Treating substance use disorder is a complex issue that is both medical and social.
Earlier this month, former Surgeon General Vivek Murthy spoke at an event about the future of healthcare—a future where people with substance use disorder are treated with compassion and care. To change the culture around addiction, he said, we need to think big.
“The role the federal government needs to play is a role in setting a vision and benchmark for where we need to go on opioids,” Murthy said. “How much are we trying to reduce opioid deaths in the next 1 year, 5 years? I don’t think that’s been stated clearly. How are we holding states and the federal government accountable for doing the work that needs to be done … for changing outcomes? This is a place where government has to step up.”
Addiction is not a disease of choice, Murthy reiterated. He suggested that the origins of the opioid epidemic and other substance use disorders are deeper than biological causes. He said, “There’s a deeper pain that people are experiencing, a deeper despair in their lives, that is temporarily being assuaged not just by opioids but also alcohol [and other substances]. We need to think more deeply about the root causes of addiction… it’s in many ways as much a social disease as much as biological disease.”
With that in mind, Murthy, who wrote the first-ever Surgeon General’s Report on Alcohol, Drugs, and Health, suggested investing in more prevention strategies. He emphasized the importance of “upstream prevention programs, which are often school- and community-based and relatively inexpensive to administer, but can have a dramatic impact on drug use among children, adolescents and adults.” According to Medpage Today, every dollar spent instituting the Good Behavior Game to improve classroom cohesion results in a $64 reduction in healthcare costs, criminal justice costs, and lost economic productivity.
Changing the way we handle addiction socially is just as important as addressing the medical or biological issues that cause it. Reducing prescribing of opioids, extending medication-assisted treatment, and increasing access to recovery services can all improve outcomes for people with substance use disorder. Murthy said, “There are still far too many people who need treatment and can’t get it, but in places like Rhode Island, the state has now moved to make medication-assisted treatment available in the prison system … [resulting in a] reduction in overdose deaths by nearly 12% statewide in Rhode Island in just a year.”
At the same event, Seema Verma, the administrator of the Centers for Medicare & Medicaid Services (CMS), said that states can be instrumental in addressing the causes of addiction. She said states may want to consider “ideas around risk assessment and not only identifying substance abuse but also [performing] a comprehensive health assessment to look at all the health issues a person may be facing,” she said.
The goal of healthcare coverage should be not only to provide access to care but also to provide a way to a better life. Treating substance use disorder is a complex issue that is both medical and social. Changing our national approach to treatment, from Pennsylvania Avenue to Main Street, is key to saving lives.