Physicians, nurses, and other healthcare providers are the first line of defense in the battle against addiction and the Surgeon General, the “nation’s doctor” wants to make sure they have the proper information, equipment, and attitude to make the fight both effective and compassionate.
On Monday, Surgeon General Dr. Vivek H. Murthy joined an addiction forum in New Jersey to highlight a new focus on helping doctors curb the flow of opiates and improve treatment options while still treating patients’ pain safely. In his position as the nation’s top expert on preventative healthcare, Murthy launched the “Turn the Tide” campaign last month to help build public awareness about addiction and connect drug users and their family members with proven solutions.
Murthy said his office would soon launch a new website to help providers better understand substance abuse, its diagnosis and treatment options; it will also seek to reduce the pervasive stigma surrounding the disease, including among medical providers. Later this month his office will send a letter to 2.3 million doctors nationwide – the first outreach of this kind – asking them to get more involved. The mailing will include a pocket guide to pain treatment, designed to encourage alternative options to opioids.
Later this year, Murthy will release the first-ever Surgeon General’s report on addiction, which some have suggested is long overdue. Such science-based reports have had tremendous impact in the past, he said; when the office released a landmark study on smoking, in 1964, 42 percent of American’s lit up regularly. Today it is down to 17 percent, he said.
“Addiction really is a disease of the brain. It is not a moral failing. It is not a bad choice,” Murthy said, noting that he spends roughly half his time focused on this issue. “This is a moment where more professionals can stand up and lead – and not just within the walls of the hospital.”
The forum was the latest in a series organized by U.S. Sens. Bob Menendez and Cory Booker, both Democrats, with help from the Partnership for a Drug-Free New Jersey, to hear from residents, law enforcement officials, and others directly impacted by the state’s addiction crisis and to explore potential solutions. Held at Saint Barnabas Medical Center in Livingston, the discussion also featured Dr. David Shulkin, a former hospital executive in New Jersey who is now Under Secretary for Health with the Veterans Administration. It attracted some 300 healthcare providers, addiction experts, and others involved with the epidemic.
[related]Their efforts are part of a growing movement to help the public understand that drug addiction is a disease, not to fault the user and instead to encourage government and civic leaders to invest in prevention and treatment instead of criminalizing substance abuse. Federal data suggests some 2 million Americans are addicted to opiates and 78 die each day from the pharmaceuticals or heroin, a cheaper equivalent. In New Jersey alone, 28,000 people sought treatment last year and more than 1,200 were lost to overdoses, according to Menendez’s office.
One effort to curb the epidemic has been the federal Comprehensive Addiction and Recovery Act, championed by Menendez, Booker and Congressman Frank Pallone, (D-Monmouth), among others. Signed into law last month, it seeks to reduce the abundance of unwanted prescription drugs in circulation, improve prescription monitoring efforts, expand access to naloxone injections — which can reverse an overdose almost immediately — and create evidence-based treatment standards. However, the Republican-led Congress declined to include any funding in the bill, despite President Barack Obama’s request for $1 billion.
This situation has frustrated the senators significantly; Booker called the bill “window dressing” and said it was “shortsighted” and “fiscally irresponsible” not to invest in the prevention and other protocols outlined in the new law, which would reduce addiction and save public money over time. “This is much more than just a policy issue. It’s more than just a debate,” Menendez added. Providing funding for CARA’s programs is “the essence of saving lives,” he said.
Work is well underway to reduce patient dependence on opiates and other addictive pain drugs at the Veterans Administration, Shulkin explained. The former Morristown Memorial Hospital president was tapped last spring to head health programs at the agency, where pain management is big business. He said 60 percent of soldiers return from combat with chronic pain and 50 percent of older vets face the same condition – twice the national rate.
At the VA, healthcare providers work in integrated teams and share a database of patient records that allows them to carefully track medications and other treatments. Patients sign a pain contract that outlines their responsibilities, and they submit to urine tests. Information about abuse is included with all opiate prescriptions, along with a stamped envelope allowing vets to mail back any unused pain pills. The agency also works to integrate mental healthcare and encourages alternatives to pharmaceuticals like meditation, exercise, and partnership with companion animals.
The results have been impressive, Shulkin said. Opioid prescriptions have declined 20 percent since 2013 and the doses are one-third lower. While 12 percent of vets nationwide are on opiates, in New Jersey the figure is just five percent, he added.
“This is an area where we are leading in American medicine,” Shulkin said.
An integrated network like RWJ/Barnabas Health – the product of a merger earlier this year – can work in a similar way to track patient prescriptions and outcomes and provide comprehensive care, Murthy suggested. The Barnabas Institute for Prevention is now expanding a pilot program launched earlier this year – and believed to be the only one of its kind nationwide – that connects former drug users, trained as recovery specialists, with addicts who end up in the emergency room.
The recovery specialist pilot program is one of several efforts that attracted support from Gov. Chris Christie, a Republican who has made addiction a priority for his administration. Murthy also praised the state’s Prescription Drug Monitoring Program, which Christie has connected to systems in New York and other states.
But Murthy said legislation and government initiatives will only go so far; healthcare providers need to become more actively involved in the fight against addiction. That requires more modern, effective training. All medical professionals – regardless of their future specialty – are taught how to take blood pressure and to titrate medications; Murthy said med schools should provide the same type of comprehensive basic training for addiction. “It should be something all of us are trained to recognize and all of us are trained to treat,” he said.
Murthy also urged healthcare providers to speak up publicly about the impact of the disease and to contact their elected representatives, who rarely hear from clinical providers directly. Physicians in particular are held in high esteem by society and should use that platform to help people understand how substance abuse is a disease, not a weakness. But first they have to learn the facts and get over their own misgivings about addicts, he said.
“There is a prejudice and stigma that exists in our hospitals,” Murthy said. “That’s a cultural change we have to own as profession.”