DRUGS IN AMERICA

Solving the opioid crisis

The surgeon general issues a plan but will Trump follow it?

The surgeon general just told the U.S. how to solve addiction

Amid the divisiveness of the 2016 election, one issue united both parties: the need to address opioid addiction in America. Hillary Clinton proposed “a bold plan to prevent and treat addiction,” and President-elect Donald Trump said flatly on the campaign trail: “We have to solve this crisis.”

But exactly how Trump plans to tackle the problem that now that he’s headed to the White House remains unclear. Perhaps with that in mind, U.S. Surgeon General Vivek Murthy is offering some guidance in the first-ever “Surgeon General’s Report on Alcohol, Drugs, and Health” on Wednesday.

The 428-page report includes some alarming statistics, like the fact that 20 million Americans have substance use disorders, but only about 10 percent of them ever receive any type of specialty treatment. It also notes that prescription painkillers and heroin now kill more than 74 Americans each day, making drug overdoses the leading cause of accidental death in the United States.

The surgeon general’s guide to solving the problem includes:

Expand access to medically-assisted treatments (MAT) such as methadone and buprenorphine, also known as Suboxone. The surgeon general questioned the effectiveness of the abstinence-only approaches to addiction, and said “studies have repeatedly demonstrated the efficacy of MAT at reducing illicit drug use and overdose deaths.”

Stop reality TV-style “interventions.” “Confrontational approaches in general, though once the norm even in many behavioral treatment settings, have not been found effective and may backfire by heightening resistance and diminishing self-esteem on the part of the targeted individual,” the report says.

Get better at prevention. “Studies have found that many schools and communities are using prevention programs and strategies that have little or no evidence of effectiveness,” the report says.

Fix the healthcare system. The suggestions include combining mental and behavioral health services with substance abuse treatment, and expanding insurance coverage to lower the cost of going to rehab.

Whether or not any of this will translate to action by the federal government remains to be seen. Trump has vowed to “stop the flow of illegal drugs into the country” by kicking out undocumented immigrants and cracking down on illicit drug shipments from China, and he lauded his running mate Mike Pence for increasing mandatory-minimum sentences for drug offenders. Those are the same approaches the U.S. has been taking for years, and exactly the opposite of what Murthy recommends.

As noted by the Associated Press, Trump and Republicans in Congress have also promised to repeal Obamacare, “which made addiction treatment an essential health benefit.” Trump has also said he’ll also take steps to “dramatically expand access to treatment slots and end Medicaid policies that obstruct inpatient treatment.”

“I would also expand incentives for states and local governments to use drug courts and mandated treatment,” Trump said in October. “These can be a cost effective, appropriate, and humane response to addiction.”

But how these programs will work and who will pay for them are questions that remain unanswered. Trump will almost certainly opt to replace Murthy with his own appointment, but the surgeon general offered some advice for the future.

“We need to invest more in expanding the scientific evidence base for prevention, treatment, and recovery,” he wrote. “We must help everyone see that addiction is not a character flaw — it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”

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