Newswise — Nearly 2 million people in the United States are addicted to prescription opioids, and millions more feel the pain, including their families, friends and clinicians.
How did we get here?
“When we look back in 20 years I want us to say, ‘This is when the country woke up, when we as clinicians decided to step up in our role as leaders, as advocates, to create a foundation for better health.” — Vivek Murthy
U.S. Surgeon General Vivek Murthy charted the history of the opioid epidemic and his hopes for ending it during Grand Rounds held June 17 at Harvard Medical School.
Twenty years ago, physicians were urged to treat pain more aggressively, said Murthy, who practiced internal medicine at Brigham and Women’s Hospital until being named the nation’s chief public health officer in 2014.
Amid heavy marketing, some doctors prescribed opioids under the false impression that these painkillers were not addictive if they were used to relieve pain, he said.
Opioid prescriptions have quadrupled since 1999, he said, and so have opioid overdose deaths.
Yet Murthy is encouraged by efforts being made across the U.S. to address the crisis, calling Massachusetts a bright spot in the country for what the commonwealth has been doing to respond to the crisis.
The surgeon general’s day in Boston began with a visit to two programs where people are battling substance use disorders as well as the unemployment and homelessness that often accompany them.
Murthy stopped at Boston Medical Center’s Opioid Treatment with Buprenorphine Program and at the Supportive Place for Observation and Treatment Program, run by Boston Health Care for the Homeless.
“When we look back in 20 years,” he told his HMS audience, “I want us to say, ‘This is when the country woke up, when we as clinicians decided to step up in our role as leaders, as advocates, to create a foundation for better health.’”
In the TMEC amphitheater—a familiar setting from his time at the Brigham—Murthy joined three panelists to discuss local efforts to combat the opioid epidemic: Monica Bharel, commissioner of the Massachusetts Department of Public Health; Sarah Wakeman, HMS assistant professor of medicine at Massachusetts General Hospital; and Michael Duggan, founder of Wicked Sober.
Jeffrey S. Flier, HMS dean, welcomed the group, outlining the dimensions of the opioid crisis and how the School is collaborating to overcome it.
“We are all working together to further develop our curriculum competencies so that we can improve how we teach future physicians better pain medicine prescription practices and give them a more accurate understanding of the signs of addiction,” Flier said. “Planning is ongoing as to how we will integrate the new curriculum across all our teaching hospitals.”
“We have to change how our country thinks about addiction,” Murthy said. “Right now there are too many people in America who think of addiction as a character flaw, as a moral failing.”—Vivek Murthy
Murthy urged clinicians and students to meet the challenge in three ways.
“We have to ensure that we are sharpening our prescribing practices as clinicians, so that we can prescribe opioids when necessary but avoid them when they are not,” he said. “We also need to ensure that we are expanding access to treatment.”
“We have to educate the public,” he said. “We all know as clinicians that every medicine has benefits and potential risks. But when it comes to opioids, it’s clear we have to do more to help the public understand what some of those risks are.”
Perhaps more difficult to overcome is the power of substance use stigma, which makes a methadone clinic less palatable than a cancer clinic in many neighborhoods.
“We have to change how our country thinks about addiction,” Murthy said. “Right now there are too many people in America who think of addiction as a character flaw, as a moral failing.”
Stigma keeps people from seeking help, even from their doctors, Bharel said.
“We have to recognize substance abuse as the medical disease that it is,” she said.
Wakeman, who directs the MGH Substance Use Disorders initiative in the MGH Center for Community Health Improvement, compared addiction to diabetes. Both involve genetic, behavioral and fundamental biology factors. Both benefit from care that recognizes the whole patient.
“Treating addiction is both the single most rewarding thing that I do in medicine and one of the easier things we do in medicine,” she said. “The good news is recovery happens. It’s a totally treatable illness.”
Duggan’s Wicked Sober organization helps individuals and families struggling with addiction by connecting them with resources for treatment. Sober himself since 2009, Duggan told his story of addiction to painkillers, which began with a hockey injury during his senior year in high school.
“My story isn’t unique, “ he said. “It was easier for people my age that I knew to get access to pain medication legally or illegally than it was to get somebody to buy alcohol for an underage individual.”
At his program, Duggan tries to give people more than the list of phone numbers he got when he left treatment. He said he focuses on coordinating care for people whose addiction robs them of the ability to make rational decisions.
Murthy asked the audience to look for a letter coming next month from his office to practitioners around the country, offering guidance on substance use disorders.
Later this year, Murthy said, he will issue the first surgeon general’s report on substance use, addiction and health. He said he hopes it will have an effect approaching the impact of the 1964 surgeon general’s report on smoking.
“We have an especially important role as physicians,” Murthy said. “Many of us came to the healing arts because we want to relieve suffering. With that has come a moral responsibility not only to care for individual patients, but to step up and help address some of our country’s most intractable public health problems.”
Recognizing the many demands on physicians’ time and energy, he also offered a bright side to the successful treatment of people with addiction.
“I believe that impact is one of the most powerful antidotes to burnout,” he said.
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