Ten Takeaways from the Surgeon General's Opioid Report

November 7, 2018

In a new report on the opioid epidemic, Surgeon General Jerome Adams, MD, highlights the need for a cultural shift in the nation's perception of substance-abuse disorders (SUDs). He emphasizes that SUDs are chronic-but-treatable diseases.

To remedy the problem, Dr. Adams, an AMA member, suggests that physicians and policymakers focus on evidence-based treatments— both medications and behavioral therapies—that can save lives and restore people's health and wellbeing. The AMA agreed that there is a great need to recognize that patients suffering "require medical intervention, not moral judgment."

Here are ten major takeaways from the report:

  1. Only 1 in 4 people, (28.6 percent) with opioid-use disorder (OUD) received specialty treatment for illicit drug use in the past year, 45.5 percent of people with a SUD also have a mental disorder, but only half (51.0 percent) receive treatment for either disorder.

  2. Individuals receiving buprenorphine with counseling have significantly lower total health care costs than individuals receiving little or no treatment for their OUD ($13,578 compared to $31,055). As of September 2018, 44,968 physicians and 8,825 nurse practitioners and physician assistants, are approved to prescribe buprenorphine.

  3. Research has found that, for every dollar spent on prevention programs, the program returns between $0.62 and $64.18 in reduced costs.

  4. Incorporating treatment for multiple SUDs can be beneficial and is associated with a 25 percent increase in the likelihood of maintaining long-term abstinence from alcohol and drug misuse.

  5. Evaluation studies have clearly shown that syringe services programs are effective in reducing HIV and HCV transmission and do not increase rates of community drug use. They help individuals engage in treatment to reduce, manage, and stop their substance use when appropriate.

  6. The introduction of illicitly manufactured fentanyl and other highly potent synthetic opioids to the drug supply makes immediate access to naloxone crucial to effective overdose death prevention. Although regulations vary, most states have passed laws expanding access to naloxone without a patient-specific prescription.

  7. Multiple factors create barriers to widespread use of MAT. These include provider, public, and client attitudes and beliefs about MAT; lack of an appropriate infrastructure for providing medications; payment policies; need for staff training and development; and legislation, policies, and regulations that limit MAT implementation.

  8. An abstinence-only philosophy that avoids the use of medications for opioid treatment is not scientifically supported. Research clearly demonstrates that opioid-agonist therapy leads to better treatment outcomes compared to behavioral treatments alone. Decades of research have shown that the benefits of opioid agonist therapy greatly outweigh the risks associated with diversion.

  9. A public health approach to the opioid crisis will also reduce other harmful consequences, such as infectious disease transmission and neonatal abstinence syndrome.

  10. Effective integration of prevention, treatment, and recovery services across health care systems is key to addressing opioid misuse and its consequences, and it represents the most promising way to improve access to and quality of treatment.