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Surgeon General Must Embrace Evidence-Based Addiction Treatment, Harm Reduction

One predictor for future behavior is past behavior. Recently the Huffington Post re-ran a 2015 post on how present-day US Surgeon General Dr. Jerome Adams, then Indiana State Health Commissioner, responded to a spike in HIV cases brought about by sharing of needles among intravenous opioid abusers. He embraced harm reduction and evidence-based responses.

Traditionally the office of US Surgeon General has been a non-political one. True, the USG is appointed by the president, but it’s unusual for them to leave before the end of a four-year term, sometimes more than one (one USG served five of them). President Dwight Eisenhower’s USG resigned when John F. Kennedy came to office to give the president of the opposite party a chance to nominate his own candidate, but that was his choice.

President Barack Obama’s last USG was Vivek Murthy, who was asked to resign by President Donald Trump more than 18 months before his term was due to expire. No reason was given, but there are at least two suspected motives:

  • Murthy supported treating gun violence as a public health problem, which was anathema to absolutist Second Amendment supporters.
  • Murthy felt that flavored tobaccos for e-cigarettes to vape would encourage young people to smoke, so opposed them. On that ground, Grover Nordquist’s Americans for Tax Reform initiated an online petition for Trump to fire Murthy.

Murthy’s main accomplishment as USG was the publication of a USG report on Substance Abuse, which differs somewhat from what former Health and Human Services secretary Tom Price and Attorney General Jeff Sessions have said about addiction, a possible third motive.

And the President might have fired Murthy just because he was an Obama appointee. One interpretation of the motivation behind many of the president’s actions is that he wants to undo everything Obama did just because Obama did it.

Some Trump appointees have seemed to be people who want to dismantle the agencies in which they have been placed in charge. That doesn’t seem to be the case with Dr. Adams as USG. However for an appointee to a non-political post, he has spent much time recently defending the President’s approach to the opioid public health emergency. He claims Trump has “distributed” an additional $800 million “for prevention, treatment, first responders, prescription drug monitoring programs, recovery and other care in communities, inpatient settings, and correctional systems.” But Trump hasn’t requested any additional funds, and by declining to call opioids a national emergency, he hasn’t freed up those funds. Most of that $800 million is probably money that Obama and the previous congress approved before the elections.

Also worrying is that Adams was drawn not from the US Public Health Service – USG is the overall head of the Commissioned Corps, the federal uniformed service of the USPHS – but from among Trump’s political cronies. Since these 6,500 health professionals are members of the USPHS, this is a faux pas at least.

Other than that, Adams seems well-qualified. In Indiana he supported syringe exchanges, medication-assisted treatment (methadone, Suboxone) for opioid or opiate addiction or dependence, harm reduction training for police, the destigmatizing of addiction and a Good Samaritan law to make fellow drug users less reluctant to call an ambulance or take a friend to the ER during an overdose. That suggests pragmatism over politics.

He could be a great help in the opioid epidemic – he knows about using opioids for chronic pain – if he doesn’t spend all his time defending the president’s so-far tepid response.