In 1964, U.S. Surgeon General Dr. Luther Terry issued a landmark report on tobacco and health that changed the course of American history, spurring the decline of smoking in the United States.
More than 50 years later, Surgeon General Dr. Vivek Murthy hopes he can do something similar for addiction. Murthy's new report on alcohol, drugs and health is the first in which a surgeon general addresses substance use disorders as a disease the nation can address.
In the more than 400-page report "Facing Addiction in America," released Thursday, Murthy recommends evidence-based early interventions for young people, expanding treatment programs that have been proven to work, and investing in substance use prevention and treatment research.
A few specific recommendations include adding addiction screenings in primary health care settings and hospitals, creating recovery-based high schools and colleges, and establishing community forums to emphasise the medical nature of addiction.
It's also a cultural call to action.
"I'm calling for a cultural change in how we think about addiction," Murthy told The Huffington Post. "For far too long people have thought about addiction as a character flaw or a moral failing."
"Addiction is a chronic disease of the brain and it's one that we have to treat the way we would any other chronic illness: with skill, with compassion and with urgency," he added.
For far too long people have thought about addiction as a character flaw or a moral failing. Surgeon General Vivek Murthy
Indeed, America's addiction problem is urgent. There are more than 20 million Americans who have a substance use disorder and 12.5 million who reported misusing prescription painkillers in the last year. Opioid overdose deaths have quadrupled in the U.S. since 1999.
Murthy toured the country earlier this year interviewing Americans about their concerns, and addiction was a big one. Many people didn't want to talk to the surgeon general if the press was around, because they were afraid of losing their jobs and friends if anyone found out about their substance use disorder, Murthy explained. They also worried that doctors might treat them differently.
The numbers bear out that fear of stigma. According to the new report, only 10 percent of people with substance use disorder receive any type of treatment for their addiction.
Addiction treatment should be part of routine doctors' visits
The overarching theme of the new report is that substance use disorders are medical problems, and the logical next step is integrating substance use disorder care into mainstream health care.
According to the report, mainstreaming addiction treatment can improve the health of millions of Americans, regardless of income and social status, and save the health care system money.
This idea dovetails nicely with the letter Murthy sent to 2.3 million doctors and medical professionals in August, asking for their help to solve the United States' opioid epidemic and requesting they sign a pledge to screen patients for opioid use disorder, connect them with evidence-based treatment and discuss addiction as a chronic illness.
"We need to take the next step and ensure that these kinds of services are available to everyone. That's where, right now, we have some real challenges as a country," Murthy said. "We know that despite the evidence that treatment works, not everyone can get access to it."
Harm reduction is a key part of Murthy's plan
One of the more radical elements of the new report is that it embraces harm reduction strategies including overdose prevention education, needle exchanges and access to the overdose reversal drug naloxone.
Although critics of harm reduction say it encourages drug use, evidence from the new report shows otherwise. It argues harm reduction connects drug users to health care so that when they are ready to stop using, they have the resources to do so. It also reduces the spread of infectious disease.
"Safe syringe programs have been an effective strategy at reducing infectious disease transmission ― like reducing HIV and hepatitis C," Murthy said, noting that when an HIV erupted in Indiana last year, it was instituting a needle exchange program that finally curbed the outbreak.
Addiction treatment without Obamacare
As it stands, not all Americans have access to substance use treatment, and the resources that are available aren't equally distributed across the country.
There's also the looming question of what will happen if the Affordable Care Act is repealed after President-elect Donald Trump takes office. The ACA currently requires that most U.S. health plans offer prevention, short interventions and other substance use disorder treatments to insurance holders.
While it's unclear what steps Trump's administration will take toward dismantling the ACA, if any, the Congressional Budget Office estimates that rolling back the ACA would leave 22 million additional Americans uninsured.
There are still millions of people in our country who are struggling without insurance coverage.
"We've had 20 million-plus people who have gained coverage over the last several years through health reform efforts," Murthy said. "Whatever we do going forward, in terms of additional policies that we adapt, we have to ensure that we are protecting and expanding insurance coverage."
"As much progress as we've made, there are still millions of people in our country who are struggling without insurance coverage, who can't get access to substance use treatment services," he added.
Regardless of politics what happens with the ACA, Murthy stressed that changing our attitudes about addiction is one things that everyday Americans ― and doctors, policymakers and law enforcement officials ― can do to get involved.
"What's really at stake here are our family and friends," he said. "Addiction is not a disease that discriminates and it has now risen to a level that it is impacting nearly everyone."
Need help with substance abuse or mental health issues? Call the South Africa Depression And Anxiety Group on 0800 2122 23.