Drug, Alcohol Abuse Not a Character Flaw: Surgeon General’s Report

Substance misuse is an important health problem that needs a medical approach

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Abusing drugs or alcohol is an important health problem that needs an integrated, multi-focused medical approach and should not be treated as a moral failing or character flaw, says a new report released Thursday by the U.S. surgeon general’s office.

The report is the first from the U.S. surgeon general’s office dedicated to substance misuse and related disorders. The report covers alcohol, illegal drugs and prescription drugs, with chapters devoted to the neurobiology of addiction, as well as recommendations for prevention, treatment, recovery and health systems integration.

More than 27 million U.S. residents reported using illegal drugs or misusing prescription drugs in 2015, the Center for Behavioral Health Statistics and Quality reports. That same year, more than 66 million people — nearly a quarter of the U.S. adult and adolescent population — reported binge drinking in the past month.

“Alcohol and drug misuse and related disorders are major public health challenges that are taking an enormous toll on individuals, families and society,” the surgeon general’s report says.

Effective prevention, treatment

One particularly encouraging aspect of the surgeon general’s report is it acknowledges that effective prevention and treatment methods exist to treat substance abuse — and that these methods should be more widely used, says addiction psychiatrist Jason Jerry, MD.

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Dr. Jerry says he hopes the report will have the same effect as the surgeon general’s landmark 1964 report on smoking, and generate a massive nationwide campaign to address the substance abuse problem, particularly for prescription painkillers called opioids.

“I think there’s this misconception in our country that we’re in the midst of a pain epidemic — and we’re not,” Dr. Jerry says. “We’re really suffering the scourge of pills, too many painkillers that ultimately lead to opioid addiction and then to heroin addiction.”

Physicians are becoming increasingly aware of the need to avoid prescribing narcotics in situations where ibuprofen or naproxen could work just as well, Dr. Jerry says. Awareness is growing among patients, too, he says, and it’s important for them to question the need for narcotics prescriptions.

“I think now, for the first time, you really have people thinking twice about whether they should accept that prescription for a narcotic pain medication from their doctor or dentist, rather than taking it just because it was prescribed,” he says.

The rise of opioids

Misuse of prescription painkillers, which are sold under brand names such as OxyContin® and Percocet®, has exploded in recent years.

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In the mid-1990s, the pharmaceutical industry, through aggressive marketing schemes, placed tremendous pressure on doctors to be more liberal with their opioid prescribing practices, Dr. Jerry says. Pharmaceutical companies spent millions of dollars on campaigns to influence state medical boards to sanction doctors for under-treating patients in pain and got accrediting agencies to get the “fifth vital sign” — also called the 10-point pain scale —  into the medical records of patients across the country, he says.

“The culture of pain management in this country was dramatically changed and that culture persists to this day despite the prosecution of several pharmaceutical executives for their aggressive marketing strategies,” Dr. Jerry says.

The unexpected result: growing rates of heroin addiction. People who became addicted to opioids turned to heroin because it’s cheaper and more readily available than prescription drugs.

“Many people are involved in the fight against the heroin epidemic right now,” Dr. Jerry says. “For those involved in that advocacy work, sometimes it can be a bit disheartening to see the ever-escalating mortality from this disease. It leaves one wondering whether or not we’re making a difference at all.

“I think the surgeon general’s report emphasizes that we are making a difference,” he says. “People are, for the first time, talking about this disease. They’re talking about it openly – there’s greater awareness about this and that awareness and talk is rising to highest levels of hospital and the government.”

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