Feature War on Drugs

US surgeon general: doctors have central role in solving opioid epidemic

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j715 (Published 15 February 2017) Cite this as: BMJ 2017;356:j715
  1. Richard Hurley, features and debates editor, The BMJ
  1. rhurley{at}bmj.com

Vivek Murthy, the US surgeon general, has highlighted prescription opioid misuse as a serious public health problem. Richard Hurley spoke to him about what he thinks needs to be done

“If we’re really going to address not just the opiate crisis but addiction in America we need the medical profession to be a key part of the solution,” implores Vivek Murthy, the US surgeon general, when I interview him for The BMJ.

Describing the country’s epidemic of drug addiction as a “crisis” and a “moral test for America,” he calls for “a cultural shift in how we think about addiction.”

Clinicians have an important role, he says, not just in their prescribing practice but also because “they have the ability to reframe how our country thinks about addiction.

“For far too long addiction has been looked at as a character flaw or a moral failing,” he says. “It’s been looked at differently from other illnesses like diabetes and heart disease—with more judgment. Many people with addiction have not felt comfortable coming forward and asking for help.”

America’s addiction epidemic in numbers1

  • 48 million Americans used an illicit drug or misused a prescription medication in 2015

  • More than 20 million US residents have a substance use disorder

  • Associated healthcare, lost productivity, and criminal justice drain more than $400bn (£300bn; €370bn) a year

  • 47 055 people died from drug overdose in 2014, with 28 647 deaths associated with opioids including prescription painkillers and heroin—the most ever recorded

“This is a public health problem that requires a public health solution. We now have evidence based treatment strategies that work,” he says. “The challenge is ensuring that we get these to the people who need them.”

He wants more clinicians to have training to screen …

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