Maybe I’m naïve, but I was shocked earlier this month by the sight of a homeless man on a sidewalk in downtown San Francisco sticking a needle into his arm in broad daylight.
I was a few blocks from the Moscone Center in the heart of the city, and I kept on walking. But it was hard to get the picture out of my head.
Then last week, U.S. Surgeon General Vivek Murthy put a national spotlight on the problem with the release of his landmark report on the country’s addiction crisis. Millions of Americans suffer from alcoholism or addiction to legal and illegal drugs, but only a fraction receive treatment, according to Murthy’s report.
While one in seven Americans will face a substance use disorder at some point in their lifetime, the report says only about 10% of those with addictions will receive any kind of specialty treatment. Murthy said it would be unacceptable in this country if only one in 10 people with cancer or diabetes could access treatment, and it should not be the case with substance abuse.
The report, the first from a surgeon general to address addiction, calls for a shift in the way the country views substance addiction. “Addiction is a chronic but treatable brain disease that requires medical intervention, not moral judgement,” Murthy writes in the report.
Some hope Murthy’s report will spur change much the way the 1964 surgeon general’s report on cigarette smoking and its link to lung cancer changed the country’s attitude about tobacco.
That remains to be seen.
We've done it before. Cancer & HIV were surrounded by fear and judgment. Now they're regarded as medical conditions. #FacingAddiction
— U.S. Surgeon General (@Surgeon_General) November 23, 2016
Who can predict what the ultimate impact of the report will be, but it is likely part of Murthy’s swan song. An Obama appointee, Murthy will likely be replaced by a new surgeon general, as President-elect Donald J. Trump is expected to appoint his own nominee and will have to decide how best to combat the opioid epidemic.
Professionals working in addiction medicine, however, are worried. They fear that repeal of the Affordable Care Act will mean people addicted to drugs will lose access to treatment and that accidental deaths from opioid overdoses will increase.
Murthy’s report said that 78 people die every day in the United States from opioid overdoses. While heroin overdoses are killing many people, others are dying from legally prescribed opioid painkillers. Murthy, who earlier this year wrote a letter to America’s doctors asking them to take a pledge to reverse the country’s opioid epidemic, in the new report calls on primary care doctors to step up screening of patients for substance abuse.
The report also calls for a change in the way the healthcare system treats substance abuse disorders. Along with the inability to access or afford care and fear of shame and discrimination, people fail to get treatment because of a lack of screening for substance misuse and substance use disorders in general healthcare settings, the report said.
Most treatment takes place in drug and alcohol treatment programs with little involvement by primary or general healthcare. “However, a shift is occurring to mainstream the delivery of early intervention and treatment services into general healthcare practice,” the report said.
Murthy called on the country’s physicians to step up and play a role in screening patients and intervening early. “Supported scientific evidence indicates that substance misuse and substance use disorders can be reliably and easily identified through screening and that less severe forms of these conditions often respond to brief physician advice and other types of brief interventions,” the report said.
Time will tell how far-reaching the impact of Murthy’s report will be, but let’s hope it pushes the fight against addictions in the right direction.—Joanne (@PracticeMgt)