Maine public health and addiction experts praised a report on the nation’s drug and alcohol crisis issued Thursday by the U.S. surgeon general, saying it could reshape the public conversation around addiction the way similar reports did for tobacco use in the 1960s and the AIDS epidemic in the 1980s.
The report from U.S. Surgeon General Vivek Murthy, titled “Facing Addiction in America,” is the first of its kind and outlines in bleak terms the severity of the problem. Since 2000, more than 500,000 Americans have died from drug or alcohol abuse. Nearly 21 million people suffer from substance abuse disorders, yet only about 1 in 10 gets treatment.
Murthy told The Washington Post that the crisis represents “a moral test for America.”
“I want our country to understand the magnitude of this crisis,” he said. “I’m not sure everyone does.”
Maine’s top two health officials – Health and Human Services Commissioner Mary Mayhew and state health officer Dr. Christopher Pezzullo – were out of state Thursday and not available for comment, a department spokeswoman said.
Dr. Dora Anne Mills, former director of the Maine Center for Disease Control and Prevention and now an administrator at the University of New England, said the report has the potential to “change the paradigm” for how substance abuse is viewed.
“We’ve seen for far too long that it’s been treated differently than other health issues,” Mills said.
In some ways, Mills said, a shift already is happening. When she attended medical school in the 1980s, she said she could count on one hand the number of hours she spent learning about addiction and drug treatment. Now it’s a major part of the curriculum for UNE students.
REVEALING INFORMATION IN REPORT
Shawn Yardley, CEO of Community Concepts, a Lewiston-based social services agency that works with individuals battling substance abuse disorder, agreed that the report should help change the conversation.
“We need to get people away from this idea that people choose to be addicts. They don’t,” he said. “Just like people don’t choose to have heart disease or diabetes, even though they might have made lifestyle choices that contributed to those diseases.”
Malory Shaughnessy, executive director of the Maine Alliance for Addiction and Mental Health Services, said that if nothing else, the report shows the public how pervasive the problem is.
“I think not only does it solidly document the extent of the issue, but it explains the science behind it, too,” she said.
Murthy’s report focuses on treating addiction as a disease of the brain, not as a moral failing, and trying to further break down the stigma associated with substance abuse disorder. He likened it to diabetes, which is treated regularly and comprehensively by nearly all physicians.
Lindsey Smith, who has studied the drug crisis and is a research associate at the Cutler Institute at the University of Southern Maine’s Muskie School of Public Service, said more people need to see it in those terms.
“What I think is so great about this report is that for the first time there is a compilation of a lot of the evidence that points to substance abuse disorder being treated not as an acute problem, but as a chronic medical condition that needs maintenance and support,” she said. “That’s really an important point to help shift people’s mindset.”
REPORTS BRING PROBLEMS TO LIGHT
In the past 52 years, there have been 56 reports produced by U.S. surgeons general, more than half of which have been devoted to smoking or tobacco use. Other reports have focused on nutrition, child sexual abuse, suicide and mental health, among other things.
Perhaps the best-known surgeon general’s report was the first, a 1964 review of the health effects of smoking. That led to a monumental shift in how the public viewed tobacco use and paved the way for increased awareness, including the placement of warnings on packages.
Similarly, a report issued in 1987 on the growing AIDS epidemic brought to light a disease that the public knew little about.
But this is the first surgeon general report to tackle drug and alcohol abuse.
Many states have been hit hard in recent years by the drug epidemic, including Maine. Overdose deaths have been rising steadily in the state, and 2016 will see a record number. According to data released this week by the state Attorney General’s Office, 286 people died of drug overdoses through Sept. 30, surpassing last year’s record of 272 for the entire 12-month period.
Even at the height of the AIDS epidemic, Maine never had more than 50 deaths in any year. From 1984 through 1998, according to the U.S. Centers for Disease Control and Prevention, there were 620 deaths. That’s about two years of drug overdose deaths at the current pace.
Shaughnessy said the report is a good step, but she doesn’t know what the administration of President-elect Donald Trump will do with it.
“For all this talk about building a wall and keeping the heroin out, the problem just isn’t that simple,” she said. “Even police are saying that now. We must stop the demand.”
Shaughnessy said the solution is not just to throw money at the problem, although it will take resources. For instance, she said the rates to providers for Medicaid patients have not increased in years, forcing some to abandon those particular services.
ADDRESSING CRISIS AT STATE LEVEL
In July, Congress passed the Comprehensive Addiction and Recovery Act, the first major federal addiction legislation in years. The bill authorized spending $181 million across several areas – prevention, treatment, recovery, law enforcement, criminal justice reform and overdose reversal – but money must still be allotted each year through the appropriation process.
Spending money on treatment and prevention is a better investment, according to the report, which says each dollar spent on treatment saves $4 in health care and $7 in criminal justice costs.
Yardley, of Community Concepts, who has been involved in public health at the state level for decades, said making changes has been difficult even as the crisis worsens.
“We still don’t have that fundamental agreement on what it is we’re trying to solve,” he said.
DHHS spokeswoman Samantha Edwards said in an email response to questions this week that the state is working to expand treatment – as well as enforcement and prevention – to try to stem the drug crisis.
“The department is committed to addressing the drug epidemic facing the state of Maine,” she said. “Under Gov. (Paul) LePage, it has been an ‘all hands on deck’ approach to take this issue head-on.”
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