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Murthy: Opioid crisis solution starts with culture change

May 26, 2017
by Alicia Hoisington
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In 2015, about 52,000 deaths resulted from drug overdoses in the United States, according to data cited by Toby Cosgrove, MD, CEO and president of the Cleveland Clinic, during a community health forum in Cleveland on Thursday. The national costs associated with the crisis total $55 billion in health and social costs, and $20 billion in emergency dependent and inpatient care.

Clearly, the epidemic is a public health crisis that requires a public health solution, according to Vivek H. Murthy, MD, the former U.S. surgeon general, who spoke during the event. He has spoken about addiction frequently since the November 2016 release of the seminal surgeon general’s report, “Facing Addiction in America.”

The solution starts with changing the national dialogue around addiction treatment.

“Far too many people look at addiction as a disease of purely choice; they look at it as evidence of a character flaw or a moral failing,” Murthy said. “They don’t recognize that this is, in fact, a disease of the brain that is well-documented by science.”

That’s why the disease needs to be treated with the same care, compassion and urgent attention as conditions such as diabetes or high blood pressure, he said. And although the recidivism rate is high, treatment must be viewed as ongoing chronic care.

“There is often an idea out there that treatment for addiction is to stick someone in a rehab for two weeks and they come out cured,” he said. “That is not, in fact, how you treat addiction. If that is the approach you take, then relapse rates are incredibly high.”

The treatment for substance-use disorders often requires medication, counseling services and social support, according to Murthy. And there are several things primary care and specialty healthcare providers can do to change the culture, including:

  • Change prescribing practices. Providers need to be trained on how to recognize and assess pain with the necessary tools to treat patients safely, which starts by using prescription drug monitoring programs to note any red flags.
  • Leverage treatment resources that are available. Clinicians need to know where and how to find this information so that they can direct patients accordingly.
  • Become advocates. Institutions have a loud voice that can be used to affect change in the community or ask legislators to put dollars toward education, training and treatment—and they need to use that voice.

Emotional well-being

Too often providers focus on the physical when it comes to pain, overlooking the emotional aspect of it, Murthy said. An investment in understanding emotional well-being is critical for long-term success in combating the opioid crisis.

Today’s world is one of the most connected eras ever thanks in part to technology and social media, he said. In the 1980s, about 20% of adults said they were lonely. Today, that figure has jumped to 40%. That loneliness can be deadly, according to Murthy, with shorter life spans that are comparable to the effects of smoking or obesity.

“We have to understand that it’s part of what’s driving this overall epidemic, which is why we have to make emotional well-being a priority … because it drives the health outcomes that we ultimately care about,” Murthy said.

Additionally, safer ways of addressing physical pain need to be top of mind. While opioids are effective at reducing pain, they are not safe, he said. Physical therapy and cognitive behavioral therapy are safe tools for treatment. However, they are underutilized because of time or insurance-coverage constraints.

 “This is where we have a lot of room to grow,” Murthy said. “If you are serious about addressing the opioid crisis in America, you have to be serious about expanding coverage because those two go hand in hand.”

Alicia Hoisington is a freelance writer based in Ohio.