‘We Have to Make It Easier to Get Help Than to Get High’.
Jerome M. Adams, 20th Surgeon General of the United States, drove home the severity of the opioid crisis with a simple question.
“Raising your hand, how many of you know someone who is suffering from an opioid use disorder?” he asked a standing room-only crowd of 400 at a Dean’s Seminar on January 25, titled “The Opioid Crisis in America: A Conversation with the US Surgeon General.”
Almost everyone in the room raised their hands—including Adams. “My little brother, Phillip, is in state prison right now, suffering from a still-untreated substance use disorder,” he said. “Addiction touches each and every one of us. No one is spared, Black, White, rich, poor, urban, or rural.”
According to the Centers for Disease Control and Prevention (CDC), drug overdose deaths in the US have increased more than six-fold since 1980, and overdose is now the fourth overall cause of death, behind only heart disease, cancer, and chronic lower respiratory disease. An epidemic that affects so many people, Adams said, will take everyone to beat it, from scientists to law enforcement to local community leaders.
“We must mount a robust response, but we can’t do it alone,” he said.
To illustrate the importance of these partnerships, Adams shared his own experience as Indiana’s health commissioner, when he presided over the state’s efforts to deal with an unprecedented HIV outbreak driven by needle drug use in Scott County. To tackle the outbreak, Adams first reached out to county faith leaders, the local chamber of commerce, and the chief of police, seeking buy-in on evidence-based methods for prevention and treatment. “Science is what we know to be true, and policy is what we can convince the public to accept,” he said.
The strategy worked, Adams said, and, surprising many, the public “in conservative Indiana” even accepted a syringe exchange program, a proven method often held back by negative public opinion.
Adams also warned against only putting the newest and best treatment methods into place in the communities where it is easiest. “I’m concerned that we are at times setting ourselves up to worsen disparities when we only allow the preventions we know to be effective to be applied to certain communities,” he said. Advancing strategies in communities with fewer resources and more distrust is worth the challenge, Adams said, but it takes partnerships to build support.
Monica Bharel (CAS’94, MED’94), commissioner of the Massachusetts Department of Public Health, also spoke at the event. Bharel said the gap between addiction science and policy is driven by stigma, which is especially apparent in the state’s limited number of treatment centers. “It’s very hard to expand the opportunity for treatment, because people don’t want these places in their backyard,” she said.
She also noted that only one-third of treatment centers use medications like methadone. “If someone presents with a non-fatal overdose, and they get started on either buprenorphine or methadone, their risk of fatal overdose goes down by 50 percent,” Bharel said. “Just imagine if that was a chemotherapy or a blood pressure drug. Everyone would have it, and we would all be using it.”
Jonathan Woodson, director of the BU Institute for Health System Innovation and Policy, which co-sponsored the event, moderated a discussion between Adams and Bharel that focused on actionable steps to combat the epidemic. Discussing how the public can get more involved, Adams and Bharel stressed the importance of increasing public access to naloxone, the overdose-reversing medicine also known by the brand name Narcan. Massachusetts has ramped up both availability and training, Bharel said, and bystanders have already saved thousands of lives.
Bharel and Adams then demonstrated its use on stage with a training kit that sprays water. “I’m not going to squirt water up your nose,” Bharel told Adams, with a laugh from the audience. Holding up the nasal spray dispenser, she walked the audience through a hypothetical scenario: “So, someone is down, you understand they’re non-responsive, you think it’s an opportunity to use naloxone, and you just—” she said, and sent a small cloud of mist up in front of the stage.
Every non-fatal overdose is also an opportunity to connect someone with treatment, Adams said, emphasizing that everyone who interacts with people with opioid use disorders, from primary care physicians to criminal justice workers to homeless advocates, needs to work together toward that aim.
“We have to make it easier to get help than to get high,” he said.
Raising the success rates of treatment also means providing “wrap-around services” for people struggling with addiction, Adams said. “One of the things that we’re working on at the federal level is to be more permissive with Medicaid waivers, so folks can provide not just addiction treatment in the traditional sense, but an expanded definition of treatment that includes peer recovery coaches, housing, job training, and all of the things that we know are critical components of success, and that we know if they are not provided will increase the chances of relapse,” he said.
Ultimately, Adams said, the key to advancing against the opioid epidemic is to amass more evidence of what contributes to successful recovery, and then to put that evidence to work in the form of policy.
“We need to fight for good, evidence-based programs and show communities how they can incorporate them,” Adams said. “If we do that, we will get where we need to be. I’m convinced of it.”