Surgeon General Urges MDs to Help End US Opioid Epidemic

Pam Harrison

November 10, 2016

For the first time in its 145-year history, the Office of the Surgeon General issued a letter specifically targeting US medical professionals, urging them to help end the country's opioid epidemic.

In an article published online November 9 in the New England Journal of Medicine, US Surgeon General Vivek Murthy, MD, discusses the rationale for sending the letter.

The letter, which included his personal appeal and a pocket card outlining how physicians and allied healthcare professionals should assess, prescribe, evaluate, and treat overdose and addiction, is part of a larger online campaign, Turn the Tide Rx, aimed at educating clinicians on how to more effectively approach opioid-use disorder, otherwise known as opioid addiction.

"I chose to take these actions because of the magnitude and trajectory of the opioid epidemic," Dr Murthy writes.

He points out that since 2000, the number of people who have died of overdose from either prescription opioids or illicit opioids has nearly quadrupled.

"This increase parallels marked growth in the quantity of opioid pain relievers being prescribed," he adds.

Last year, an estimated 2 million Americans were addicted to prescription opioids, and more than 12 million others acknowledged that they had misused opioids.

Not unexpectedly, such widespread misuse is contributing to a resurgence in heroin use as well as the spread of HIV and hepatitis C.

However, Dr Murthy notes, all is not lost.

"I saw firsthand that when given access to evidence-based treatment, people can recover and rebuild their lives," Dr Murthy writes.

He also witnessed how making sure first responders have the opioid antagonist naloxone at the ready saves lives of those who inadvertently overdose.

Dr Murthy reports that he has also met with many clinicians who told him they are trying to reduce unnecessary opioid prescribing by using a variety of strategies, including prescription-drug monitoring programs.

The federal government has played an important part in helping to stem the opioid epidemic as well.

For example, the Obama administration has invested millions of dollars in addiction treatment programs. Efforts include guaranteeing that first responders have access to naloxone.

The Centers for Disease Control and Prevention, in Atlanta, Georgia, has issued guidelines for opioid prescribers as well.

"Going forward...it will be necessary to continue efforts to expand insurance coverage, which is essential for obtaining access to prevention and treatment services," Dr Murthy adds.

However, he points out, government cannot solve the opioid epidemic on its own. Clinicians in particular need to step up to the challenge and assume a leadership role if the epidemic is to be successfully curtailed.

"We can sharpen our prescribing practices and use prescription-drug monitoring programs to reduce the risk of opioid misuse and overdose," Dr Murthy writes.

Clinicians can also lobby medical schools and other educational venues to make sure students and licensed practitioners alike are trained in the management of opioid-use disorder.

"Perhaps most important, we can use our position as leaders in society to help change how our country sees addiction — not as a personal failing but as a chronic disease of the brain that requires compassion and care," Dr Murthy writes.

He also writes that eradicating societal bias against addiction is essential for having people come forward and ask for help.

In addition, the surgeon general issues a plea for physicians to consider nonopioid prescriptions when they need to treat patients with pain. He also calls for society to pay more attention to the physical and emotional factors that often exacerbate pain for those who suffer from it.

At the same time, "we have to do all these things without allowing the pain-control pendulum to swing to the other extreme, where patients for whom opioids are necessary and appropriate cannot obtain them," Dr Murthy cautions.

Dr Murthy has disclosed no relevant financial relationships.

New Engl J Med. Published online November 9, 2016. Full text

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