America’s doctor pays a house call

PALMER — In 1964, U.S. Surgeon General Luther Leonidas Terry issued the first report linking tobacco use with health problems.

Five decades later, smoking deaths have been reduced dramatically, and nary a soul isn’t fully aware of the dangers.

Dr. Vivek Murthy hopes the report, and the attention his office is bringing to the nationwide scourge of opioid addiction, will one day lead to a similar public awareness.

On Thursday, he headlined a series of distinguished speakers at the Alaska Wellness Summit: Conquering the Opioid Crisis, and told a packed house at Mat-Su College’s Massey Theatre that winning the war on opioid addiction is a cultural struggle.

“I remember getting advice from a business leader, who said, ‘culture eats policy for lunch every day,’” Murthy said as part of a ‘fireside’ discussion with Alaska’s Chief Medical Officer Dr. Jay Butler. “You can have really good rules and regulations, but it’s the cultural normatives that matter.”

Murthy said his approach toward tackling America’s opioid abuse problem dovetails, in many ways, his approach to improving health care in general. His first priority for both is a shift toward prevention, and his second is promoting health equity.

He calls the campaign against opioid abuse “Turning the Tide.”

“We got here on a path paved with good intentions,” he said. “Twenty years ago, clinicians were urged to treat pain more efficiently and they did that without training. And since 1999, we have quadrupled our number of opioid overdoses and that coincides with a quadrupling of the number of opioid prescriptions.”

Alaska was the latest stop on Murthy’s ‘Turn the Tide’ tour, and Thursday’s event, sponsored by Sen. Dan Sullivan, gave him a chance to address a high number of Alaska clinicians, the very people to whom he sent 1.2 million letters a month ago, urging them to change their practices when it comes to prescribing pain medication.

Like Terry’s report on tobacco, such a letter from the Surgeon General to virtually all clinicians nationwide, was a first.

“This is one of those moments where we have to call the profession to action; the letter is really a jumping off point,” Murthy said. “It comes with a (reference) card they can keep in their white coats, fleeces or suit pockets, and we’re accompanying it with a series of visits across the country.”

But changing the habits of prescribing doctors is just one part — and maybe the easiest part — of turning the tide against opioid abuse.

“Perhaps the biggest thing and the most challenging thing is to change how our country sees addiction — it’s a cultural challenge,” Murthy said. “Too many people still see addiction as a bad decision, or a character flaw, but we have to treat these people with the same compassion we do for people with diabetes or heart disease.”

And that judgment placed upon those with addictions, can create a dangerous culture of shame, Murthy said.

“All of us need to create an environment where people can ask for help… to make it easier to educate about these disorders,” he said. “In too many communities, addiction is still taboo.”

Alaska’s problems with opioid addiction may be among the worst in the country. In touring the state the last two days, Murthy found the usual factors — remoteness and a lack of technology in rural areas, to be barriers to health care. But, he said, the problem in Alaska is one that will require an Alaskan solution.

“The bright side of this crisis, and what’s impressed me so much was the strength and resilience of the Alaskan people, which is greater than the magnitude of the crisis we face. But we lose that when we forget about the role each of us has to play; whether it’s how to prescribe, or to change the way people think about addiction.”

At the end of his hour long talk with Butler, Murthy took questions from the audience, and, at one point, left the stage to embrace the mother of a son killed by a heroin addict, who asked what could be done to treat drug addicts while they are in prison before they come out.

He took a final question from Pastor Reginald Bright, of Anchorage, who asked why veterans, such as himself, have so much difficulty getting marijuana to treat their significant pain issues as an alternative to opioids.

Murthy responded that the verdict on the scientific benefits of marijuana was still out, but that needs to change.

“On marijuana, the question is always asked, ‘is this high-quality data?’” Murthy said. “The answer is, there isn’t enough high-quality data — but this is contrary to some people’s experience… I believe we need to not just continue, but accelerate studies to see if marijuana has therapeutic benefits.”