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.  

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