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Can NJ’s Programs to Prevent and Treat Addiction Serve as National Model?

U.S. Surgeon General says treatment for substance-use disorders should emphasize harm reduction and involve new medications

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New evidence-based prevention and treatment programs — like some now in use in New Jersey — have shown real promise, but much more must be done to address what is now a national public health crisis stemming from epidemic rates of drug and alcohol abuse, according to a landmark report issued Thursday by the U.S. Surgeon General.

Dr. Vivek H. Murthy, the “nation’s doctor,” found that nearly 21 million Americans suffer from substance-use disorders, more than all those with cancer combined. Despite a growing awareness of addiction, greater options for treatment, and better insurance coverage, only one in 10 of these individuals can connect with the care they need.

The report, which fills more than 420 pages, calls for the expansion of proven science-based programs that prevent or reduce drug or alcohol use, limit the likelihood of harm for those who do use, and employ new technologies and modern medications to help curb relapses — methods that have already proven effective in the Garden State, experts said.

Murthy also stressed the need for everyone — healthcare providers, government regulators, industry leaders, and the public — to view substance abuse as a public health emergency that should be tackled with the same dedication they would apply to any other chronic disease. For too long, addiction treatments have been plagued by stigma and users judged as morally weak, even by healthcare professionals, he said.

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Surgeon General Dr. Vivek H. Murthy shows a naloxone nasal spray.

“Alcohol and drug misuse and related disorders are major public health challenges that are taking an enormous toll on individuals, families, and society. Neighborhoods and communities as a whole are also suffering as a result of alcohol- and drug-related crime and violence, abuse and neglect of children, and the increased costs of health care associated with substance misuse,” Murthy wrote.

Although the Surgeon General has reported in the past on aspects of substance-use disorders, this is the first publication dedicated to the larger issue, and it is designed to rally the public, policymakers, and providers around new opportunities for effective treatment.

During an event in Livingston this summer, at which Murthy outlined his campaign to further engage doctors and nurses in tackling addiction, he said these science-based reports have had a powerful impact in the past. When the office released its landmark smoking study in 1964, more than four-out-of-10 Americans lit up regularly; today some 17 percent are considered smokers, he said.

Roseanne Scotti, New Jersey director for the Drug Policy Alliance, said the publication is “very significant.” Scotti said the organization was encouraged by many of Murthy’s recommendations, including support for needle-exchange programs, which help intravenous drug users avoid blood diseases and provide a route to treatment; the use of naloxone to rapidly reduce an opiate overdose; and programs that include medication-assisted treatment with buprenorphine or methadone.

“New Jersey has made progress on all these fronts,” Scotti said, praising Gov. Chris Christie’s approval this year of a bill to expand and fund needle-exchange programs, the state’s ongoing work to arm police officers and others with naloxone, and the recent change to allow medication-assisted treatment in the drug court programs. Christie has also invested in a ”recovery coach” pilot program that pairs former addicts in recovery with overdose victims in crisis to encourage their recovery, another approach endorsed in Murthy’s report.

“We still have a lot of work to do, and we desperately need more funding for drug treatment,” Scotti added.  “This report though is confirmation of many of the actions New Jersey has taken to help people with substance use disorders.”

Murthy’s report included a “vision for the future” section that called for an expansion of evidence-based programs that are applied using the same chronic-illness strategies providers use to treat asthma or diabetes. Individuals need to be screened for addiction issues more frequently and, as part of their regular medical care, medication-assisted treatment should be more available, and quality treatment programs must be expanded.

“It’s about promoting these evidence-based practices that have been stigmatized in the past,” Scotti said, explaining that there has been a split within the addiction community about the role of long-term medications used to stabilize the life of opioid abusers. “We need to make individual treatment decisions, just like we would for any other disease.”

These treatments costs money, but they are far less expensive overall than not addressing addiction, Murthy wrote, and when approached like other chronic diseases, addiction has similar rates of treatment success. And, while remission is not uncommon — as it is with all chronic diseases — “recovery is now possible,” the report states.

To improve the healthcare system’s ability to address addiction issues, Murthy said substance-abuse and mental health treatment must be better integrated with mainstream medical care. A coordinated system would allow for more effective early intervention, since many drug users enter treatment after seeking care for an unrelated condition. It would also improve providers’ ability to address multiple diagnoses and boost the attention and funding devoted to addiction issues.

“Integration can help address health disparities, reduce health care costs for both patients and family members, and improve general health outcomes,” Murthy wrote.

The report stressed that a primary factor in the “treatment gap,” in which 90 percent of addicts don’t get the care they need, remains the fear and shame associated with the disease. Science shows that addiction is a chronic brain disease with the same potential for relapse and recovery associated with other conditions, it notes, and the disruptions in brain circuitry caused by substance abuse last long after a user gets clean. But societal stigma remains and contributes to the disparity in care.

“Making this change will require a major cultural shift in the way we think about, talk about, look at, and act toward people with substance use disorders,” Murthy wrote. “Negative attitudes and ways of talking about substance misuse and substance use disorders can be entrenched, but it is possible to change social attitudes. This has been done many times in the past: Cancer and HIV used to be surrounded by fear and judgment, now they are regarded by many as simply medical conditions,” he said.

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