Posted by & filed under Noah's Notes.

On November 17 The U.S. Surgeon General, Dr. Vivek H. Murthy released the first ever Surgeon General’s report addressing substance abuse and addiction.

Entitled “Facing Addiction in America” this remarkable 500 page document summarizes all that we know about this disease and its treatment and creates a hopeful roadmap for the future. As General Murthy points out:

  • 21 million Americans have a substance use disorder (for the vast majority it is alcohol)
  • 66 million people report binge drinking each year
  • 88,000 people die each year from complications of alcohol
  • 47,000 die from complications of drug use.

The total annual cost of all of this, including lost productivity, criminal justice and treatment is $442 billion. These ought to be compelling arguments for policy makers, healthcare systems, public health organizations, caregivers, and education systems to act. And the combined and collaborative effort of all of these sectors is exactly what the report repeatedly and convincingly recommends.

Dr. Murthy explains and emphasizes the neuro-biologic basis of substance use disorders (also known as addiction), highlights evidence based preventive education for all age groups, summarizes the evidence supporting effective treatment for Opioid Use Disorder and stresses the need for integration of screening for, and the diagnosis and treatment of use disorders in all health care settings. His vision for the future includes:

  • Reframing substance use disorders in a public health context, rather than a criminal justice context (although he acknowledges the effectiveness and supports the use of modest law enforcement interventions, such as the positive impact of OUI laws in decreasing deaths from drunk driving)
  • Expanding access to evidence based treatment
  • Implementation of broad prevention programs
  • Full integration of substance abuse/substance use disorder treatment services within the rest of healthcare
  • Coordination and implementation of laws requiring equal coverage for mental health and substance abuse under the Affordable Care Act (this may be threatened if the new administration repeals or retracts the ACA)
  • Ongoing research to guide the public health approach in the future

The Surgeon General’s recommendations for healthcare delivery systems include:

  • Promotion of primary prevention through safe prescribing practices
  • Effective and evidence based treatment of chronic pain
  • Use of important adjunctive tools like the Prescription Monitoring Program (where prescribers can see all controlled substances prescriptions a patient has received)
  • Evidence based treatment for substance use disorder
  • Integration of mental and behavioral health services with primary care
  • Payment reform to support these changes
  • Full use of Health Information Technology, including not just the electronic health record and disease registries, but innovations like computer based education and treatment and mobile apps

The collaboration of legislators and the administration, public policy leaders, health systems, mental and behavioral health providers, law enforcement and educators from across the state will allow us to continue to address this most important public health challenge of our time.

Noah Nesin, MD

Dr. Nesin, Vice President of Medical Affairs for PCHC, is a family doctor with 30 years of experience.

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