Opioids

Surgeon general to AMA: Look upstream to prevent nation’s ills

AMA members need to lead the nation in a civil discussion—even when it comes to hot-button issues such as gun violence, the stigma surrounding substance-use disorder, and health equity—U.S. Surgeon General Jerome Adams, MD, said in an address at the 2018 AMA Annual Meeting in Chicago

Dr. Adams, who is participating in the meeting as a delegate of the U.S. Public Health Service, noted that he joined the AMA 20 years ago as a student at the Indiana University School of Medicine. He said the experience “lit a fire” and helped him develop as a physician leader.

“If it weren’t for the AMA, I wouldn’t be standing before you now as the 20th U.S. surgeon general,” Dr. Adams said.

(After his speech, Dr. Adams took part in a one-on-one Facebook Live Q&A with AMA President David O. Barbe, MD, MHA, in which he elaborated on the themes of his speech and why he wanted to address the AMA. Watch the video.)

Speaker of the AMA House of Delegates Susan R. Bailey, MD, introduced Dr. Adams as “vital partner with the AMA in our work to reverse the opioid epidemic.” Most of the surgeon general’s talk centered on the need to remove the stigma associated with substance-use disorder, increase access to medication-assisted treatment, and to widen the availability of opioid overdose antidote naloxone.

There is an opioid overdose death every 12.5 minutes in the United States, Dr. Adams said, adding that 56 percent of those occur in a home.

“All Americans need to become first responders,” he said, while challenging delegates to raise awareness of naloxone by going to a pharmacy and asking if it’s available—thereby “normalizing” the use of overdose-reversal drug “the same way we normalized CPR.”

“Addiction is a chronic disease and not a moral failing,” Dr. Adams said while acknowledging that his brother has this disease.

Medication-assisted treatment, harm-reduction approach and naloxone “don’t enable continued drug use,” he said.

Dr. Adams also called on physicians to look upstream for root causes and preventive solutions to substance-use disorder and other health issues and to recognize that the vast majority of patients in pain are not drug seekers.

Physicians not only have an opportunity to improve the nation’s health, but an obligation to do so, Dr. Adams said, while noting how effective physician advocacy efforts can be.

The AMA is who Congress listens to, he said, and state legislatures listen to state medical societies and specialty organizations. Dr. Adams highlighted AMA efforts and resources such as the End the Epidemic opioid microsite, Prevent Diabetes STAT and Target: BP™.

AMA “members really do move medicine,” Dr. Adams said. “My AMA moves hearts. My AMA moves minds.”

Related Coverage

Surgeon general: Naloxone should be widely prescribed, carried

Earlier this year, Dr. Adams issued a health advisory on naloxone that explained the drug’s benefits and urged those at elevated risk of an opioid overdose or close to someone at high risk to talk with their doctor or a pharmacist about obtaining naloxone, learning the signs of opioid overdose, and getting trained to administer naloxone.

The goal of the advisory was “to broaden the public awareness, availability, and use of life-saving naloxone to reduce opioid mortality,” Dr. Adams wrote in a JAMA Viewpoint essay.

He was a practicing anesthesiologist at the Sidney & Lois Eskenazi Hospital in Indianapolis and serving as Indiana’s health commissioner when he was nominated by President Donald Trump to serve as surgeon general.

His term as state health commissioner began in October 2014. In January 2015, the state began investigating a cluster of 11 newly identified HIV infections in a rural area near the Kentucky border. Ultimately, 181 diagnosed infections were linked to the outbreak with 173 of the patients reporting injection drug use.

Dr. Adams is credited with taking swift action to declare a public health emergency and implementing a multi-tiered response that included access to health insurance and HIV care and treatment, and persuading then-Gov. Mike Pence to reverse his opposition to needle-exchange programs.

Indiana’s senators, Republican Todd Young and Democrat Joe Donnelly, invited Dr. Adams to speak at Senate hearing in February 2016 at which he described the problem the outbreak represented.

“The Scott County HIV outbreak was not the beginning of a problem, but the culmination of an opioid epidemic that has been building for more than a decade,” Dr. Adams said.

“There are hundreds of places like Scott County across the country,” he told the senators. “If we don’t address the root causes of this epidemic, namely the overflow of prescription opioids into communities and the lack of options for those battling substance-use disorder, other places across the country will find themselves dealing with a situation like the one in Scott County.”

Read more news coverage from the 2018 AMA Annual Meeting.