BHA staff meeting the US Surgeon General
In the audience of more than 200 people waiting to hear U.S. Surgeon General Dr. Vivek Murthy speak Tuesday night at Knox County Health Department, two women talked quietly about their adult children.
"I can't even tell you how many overdoses," one said.
"And how many times they said they were clean?" said the other. "They put on a good show."
During the public town hall meeting, Murthy spoke about the importance of preventive care and good emotional health; the controversy around the safety of electronic cigarettes; his "call to action" for Americans to "briskly walk" 22 minutes a day, which he said would cut their risk of heart disease and sudden death by 20 percent and diabetes by 30 percent; and the mosquito-borne virus Zika, which was discovered decades ago but is receiving new attention because of its spread to more countries and tie to serious birth defects.
"We're learning new things about this virus every day and every week," said Murthy, although so far any mosquito-borne U.S. cases have been contracted abroad.
But it was clear from the questions the audience submitted what most people were there to hear him speak about.
Murthy, the nation's 19th surgeon general, initiated the national tour, "Turn the Tide Rx," to spread awareness about three priorities of his office: to expand access to addiction treatment, especially among the poor and uninsured; to expand public access to the drug Naloxone, which can reverse the effects of opioid overdose; and to change the prescribing habits of providers so that opioid drugs are no longer the front line of treatment for pain.
He'd spent the day meeting with providers, law enforcement officers, legislators and community advocates about how to further those goals. At the town hall, he outlined his plan to send a letter to more than 2 million providers who prescribe opioid drugs, along with a "pocket guide" on appropriate prescribing.
"We want to sharpen their skills … so that they are treating pain, but safely and effectively, and without putting folks at risk for addiction," he said, to audience applause.
With the CDC issuing new guidelines on the use of opioids to treat pain, Murthy said he foresees the medical community addressing prescription painkillers the way it did the overprescription of antibiotics for viruses when patients demanded them. That started to change, he said, when providers began to suggest to patients that antibiotics might not be the right treatment for their illness.
"Now the word is out," he said.
Murthy said later this year he'll release the first-ever surgeon general's report on substance use and addiction and health.
"The purpose of that report will be to bring together the best available science on substance use and addiction, so that clinicians know how to treat patients, so that policymakers know what programs work and what to support, and so that families know what to do when they're concerned about a loved one," he said.
Those include evidence-based programs that use both medication-assisted therapy — such as methadone, suboxone, or newer drugs like Vivitrol — and counseling, he added, and insurance reimbursement must change to include the counseling component, as well as to include alternate treatments for pain.
On his visits to other communities where addiction is rampant, he said, he sees "far too many" families "suffering in silence" because of the stigma around addiction. Health providers, community members and law enforcement need to work together on the answer, he said.
"This is a problem that we have the power to bring out of the shadows," Murthy said. "If we do that, then we will not only make it easier for people to get help, but we'll make it easier for us to come together and fashion solutions."
In the audience, the other conversation continued.
"He's been in jail long enough this time to get clean," one woman told the other. "Maybe he'll stay clean this time."
"We can only pray," she answered.