“I want to be a voice for coverage,” Vivek Murthy said. “With substance abuse, that couldn’t be more important.” | Getty Surgeon general ramps up addiction battle

The U.S. surgeon general has released the first comprehensive report on addiction in America, and he wants it to have as much public health punch as the groundbreaking report on the dangers of tobacco 50 years ago.

In an interview with POLITICO on the eve of its release, Surgeon General Vivek Murthy said that he’s determined to make the report an action item in communities across the country, and not just put it on the shelf.


“We can’t afford not to address it,” he said. “We can’t afford to stay on the path we’re on.”

More than 20 million people in America have substance abuse problems; 78 die every day from opioids alone.

The report, released Thursday morning, is about substance abuse broadly — both alcohol and drugs, legal and illegal. But it’s the opioid epidemic that has grabbed public attention. And opioids have gradually emerged as one of Murthy’s top priorities, particularly as he’s traveled the country listening to families' stories.

In Washington and the states, Republicans and Democrats alike have endorsed a more robust response, and Congress passed bipartisan legislation — although it’s not yet funded. But the report, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health,” arrives amid heightened uncertainty about policy and access to treatment.

The incoming Trump administration has not outlined a detailed opioid policy, although Donald Trump during the campaign pledged to stop illegal drugs from flowing across the borders and to make sure people with addiction have “the assistance they need to unchain themselves.”

Yet the Republicans’ vow to repeal the Affordable Care Act threatens to roll back access to mental health and substance abuse treatment, which are legally required basic benefits under the law. The GOP has said Obamacare's eventual replacement will have fewer mandated benefits and coverage requirements.

Even with the current health law, only one in 10 people in need of substance abuse treatment gets it.

“I want to be a voice for coverage,” he said. “With substance abuse, that couldn’t be more important.”

Murthy is only about halfway through his four-year term, so he could remain in office well into the Trump presidency. “This is my plan going forward,” he said of his determination to change the country’s approach to addiction. “I intend to keep serving as long as I can.”

“I’ve worked with people on both sides of the aisle,” he added.

And to turn this report into action, he will work with state and federal policymakers, families, community groups, schools, law enforcement, doctors and hospitals — and anyone else willing to pitch in to save thousands of lives and the $420 billion a year spent on abuse-related health care, criminal justice and lost productivity.

The report itself has three basic themes.

Addiction is a chronic neurological disease, not a moral failing or lack of willpower. That means it’s time to stop the “shame and misunderstanding,” the report says.

Prevention is key. Keeping teens in particular from trying drugs and alcohol vastly lowers the likelihood of addiction later on.

And treatment works. Not perfectly, but it works.

“We’ve got an evidence-based toolkit,” Murthy said. “The solutions for each community may vary, but it’s evidence-based.”

Murthy knows that to make the report a lasting part of the health care terrain — the way the 1964 tobacco report was — he’s got to “scale it.”

One focus will be on improving training so doctors can screen for — and treat — substance abuse. He’s already gotten a strong response from physicians to a letter he sent all of them this year urging them to tackle the crisis.

“It’s been fascinating feedback [from] clinicians who didn’t recognize the scope of the epidemic and the connection between their prescribing practices and the epidemic.”

He’s spent a lot of time traveling the country listening to stories — sometimes of recovery, too often of grief.

One stop Murthy made that brought home the depth of the crisis was in a tiny village in Alaska, called Napaskiak, which can be reached only by boat. It has fewer than 500 people — and a drug problem.

The village keeps medical supplies, including painkillers, in a small building no bigger than a room, he said. It was broken into multiple times, and the painkillers were taken. Finally, the villagers boarded it up. Then the thieves came in through the roof.