Surgeon General Jerome Adams told a Chicago conference Friday that shame over opioid addiction and treatment is a major reason why the lethal epidemic continues to rage.
“Stigma keeps people in the shadows,” he said. “It keeps people from coming forward, it keeps people from asking for help or even acknowledging that they have a problem in the first place. The more we share our stories, the more we lower stigma.”
The conference, put on by the Center for Compulsive Behavior and Addiction at Rush University Medical Center, was aimed at addressing Chicago’s opioid crisis. Reducing stigma was part of the agenda.
Adams, who has held the job of America’s top doctor since 2017, has personal experience in the matter. His brother, he said, is serving a 10-year prison sentence for crimes he committed while in the grip of addiction.
“My family managed to raise a surgeon general; I think they did OK,” he said. “They also raised my brother who is in prison, suffering from substance use disorder.”
But Adams said public health experts must persuade skeptics that the crisis should be addressed with science, not moral judgment. He was health commissioner of Indiana when a rural county saw an HIV outbreak related to the intravenous injection of Opana, an opioid painkiller.
He said that had he tried to force conservative local officials to open a syringe exchange program to get contaminated needles out of circulation, “the local police would have set up a perimeter … and no one would have come in. All the science in the world wouldn’t have helped us advance the remedy we needed.”
Then-Gov. Mike Pence, who had opposed syringe exchanges, ultimately declared a public health emergency that allowed a program to open. Some have credited the exchange with quelling the outbreak.
Adams said stigma also inhibits the spread of the “gold standard” of opioid addiction treatment — medications like methadone and buprenorphine that stem the craving for heroin or pain pills because they, too, are opioids.
He said too few doctors are qualified to prescribe those medications (many counties in Illinois don’t have a single physician who dispenses them). Doctors from OB-GYN offices to emergency rooms should get the eight hours of training and federal waiver they need to dispense buprenorphine, he said.
A member of the audience suggested that requirement — which does not exist for doctors who want to prescribe opioid pain pills — also contributes to stigma, as though the treatment were as dangerous as the addiction.
Adams disagreed, saying doctors already receive too little education on opioids.
“There are a lot of us on the federal level who have real pause about getting away from one of the pathways that folks actually have to get trained in substance use disorder,” he said. ” … Eight hours of training is not a heavy lift within thousands of hours folks put in during residency training programs.”
Sen. Dick Durbin also spoke at the conference, describing the opioid crisis as a symptom of deeper societal problems such as trauma, economic upheaval and hopelessness. He also said any settlement that comes from the massive lawsuit against pharmaceutical companies should be reserved for public health programs, not general government spending.
Kathryn Perticone, clinical director of Rush’s substance use intervention team, told the Tribune she frequently encounters the stigma against medication-assisted treatment, both from people with opioid use disorder and their families.
She said she tries to point out that the symptoms of the disorder — using opioids uncontrollably despite negative consequences — can be prevented with buprenorphine or methadone, just as insulin prevents the symptoms of type 1 diabetes.
When she makes that point during one-on-one conversations, she said, she is often successful.
“I say (to the mother of someone who has overdosed), ‘These are all the symptoms you’ve been dealing with, the symptoms that have been keeping you up at night,’ ” she said. “‘If I can prescribe him this medication, he will no longer have those symptoms. He will literally no longer have that illness.’ That’s where I get the most benefit.”
Twitter @JohnKeilman
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