The Surgeon General weighs in

As you've probably already heard, last Thursday the U.S. Surgeon General, Vice Admiral Vivek H. Murthy MD MBA, formally made public his office's groundbreaking Report on Alcohol, Drugs and Health entitled "Facing Addiction in America." I knew it was coming - he promised it on March 30 when he spoke at the National Rx Drug Abuse & Heroin Summit (just prior to President Obama's panel) in Atlanta. This is a tweet I sent from the audience of a couple thousand people ...

#RxSummit Upcoming Surgeon General rpt is not just for prescribers but for the community. Affect policy, practice, perspective. Can't wait!! 

At the same RxSummit, President Obama announced that over sixty medical schoolswere going to increase education to their students on the potential dangers of opioids (a comprehensive plan to address the epidemic, including better/more education, had been originally launched in October 2015). Since that time, another ten medical schools have joined, and hopefully that list will continue to grow.

Between March 30 and November 17, the Surgeon General has been touring around the country, speaking with people directly impacted by addiction. Obviously, my focus is on prescription drugs and chronic pain, but as you read the report it's much broader than that. His bottom line? "Science tells us that addiction is not a disease of choice. It’s a disease of the brain."

In parallel with the touring, the Surgeon General's office launched #TurnTheTide (The Surgeon General's Call to End the Opioid Crisis), which is an aggregation of online resources for prescribers. Possibly the most important part of this initiative is the pledge that he's asking all prescribers take that asks them to do three simple (albeit hard) things:

1. Educate ourselves to treat pain safely and effectively.
2. Screen our patients for opioid use disorder and provide or connect them with evidence-based treatment.
3. Talk about and treat addiction as a chronic illness, not a moral failing.

If you're a prescriber and haven't taken this pledge, do so here. If you're a patient or a caregiver, ask your prescriber whether they've taken the pledge. If you're a payer, ask the prescriber if they've taken the pledge. If the prescriber has not taken the pledge, or is unwilling to do so, that should prompt further questions as to the rationale for the opioids.

In March, the Centers for Disease Control and Prevention published their "CDC Guideline for Prescribing Opioids for Chronic Pain." Since both the CDC and the Surgeon General are part of the U.S. Department of Health & Human Services, I'm assuming there was coordination (and it was part of the overall strategy).

Then, in August, the Surgeon General sent a letter (read it here) to every doctor in the U.S. to warn them about the addictive nature of opioids. This CNN article provides excellent context, including the apparent inspiration for the letter during a conversation with a Florida cardiologist friend ...

"I was having dinner with him and I said, 'Can you believe that we were taught that these opioid medications weren't addictive in our training?' " Murthy told a group at the Aspen Ideas Festival in Colorado in June. "And he put down his fork and he looked up at me and he said, 'Wait, you mean they are addictive?' " Murthy added. 

Seriously?

I had the honor of being a co-panelist with Rear Admiral Pamela Schweitzer, Chief Pharmacy Officer and Assistant Surgeon General, at the NAMSAP conference in September. While she was unable to be onsite in San Antonio (she attended via Skype), she reiterated the Surgeon General's plans and expressed her corporate and personal desire to address the opioid epidemic and advocacy for #TurnTheTide. It was obvious from the planning conversations and the panel itself that this issue was important to herself and her colleagues.

This has been a strategic and comprehensive battlefront on the combination of addiction and opioids for awhile. In fact, it started in 2011 when the White House published their first "Epidemic: Responding to America's Prescription Drug Abuse Crisis" (which was one of my first source materials when I first started speaking publicly). Beyond a doubt, it's making a difference.

So back to "Facing Addiction in America." I read the Executive Summary. Again, this report is not specific to opioids, but the broader subject of addiction. The following points in each section resonated with me and my focus as The RxProfessor:

• The Neurobiology of Substance Use, Misuse, and Addiction - The person no longer takes the substance to “get high” but instead to avoid feeling low
• Prevention Programs and Policies - It is never too early and never too late to prevent substance misuse and substance-related problems … Prevention works. However, it must be evidence-based
• Early Intervention, Treatment, and Management of Substance Use Disorders - With any other health condition like heart disease, detecting problems and offering treatment only after a crisis (overdose, criminal justice system) is not considered good medicine
• Recovery: The Many Paths to Wellness - Successful recovery often involves making significant changes to one’s life to create a supportive environment that avoids substance use or misuse cues or triggers
• Health Care Systems and Substance Use Disorders - Health care organizations are recognizing that substance use disorders must be detected and treated like other health conditions and that it is in their best economic interests to do so

So what does this all mean? There is no excuse for the continued over-prescribing of painkillers. For anyone. It is not a function of identification of the issue ... it's about change. Borrowing the famous analogy in "Good to Great", either get on the bus or get off the bus. Either way, change is happening. And it will change, and save, lives.

About the Author

Mark Pew, Senior Vice President of PRIUM, has been focused since 2003 on the intersection of chronic pain and appropriate treatment. That ranges from the clinical and financial costs of opioids and benzos, to the corresponding epidemic of heroin use, to the evolution in medical cannabis. Educating is his job and passion. Contact Mark at mpew@prium.net, on LinkedIn at markpew, or on Twitter @RxProfessor.

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