills, they would never do heroin.

They would never put a needle in their arm.

Crossing those thresholds into the next phase, it's literally five minutes, because you go from, "I've never had a needle in my arm," to, "A needle was in my arm," and now we're off and running.

- I was completely shocked.

I quickly found out that drugs don't discriminate; they're everywhere.

- For an addict, like Cameron, what happens is that drug replaces everything.

It replaces your love for your parents.

It replaces your love for your friends, your other family members.

You steal, lie, cheat, do whatever you can to get the money to get your next fix.

That sounds like a cliche, but it's a cliche because it's true.

That's what happens.

- Since my son passed away, my life has completely changed.

I felt like nothing was the same anymore, and nothing meant as much anymore, and so it was very difficult, and it's still very difficult.

Even though it's been five years, it still feels like it was yesterday.

- [Narrator] As with many parents who lose a child to opioid addiction, Jennifer has devoted her life to helping others.

She started Serenity Mesa, a youth addiction recovery program.

- We do longterm treatment for young men, age 14 to 21, and we provide not only drug treatment and counseling but life skills, high school education, and job placement, job readiness programs, things like that.

And we're able to really dig deep into some of the trauma and some of the underlying issues that may have caused their substance abuse in the first place.

- [Narrator] Helping others deal with addiction has helped Jennifer face her own loss.

- It helps to help other people, and to see all the young men at Serenity Mesa, and the progress that they make, and how well they do.

They're battling to save their life right now.

They don't realize it 'cause they're so young, and that was the issue, I think, with Cameron, is he was just so young he didn't know he was dealing with a life or death situation.

He just thought he could quitewhenever he wanted to and everything would go back to normal.

They say that you learn to live with grief; you don't get over it, it doesn't go away, but you learn to live with it.

But I still think about him all the time.

- It's been said to me that these people aren't bad people trying to be good; they're sick people trying to get better.

- With the opiate population, it's different in the fact that a lot of times they don't see this train coming down the tracks.

It's an injury, it's a surgery, and often times that's where it starts.

- [Doctor] Hey Bill.

- [Bill] How are you?

- [Doctor] Good.

- Nice to see you again.

- Yeah, so it's been, what, two weeks now?

- I was 15 years old and I had a tumor in my spine.

Spent a week in the hospital, and they sent my home with a bunch of medication.

I ended up being addicted to opiates.

I gave up.

I didn't care what happened to me.

It's a pretty horrible feeling when you don't really care if you live or die.

- [Doctor] Okay, so what's up for this week?

What do you have planned?

- My son loves dinosaurs, so I think this weekend we're gonna go to a fossil museum, should be fun, I'm excited.

It's amazing what you think is normal turns out to be this terrible ordeal that I dealt with for the past 15, 16 years.

It takes over your life.

It's sickening to even think of the things that I've done and the people that I've hurt, and just not to even care at the time what was going on.

- I think deep down every addict has a desire to not be living that life anymore.

I think that desire has to be strong enough to want to change to outweigh the draw, the pull from that part of the brain that's been sort of hijacked by the addiction.

- [Narrator] Opioids are one of the toughest addictions to break.

Opioids produce an addictive euphoria that alters the chemistry of the brain.

According to the National Institute on Drug Abuse, treatment programs that focus only on abstinence do not result in longterm recovery.

- The reality is there's no fix, there's no cure for this disease.

There's a lot of work involved in this.

It's not just a quick fix or a miracle cure.

- There's not a magic bullet out here.

We don't have a one-and-out, or come in and we'll save you and you're gonna be all good.

It's a long and difficult road.

- [Narrator] Opioid addiction is a chronic disease, like diabetes or heart disease.

All need to be managed for a lifetime.

Treatment for addiction typically includes some form of individual or group therapy.

- What you become when you're getting high is not who you are.

Who you are is sitting in this chair today, fighting, struggling, with the courage, the faith and the hope that tomorrow could be a better day.

The disease can be arrested.

You can lock it up and lock it up forever.

As long as you don't put that key in the lock and turn it and let it loose, you can be free from the horrors of addiction.

- Things got really rough for me before they ever seemed like they were gonna get better.

- I can remember one time I was working with a family, and the day the young man was to leave our facility, the mother thanked me, she said, "Thank you for curing my son."

And I said, "I'm sorry, there's really no cure.

"This is a daily reprieve contingent upon "what your son is gonna do moving forward."

- It's hard as hell to bring yourself to a program like this, to do something to really change your life and get outside of your comfort zone.

- [Narrator] Treatment must address changes to the brain caused by opioid addiction.

Medication-assisted treatment is a proven effective treatment for individuals with opioid use disorder.

Use of medications helps to ween the brain off opioids and improve outcomes for addicted patients.

- One of the most effective treatments is a medicine called Suboxone or buprenorphine.

It will control people's cravings and it reduces the risk that they're gonna die of an overdose.

- Opioid replacement with buprenorphine is one of those things that, for many people, is a game changer.

- [Narrator] While medication-assisted treatment improves the chances for recovery, there is a lingering issue of why treatment for opioid addiction often fails.

- Oftentimes it's not just one treatment, it's multiple treatments, and that's where, I think, the frustration comes in, where people thing that recovery doesn't work, it's fruitless, it's just not gonna happen; my loved one's been through this three, four, five times.

- Once somebody becomes addicted to opioids, it's a lifelong problem.

They're not gonna get better by checking into a rehab for 30 days or getting detoxed.

The treatment is generally gonna be very long.

- What we need to do is look at addiction as a continuum.

Treatment doesn't end at one year, doesn't end at two years.

I think what we face constantly is families, friends, employers that think that a stint in a rehab for a month means potential success.

But for the most part, people will have lapses.

- [Narrator] Because information about treatment is not well documented, it is hard to know how many people relapse.

But relapse does not mean failure.

- You're going to treatment and it doesn't fix you.

And you're gonna have people who fall off the wagon.

But the things is, is not to condemn the kid; it's to say okay, we need to start all over again.

- We have to prepare people for relapse better, because it is likely; that's what the research tells us, that's what we see on the ground, and families, people, need to be prepared for that.

- Addiction is looked at as you did it to yourself.

It's your problem.

Pick yourself up by your boots, pull your socks up, and go take care of yourself.

It doesn't work like that.

It doesn't work like that at all.

- Is everybody excited about getting going here today?

(cheers) Yeah, all right, let's do this!

One of our most popular classes are cycling, or 'spin', as people know it.

- [Narrator] Treatment goes beyond dealing with the power of the addiction to help patients reconnect to seemingly ordinary activities.

- Pick up your pace a little bit.

It not only helps with your fitness, improve fitness, but it also improves your mood, which will then, they'll feel better about themselves.

They'll have better confidence in themselves, because they are very broken when they first come in to us.

- It's not hopeless, but because it's not an easily resolved problem, they're scared out of their minds.

- It took me to get hope in myself that I could do this before I could even really make any actions toward recovery.

- You walk around here, and you talk to the people that are here, and for this point in time they have a chance.

- [Narrator] The challenge for many is finding access to treatment.

The National Institute on Drug Abuse estimates fewer the 12% of Americans suffering from substance use disorders receive treatment.

For many, the stigma associated with opioid and heroin addiction gets in the way of treatment.

- Well when you talk about addiction, sometimes that triggers responses based on prejudice and ignorance.

So there are some who might think that it's not a medical problem at all, it's just a moral character defect.

- [Social Worker] It's a really important thing to work on yourself and have goals in the end.

- What I don't like about describing this as an abuse problem is I think it puts in people's mind the notion that what we're dealing with is a problem of people behaving badly, taking dangerous drugs because it feels good and they're accidentally killing themselves in the process.

That isn't what's going on.

Once you're addicted, you're not doing it because it's fun or you're choosing the lifestyle.

You're doing it because you have to.

- Those are things that we can use for our recovery.

- You should not be ostracized, and you should not be punished because something happened to you unintentionally or accidentally.

- The families that are grappling with a loved one that is in the throes of addiction, our message, from personal experience, to them is grab your child, hold them tight, and let them know that you're in it together.

It's not just them alone, you're in it together.

Because that child is in for the fight of their life for the rest of their life.

- [Avi] This disease that has been killing thousands of people in the past few years.

- [Narrator] When Avi and Julie Israel lost their son to opioid addiction, they wanted to help other families.

- This is all about awareness to a very horrible, horrible addiction.

- [Narrator] Avi and Julie started Save the Michaels of the World in the hopes of preventing other family tragedies.

- This disease is killing people across the country.

There's no boundaries to it.

There's no class levels.

There's no education levels or any of that stuff.

There's people dying all over.

It should be more of an outrage out there.

People should be out there demanding results.

- I think there's not more outrage because the people that are not affected don't think it's gonna happen to them, which that's a false sense of security because, you know what, you are one car accident, one surgery, one wisdom tooth, one sports injury away from the disease of addiction, 'cause that's how fast it can happen to your family.

- There is a growing outrage; not enough.

Maybe we might've been in a better place right now if there had been more outrage early on.

- And so now we're reaping the consequences of what we have sewn.

And now we're trying to undo some of that stuff.

It's a lot easier to do it than it is to undo it.

- [Narrator] There are small signs of progress in combating the opioid epidemic.

The Centers for Disease Control reports opioid prescribing peaked in 2010, and decreased each year through 2015.

Experts say the drop is a sign the culture of overprescribing is changing.

But fewer prescriptions have not resulted in a drop in opioid addiction and death.

There are no easy solutions to the opioid epidemic.

While treatment is essential, any longterm approach must focus on prevention.

- If we had the right education and people were motivated the right way, they wouldn't get this disease in the first place.

So there's a great amount of hope if we shift our thinking about our approach to this disease and shift more towards prevention and early identification.

- The way you respond to disease epidemics or outbreaks is really by accomplishing two things.

The first thing that you need to do is to prevent new cases of the disease.

You want to contain it, keep new people from getting it.

And the other thing that you need to do is you need to treat the people who have the disease so they don't die from it.

That's really gonna be the only way we can bring down overdose deaths in the short-term.

- I would start with a massive educational campaign, the same kind of educational campaign and awareness that they did for any other new, emerging disease.

- So now we have to start thinking about educating our children better, about educating doctors better, about educating parents better, about educating our public health officials better, about educating our politicians better.

All of those people have to come together to really affect a strategy of prevention.

- I believe that we need to educate at a much younger age then we do now.

But again, because of the disease of denial, many folks are gonna say, "Well, we don't need that in my town.

"We don't need that in my school.

"That's for down the road."

But the problem is 'down the road' is right in your locale.

- We've got to fix this.

And it's gonna take some big time solutions here.

This is not gonna be something where you put up a couple billboards and it's all gonna get better.

People want it all fixed next month: here's the problem, now at five o'clock, solution, film at 11.

It ain't gonna happen.

Everybody has to accept their little piece of responsibility for this and do their part to fix the problem.

As long as everybody's saying, pointing the fingers and blaming somebody else, it's not gonna get done.

- But I think what is beginning to have an impact is increasingly you're seeing families that have been affected by the problem speaking out.

And some of these family survivor advocates are having an impact.

- I think prevention is key; educating the parents, educating the coaches, educating the kids through the school systems.

- How many of you found something interesting?

- If we had prevention programs in all the schools and all the districts from an early age on up, then kids would have the education, parents would have the education, and all the people around them, the coaches - it's a community problem.

Wherever there's a propensity for somebody to get an opiate, whether it's a dentist, a doctor, wherever, the education needs to be there.

- The families that are left behind, who want to tell the stories because they don't want it to be that their child or loved one died in vain.

They want to spare other people the agony of losing a loved one.

And I think that's gonna be the strongest boost to really changing society's attitude.

- In life, as in death, you fight for your children.

It's Michael's spirit ... that drives us.

You don't want the world to forget that there was a kid by the name of Michael Israel that lived here.

He was a good kid.

He was a terrific kid.

And we miss him.

- He has also put us on a path and a journey where we're gonna take it to the end.

There's no turning back now.

- We watched a beautiful boy go from jumping around and everything and being so funny into suffering and numb.

So you fight for him.

And we took him all over to get him help.

And now we're taking Michael all over to get other people help.

When we first started talking about this, we were like a little flickering candle.

And now we have like a flashlight beam.

It's still not daylight out there.

We still got a long way to go.

It's moving in the right direction.

And unfortunately it's taken a lot of death to get this movement, and it's gonna take more death before this stops.

- I see tragedies, for sure, but I also see successes, and that's where the hope comes, 'cause it doesn't have to be like this.

Our society doesn't have to be riddled with addiction.

We don't have to pick up the paper and read about all these kids that overdose everyday.

We don't have to do that, we can do better.

We know how to do this, it's just getting the will to do it.

That's the hard part.

(somber music)