WASHINGTON — Dr. Vivek Murthy, who was ousted last month as surgeon general by the Trump administration, returned to public debate on Thursday to speak out against Secretary of Health and Human Services Tom Price and a comment he made about addiction treatment.
Murthy took to Twitter late in the afternoon to support the use of medications to treat addiction. In a string of posts, he said that the approach was scientifically shown to be effective in addressing addiction, a point he said his office made in a report last year.
“Science, not opinion, should guide our recommendations and policies,” he said, after tweeting that “there is a lot of confusion about addiction treatment.”
The tweets came just a day after after Price suggested he was skeptical about medication-based addiction treatments.
“If we’re just substituting one opioid for another, we’re not moving the dial much,” Price had said to the Charleston Gazette-Mail in West Virginia, where he was meeting with state officials about efforts to tackle the opioid epidemic there. “Folks need to be cured so they can be productive members of society and realize their dreams.”
Murthy later confirmed in a statement to STAT that his posts were a direct reference to Price’s earlier remarks.
“If recent comments from the Administration indicate a shift away from an evidence-based, public health approach to the opioid crisis, I am concerned the negative impact on the health of Americans will be considerable,” he wrote. “It is important that people know the truth about what science says about opioid addiction treatment: medication-assisted treatment works.”
“It is also important that we not further stigmatize medication-assisted treatment by incorrectly implying that it is not effective,” Murthy continued. “That will only make it harder for people to seek out the care they need.”
Murthy, a mild-mannered physician, was appointed during the Obama administration and has avoided stirring up controversy, though his confirmation process was more contentious than is typical. His remarks were a rare direct rebuke by one former administration official of another just months on to the job. Murthy also remained an officer in the US Public Health Service Commissioned Corps after being relieved as surgeon general, meaning his comments are effectively a rebuke of his boss.
An HHS spokeswoman rejected the criticism from Murthy.
“This whole narrative is not based in fact,” said the spokeswoman, Alleigh Marre. “One of the secretary’s five pillars for combatting the opioid epidemic is expanding access to treatment and recovery services, including medication-assisted treatment.”
Marre said Price had made the point that “what’s right for one person isn’t necessarily right for another person” in terms of treatment. He also cited vivitrol, which is used as a medication-assisted treatement but not an opioid, as a possible treatment.
The most popular medication-assisted treatments are, as Price said, opioids — drugs like methadone and buprenorphine used to mitigate withdrawal symptoms and help people reduce the risk of relapse while helping to control cravings for more potent opioids. There are concerns among some, however, that some of the medications prescribed do more harm than good and can lead to separate dependencies.
But the report by the surgeon general’s office under Murthy concluded otherwise.
“The research clearly demonstrates that MAT leads to better treatment outcomes compared to behavioral treatments alone,” the report said. “Moreover, withholding medications greatly increases the risk of relapse to illicit opioid use and overdose death. Decades of research have shown that the benefits of MAT greatly outweigh the risks associated with diversion.”
But the gap between Murthy’s remarks and Price’s opened a window on the debate over medication-assisted treatment. While the treatment community is largely supportive of that approach, there are other approaches including abstinence-based and behavioral therapy programs, and it remains unclear how the Trump administration will seek to shape policy on the issue. In his interview with the Gazette-Mail, Price was said to have touted faith-based programs.
The White House has asked New Jersey Governor Chris Christie to lead a panel on opioid addiction. That panel has been given 90 days to deliver to the president interim recommendations on how the government can address the opioid crisis, and until Oct. 1 to issue its final report.
This story has been updated to include a statement from Vivek Murthy and comment from HHS.