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    Why addiction change shouldn’t come from DC

    US Surgeon General Vivek H Murthy, MD, recently issued a report that reveals that millions of Americans suffer from alcoholism or addiction to legal and illegal drugs—but that only 10% are treated.

    The questions are: What power does such a report have to actually change that dismal rate? What else is necessary?

    The smoking model

    In 1964, the Surgeon General’s report on smoking and health, issued by one of Murthy’s predecessors, dramatically impacted both policy and public attitudes on smoking—that era’s major national health risk.

    The report’s impact on both citizen perception and behavior was both impressive and measureable. In 1958, only 44% of Americans believed smoking caused cancer according to Gallup. By 1968—a mere 4 years following release of that pivotal report—78% believed it did.

    The 1964 report urgently stated: “Cigarette smoking is a health hazard of sufficient importance to warrant appropriate remedial action”—remedies that were left to politicians to develop and implement.

    Related: Can we prediagnose opiate addiction?

    By 1965, Congress had required that cigarette packs carry a health warning by order of the Surgeon General. By 1970, Congress had also banned all cigarette advertising on television and radio. Within a decade, due in large measure to the Surgeon General’s report and the laws it fostered, it had become common knowledge among US citizens that smoking damages health.

    Owning the problem

    Unlike his predecessor’s report, Murthy’s report on addiction is intended to spur action not just by policy makers, but also by healthcare professionals themselves. [Whereas] many Americans are dying of overdoses of heroin, many others are dying of opioid painkillers legally prescribed by physicians.

    However, even though it is the first Surgeon General report to address the substance abuse crisis, it may not have the same powerful impact on addiction that the 1964 report had on smoking. In fact, in response to its release, Democratic Senator Edward Markey of Massachusetts has already issued a statement calling the report a “missed opportunity,” and calling out his congressional colleagues for their half-hearted response to the addiction crisis that prompted it.

    “Deaths caused by prescription drugs and heroin are growing exponentially every year,” stated Markey. “Yet this report fails to provide a road map [for] how best to curb opioid addiction. Also, the report came at the end of [President] Obama’s tenure [while he was] pleading with Congress for $1 billion to fight the opioid epidemic, but Congress only set aside $181 million.”

    Addiction and the new president

    Physicians, Congress, and the pubic alike will be watching for the new administration’s response to the Surgeon General’s call for action on addiction. President Trump has already stated he will “try everything we can” to get Americans “unaddicted.”

    [Although] it remains to be seen how high the addiction crisis ranks on the new administration’s list of priorities, it is worth noting that the new president already learned firsthand the devastating truth of the Surgeon General’s findings. His brother Freddy died of alcoholism at age 43.

    Start the talk

    The Surgeon General’s report concludes that speaking openly about addiction is the crucial first step in combatting it. Murthy calls for a cultural change that starts with our perception of addiction itself, “not as a moral failing, but as a chronic illness [that needs] to be treated with skill and compassion.” He has vowed to continue his work to “change how we are talking about addiction and [to] get people to step forward and ask for help.”

    Next: The pediatric side of the opioid epidemic

    We pediatricians interact directly with our patients. Politicians don’t. We hold the power to begin conversations about addiction issues with those directly at risk. If we make time to take an adequate history, to probe for generational patterns, to ask parents about their own parents’ experiences with addiction, we may also have the power to intervene in the addiction death spiral itself.

    “The urgency to address addiction is only growing,” Murthy stresses. Today, 1 in 7 US citizens is expected to develop a substance abuse disorder at some point in their lives. Every day, 78 people die from opioid addiction—a number that has quadrupled since 1999. By asking about family addiction patterns right at the point of care, true change may be more likely to start in pediatricians’ offices than in congressional ones.

    Read the Surgeon General’s full report Facing Addiction in America here.


    Howard King, MD, MPH
    Dr King, a board-certified pediatrician, is founder and director of the Children’s Emotional Health Link, and honorary member of the ...

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