First Time in History Surgeon General Reports on Drug Crisis

Published on November 23rd, 2016

surgeon-general-murthyFor the first time in American history, the Surgeon General’s Report focuses on our nation’s substance abuse epidemic, and how we can help fight it. Dr. Vivek Murthy has been the American Surgeon General since 2014, the year that set the record for most drug overdoses in the US. His understanding of addiction as a disease and not as an immoral taboo is refreshing, especially since it seems most people view substance addicts as lesser people. (Note: substance abuse/addiction includes that of illicit drugs, alcohol, and/or prescription pills.)

In his most recent report, Dr. Murthy addresses the scope of our nation’s substance abuse epidemic, the science behind addiction, methods of preventing and/or treating addiction, and finally, how our health care system could integrate addiction treatment.

Most of what Dr. Murthy reports is already common knowledge in the addiction treatment community. Drug addiction is everywhere. Murthy states that 10% of Americans over age twelve reported drug abuse last year, and 25% of them reported binge drinking. These are just the numbers reported. Although unprovable, it seems likely that these numbers are higher. Surely some substance addicts are in denial, and others surely do not report having a problem out of shame.

Dr. Murthy addresses the shame that drug addicts and alcoholics feel. He begs America to stop looking at addiction as “moral weakness or as a willful rejection of societal norms.” Instead, he wants us to view addiction as a mental health issue that requires evidence-based, individualized treatment… just like every other medical disorder.

The Foundation

Yes, the addiction crisis is alive and well in America, but the truth is we’ve come a long way in fighting it. Dr. Murthy lays out what he calls “reasons for hope and optimism” as part of his report, and they are the foundation on which to build a better addiction treatment system. There is much work to do, but Dr. Murthy shows us that it’s possible.

“Addiction to alcohol or drugs is a chronic but treatable brain disease that requires medical intervention, not moral judgment.” Let’s start there. Nothing will change at all if society continues to view addicts in a negative light. Dr. Murthy points out that research and evidence has led to this conclusion, that addiction is a disease, not a lifestyle.

Policies are in place nationwide joining the effort to stop and prevent addiction. Government programs, non-profit organizations, and community-based groups exist to help combat the issue. Also, medicines and behavioral therapies exist that effectively treat addiction. The US is home to approximately 15,000 addiction treatment facilities.

Over 60,000 Alcoholics Anonymous (AA) groups meet in this country alone, with over 1.2 million members. Narcotics Anonymous (NA) groups reach almost the same figures. Communities all over America contribute every day to the struggle against addiction. The general public is concerned, and for the most part aware of our crisis. The healthcare system, however, presents some obstacles in the way. Dr. Murthy lays them out, and offers solutions.

The Healthcare Marketplace, established as part of Obamacare, offers Americans a variety of health insurance coverages. Those insurance companies who participate in the marketplace “must now cover costs related to mental health and substance use disorder services, including behavioral health treatment,” as noted in the report. Plus, in the wake of recent spikes in opioid overdoses, Dr. Murthy sent a letter this August to every doctor in America, pleading with them to do their part in reducing prescriptions.

This is a major step toward the widespread availability of addiction treatment. However, the Substance Abuse and Mental Health Services Administration discovered that currently only 10% of those with a substance addiction receive the appropriate treatment. Still, Dr. Murthy makes it clear that efforts in the healthcare industry are being made to prevent and stop addiction.

Lastly, reforms in criminal justice being made are essential to fighting addiction. Action is being taken nationwide to “place non-violent drug offenders in treatment instead of jail,” and to utilize “evidence-based treatment for incarcerated persons…,” Dr. Murthy points out. This trend may just be beginning, but it offers a lot of hope. Non-violent drug offenders make up over a quarter of our prison population, with an average sentence of 8.5 years.

That’s over 3,000 days in a prison cell for getting caught having a disease.

All of the above makes up the foundation on which we as a nation can build a solution to the drug and alcohol epidemic that affects 1 out of every 3 American households. The process of building this solution requires massive effort. Dr. Murthy believes that there is, however, a clear path.

First, define addiction as a brain disease with a scientific cure. This will change the public opinion of addiction from one of disgust to one of empathy. Addiction will hopefully become realized as the disease it truly is. Second, upgrade and make more available evidence-based methods of addiction prevention, intervention, treatment, and recovery. Dr. Murthy believes we are aimed in the right direction in this regard, but not moving fast enough. Third, healthcare needs to be reformed in order to sustain all of these changes. It’s one thing to establish methods for treating addiction, and another thing to actually carry them out.

From this point in the article, we summarize the topics Dr. Murthy covers in his Surgeon General Report. Then we take a look at president-elect Donald Trump’s proposed drug policies, and how they relate to Dr. Murthy’s report.

Summary of Surgeon General Report

1)  Science

The body of the report is broken down into six sections. Dr. Murthy begins with the science behind why substance addiction is a disease of the brain, in the first section, titled The Neurobiology of Substance Use, Misuse, and Addiction. Put simply, drugs release dopamine in the brain, a chemical responsible for producing pleasure. This is what causes the high. Every substance acts differently on the brain, but all addictive drugs release dopamine.

The more a substance is used, the more dopamine released, and the brain adapts to become less sensitive to dopamine. Therefore, the user must take more of the substance in order to feel high again. This is what causes tolerance. Worse yet, with more substance abuse, the brain becomes trained to associate the substance with pleasure. As a result, the user “no longer takes the substance to ‘get high’ but instead to avoid feeling low,” as written in the report.

How Trump’s Policies Will Affect:

While president-elect Trump hasn’t much addressed the scientific side of addiction, he and his staff do fully support CARA, the Comprehensive Addiction Recovery Act. Part of its provisions include treating those who are incarcerated and suffer from addiction with evidence-based treatment. While indirect, this does show that Trump and his staff agree with addiction being a disease.

2) Prevention

In order to prevent substance abuse, which leads to substance addiction, we must first realize a couple things. One is that addiction usually begins in youth. According to a study published by the National Library of Medicine, 70% of substance addictions begin before age thirteen. Only 27% of substance addictions begin at age eighteen and over. Another thing to realize before preventing substance abuse is that there are both risk factors and protective factors.

A risk factor is anything that increases the likelihood of substance abuse. Common examples include parental substance abuse, living in an area with lots of substance abuse, and going to a school with lots of substance abuse. More specific risk factors tend to vary by individual. Common examples include a strong family relationship, positive social ties, emotional balance, and refraining from risky behavior. As with risk factors, more specific protective factors vary.

So, to prevent addiction, it is necessary to reduce or eliminate risk factors, increase protective factors, and continuously educate our youth on the dangers of substance abuse.

How Trump’s Policies Will Affect:

Trump’s support of CARA will serve to greatly benefit prevention of substance abuse. The first of the act’s four main points focuses on prevention efforts and substance abuse education, especially for children, parents, and the elderly.

3)  Intervention & Treatment

Please do not think of an intervention as some gathering of friends and family, as seen on television. Although they do exist, and are called interventions, Dr. Murthy defines intervention in this context as “a professionally delivered program, service, or policy designed to prevent substance misuse or treat an individual’s substance use disorder.” The treatment comes from the intervention.

Dr. Murthy believes intervention and treatment begin with a screening at the doctor’s office. “Screening for substance misuse in health care settings including primary, psychiatric, urgent, and emergency care is the first step in identifying behaviors that put individuals at risk for… developing a substance use disorder…,” he says. The argument is hard to deny.

Screening for substance abuse would allow for individualized treatment plans. Also, an estimated 40% of those with substance abuse disorders do not believe they have one, and so screening could dramatically lower substance abuse rates. Also, treatment could be specifically catered to the intensity of each individual’s addiction.

How Trump’s Policies Will Affect:

Trump and his staff do support both intervention and treatment; however this is where things get a tiny bit tricky. Trump plans on taking an approach to fighting substance abuse called interdiction. What this means is Trump wants to attack the physical drugs themselves more so than the psychological aspect of addiction.

While he does support the ongoing increase in Narcan availability, as well as the use of drug courts over criminal courts for non-violent drug offenders, Trump has not offered much in the way of reforming healthcare.

4) Recovery

Dr. Murthy understands that addiction treatment and recovery doesn’t happen quickly. It takes a lot of effort and lot of assistance. According to the American Psychiatric Association, it takes one year of abstinence from illicit drugs to enter remission, and 4-5 years of abstinence from alcohol to do so. Therefore, recovery should be a lengthy process equally as important as prevention, intervention and treatment.

How Trump’s Policies Will Affect:

Frankly, Trump has not addressed the recovery period of substance abuse treatment whatsoever. Although, once again, his support of CARA seems to align with Dr. Murthy’s report. Also, the communities of America continue to pull together and form recovery support groups such as AA and NA.

5) Healthcare

As stated, Dr. Murthy believes substance abuse screening is essential to the road to recovery. However, the Surgeon General takes it one step further in his fifth section of the report. He believes there needs to be an integration of substance abuse treatment into traditional healthcare services.

Also, Dr. Murthy wants us to remember something very important, and often forgotten about in the medical industry: “Substance use disorders are strongly intertwined with other medical conditions, making an integrated approach to care essential.” As a matter of fact, 40% of those with a substance abuse disorder simultaneously suffer from a mental health disorder. Half of these people receive no medical help for either disorder.

How Trump’s Policies Will Affect:

Trump is aware that the healthcare industry needs to make some changes in order to better suit substance abuse treatment. However, aside from acknowledging this, he and his staff have not provided anything clear to actually accomplish this task.

6) Conclusions

There needs to be a cultural shift before there can be an increase in treatment. Once substance addiction is not seen as a negative lifestyle, but for the disease it is, then we can begin to collectively fight it. Once addiction is treated with the same resources and attitude as, say, diabetes or asthma, other chronic diseases, we will be getting somewhere.

Dr. Murthy writes, “By adopting an evidence-based public health approach, America has the opportunity to take genuinely effective steps to prevent and treat substance-related issues.” He also notes that this would not be the first time in history that a disease had to pass from social stigma to actual disease. “Cancer and HIV used to be surrounded by fear and judgment, now they are regarded by many as simply medical conditions.”

Trump aims to attack the physical source of America’s substance abuse problem. In brief summary, Trump’s plan is to cut off all imports of illegal drugs from outside countries, increase the availability of Narcan, further limit the amount of opioid medication is manufactured, and to support CARA, which is hailed as “the most expansive federal, bipartisan legislation designed to ensure the devotion of federal resources toward evidence-based education, treatment and recovery programs for addiction,” by Sovereign Health.

It is yet to be seen how Trump’s drug policies will mesh with Surgeon General Murthy’s historical report. One can only hope that they mesh well. Trump will focus on the physical drugs, while Murthy (and the medical industry) focuses on the psychological aspect. It may very well work. For the millions of Americans suffering from substance abuse disorders, we pray it works.

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