New Meds Block Heroin Craving, But Reporter Finds Treatment Centers Don't Use Them

February 4, 2015

Guest: Jason Cherkis

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross. Police and public health officials in the U.S. have been struggling in recent years with the dramatic rise in heroin addiction and fatal overdoses from the drug. The Centers for Disease Control and Prevention reported that more than 8,000 people died from heroin overdoses in 2013 - a 39 percent increase over the year before. The epidemic has been especially severe in Kentucky, where heroin deaths increased by 550 percent in one year between 2011 and 2012 and have continued to climb steadily. That's where our guest, investigative reporter Jason Cherkis, spent more than a year looking into heroin addiction and treatment. He says there's a growing consensus among medical experts that the most effective treatment for addicts is a combination of counseling and new medications, especially the drug Suboxone, which blocks the craving for heroin. But Cherkis reports most drug treatment facilities rely on an abstinence-based approach, which rejects the use of these new medications. The result, he says, is high rates of failure for addicts trying to get clean and, all too often, fatal overdoses when they relapse. Jason Cherkis is a national investigative reporter for The Huffington Post. His series about heroin addiction and treatment called "Dying To Be Free" was published last week. He spoke with FRESH AIR contributor Dave Davies.

DAVE DAVIES, BYLINE: Jason Cherkis, welcome to FRESH AIR. Give us a sense of how long you worked on this project and how many grieving families you met and spoke to.

JASON CHERKIS: Well, I started the project, I think, in October 2013. I had gotten a tip from a nurse that I had worked with on a couple of stories about Obamacare and Kentucky's implementation of it. And she had said to me, you know, you really need to focus. You really need to do a story on heroin. It's exploding in Lexington and other parts of the state. And so then I started talking to the county coroner for Lexington, and he was so moved by what was going on and didn't know what to do, I think. I think he was sort of at a loss - just the amount of heroin overdoses that were happening in his county. And he sent me the death certificates for all of the overdose victims for that year - for 2013. And I just started working my way through them, reading over them and calling the families. And I did a little bit of interviews with families in Lexington, but most of my work was in northern Kentucky. I chose three counties in Northern Kentucky - Kenton, Boone and Campbell because they seemed to be the most - or the hardest hit counties in Kentucky. And I took the 93 cases that happened in 2013 and I just worked my way through them. And I think all told I talked to about 50 families who had lost loved ones from overdose.

DAVIES: You begin the series with the story of a guy named Patrick Cagey, a young man. Do you want to just tell us a bit about him?

CHERKIS: Well, I first came to understand his story through - obviously through his parents, through interviews with them. And I had reached out to them in, I guess, November of 2013, and I was really taken with his story. He was a young man in his early 20s who had graduated from University of Kentucky. He had worked a really great job as a - helping victims of traumatic brain injury. He was a competitive body builder and a successful high school wrestler who had exhibited an - a really great amount of discipline in his life, just through physical fitness and through wrestling to the point where he would measure his own water intake. And I thought if there's ever a person that had the discipline to stick with a 12-step program, to stick with the - just sort of that sort of absent space, you know, willpower, it would be Patrick Cagey.

DAVIES: Now, he got involved with drugs. I guess he had a knee injury, right, and got on painkillers and that led to heroin.

CHERKIS: Yeah, he had a series of really nasty injuries in high school during his wrestling career - really bad knee injuries - had to have knee surgery. And then those injuries sort of came back at the end of his college career - his time in college. And then he got back on pain medication and then that developed into an addiction. And so it wasn't like he was using originally - or using those pain medications to party or to, you know, that kind of thing. He'd use them simply to treat an injury and then that developed into an addiction. And then that addiction - that addiction to pain pills like Percocets - he transitioned to heroin when he could no longer get Percocets or the other pain medications or they were too expensive. And then he used heroin basically in secret from - he just kept it from his family for as long as he could.

DAVIES: He went into treatment. What happened?

CHERKIS: He stuck with the program. It was a month-long program and I think his parents did the best they could. They visited him every weekend. They talked to him every night. They monitored his progress as best they could with their staff. And then when he came home they had a family meeting where they discussed all the options. He admitted to them of his heroin issue, which he had continued to keep secret. As far as they had known at that point it was just a pill addiction. But what was unique in a way to Patrick is that his mother, Anne, is a nurse and she had had an experience - she had worked in a methadone clinic and had experience working in drug treatment. And so she was well aware of the medical options and she asked him right then and there do want to try a medical option? Do you want to try methadone or Suboxone? We'll make sure to get it for you. And he said at the time him, you know, I want to go - I want to continue with this 12-step program. I want to try it. I want to try my best to stick with the teachings of The Big Book, and he did. He went to meetings every night. He could quote The Big Book from memory to his mother at the dinner table. But at the end of the week he wasn't doing so well and he relapsed and that relapse ended up being fatal. He overdosed on a Saturday - four days after leaving drug treatment.

DAVIES: You in the piece have a recording of Patrick Cagey's parents, Jim and Anne, when they had tried to get the medical records from the - from his treatment facility. They'd made calls and written requests, which were ignored. And so they finally drove up there and met with the director. I thought we would hear a bit of that tape. This was recorded by Jim Cagey and Anne Roberts, the parents of Patrick who had died from an overdose. Let's just listen to a bit of this.

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ANNE ROBERTS: It's just so painful. I just - I don't understand it. You know, we thought he came in for a pill addiction. And when he got home that Tuesday, he said he had been addicted to heroin. And, you know, throughout the whole month it never came up. I don't see how he could've been here for a whole month and it not come up, you know? I just - I'm at a loss.

JIM CAGEY: Or at least that we didn't know about it.

ROBERTS: You know, I'm just at such a...

UNIDENTIFIED MAN: Did you all do any family assistance with him or anything like that?

CAGEY: Yeah, well, we...

ROBERTS: Well, we came to the...

CAGEY: We gave what was prescribed. You know, we...

UNIDENTIFIED MAN: Come in and meet within the family group and then...

ROBERTS: Yes.

UNIDENTIFIED MAN: Individual or family.

ROBERTS: The family - we never met with the social worker. She did not have time, and...

CAGEY: We tried a couple times to, you know, to...

ROBERTS: To set a time and...

CAGEY: Talk to her.

ROBERTS: She only said, you know, Patrick's doing fine.

DAVIES: Painful to listen to. Parents of a young man who died of a heroin overdose and I - this raises an interesting point which is when - these are often young people in these treatment programs. What kind of information or advice do family members get from the treatment programs once they get out, when these people face obviously enormous challenges in trying to stay clean?

CHERKIS: I think that was one of the most shocking things of - during the course of my reporting - is how often the parents are cut off from the treatment clinics themselves once they drop their children off. In some cases, the parents had to earn the right to see their children in treatment. In Patrick's case, Jim and Anne had to go and attend a lecture every Wednesday, and if they didn't attend the lecture they would not be allowed to see their son on the weekends. And the lecture was exactly the same every single week. It never changed.

In other cases, family members were barred from seeing their loved ones. These were family members that gave up their entire life savings to put their children in treatment. And so, there is this us versus them sort of thing. Once the child enters treatment, the parents seem to be cut off. And that's even more so at the end of treatment. A lot of parents that I had interviewed talked about not knowing what to do when their child left drug treatment - you know, where do they go? Why don't they have a sponsor or what's the next step? A lot of the parents just picked their children up and then they didn't know anything. And they were just happy that they had graduated from a program. And they never got any sort of discharge plan for any sort of roadmap about what to do next. They were kept in the dark. They were kept in the dark at the beginning of the process and at the end. And I think that was - that was worse than when the mistakes can be made, is that I just wished - and did not understand why, in the case of Patrick, why the facility Recovery Works never notified his parents and said, hey, he keeps thinking that he's going to relapse or maybe we should keep him in a little longer. They never expressed any sort of doubts that Patrick wasn't doing well. When the parents eventually got the records, it clearly showed that Patrick struggled a little bit, that he had talked a lot about relapsing and his fears of relapsing. And the parents were never, ever notified of that.

DAVIES: Jason Cherkis series about treating heroin addiction "Dying To Be Free" has been published in The Huffington Post. We'll talk more after a short break. This is FRESH AIR.

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DAVIES: This is FRESH AIR. And if you're just joining us, we're speaking with investigative journalist Jason Cherkis. He has a series about heroin addiction treatment and how ineffective many, many public programs are. It's been published in The Huffington Post. It's called "Dying To Be Free."

You know, some of these facilities, you write, work on kind of the basis of kind of like a boot camp-like humiliation, you know, when addicts really get on other addicts. Do you want to kind of explain the principle here?

CHERKIS: Yeah, it's rooted in a system that was developed in the '50s as sort of vicious group therapy. That was developed by a guy named Charles Dederich, who had come up with this commune called Synanon. It's sort of a complicated story. But, essentially, he came up with this idea that no one knows an addict better than another addict, and no one knows a way to sort of call an addict act out better than another addict. And so they would have these group sessions where they would just yell at each other in an attempt to develop some kind of catharsis or moment of greater truth. It's sort of a divine moment through yelling and through sort of name calling and sort of therapy. And then those sort of sessions became more intense. They grew longer. There was different kind of styles of them. They could go on for 48 hours or longer. And then that sort of idea of addicts wanting to sort of punish each other has sort of carried through in treatment. It's sort of a common theme among most abstinence-based treatments, this idea that we're going to police each other; that we're going to, you know, call each other out when we're not doing well. And I found it to be kind of a fairly rough and primitive way to do therapy.

DAVIES: You describe an episode you saw at a place called the Grateful Life treatment center. And it involved a coffee cup. You want to just tell us that one?

CHERKIS: Yeah, I mean, and it was quite - this was not an unusual event. But they have these things called community meetings. And at the meeting that I attended, there was a 44-year-old addict. He had left a coffee cup unattended. And I think when he was asked about it, he had lied and said that it wasn't his cup. And this became entree for a lot of the younger addicts to sort of delve deeper into his issues or to just pointedly question him about it. And then they would write punishments on the board that he would have to do, such as write essays, you know, read certain chapters, attend different - extra group sessions, and that kind of thing. But it was all around leaving a coffee cup unattended.

And what was sort of startling is he admitted to doing this. He had said, I had felt kind of all the right things. But they had taken his being forthright as not good enough, and it became an excuse to attack his beliefs, attack his - the depth of his belief. They had asked him at that point, well, do you believe in God? The leaving the coffee cup unattended was a sign that maybe he didn't believe in God enough, and that to me felt a little bit troubling.

DAVIES: You write about one of the most aggressive people in this process, of kind of questioning him and humiliating him - a young addict named Kenny. Tell us about him and kind of how he did with the treatment?

CHERKIS: Well, you know, I spent a fair amount of time at grateful life. And Kenny Hamm was one of the first addicts I met. He was the first addict that the facility introduced me to. I think he was widely seen as sort of their star pupil - a kid who had gone through treatment. He had failed treatment several times before. And he was still quite young. He had lost a partial baseball scholarship and had developed an addiction to pain pills and then heroin. But he had come to the facility, and he had sort of taken to it after all these failed attempts and was really sort of their star. He sort of stuck out at different classes that I saw and really was a thoughtful advocate for the type of 12-step philosophy that Grateful Life had. He was articulate. And he even expressed doubt about this idea that if you just believe enough you could overcome your addiction. He worried that maybe belief wasn't enough, maybe it required something else. And that - it was something he couldn't quite figure out. And I think towards the end of his stay at Grateful Life, he really worried and was concerned about what he was going to do next, like, you know, how he was going to sort of take on the real world as opposed to Grateful Life; that he had sort of mastered Grateful Life and then what was going to happen in the real world? And three months after he left Grateful Life, he relapsed, and then he went to jail.

DAVIES: You talked about how it's so typical for addicts to drop out of programs and relapse. And every addict who goes into a program wants to get off of heroin. They don't want to be a heroin addict. What's the impact on addicts? Do they feel like failures?

CHERKIS: They do. I mean, it was the one thing that surprised me. It was one of the first things that surprised me when I started doing the reporting and started talking to addicts was that not only did they want to get clean, but that their failures, their sort of being hooked on this drug and not figuring out a way out of it, it took a mental toll on them. They - so many of the addicts that I interviewed talked about suicide, talked about wanting to overdose. There was a guy in my story who had tried to overdose three times on purpose. They talked about this sort of misery of using. You know, as one - I had interviewed an addict who was still using. When I had interviewed him - and he had just gotten high a couple hours ago - and he had said to me, how would you feel if a treatment center told you that your life depended on you completing the program and then you still couldn't complete the program? How would you feel if you couldn't even be successful when you knew your life depended on it? And I feel like for so many of these addicts, they just struggled. They didn't know where to turn or who to turn to and just thought of themselves as failures. They didn't think of the treatment centers as failing them.

DAVIES: So how does heroin - what do we know about how heroin affects the brain?

CHERKIS: One of the things that I wanted to sort of address was this idea that addiction is a disease. It's often sort of lip servers that they say in every treatment place. Addiction is a disease. And I wanted to know how it affected the brain. If it was a disease, how did it affect the brain? For my interviews with scientists like Dr. Kreek in the story and other doctors who studied the brain and studied brain imaging and sort of looked at all different ways that heroin attacks the brain, the main problem is that it really corrupts the receptors that sort of monitor endorphins and the endorphin rush. And so what it does is impairs the brain or sort of warps the brain into becoming addicted to sort of that unnatural endorphin rush. And so you have to keep using heroin. It also affects emotions, judgment, memory. It creates the craving.

DAVIES: And it affects the brain differently than alcohol, which of course is the drug upon which a lot of treatment regiments were based, right?

CHERKIS: Yeah. Yes, and the difference with alcohol is that if you relapse, the chances of you dying are very slim. But when you relapse on heroin, you have a chance of dying. It's a much greater chance, especially after a period of abstinence, like if you go through - one of the things that I was interested in is that there's sort of a common form of drug treatment, sort of a 30-day program. And what I wanted to know was at the end of the 30 days, where are you? Where is the addict chemically? Where is his brain chemically? Has his brain healed in time within that 30 days? And the consensus appears to be, at least, that it hasn't healed and that it still can - there can still be those sort of triggers or still that sort of - the brain still hasn't healed from that addiction. And so you get sort of this phenomenon where people could be - addicts just driving by a location that they might have passed when they used could be a trigger. A certain smell could be a trigger or just hearing other addicts tell their stories at a meeting, perhaps, or just in conversation could be a trigger for them to use again. One of the things that I thought was sort of interesting when I was doing my story, I had been on the story so long that a couple of the addicts who were in treatment had relapsed and had left treatment. And I had asked them - you know, I tracked them down. And I had asked them, what were you thinking when you used again? You had this amassed, a significant amount of time being sober and sort of being in recovery...

DAVIES: And knew how harmful it was. I mean, obviously, they didn't want to be a heroin addict, right?

CHERKIS: Yes. Yeah, and, you know, spoke quite eloquently about the disease. And they say that they didn't think at all. They don't remember thinking. They remember seeing the drug or being lured to it in a way - you know, someone called, a friend called - and just not really doing much thinking at all. They just immediately used. They couldn't explain it. They were sort of at a loss to explain why they used again or why they had relapsed. It was just so automatic to them. It was almost like they couldn't control it.

DAVIES: There's another point in here which you made, which hadn't occurred to me, is that when people detox and they get off the drug, they may come out and they still have the cravings because their brain is still addicted, but their physical tolerance for large amounts of the drug has declined. And that can get you into a fatal overdose situation.

CHERKIS: Yeah, they often - they might use the same amount again, thinking, oh, I'm used to a certain amount. And then - but it would have disastrous consequences. And that happened regularly. I mean, there was a kid that I had interviewed, and he had relapsed in a hotel room where he worked, and - him and a friend from the same treatment place - and the friend overdosed. He had to be revived. Another kid I had interviewed had also relapsed, and he nearly died because he had used again. It was pretty common.

GROSS: Jason Cherkis will continue his interview with FRESH AIR contributor Dave Davies in the second half of the show, and talk about new drugs that are proving effective, along with counseling, in treating heroin addiction and why many drug treatment programs aren't using those drugs and are sticking with 12-step abstinence-based programs. I'm Terry Gross, and this is FRESH AIR.

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GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to the interview that FRESH AIR contributor Dave Davies recorded with Jason Cherkis about his year-long investigation into heroin addiction and treatment. His report "Dying To Be Free," was published last week in The Huffington Post where he's a national investigative reporter.

DAVIES: Methadone was used to treat addicts - help them get off heroin - as far back as the '70s, but there are these new drugs, buprenorphine and Suboxone. You want to explain how they're different and how they work?

CHERKIS: Well, I think for buprenorphine and Suboxone, one of the key things in the way that it works is that a doctor can prescribe it if they're certified, so you don't have to go to a clinic the way you have to do with methadone. Methadone's regulated. The regulations around methadone are much tighter, in a way.

I would describe Suboxone as, like, the medications that are used to treat smoking addiction. It's almost like a Chantix. It sort of blocks the receptor. When I had interviewed doctors in France about their use of Suboxone, they talked about it in very simple terms. They said it simply blocks the craving. And that's the sort of key to all addiction, is that it stops addicts from craving heroin. It makes them, as they say repeatedly to me and in research papers that I've read, it just makes them feel normal again. They don't have that sort of hankering for the drug. They don't have the same withdrawal effects if they're on Suboxone. It really helps cut down on the sort of painful withdrawals that they can go through. It allows them to attempt and to sort of rebuild their lives again without having to go through any of the sort of painful steps that you might see in a treatment center.

DAVIES: Yeah, you said, it essentially buys time for an addict...

CHERKIS: Yeah.

DAVIES: ...Right, so that they can work on the things in their life that need to get fixed - their employment, their relationships - that kind of thing.

CHERKIS: Yeah, it calms them down. It gives them a space and time to address their other issues, to repair relationships, to get back to their education or find work. I think the best way to describe it is that it - addict after addict has told me it made them feel normal again. It sort of righted the ship, if you will, and it allows them the space and the time to sort of work on their issues as an adult. I feel like a lot of the doctors that I had interviewed about their relationship with their sort of Suboxone patients, they saw it as a therapeutic model just by giving them the medication. They meet with them once a month. They talk to them about their issues. They help them. They give them counseling, or they refer them to counseling. They give them referrals to GED programs and things like that. They work with them on their issues. But it's essentially sort of a contract. I understand that you're going to take this medication correctly and that we're going to work together on your issues.

DAVIES: You write that this combination of medication and counseling is sort of the accepted standard of care among medical authorities in the United States but is not largely practiced. Instead, the rehab clinics focus on abstinence-based programs. You visited a lot of these places. I assume you - a lot of them were really decent and well-meaning people. Why were they clinging to these ideas which, at least as you - in your research suggests, just were not effective?

CHERKIS: I think part of it is that most of those folks that work there that I had interviewed, they had come up through the program itself, so they had - it worked for them, so they felt that they were great advocates for it because they were true believers. They had gone through it, and they now were going to carry their message forward. So everybody had a story. It wasn't - you know, it's like at the end of my piece. When Jim and Anne confront recovery works about Patrick's treatment there, the executive director - his response was to just tell his own recovery story - to tell how he got sober. And I think in a lot of cases, that's all that people have is that story - that example. And I think people clung to that. Well, if it worked for me, it's got to work for everybody else. You had folks who sort of came up through the system and may not have been heroin addicts, but they were making judgments about heroin addicts. I think, you know, the most instructive example is Marv Seppala from Hazelden, who had gone through programs, had gotten sober, and...

DAVIES: And Hazelden is probably the premier treatment facility in America, right - in Minnesota, right?

CHERKIS: Yeah.

DAVIES: Yeah.

CHERKIS: Yeah, it's one of the - you know, probably the preeminent treatment center in the country. And, you know, he saw kids failing his program, but he didn't use it as a way to justify his program or hide behind their brand or say they couldn't handle it. He went back, and he interviewed and tracked down those kids that had failed his program or dropped out or relapsed and interviewed them. And what he came away with was, hey, we weren't adapting to them. We weren't changing our curriculum to meet their needs. And then he adopted a medical model, and he's had some success with it.

DAVIES: So Hazelden, which clung to abstinence for so long, is now moving towards the use of Suboxone and other - a combination of counseling and medication?

CHERKIS: Yeah, they've now implemented that program, and I think it's been for about two years now. And they've been able to lower their dropout rate significantly from about 22 percent to 7 percent.

DAVIES: You know, you said that a lot of people at drug treatment programs cling to the abstinence-only approach because that's where they came from and it worked for them. But there are others involved in it. I mean, there, you know, are state health departments that make big policy decisions about what gets funding. And there are, you know, correctional systems - I mean, people presumably that want things that work. Why are they not moving in this - in the direction of medication and counseling approach?

CHERKIS: I think it's two reasons. I think it's cultural. I think that we still view addicts as criminals. And I think that that sort of shades a lot of what we talk about when we talk about addicts. I think number two is that we just don't have a good public policy on drug addiction at all. I think there was a study that I cite in the piece that talked a little bit about just sort of the landscape of drug treatment and how it's been cut off from the medical field. But part of that is that we just don't have good public policy on this issue. We have a system largely governed by funding. I mean, for example, in Kentucky the main publicly funded drug treatment is funded through HUD, and so the people that run the drug treatments - those facilities in Kentucky are run through the Housing Department. It's not a doctor. It's a guy in the Housing Department. And I know in Kentucky that there is a public health official, and he would like a medical model. But he's sort of hemmed in by the cultural issues, the idea that abstinence works best and the idea that addicts are criminals. I mean, he complained to me that it's just tough to go to the legislature even to ask for any money because there are people in the legislature that don't want to fund drug treatment at all.

DAVIES: At the policy level, like in the counties that you looked at in Kentucky, who is making the decisions about what kind of approaches are used in heroin treatment?

CHERKIS: Well, I think for a huge percentage of addicts, those policy decisions are actually made in the court system. I think for a large percentage of addicts, maybe upwards of 50 percent, their entree into drug treatment is through drug court. They might not have money. Or in Kentucky, for example, there is something called Casey's Law, where parents can petition the court to have their children be placed in drug treatment against their will. And so for a lot of places, the judge is the policymaker, and in Kentucky, those judges are against the medical model. They view Suboxone with suspicion. They view it as just any other drug.

DAVIES: What's the role of primary care physicians in treating heroin addiction? Is there one?

CHERKIS: Well, they - I mean, primary care doctors - there could be a role for them, but they have largely stayed out of this field. Addiction is largely not taught in medical school, and just a very small percentage of primary care doctors want to get involved in treating addicts. But if they wanted to be involved, they could get certified to prescribe buprenorphine or Suboxone. They have to go through a course. And then for the first year, they're limited to 30 patients, and then the next year and the year after that, they're limited to a hundred patients. And so you do get into problems where, especially in regions hit hard by heroin addiction, you have doctors with huge waiting lists.

For example, in my story, the two doctors that I interviewed, they had waiting lists of up to a hundred people, and that could take, you know, a really long time. I mean, there was a pretty tough situation that I sort of describe in this story of a mother who was taking Suboxone while her son was at Grateful Life, and she was worried about what he would do after leaving Grateful Life. And her goal was to sort of taper off Suboxone and then give her son her place with the doctor so that he could take Suboxone if he needed it.

DAVIES: What happens overseas? Is their approach different?

CHERKIS: The CDC has advocated for it, and you know, in 2005, the World Health Organization, they had listed Suboxone and methadone as essential medications. And I think that largely stems from the experience that folks have had or doctors have had, rather, overseas. I think the best example is France. They were one of the first to implement a Suboxone and a methadone program, and they were able to cut their overdose death rates dramatically by upwards of 80 percent. And that was the statistic that I sort of most thought about when I was working on this story.

We have a epidemic where people are dying every single day. And I thought well, how could we stop people from dying, or what would be the way to do that? And I often thought of France and how they implemented Suboxone and methadone and how they so dramatically reduced those death rates. I think that that's sort of a key statistic and a key indicator that we could improve our health care system here. We could lower overdose death rates if we implement a similar program.

DAVIES: The piece says that people who run drug treatment programs and judges who send people to drug treatment programs are kind of ignoring medical evidence that suggest a combination of medication and counseling is the best approach. Is it changing, do you think?

CHERKIS: I think it's slowly going to change. I think with - as I had mentioned in the story with Hazelden adopting a medical model and Phoenix House adopting a similar model - and Phoenix House is a pretty big chain of treatment centers - that'll help. And I think even at the - as I was getting finished with my reporting, like, literally, like, a week away from finishing it and from publishing the story - the hospital chain in Northern Kentucky announced that they were actually going to partner with Hazelden and adopt that curriculum. And this had been after years and years of ignoring the problem and sort of stonewalling doctors who had asked St. Elizabeth to adopt a medical model and just sort of being blown off. And so they made this big announcement a couple weeks ago that they were going to attempt this Hazelden curriculum for heroin addicts and for opiate addicts.

DAVIES: Well, Jason Cherkis, thanks so much for speaking with us.

CHERKIS: Thank you for having me.

GROSS: Jason Cherkis is a national investigative reporter for The Huffington Post, where his report about heroin addiction and treatment, titled "Dying To Be Free," was published last week. He spoke with FRESH AIR contributor, Dave Davies, who is also senior news reporter for WHYY. Coming up, our jazz critic, Kevin Whitehead, reviews a 1951 live nightclub recording by pianist Lennie Tristano's sextet that's just been released for the first time. This is FRESH AIR.

TERRY GROSS, HOST: This is FRESH AIR. A 1951 live nightclub recording by pianist Lenny Tristano's sextet at Chicago's Blue Note club has been released for the first time. Jazz critic Kevin Whitehead says, Tristano had a cool, egghead reputation. That same year, Time magazine called him the Schoenberg of jazz. But Kevin says he could play pretty hot. Here's Kevin's review.

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LENNY TRISTANO: We'd like to play "Sax Of A Kind."

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KEVIN WHITEHEAD, BYLINE: Lennie Tristano's sextet with Willie Dennis on trombone in 1951. "Sax Of A Kind" is by band saxophonists and Tristano star pupils, Lee Konitz and Warne Marsh. Lennie told them to write lines that sounded like how they wanted to play - in their case, fast and fleet, with plenty of complications, like their teacher. When Tristano solos on piano, his right hand sings like a horn, or jumps into hyperspeed, or hints at Bach keyboard inventions. But he also knows piano is a percussion instrument.

(SOUNDBITE OF LENNY TRISTANO SEXTET SONG, "ALL THE THINGS YOU ARE")

WHITEHEAD: Funny to hear Tristano shrink into the background whenever the horns speak up - he didn't like a rhythm section to upstage a soloist. This is from the nightclub recording "Chicago April 1951," on two CDs from the Uptown label. As ever, Tristano used the chords to familiar pop tunes as grist for improvisation; here they improvise a little counterpoint too, though not in the Bach style. Dave Brubeck once trashed Tristano's casual approach to such interplay, and for sure this sextet's free-for-alls are less tidy than Brubeck counterpoint. This is from "All The Things You Are."

(SOUNDBITE OF LENNY TRISTANO SEXTET SONG, "ALL THE THINGS YOU ARE")

WHITEHEAD: The Tristano gang's cool reputation owes a lot to his thoughtful tenor saxophonist, Warne Marsh. His prime inspiration was Lester Young, the epitome of cool, who could make a few well-chosen notes swing like crazy. Marsh could do that, too. Here he takes off from his own soloistic written lines.

(SOUNDBITE OF LENNY TRISTANO SEXTET SONG, "I CAN'T BELIEVE THAT YOU'RE IN LOVE WITH ME VARIATIONS")

WHITEHEAD: Warne Marsh made an excellent fit with alto saxophonist Lee Konitz, who’s still out there exploring the same tunes 64 years later. Marsh is great, but Konitz moves me more. In 1951 he had his partner's unflappable cool, but his tone had more bite - had some of that Charlie Parker cry in it. It still does.

(SOUNDBITE OF LENNY TRISTANO SEXTET SONG, "I'LL REMEMBER APRIL")

WHITEHEAD: All those standard chord progressions and the string-of-solos format get confining after a while; you wish they'd break up the routines a bit. Lee Konitz has spoken of Tristano gigs where the counterpoint would break into free improvisation sometimes. They don’t get up to that here, but we'll take what we do get - Tristano and company narrowly focused and burning bright - jazz laser beams.

(SOUNDBITE OF LENNY TRISTANO SEXTET SONG, "I'LL REMEMBER APRIL")

GROSS: Kevin Whitehead writes for Point Of Departure and is the author of "Why Jazz?" He reviewed "Chicago April 1951," the live nightclub recording by pianist Lennie Tristano's sextet, released for the first time on the Uptown label. For those of us who are fans of "Breaking Bad" and have been waiting for the spinoff "Better Call Saul," the wait is about to end. Coming up, our TV critic David Bianculli reviews the premiere. This is FRESH AIR.

TERRY GROSS, HOST: This is FRESH AIR. Sunday and Monday, the AMC cable network presents the two-night premiere of "Better Call Saul," starring Bob Odenkirk as a fast-talking struggling lawyer. It's the much-anticipated spinoff prequel to "Breaking Bad," which our TV critic David Bianculli considers the best drama series ever produced for television. And "Better Call Saul," he says, is off to a great start.

DAVID BIANCULLI, BYLINE: I'm guessing that the first thing fans of Vince Gilligan's "Breaking Bad" want to know is whether its AMC prequel series "Better Call Saul" is anywhere near as good as the original, which was TV at its very best. And I'm also guessing that people who haven't yet worked their way through "Breaking Bad" - and really, by now, why not? - are wondering whether they can enjoy this new series without having absorbed the old one. So let me announce with enthusiasm at the outset, yes and yes. "Better Call Saul" not only stands right alongside "Breaking Bad" as a stunningly entertainingly TV series, it stands on its own. Oh, if you know "Breaking Bad" well, you'll love some of the surprise treats and appearances heading your way. But even if you're a complete stranger to the character played by Bob Odenkirk in "Better Call Saul," you're in for a great ride.

"Better Call Saul" has the same tight plots, rich characters and delicious twists as its parent series. Yet, "Better Call Saul" isn't a reboot. It's a pre-boot. The central story of this new AMC series tells how Jimmy McGill, a scrappy, low-rent public defender in Albuquerque, N.M., came to adopt a sleazy new persona as Saul Goodman, a criminal lawyer specializing in representing unabashed criminals. If Saul Goodman were a superhero, this would be his origin story. And that's really what this show is about because Jimmy McGill, from the start, does have a superpower. It's his quick wit, his fast mouth.

"Better Call Saul" is co-created by Gilligan, who created "Breaking Bad," and Peter Gould, the writer-producer who created the Saul Goodman character way back in season two. Together, they've come up with something very ambitious and yet, very playful, here. For starters - literally - this prequel series actually begins as a sequel, set somewhere in the snowy North after the events of "Breaking Bad." Saul is hiding in plain sight, just as he said he would, with a new name and a blend-into-the-woodwork job, managing a Cinnabon concession at a local mall. Yet, he's terrified that even in that public a place, danger and death lurk behind every corner and can be read in every unsmiling face.

To me, it's as if "Better Call Saul" starts precisely where "The Sopranos" suddenly stopped. There are two stylistic choices in this opening scene that ought to sell viewers on "Better Call Saul" immediately. One is that this scene, set in the current timeline after the end of "Breaking Bad," is in black and white. That's how bleak Saul's new life is. And for this new show's first seven minutes, Saul doesn't say a word - not one. This guy who lived and prospered with his gift of gab, like a courtroom Sgt. Bilko, is completely silent for what in TV terms is an eternity. It's only when he goes home, pours a drink, gets bored watching television and slides an old video cassette into his VCR to watch a series of his vintage TV ads, that we hear his voice for the first time. The older Saul listens and watches wistfully as director Gilligan closes in on his weary face.

(SOUNDBITE OF TV SHOW, "BETTER CALL SAUL")

BOB ODENKIRK: (As Saul Goodman) Don't let false allegations bully you into an unfair fight. Hi, I'm Saul Goodman, and I will do the fighting for you. No charge is too big for me. When legal forces have you cornered, better call Saul. I'll get your case dismissed. I'll give you the defense you deserve. Why? Because I'm Saul Goodman, attorney at law. I investigate, advocate, persuade and most importantly, win. Better call Saul.

BIANCULLI: After that, the series flashes back to 2002 - long before those ads were produced - when the future Saul Goodman was still a hustling attorney named Jimmy McGill. Now the show switches to color - a reversal of the usual cinema dynamic of color for the present and black and white for the past - and "Better Call Saul" really takes off.

I'm determined not to spoil any surprises here, but in the first hour alone, there's one that made me smile and another that made me gasp. And it shouldn't be surprising, given how Gilligan cast "Malcolm In The Middle" sitcom actor Bryan Cranston and allowed him to blossom as the Emmy-winning dramatic actor of "Breaking Bad," that comic actor Bob Odenkirk is given such weight and responsibility here. But he is, and Odenkirk is thrilling - another brilliant, genre-crossing role from another gifted actor.

Here's Odenkirk as Jimmy McGill, trying to persuade a young accountant and his wife to allow him to represent them. You can hear the pitch, but at the same time, you can almost smell the desperation.

(SOUNDBITE OF TV SHOW, "BETTER CALL SAUL")

ODENKIRK: (As Jimmy McGill) Look, all I knew is what I read in the paper, and, typically, when money goes missing from the county treasury and the number here is 1.6 million...

UNIDENTIFIED ACTOR #1: (As wife) Well, that's an accounting...

UNIDENTIFIED ACTOR #2: (As accountant) Accounting discrepancy.

ODENKIRK: (As Jimmy McGill) It's a discrepancy, absolutely. But, typically, when that happens, the police look at the treasurer and since that person is - I just think a little pro-activity may be in order.

UNIDENTIFIED ACTOR #2: (As accountant) I just think I'd look guilty if I hired a lawyer.

UNIDENTIFIED ACTOR #1: (As wife) Yeah.

ODENKIRK: (As Jimmy McGill) Well, actually, it's getting arrested that makes people look guilty, even the innocent ones. And innocent people get arrested every day and they find themselves in a little room with a detective who acts like he's their best friend. Talk to me, he says. Help me clear this thing up. You don't need a lawyer. Only guilty people need lawyers, and boom - hey, that's when it all goes south. That's when you want someone in your corner, someone who will fight tooth and nail. Lawyers - you know, we're like health insurance. You hope you never need a it, but, man oh man, not having it - no (laughter).

BIANCULLI: There are plenty of funny moments in "Better Call Saul" - and, at least in the opening episodes, some very overt stylistic nods to a few classic films from the '70s. But there's drama and darkness, too. Even though we know Jimmy McGill will survive the flashbacks in this series, there's still a lot of tension. And watching him transform is going to be a blast.

GROSS: David Bianculli is founder and editor of the website TV Worth Watching and teaches television and film history at Rowan University in New Jersey. Tomorrow, we'll talk about a new novel about race, class and identity told from the point of view of the daughter of Afrocentric parents, growing up in the '80s in West Philadelphia. My guest will be Asali Solomon, the author of "Disgruntled." FRESH AIR's executive producer is Danny Miller. I'm Terry Gross.

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