SOUTHERN INDIANA — Local health leaders are hoping a first-of-its-kind report from the U.S. surgeon general on the growing problem of drug addiction is a groundbreaking moment in fighting substance abuse in Southern Indiana.
The 472-page report, "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs and Health," details the scope of addiction in America — from physiological and psychological causes and effects on individuals, their families and communities, to prevention strategies and policy changes to properly address treatment.
It's the first time the surgeon general has issued a report on addiction, and the first of this size and scope since the Surgeon General's Report on Smoking and Health, released in 1964.
Perhaps most notable is Surgeon General Vivek Murthy's words defining addiction. Since it is largely stigmatized and often misunderstood, many do not get treatment they require to return to being healthy and whole members of the community.
“Addiction is not a character flaw,” Murthy states in the report. “It is a chronic illness that we must approach with the same skill and compassion that we approach heart disease, diabetes and cancer.
“Research reviewed in this report should eliminate many of the long-held, but incorrect stereotypes about substance misuse and substance abuse disorders, such as that alcohol and drug problems are the product of faulty character or willful rejection of social norms.”
These misconceptions have gone a long way to keep people from receiving treatment, either out of shame from the stigma or because the resources are not accessible.
LOCAL RESPONSE
“[Addiction] is just as much a disease as is high blood pressure or arthritis,” Dr. Kevin Burke, Clark County health officer, said.
“We need to make sure that we have an adequate effort to address the problem," he said, "and the biggest part of an adequate effort is to make sure we have funding from the state and federal government for the support programs to treat addiction.”
While there are some outpatient programs currently available in Clark and Floyd counties, there are far fewer beds available for in-patient recovery plans — something that can be crucial to the success of the addicted person.
“Some of these individuals who decide they're ready to quit wait so long for the bed because the beds tend to be full that [the person] who is waiting for this opportunity to go into rehab then relapses because they couldn't manage it on their own,” he said.
Burke said he'll be meeting soon with LifeSpring and other community stakeholders to discuss how they should move forward with possible programming changes in the near future in light of the report, “to decide how we might change our service or department goals,” he said.
But growth of programs still comes back to funding, he said. While he hopes the report could increase the chances for state and federal support, it's too early to tell.
“I don't yet have a good feel for whether federal funds will grow in this area or whether they'll drop,” he said. “Part of that will be determined by the policies of the new president and his administration.”
According to the report, more people in the United States have a substance abuse disorder — 1 in 5 — than cancer.
“We wouldn't tolerate it if only 10 percent of our cancer patients got treated,” Dr. Tom Harris, Floyd County health officer, said. “But that's what's happening with substance abuse, only about 10 percent are currently in some form of treatment program.”
He said while in-patient beds might not be available for everyone, there are still underutilized outpatient programs — Our Place, Turning Point and referrals from LifeSpring — that could help.
In 2014, there were 43,000 deaths nationwide from drug overdose, and 88,000 deaths resulting from alcohol. The economic impact is estimated at $249 billion for alcohol-related issues, or $2.05 per drink, and $193 billion in economic impact of drug usage.
In Clark County, alone, there were 69 deaths from drug overdose as of August. As of press time, there were an estimated 20 in Floyd County.
“I've been in the community 20 years now and there's always been a high level of benzodiapamine use, which is Xanax and Valium and Atavan,” Harris said. “But the opiates are definitely a lot worse than they used to be.
“We have seen a massive spike in opioid problems ... heroin or what people think is heroin, which is more frequently [the more deadly] fentanyl or something else.”
He said the scope of the problem is a lot different than the medical community could have predicted decades ago.
“I went to a lecture in the early 1990s and the guy covered heroin overdoses. [He] said, 'We're just going to talk about this because it's historical. You'll never see one of these because nobody does heroin anymore,'” Harris said.
“Now, it's like every day I go to work I see a heroin overdose or somebody I'm working with does,” he said.
PREVENTION IS KEY
The Surgeon General's report outlines the importance of prevention, which can come in the form of education, reduction of access to substances and stricter punishments for illegal actions such as driving under the influence.
Both county health officers want to see more prevention education implemented.
Burke said he'd like to see prevention education as early as kindergarten and continuing through high school and potentially beyond.
“I think we need to pound away at an anti-drug message repeatedly through those formative years,” he said. “Starting early and continuing at least through 12th grade perhaps even trade school, colleges and universities.”
Th report also talks of the benefit of harm-reduction methods — programming that can reduce the associated risks of some substance abuse, but designed for people who may not be ready to stop using the substance.
An example would be the Clark County needle exchange, which was approved in August and slated to open in early 2017. By providing clean syringes to users who inject drugs, the program could reduce the number of new HIV and hepatitis C transmissions, and also provide outreach.
The county has also worked to put naloxone, an opioid overdose reversal drug, into the hands of residents and has provided training on its use.
Though it will take time to see what policy changes could be put in place as a result of the Surgeon General's report, Burke and Harris agree that it is a huge step toward understanding and treating substance abuse in this country.
“How we respond to this crisis is a moral test for America,” Murthy states in the report. “Are we a nation willing to take on an epidemic that is causing great human suffering and economic loss? Are we able to live up to that most fundamental obligation we have as human beings — to care for one another?”