Surgeon General Warns Every Doctor on Opioid Epidemic

Posted on August 26th, 2016

The U.S. surgeon general this week took historic action to stem the nation’s deadly opioid epidemic by writing a warning letter to every doctor in America about the addictive potential of prescription painkillers, blamed for the deaths of 78 people every day.

Surely, this isn’t news. With the blanket media coverage of the fatal overdose of music icon Prince, coupled with the daily drumbeat of stories about unintentional deaths tied to dependence on pain medication and its cousin from the streets, heroin, didn’t everyone already know the dangers of opioid addiction? Wasn’t it common knowledge that dependence on these drugs is one of the scourges of our times, killing the rich and poor, young and old, with equal efficiency? And if not already evident to the general public, was this a warning that doctors, of all people, needed to hear?

Sadly, yes. After a recent tour of the country, Surgeon General Vivek Murthy discovered that despite exhaustive media coverage about the opioid epidemic, many doctors are still in the dark.

He said even a friend of his didn’t know.

“I was having dinner with him and I said, ‘Can you believe that we were taught that these opioid medications weren’t addictive in our training?’” Murthy told a group at the Aspen Ideas Festival in Colorado in June.
“And he put down his fork and he looked up at me and he said, ‘Wait, you mean they are addictive?’” asked the friend, whom Murthy said has trained at some of the best institutions in the country.

It was a double-take moment that convinced the surgeon general to take the unprecedented step of reaching out to every prescriber in America, urging them to do three things:

“Number one is to sharpen their prescribing practices, to make sure that we are treating pain safely and effectively,” Murthy told CBS News. “Number two, it’s to connect people to treatment who need it, and right now we have a major treatment gap in this country that we have to close. But the third is we’re asking clinicians to help us change how our country thinks about addiction.”

The Devastating Toll of Opioid Addiction

More people died from drug overdoses in 2014, the latest year for which there are statistics, than in any year on record, according to the Centers for Disease Control and Prevention. Most of the fatal overdoses (more than six out of 10) involved an opioid such as OxyContin, Vicodin or Percocet. And eventually, for some, painkiller abuse leads to heroin, which is also an opioid that can be bought on the street. “I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic,” Murthy wrote.

In an effort to retrain physicians, Murthy included in his mailing a pocket guide detailing “best practices” for prescribing opioids. The card gives physicians a four-point checklist to consider before putting a patient on opioids. Physical therapy, non-addictive painkillers and even talk therapy like cognitive behavioral therapy (CBT) may be appropriate for some patients, the card reads, and if doctors do choose to prescribe opioids, they are instructed to “start low and go slow.”

How the Opioid Crisis Developed

Like many doctors, Murthy’s friend, a cardiologist in Florida, was taught in medical school that opioids weren’t addictive as long as they were used for legitimate pain. “Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely,” Murthy wrote in the letter. “This coincided with heavy marketing of opioids to doctors.”

Ending the Stigma

In addition to bringing doctors up to speed on opioid addiction, the surgeon general is asking all Americans to change the way they think about substance abuse. Physicians, he said, can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing.

Indeed, research points to addiction as a disease of the brain, not a personal failing or moral weakness, and it can be treated, Dr. David Sack, an addiction specialist with Elements Behavioral Health, told Psychology Today. “Multiple treatment options are now available including 12-step offerings and 12-step alternatives, medication-assisted treatment, and a variety of therapies that can help the person uncover the source of their drug use and begin to heal the damage done to their brain,” Dr. Sack said.

Advice to Patients

While many people who have become dependent on opioids still “doctor shop” to get more of the drugs after their original prescription runs out, other patients are concerned about getting that first opioid script. They’ve heard the news about the opioid epidemic and fear they, too, could become a statistic. If you fall into that category and your doctor wants to prescribe opioids, make sure they are not “pulling out the big guns simply because they think you want them,” Dr. Sack said. Ask about the risk versus benefits and whether a non-addictive treatment might work as well. There’s a good chance it will. In an ironic twist, researchers have found that opioids can make chronic pain worse, rather than alleviate it. That effect is known as opioid-induced hyperalgesia, or the tendency for people to become more sensitive to pain signals after using opioids for an extended period.

The surgeon general is also pushing for increased access to addiction treatment. He is urging all doctors to screen their patients for opioid use and provide or connect them with evidence-based treatment. In addition, Murthy said, policymakers must provide more funding for treatment programs, noting that today more than 1 million people are going without the treatment they desperately need.

Here is Murthy’s letter in full:

LETTER FROM THE SURGEON GENERAL

Dear Colleague,

I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure.

It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain.

The results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.

I know solving this problem will not be easy. We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. This is one of those times.

That is why I am asking you to pledge your commitment to turn the tide on the opioid crisis. Please take the pledge. Together, we will build a national movement of clinicians to do three things:

First, we will educate ourselves to treat pain safely and effectively. A good place to start is the TurnTheTideRx pocket guide with the CDC Opioid Prescribing Guideline. Second, we will screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. Third, we can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing.

Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.
Thank you for your leadership.

Vivek H. Murthy, M.D., M.B.A.
19th U.S. Surgeon General

By Laura Nott

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