Toward the end of 2016, Surgeon General Dr. Vivek Murthy did something no Surgeon General had done before. He released a comprehensive report on the United States drug epidemic and steps to combat it. Entitled Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, this report focused largely on rising rates of opioid and prescription drug abuse. When later speaking to The Fix, he said this of his decision:
“The decision to issue a report on alcohol, drugs, and health was the first major decision I made after becoming Surgeon General.”
The closest thing to such a report ever released was the 1964 Surgeon General report on tobacco. In a similar manner, the 2016 report focuses on health issues associated with a perceived threat due to rising rates of alcohol and drug abuse. Murthy focused on numerous forms of treatment and recovery. Not only did he address various treatment methods in his report, but elaborated later during A National Summit with the Surgeon General (hosted by Facing Addiction). Discussion points ranged from 12-step programs and technological advancements to medication-assisted treatment (MAT).
Murthy’s lengthy report and follow-up panels provide a lot of information to sift through. For now, however, we would like to focus specifically on MAT. The Surgeon General addressed not only the benefits of evidence-based treatment, but also the need to increase its availability. He also addressed the stigma associated with substance use disorders, and the need to accept addiction as a disease. As the Surgeon General had a great deal to say about each of these topics, we will break them down in detail below.
The Benefits of MAT and Evidence-Based Treatment
Medication-assisted treatment sometimes provokes controversial arguments between substance users who prefer various treatment methods. Some see it as simply one means to an end. Others stand by it completely. Still others believe it to be dangerous (especially in the case of methadone) or simply ineffective. According to Surgeon General Murthy, MAT works best when combined with other treatment methods. These include therapeutic counseling in addition to other support services. He also believes in abstinence-based recovery methods, although does not necessarily believe they work equally for all substance users. Mainly, however, he believes the primary roadblock to MAT is the need to clear up a few misconceptions about how it works.
“By its very definition, medication-assisted treatment has to include more than medication alone. It has to include counseling services and the other support services that are an important part of effective addiction treatment; that’s an important point because many people do not recognize that aspect of MAT. It does not mean that you can take a pill for a couple of weeks and be cured of your substance use disorder. That’s not actually how it works; in the same way that if you have diabetes, you don’t take a pill for a couple of weeks and you’re cured of your diabetes. It’s a chronic illness that requires long-term management, and the same is true of addiction.”
Among the other evidence-based approaches noted by Surgeon General Murthy’s report, he includes technological advancements. The Fix points out that this might include the mobile accountability tool Soberlink. This portable breathalyzer, sometimes used in custody cases and aftercare programs, uploads blood alcohol content readings into an online database. Furthermore, it uses facial recognition software to confirm the identity of the user. This means that someone cannot game the system by drinking and then letting a friend take their breathalyzer test. Soberlink obviously cannot combat the opioid epidemic, but it certainly helps keep alcoholics accountable.
Perhaps tools like Soberlink cannot combat the opioid crisis, but they do hint at a future in which other technologies might combine with MAT to improve accountability. Addicts and alcoholics already have access to online meetings and support networks. For instance, recovering users can seek support in Facebook groups such as Heroin Support for You. This means that even those who do not attend AA or NA can gain access to support from fellow sufferers. The internet age gives us access to tools once thought unimaginable. Why shouldn’t MAT patients use these tools to bolster their recovery? Surgeon General Murthy believes we should use every tool at our disposal.
Overcoming Stigma and Accepting the Disease
Speaking on the issue of stigma, Surgeon General Murthy says:
“Eradicating the stigma around addiction is going to require each of us to step up and play a part. What we are talking about here is culture change, and you can’t legislate a change in people’s attitudes or a shift in culture. Culture is formed by the attitudes and beliefs of people all across our country, and that means we actually do have the power to overcome some of these negative attitudes and biases that have developed around addiction.”
You can’t legislate culture change, but Surgeon General Murthy does believe that the medical community can do more the lessen the stigma that often scares substance users away from treatment. For instance, he wishes for medical texts to better recognize substance use disorder as a brain disease. This would potentially reduce the number of people who cite alcoholism and addiction as a mere choice, a moral failing. Murthy also wants medical professionals to define addiction as a chronic illness so that our government might stop treating it primarily as a criminal justice issue.
Because many individuals see substance use disorder as a mere character flaw, some communities will actively resist the presence of treatment centers in their neighborhoods. Murthy finds it difficult to speak with substance abusers when touring the country, as they fear the surrounding media presence. They fear that one picture taken of them next to Surgeon General Murthy will brand them an addict in the eyes of the nation. He wants to see more sufferers stepping forward to tell their stories. Murthy believes that, through honesty and understanding, our communities will come to see substance use disorder as a devastating illness. This might lead to more acceptance of treatment centers.
At this point, Murthy draws a parallel between his own Surgeon General report and the 1964 report on tobacco:
“It helped to spearhead a half-century of work on tobacco control. Right now, this is a time when I believe that our nation has to be called to action to address the addiction crisis and that’s why I issued the report on alcohol, drugs, and health. My hope is that it will move people to not only implement policies and programs that we know work, but also to examine how they think about and talk about substance use disorders in their own lives.”
In other words, you can’t legislate culture change—but legislation certainly wouldn’t hurt the cause. Especially if it results in greater funding and availability of MAT and other forms of treatment.
Increasing Funding and Availability of Treatment
Last year, our administration signed the Comprehensive Addiction and Recovery Act (CARA) into law. Unfortunately, this act’s initiatives still lack proper funding. This means that CARA’s aims to increase the availability of MAT and other forms of treatment remain unmet. Surgeon General Murthy addresses this issue in his interview with The Fix:
“We know that in order to ensure that treatment and prevention programs are being utilized in communities all across America it is going to require capital investment. As I mentioned earlier, we know that treatment programs not only are proven to work, but they save lives and money as well. In the report, we have an entire chapter where we describe a number of prevention programs that have already been implemented in communities across the country. These programs all return a range of amounts for the investment, but some of them are up to $64 for every dollar spent. That’s an incredible return on investment. To ensure that these programs are available everywhere, however, we do have to invest as a country.”
Surgeon General Murthy definitely recognizes the need for federal funding. At the same time, he goes on to explain that community resources may help enact some of CARA’s initiatives. For instance, communities can try to equip first responders with Narcan to prevent overdoses. They can also try to put opioid users in contact with treatment centers. We already see this in cases such as Operation HOPE in Maine. The government still needs to provide treatment centers with adequate funding for MAT. But in the meantime, these steps will help to alleviate the opioid epidemic.
Furthermore, the medical community can begin training more professionals in the proper administration of MAT. One of CARA’s proposals was to allow nurses and assistants to administer medications such as Suboxone. This makes up for the current cap on the number of patients that doctors can treat. By increasing the number of MAT-competent professionals, we allow more users to seek the treatment they need. The Surgeon General suggests that healthcare systems can integrate addiction treatment into traditional care, thereby increasing availability. In this way, we can ensure that more opioid addicts receive the treatment they require—even if treatment facilities must still wait for adequate funding in the interim. Gaps may still remain in CARA, but at least our Surgeon General continues seeking ways to make up for them.