In 2016 Vivek Murthy, 19th Surgeon General of the United States Department of Health & Human Services released a report “Facing Addiction.” Although this report is full of alarming statistics intended to generate a response from people, it misses the mark. One in seven Americans will struggle with alcohol or other drug abuse in their lifetimes, and about 20 million Americans currently have substance-abuse disorders. With so many people dying each day of drug overdose, 91 to be exact, and only 10% of people ever receiving any sort of help towards recovery, you would think that our Surgeon General would address such a subject. ” For far too long, too many in our country have viewed addiction as a moral failing.” “We must help everyone see that addiction is not a character flaw-it is a chronic illness” says Murthy. The Surgeon General is hoping to spark a radical change, like his predecessor Luke Terry. In 1964 Terry wrote a report that frightened Americans into facing the obvious link between cigarettes and lung cancer. Murthy’s “Facing Addiction” is not nearly as galvanized as Terry’s report, and in turn not sparking the fear that is much needed.
As it goes into talking about initiating many fronts like creating easier access to harm reduction programs, needle exchange, and the distribution of the opioid antidote naloxone, it doesn’t seem to go deep enough. For example, it calls for more drug court programs, yet it doesn’t distinguish that other diseases are not treated with punishment or criminalization. While Murthy does talk about how the media portrays the tv-style interventions, and how they are not helpful, he fails to point out how common they actually are. It is that exact repetitiveness that seems to be plaguing the treatment community. The prayer and surrender, “higher power,” 12 step programs are most commonly pressured upon patients. While he has scientific evidence to prove there is more access to treatment then before, what he does not address in his vague report is the contradictions in labeling addiction a disease. To make it easier to understand, if an individual has Bi-Polar Disorder, treatment providers would not advise the patient to just believe in a “higher power” and believe you have it in you to change. Heck no! Those individuals would be treated with medication, and proper therapy. So, why isn’t substance-use disorder patients treated the same? Or, why doesn’t our Surgeon General bring this inconsistency to light?
A key point made in Murthy’s report is “well supported scientific evidence shows that treatment for substance-use disorders – including inpatient, residential, and outpatient – are cost effective compared with no treatment.” This statement will clearly show beneficial to costly rehabs to justify crazy insurance coverage. Although for residential and outpatient treatments this is not true, for opioid addiction continuous use of maintenance medications like methadone and bupernorphine that is in most of residential care, is proven to be beneficial. A study of the UK treatment system found that “Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.” Meaning that maintenance medication plans demonstrate to be more effective than just psychological plans. Another problem that arises with the vagueness of the report is the statement on “medication-assisted programs” also known as MAT. It says ““MAT is a highly effective treatment option for individuals with alcohol and opioid use disorders. Studies have repeatedly demonstrated the efficacy of MAT at reducing illicit drug use and overdose deaths improving retention in treatment and reducing HIV transmission.” This is true for methadone and bupernorphine, but the drug naltrexone (which is also listed) has zero data backing up it’s performance. In Australian research compared to methadone related deaths, naltrexone was associated with an 8 times greater risk of death. There is simply not enough data to support that the injectable long-lasting version is linked to saving lives like methadone and bupernorphine. The data should have been made clear, and the two medications that are scientifically proven to work should have been highlighted as superior.
With 80% of American treatment facilities involving in one way or another the “12 step program,” the report describes promoting “acceptance.” The report also cites evidence that when treating alcoholism the tiered program is as effective and less problematic as other treatments such as cognitive-behavioral therapy and motivational enhancement therapy. This would be all fine and dandy, if it weren’t for one problem. Murthy fails to to explain why this ever religious treatment has no data backing up that it works for opioid treatment. Yet it is in most programs across the country that treat both alcohol-use disorder, as well as substance-use disorder. The struggle here is that this report was meant to startle the public, and promoting that the alternative to the disorder is admitting to moral misbehavior and making amends for it. It’s just not that simple. By doing this he is taking away the chance for the public to view this disorder as the disease it is, making it difficult to get quality medical care. In no way am I completely shaming the “12 step program,” I just look at the facts. This program can be found for free in most cities across the United States, and yet our addiction statistics are rapidly increasing. Something isn’t working right here. If addiction is going to be seen as a true disease, the government will stop criminalizing it, and using a religious program that offers help but not the true guidance needed should not be considered a legitimate therapy. A report that does not tackle the contradictions in this industry will not, and can not make the radical change we need as a nation. The Surgeon General is trying to make an impact, but is ultimately missing the mark, costing more lives each and every day.