Dr. R. Jeffrey Goldsmith is a professor of psychiatry and behavioral neuroscience at the University of Cincinnati College of Medicine and president of the American Society of Addiction Medicine.
Last month, Surgeon General Vivek Murthy released “Facing Addiction in America” -- the first-ever Surgeon General's Report to address the public health crisis of substance abuse and addiction.
The American Society of Addiction Medicine, the leading professional society in the field of addiction medicine, applauds this historic examination of the health effects of drug and alcohol misuse and addiction, and commends Dr. Murthy for taking action to raise awareness about this critical public health issue.
The consequences of the opiate epidemic are both personal and far-reaching, from drug overdoses and DUIs, to the spread of infectious diseases, unintended pregnancies, chronic disease and longer-term societal impacts on crime, violence and poverty.
For far too long, policy makers, the public and even health care providers have misunderstood addiction as some sort of moral failing.
Those of us who work within the mental health care and addiction sciences already know: addiction is a disease of the brain that can and should be treated with evidence-based, compassionate care. With repeated use of drugs like opioids and heroin, changes in the brain can occur, which, for many users will not go away if they stop using drugs for the moment. This is a chronic illness and should be treated as such by the health care industry.
What I would like to see is that physicians and other health care providers are ready to treat both heroin and prescription medicine addiction. This means clinical recognition of the illness, widespread recognition of high-risk populations, adequate spaces in addiction clinics, ease of referral for this evidence-based treatment, and sufficient payment to justify providing this evidence-based treatment.
Medication Can Work
At the University of Cincinnati and other research institutions, trials and studies to understand opioid use disorders demonstrate that treatment for opioid addiction by trained doctors using medication has proven successful. Research shows that taking patients off medication assisted treatment leads to relapse 80 percent of the time. The recent U.S. surgeon general’s report on addiction concurs that “abstinence-only” approaches are scientifically unsound and such programs can do more harm than good by restricting treatment for many who could benefit.
Heroin addiction scares the community, but it bears repeating that this is an epidemic. The health care community must address it as a chronic illness that's causing thousands of deaths.
There is the cultural stigma tied to it that we need to get beyond. Unfortunately, there are clinical observations that people who begin on pain pills turn to heroin because it’s cheaper and easier to get.
But the pain pill addiction is no less of a health crisis, more hidden from view than heroin. We are seeing more than 30,000 deaths each year in the U.S. alone related to opioid addiction, more than deaths from motor vehicle accidents, according to the CDC.
What We Can Do
But don’t forget about other prescription drugs, like benzodiazepines and stimulants. They too create problems with addiction and overdose deaths. Addiction in America is directly affecting millions of Americans every year: vehicle crashes, crimes, injuries, reduced quality of life, impaired health.
So what can we do?
Provide physicians with adequate training for addiction and chronic pain illnesses, and provide adequate funding for the management of these illnesses. Strengthen doctor-patient relationships so they can discuss the complexities of these chronic problems.
The surgeon general concludes his report by urging an evidence-based public health approach to prevent and treat substance-related issues. Adopting these evidence-based strategies can reduce the number of people suffering with addiction. It can shorten the duration of illness for sufferers and reduce the number of substance-related deaths.