The Secretary of HHS Alex Azar joined me this morning:
HH: So pleased to welcome to the program for the first time the Secretary of Health and Human Services, Alex Azar. Secretary Azar, welcome, it’s good to have you.
AA: Hugh, it’s great to be with you. Thanks for having me.
HH: Now we’ve never met. We have so many friends in common, but I want people to know that you are a Luttig-Scalia clerk. That just says to me smart, smart, smart. Mike’s been a friend since 1983. And I did some work for Justice Scalia when he was Judge Scalia on the D.C. Circuit. So you’ve had two bosses in Scalia and Donald Trump, who could not be more different. Do they have anything in common?
AA: They absolutely do. They both have courage. That would be what I would define. Now Justice Scalia was a man of such towering intellectual courage. And the President, in my work with him, he just is bold, he’s courageous. He is not afraid to grab onto issues that so many other politicians just run from or play incrementalism on. And that’s what’s exciting working for him.
HH: Now you’re driving, you’re going up to New Hampshire with him today. Are you going to be spending time with the President?
AA: I will be, yes. We’re traveling up to New Hampshire today. He’s going to be speaking at the Manchester Community College for an important event where he lays out a status report on where we stand on this just devastating opioid crisis, and laying out a very bold agenda for the future there.
HH: All right. Now I want to talk to you about that in a second, but I have a request.
HH: The President doesn’t call me, so you can ask him to call me about this, but, or you could lobby him. We have 138 judicial vacancies. He’s got to get, and Don McGahn’s doing a great job helping him, as is Leonard Leo, as is General Sessions, getting nominees. But we ought to have 138 nominees. We’re going too slow, Mr. Secretary.
AA: Well, I’m out of the judicial nominee world, but I will certainly press on that. And I also want to thank Leader McConnell for his efforts to just be pushing through these important nominees for these lifetime appointments.
HH: He does. He has the best record going, but we haven’t had one 9th Circuit judge, and we’ve got five California district court judges, because Dianne Feinstein won’t approve anyone. And I want the President to have the courage to say screw those rules. Those are not in the Constitution. You know that. You’re an originalist, right?
AA: I would call myself in the Scalia language a textualist.
HH: Well, the textualist says the Senate has the right to consent, not the senator from the state has a right to veto. Okay, last thing on other than opioid sort of situations. How much time are you spending with the President? And what’s his decision style like?
AA: So I’m actually, I’ve been delighted by the amount of time and interaction I have with the President. I mean, in fact, just this weekend, I spent several hours on the phone with him on a whole host of issues. He is accessible, he is engaged, he is knowledgeable. I have been just delighted by the ability that I have to interact directly with him, to get his feedback, his input, his direction on how he wants me to be doing this job and how he wants this department to function.
HH: All right. Now let’s talk about the opioid crisis, and I like to talk about three crises – the fentanyl crisis, the heroin crisis and the prescription drug crisis. And I think it is hurting us to confuse the three. What percentage of deaths do you attribute to each of those categories, Mr. Secretary?
AA: So I don’t, and I don’t want to speculate about percent of deaths. The large number of deaths that we’re seeing, and it again depends on the state, because we’ve seen some states are more impacted by the illegal black tar heroin use, and other states have been more fentanyl use. So for instance, I believe the vast majority of deaths in New Hampshire, where we’re traveling today, have been fentanyl or fentanyl analog-related. We don’t see so many deaths from the legal prescription opioids, but what we see is that’s the gateway that the vast, vast majority of individuals who become addicted to opioids start just not intending to become addicts. They go in for a knee injury or a hip or wisdom teeth, and they are overprescribed these legal prescription opioids, and they get addicted. And then they begin this transition where the doctors eventually, or the pharmacies eventually cut them off. They move to, then, street versions of those legal opioids, perhaps. Or they transition directly into heroin or into fentanyl. And it’s that pathway. That’s why we try to be very clear that this addiction is not a moral failing by these individuals. It is a medical condition that we’ve got to help them deal with.
HH: Now I understand completely some of the state laws that have been aimed at restriction opioid prescription at the beginning. But what you just said, they cut them off, because they do not want to be exposed to third party lawsuits, which are happening all across the United States, and they’re a very bad thing, because they’re going to cause people not to get opioids. They’re going to right to fentanyl. So I don’t think we’ve got the right solution here in terms of encouraging the rapid cut off of opioids.
AA: Well, one thing, Hugh, that we’ve got to do for those individuals that become addicted to the legal opioids and then become drug seekers, I think the point you make there is a very good one, that we have to make sure that those same prescribers that they go back to seeking repeat prescriptions from are better trained and able to identify the fact that they are dealing with somebody who’s addicted, and then work to connect those individuals into treatment rather than just cold cutting them off without any kind of, without any type of recognition that they are dealing with someone who has gotten addicted possibly through that physician’s own prescribing behavior even, get them into treatment. Don’t just send them on their merry way.
HH: And I also know that some of the treaters of chronic pain just switch prescriptions in order to avoid showing up on databases, and that’s no good. We don’t want people on morphine. We want, I am just, I’m thinking we are doing this all wrong on the prescriber side before we come to fentanyl, and that a lot of it is reflexive, Mr. Secretary.
AA: And that’s one of the important aspects of the President’s program, is through the CDC and NIH. We research the best pathways for the treatment of pain, that we give the best advice to our providers, to give them a helping hand how to do this the best way, how to recognize the addiction, develop through NIH and our private public partnerships non-opioid ways of taking care of pain. Make sure people are aware that you don’t have to go necessarily to an opioid. That may not be the right choice for all forms of pain. We’ve seen studies recently that seem to suggest that the basis, some basic over the counter analgesics can have as good of an impact on many people as going all the way to an opioid. We’ve got to rethink how we do pain management in this country.
HH: I agree with that. Now let’s talk about rethinking dope. And I don’t want you to get into trouble with all the normal people, but the more that we legalize marijuana, and it’s not legal. It’s illegal. But the more we pretend that states have the right to ignore schedule 1 drug restrictions, the more people are getting high on very powerful stuff. And I lived in Colorado. I spent time in California. The District of Columbia reeks of dope. This is not, will anyone have the courage to stand up and say these are not unconnected phenomena?
AA: So I can’t speak to the connection, but I can speak to marijuana. And as you have rightly said, marijuana remains illegal as a matter of, the use of marijuana, botanical marijuana, remains illegal as a matter of federal law. It’s important for us to keep emphasizing the health risks of marijuana. You know, smoking marijuana is not a risk-free, cost-free venture, especially for our youth. It’s incredibly dangerous. You can see a permanent IQ decline from repeated marijuana use among our teenagers. I think 1 in 17 of our teenagers in high school are now using marijuana on an almost daily basis. There is more marijuana use in our high schools now than tobacco. This is a real public health problem for us. This is not safe. This is not effective. It is quite dangerous, especially to our children.
HH: I’m just curious, were you a Scalia clerk when he wrote in the case having to do with the right of the Interstate Commerce Clause to support the criminalization of marijuana?
AA: I was not there that year.
HH: Okay, just checking. What was your famous case? What was your Scalia year case? And I teach Con Law, so I like to know with whom I’m speaking. What was rocking the Court when you were there?
AA: I had a terribly boring year, because we were the year after the Casey decision on abortion, Lee V. Weisman on religious liberties, and several others. And I think the justices basically took a collective sigh and decided that they were going to just hear really boring tax and ARISA cases and interstate water rights cases.
AA: Yeah, so I had an amazing experience at the Court, but we didn’t exactly have all the sexy, glamorous decisions that year. They were in a collective pause.
HH: Oh, a second message to give to the President on my behalf if you’re talking to him today. If General Sessions retires, I love Scott Pruitt. I also love Mike Luttig. Wouldn’t Luttig make a great Attorney General?
AA: Well, Mike Luttig would make a great leader in any position. It was such an honor for me to be actually at his first year of clerking for Judge Luttig.
HH: Oh, really?
AA: I was his first group of clerks.
HH: I think, I think if they needed to replace Mr. Sessions, Mike Luttig would be a guy they could not not confirm, given that he was a runner-up to be the Chief Justice of the United States. Back to the President and drugs, he tweets about a lot of things. He doesn’t tweet much about this. Would you encourage him to do so, because I actually think there’s a little Nancy Reagan thing to be going on here, which is just say no. People don’t understand. Young people especially don’t understand fentanyl will kill you.
AA: You know, Hugh, then the President actually agrees with you on that, and that’s why he’s been adamant. And one of the key legs of our program that he’s announcing, that the President is announcing today is to launch a nationwide, evidence-based, multimedia, full throttle campaign against, to increase public awareness about the dangers of prescription and illicit opioid use as well as other drug use, such as marijuana.
HH: What about the U.S. mails? And I’ve talked to General Sessions about this, and he was on talking about opioids. Until and unless we can stop Mexican and Chinese deliveries of fentanyl and other illicit substances through U.S. mail, we’re fighting a battle we cannot win. We’re being flooded.
AA: You’re right, and that’s the second part of the, so the President’s got a three-part agenda he’s laying out today. The first is to get, prevent people from getting addicted to these legal opioids. The second, as you just talked about, is cutting off the supply of illicit drugs. And that involves the mails, for instance. So we’ve got to secure our borders, our ports of entry, or waterways, against illegal smuggling. And part of that is we need to require advance electronic data for over 90% of all of our international mail shipments that have goods in them so that we can flag those high-risk shipments, and so that inspectors from my agency and others can triage and target those shipments.
HH: All right, two quick questions. I hope that Ann Agnew and Christina Pelekoutas had you well-prepared today?
HH: They’re my old pals.
AA: I’m very lucky to have, to be able to work with them.
HH: They’re my old pals. And then just ask the President to call me about judges. That’s all I’m asking. I need to lobby him, because we’ve got to pick up the pace here, Secretary Azar. We’ve just got to get going on this, and you are the guy. As a Luttig-Scalia clerk, you can talk judges with him, and he won’t see that coming.
AA: The Attorney General and the White House Counsel may get a little bothered by the Secretary of HHS talking about judges…
HH: Take your chances.
AA: But I’ll be happy, I’ll ask him to call you.
HH: Yeah, have him call me. Take your chances. Thank you so much, Mr. Secretary. Good luck today. It’s an important message. Fentanyl will kill you, America.
End of interview.