The least you need to know about the surgeon general’s report

We’ve been waiting all year for the surgeon general’s report on alcohol, drugs and health. It’s significant because not only is it the first ever report on addiction from the top federal health advocate, it’s also a document that reflects the culmination of significant changes in the national dialog around addiction and recovery.

These documents have a way of driving policy if history is any indication.

And Surgeon General Vivek Murthy, MD, MBA, released his extremely dense 428-page report, no doubt expecting it to make a noticeable difference in the prevention and treatment of addiction disorders.

You have to admit the timing here is interesting. As the nation anticipates a new health policy direction under the Trump administration, there is concern among behavioral health providers that they will ultimately see less emphasis on addiction treatment. Meanwhile, Murthy is calling for an ambitious public health approach that is based on evidence, and which includes financing strategies for service delivery. It's difficult to predict the long-term policy implications of the report.

Of note: Murthy is scheduled to remain in the surgeon general position for two more years, so he very well could press this agenda halfway through the Trump era.

Here’s the least you need to know from the surgeon general’s report:

Addiction is very costly. Substance misuse and substance use disorders are estimated to cost $442 billion each year in healthcare costs, lost productivity and criminal justice costs. Report authors say it is an economic imperative to address addiction comprehensively.

The report will help set the tone in America that addiction is a disease and not a moral failing. Everyone in the behavioral health industry has been conveying that message for years and can only hope it finally sinks in.

Summarizing data from six large studies, the report indicates 25 million people in the United States are in recovery. Authors also caution that widely held pessimistic views of recovery will continue to affect public opinion partly because sustained recovery can take several years and several episodes of treatment.

Marijuana legalization is mentioned. Although it’s not a focus, the report does recommend easing barriers in research to allow for more study of the potential therapeutic uses of marijuana. This might be a surprise to some who expected the response to be more conservative.

Authors note that relapse rates for substance use disorders are comparable to other chronic diseases. SUD relapse rates are 40% to 60%, while diabetes, hypertension and asthma rates range from 20% to 70%, according to the report, which cites an article from 2000 in the Journal of the American Medical Assn.

Not surprisingly, medication-assisted treatment (MAT) is highlighted as an evidence-based component of care. Federal efforts in the past year or so have called for greater use of MAT. Now, the report also notes that more research is needed on if, when and how patients might be transitioned off MAT.

About 300 pages into the report, its authors highlight the Comprehensive Addiction and Recovery Act (CARA) that President Obama signed in July. They also note that there is concern about the lack of funding for CARA, which impacts its potential to address the opioid crisis.

One of the recommendations suggests, among other things, that a diverse group of stakeholders should come together to establish recovery outcomes and measures. Numerous efforts in this direction over the years have failed to sustain momentum, leaving the addiction field in a more vulnerable position compared to all other healthcare specialties. Creating agreed-upon measures is a huge task, and behavioral health leaders should not shy away from it, especially not now. Never before has this industry had such attention and such potential to effect change.