On September 5, 2017, Jerome M. Adams, M.D., M.P.H., was sworn in as the 20th Surgeon General of the United States. In the months since, Adams has not only addressed the growing magnitude of opioid addiction, he’s developed and committed his office to a three-part approach to take aim at our nation’s unprecedented, indiscriminating epidemic.
A personal connection to crisis
“The role of the surgeon general is to educate the American people about the severity of the opioid epidemic and the steps that each and every person can take to respond,” Adams told Mediaplanet. “We know that the only way we’re going to turn this thing around is by everyone owning their part of it and not pointing fingers. One of the things I’ve tried to help people understand is that addiction touches all of us. People with opioid use disorder are our friends, our neighbors, our family.”
For Adams, this isn’t just a political talking point. His younger brother, Phillip, has been in and out of prison due to crimes stemming from substance use disorder. “Even as the Surgeon General, I’m not immune to this,” he shares. “I was not able to prevent my family from going down the pathway of addiction.”
Step one: normalize naloxone
The first step in Adams’s plan is increasing public awareness about naloxone, a medication that exists as both an injectable and a nasal spray and rapidly reverses the effects of an opioid overdose. Adams worked as an anesthesiologist before beginning his career in public office as Indiana State Health Commissioner in 2014, and shares a principle learned during his time spent at a level one trauma center. “You come across a person in the street bleeding, you’ve got to put a tourniquet on them to stop the bleeding before you can get them into surgery. Naloxone is that tourniquet for someone who’s suffering from an overdose. It allows us to get them into a more definitive and long term treatment.”
Currently, 49 out of 50 states have laws that make naloxone available through standing order at a pharmacy, which breaks down barriers to access and, Adams stresses, means “everyone can save a life by understanding and possessing naloxone.”
Step two: educate
To Adams, the second step of his plan goes beyond spreading statistics and fact sheets. Through education, Adams believes we can lower the deadly impact of the stigma that surrounds substance use disorder. “Addiction is a chronic disease that must be treated with skill, urgency and compassion,” he explains. “The same way we look at other diseases like diabetes, hypertension and cardiovascular disease.”
Adams cites a statistic that half of Americans say they know someone addicted to prescription painkillers. Yet half of Americans also don’t believe there’s effective, long-term treatment — and stigma plays a role in that discrepancy. Evidence validates medication-assisted treatment, or MAT, which combines medication with behavioral support. “For opioid use disorder, the standard of care is medication-assisted treatment,” Adams notes. “But of the hundreds of specialty treatment programs in the United States, only about 1 in 3 offers MAT.”
“Stigma that’s attached to addiction makes people think of MAT as enabling drug use,” he explains. “They want people to quit cold turkey.” But, he points out, “we don’t tell someone who has diabetes, ‘You can’t have insulin. You’ve just gotta deal with it on your own without any medical support.’ We’ve got to turn that around.”
Step three: prevent
The final step, Adams explains, is prevention. This includes “working with health professionals to promote safe prescribing practices and trying to help patients and providers understand the benefits of opioid alternatives, as well as how to safely dispose of and to store prescription opioids.”
“We all have a role in preventing drug use before it starts,” Adams adds. “That starts with acknowledging that opioid misuse is dangerous for kids and adults. We tend to think that because these pills came from a doctor at some point, they’re somehow safer than heroin. We now know that’s not true.”
Compassion as cure
Over the course of his brief time in office, Adams has traveled the country, observing first hand stories of both tragedy and triumph. “Although we face tremendous challenges as a nation, there is hope. People can and do recover.” He shares the story of Jonathan from Rhode Island, whose father and brother both died of an opioid overdose. Jonathan would have died too, but was brought back from a near-fatal overdose with naloxone. Now he works at a recovery outreach program, helping others through the lifelong process of recovery.
“Jonathan said to me,” recalls Adams, “‘The opposite of addiction is not sobriety, it’s connectedness.’” To Adams, this message is key. “Have the courage to talk about opioid addiction,” he says. “Just bring it up. You don’t have to have all of the answers, but you at least need to have a discussion.”
If, as a nation, we can reach out to those suffering with empathy and support, we just may be able to overcome crisis. And with his intellect, compassion and sense of urgency, Adams just may be the man to lead the way.
Emily Gawlak, [email protected]