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ASHINGTON — 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.”

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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.

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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.

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  • Being mindful of being prescribed happiness by Dr. “happiness has no roof” while the medications I had been taking, became bad medicine, were working, yet taken away. As far as I can see, Murthy has no legs to stand on as happiness doesn’t stop Fentanyl at the border and the lame use of addiction and therapy techniques to solve an economic, urban and politically motivated games issue, ware just disgusting, coming from a Doctor. Dr. Price, may be Naive or listening to Nora Volkow to much as well as Government and VA statistics that have been skewed. But he isn’t singing the song of a con man! He is singing the song of maybe to much arrogance or projection of his faith into this issue! The Disease model of addiction has done it’s damage far to long. It’s undeniable solution of a higher power, is a red herring for most addicts. As far as both Dr.s apparent vision of the forest through the trees, pain patients and that physicians caused the so called opioid epidemic through over prescribing opioids? Neither is right. If it wasn’t for the pain medications prescribed by doctors, their would have probably just been more in jail, more on street drugs than even now, more suicides and the rise of illicit opioids would have been earlier. Cut pain medications while the illicit market was really booming, shows an inability of either Physician here, to see the trees in the forest, individually, just a forest to control! For Dr. Murthy, to little to late and Dr. Price, absolutes in addiction treatment and pain care, are impossible. Let me Quote President Trump from His commencement speech yesterday! “A small group of failed voices who think they know everything and understand everyone want to tell everybody else how to live and what to do and how to think, but you aren’t going to let other people tell you what you believe, especially when you know that you are right.” When neither of these Physicians can say all cancer patients need the exact same treatment or that all diabetic patients need to take the exact same amount of insulin. When it comes to addiction and pain, which actually it is apparent that both are less understood than either cancer or diabetes, how can their be one solution that fits all individuals, for either? Unless of course either one knows which came first, the chicken or the egg and was it before or after the road! P.S. I believe that we have to be aware here that this issue has had a problem for decades. Addiction / Disease / Spiritual, Economic, Social Solutions / incurable brain disease with abstinence as the only solution \ medical treatment w medical assistance / mental illness / disabled / disability / Social Security Disability / Healthcare Problem / NIDA – 12.5 million addicts / Bankruptcy! Addiction itself is not a disability recognized by social security, the bad medical outcome from it, can be!

    • This comment is extremely long, but lacking in structured substance. I honestly can’t tell if you agree or disagree with the opinions stated in the article. But let me address something that I think your general response misses–the treatment for addiction may need individualization, but let me draw on your insulin metaphor to illustrate an important point about what individualization really means in medicine.
      Not all diabetics need the same amount of insulin, not all diabetics control their blood sugar using injectable insulin, but ALL diabetics need insulin control medication of some sort. If a doctor came along and prescribed an ACE inhibitor to treat diabetes in stead of insulin control therapy, patients would be put at risk. Certain medications are necessary for treating certain diseases because that’s simply the way our biochemistry works. While addiction treatment is not as straightforward as diabetes management, what must be understood is that the effective treatment for opioid addiction is replacement therapy using some sort of opioid receptor antagonist. That isn’t to say there isn’t a better way, but the preponderance of the data available to us indicates that this is by far the most effective treatment we have. The point here is that doctors do have the ability to tailor opioid replacement therapy to the individual patient’s needs–subutex vs. methadone, etc.–but they would be remiss in recommending far less effective treatment options to their patients out of a twisted sense of moral superiority.

    • Pall – Well, actually like I said, they are both wrong. Harm reduction would be far more successful. The problem here is that I know that there is no “disease” and that there is no scientific basis for either of these therapies. I understand the use of opioid replacement therapy. But, as a stepping stone. Not long term. In the end of my statement, I mentioned the word bankruptcy. Addiction has been a can of worms ready to pop for decades. I know I sounded a bit vague, I was trying to make a decades old point, so I will do it by saying that opioid replacement therapy is more effective than traditional 12 step models. As long as there is long term therapy instead of 12 step “aftercare”! This argument isn’t about the therapy (chicken or the egg) of these two models. It’s about economics. Always has been between these two disease based models. Harm Reduction is really the way to go. You could say that for awhile, opioid replacement therapy would have better results. Long term, unless needed for chronic pain, not realistic. Problem with it is, besides admitting that it is a (medical) disease. Economics. Social Security wouldn’t be able to sustain that. Because people have had success with sobriety with 12 step therapy, (it’s spiritual), but we will be empathetic here and allow the “disease” model. You should know this! Insurance pays for treatment, saving State and Federal facilities and the taxpayers. As a disease, if you have a medical condition from your use that is debilitating, you are eligible for disability. The disease of addiction is not in and of itself a disability, if it were to become one, it would destroy healthcare! It is unsustainable financially, in the long run, as it is being treated either way you described. I’ll just say, seen this show for decades. Ping – Pong. It’s harm reduction baby! The world has food in it, learn or teach each other how to eat and not get fat and one at a time, people will learn how to eat what they used to be addicted to or die from a medical condition. No different than heroin, a cigarette or sex. America needs to be saved from those like Nora Volkow, not embrace them! Unless she is learning? It’s about money, not science, these two are putting on a 100 year old temperance vs medical solution to addiction. Addiction alone, is psychological, not medical! Sorry, but they were teaching that in 1975. Governmental economics, illegal/legal drug markets, medical and psychiatric corruption have to much power for easy change. Addiction is part of normal human experience! To deny that, is, well obsessive. It’s politics/ideology/money/poer going on here. Actually, addiction was used to create a mess here! One last thing, look up the psychiatric fallacy! You’ll find it useful!

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