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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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  • I have more faith in Dr Murtha than in someone touting faith to overcome a serious illness such as addiction. While faith can certainly help the process, actually overcoming addiction needs to be needs to be based on science.

  • I believe Dr.Murphy is correct. But the medical community needs to address why some patients are addicted. If it’s chronic pain it can NOT be avoided. It seems you are just addressing addiction without the cause? or need. A distinction needs to be made. When taking narcotics for chronic pain, I believe you do not get “high” but relief of pain allowing the individual to maintain their ADL’s [activity of daily living]. that is the rub “INDIVIDUAL” treatment & need. This is why pain clinics are so important.

  • I am a trained clinical pharmacist who has reviewed mortality cases in hospitals due to opioids. I also agree with Dr. Vivek, in there is CLEAR evidence for addiction recovery with medications, for a limited time. From my experience, Opioids are one of the 3 killers of drug deaths in hospitals today. In the community, Opioids are NOT prescribed appropriately at all. Celebrate Recovery is a Recovery program that misses the mark on the REASON or root cause of why people abuse to start with. I pray the Trump administration hires the correctly trained healthcare pharmacist to guide safe use to prevent deaths. One person might be a Medication Safety Officer, and require 1 in each hospital as a public health code law, like California does. I live in Michigan, and they have no such thing. So, deaths continue without the resources for a proper post-mortem.

  • I am, along with the 100 millions of other Americans, are on the other end of opioids. I am one of these 100 million Americans who have chronic incurable pain disease. As the CDC, DEA and Medicaid and medicare, and numerous other government associates, are blaming Dr’s for the over prescribing of medication, NOBODY, is looking at or reading the statistics from chronic pain disease patients. How about not addressing these drugs as dangerous and addictive. Let’s look at them as lifesaving and medically necessary for the million of Americans with a chronic disease? Chronic pain is a disease. It is now becoming an epidemic.
    No other disease medication is scrutinized. We as patients are being denied, dismissed and overlooked by our drs due to all the scrutiny associated with treating chronic pain disease. Our Dr’s are afraid to treat us adequately. We have a disease that medication is readily accessible to us and we are being denied. We pain patients are truly being discriminated against, due to people who have used heroin, illegal fentanyl, and placed a blame on anyone but themselves. This is a witch hunt for Dr’s who prescribe life saving medication for pain disease patients who benefit from this medication.
    We have a chronic disease. We want to be able to take care of our homes, our children, our selves, as much as possible, but without access to these life saving medications, we are unable to do so. We want to live not just exist in pain 24/7.
    We need the government agencies to look at the real statistics, not the hand picked.
    We need help. With all the headlines, topics and stories on how opioids are bad, let’s look at what good they do for our disease of chronic pain and the million of Americans they help.

    • Thank you Ms.Simonis! We are being discriminated against; Both government & insurance companies need to let DOCTORS prescribe needed medications for their patients. Do NOT punish individuals with chronic pain diseases, cancer, DJD,etc. because some patients misuse their meds. Allow patients with chronic pain have a life! You must treat our pain as an illness because it ROBS us of a life free from pain!

    • I also have a chronic pain disorder and a nursing degree and I completely disagree with the use of narcotics for many reasons. 1- you will build up a tolerance and eventually need more and more. So what happens when you break your leg and need pain relief. Your tolerance can be so high that nothing will be effective. 2- the chemical makeup of many opioid narcotics (oxycodone in particular) is almost an exact match to that of heroin. Would you take heroin everyday? 3- Taking pain pills to relieve your chronic pain is simply a band aid. It makes you feel better without addressing the real issue and possibly stops you from doing the other things such as physical therapy that may be more beneficial to your body. And last but not least you’re taking a strong medication for chronic pain that you may have to take for a long period of time. Is that doing your body any good? Definitely not! It may just be taking years off your life!

    • Stephanie, have you actually observed any large incidence of opioid-induced hyperalgesia (opioid tolerance) in your practice as a nurse? Or does your stated position reflect more of your training than your actual observations?

      I talk with a lot of medical professionals, among them Dr Forest Tennant, MD, a prominent pain management doctor who was one of the founding members of the American Academy of Addiction Medicine and who now edits “Practical Pain Management”. In a wide-ranging telephone interview, Dr Tennant informed me that in decades of pain management practice, he hasn’t observed a single case of hyperalgesia in his patients, except among those being managed on intrathecal pain pumps. I also hear from many chronic pain patients that they also have no issues with tolerance, and experience no cravings for increased doses.

      We know that addicts do indeed develop tolerance. But there is a significant body of evidence that people in severe pain do not develop euphoria or a “high”, and may display measurable changes to the nervous system due to pain.

      Some do become “dependent” on opioids for pain relief and will experience withdrawal symptoms if opioids are rapidly tapered. But dependency is not the same medical entity as addiction and does not entail the spiral of ever-greater craving or extreme compulsive behavior which addicts display.

      The 2010 Cochrane Review on opioids for long-term treatment of noncancer pain examined 26 studies with 27 treatment groups that enrolled a total of 4893 participants. There were multiple confounding factors in the data, making it difficult to compare outcomes of these studies on a common scale of effects. However, the Review suggests that for patients who have never used opioids before, the risk of opioid abuse disorder is on the order of 2% or less. Other studies estimate the numbers at 2-10%, depending on who one believes.

      It is clear that the risk of opioid tolerance or addiction is not zero, even in properly managed patients. But it is also clear that with appropriate oversight, this risk is also not high. Indeed, it is credibly arguable that more deaths occur in the US every year due to Ibuprofen and Acetaminophen than to medically prescribed opioids.

  • That top public health officials are debating Trump appointees regarding a treatment that has decades of research evidence demonstrating effectiveness is obscene. Price’s remarks suggest that he does not even understand how these drugs are administered and used in treatment, much less how they affect the addicted brain. Aside from Price raising questions, there is no scientific debate in addiction medicine regarding the effectiveness of medication-assisted treatment. I think Nora Volkow should get into the discussion.

  • Finally, someone that puts the interest of the people before the pharmaceutical companies. Substituting one opioid for another is just extending the problem. Addiction is not a living breathing thing, but a consequence of an untreated condition. Let us really treat the individual based on their medical and emotional needs.

    We have the science and the resources, now let us get the right priorities and we can finally put a dent in this opioid epidemic.

    • Explain to me how it’s an epidemic again? The 3 percent of people who are prescribed needed medication but flip to heroin? The THREE percent? How about the alcohol epidemic. Alcohol kills 6x the number of people who take legally prescribed medications. I’m all for having proof of a condition through imaging, emg, examination, interview, etc. Heroin and prescription medication are 2 different things as is dependence and addiction. I wonder if you have a chronic condition…such as failed surgery, spondylosis, scoliosis, severe arthritis, collapsed vertebrae, or degenerative disc, or many other chronis conditions? Good luck with that Naproxen giving you any relief.

  • I am a 59 yr old woman with RA, Psoriatic Arthritis , & Fibromyalgia. I have tried everything that is out there with my Rhumatologist but nothing helped. My qualify of life has been taken and if you take the little help I get from pain RX which I take the way I am supposed to since 2006 I don’t know what I will do to get some relief!! I qualify for medical marijuana but I can’t afford it!! Which is sad that states allow the usage of it but make it unaffordable to people who are disabled and on a low income!! I am so scared of how this all may turn out!!!

    • This comment is not only irrelevant to the conversation, it is suspiciously a troll plant by people with a political agenda – like say – pro recreational marijuana camps.

    • “No Victim” — I’ve heard comments of this sort before. But I also talk with hundreds of chronic pain patients in Facebook, where one may trace family connections through profiles. The great majority of comments such as Christine’s are profoundly accurate and genuine. The US government is mounting a war against chronic pain patients, founded on lousy or no medical evidence, hype, propaganda, DEA empire building, and (in some cases) financial self-interest on the part of organizations like Physicians for Responsible Opioid Prescribing. The CDC guidelines on opioids violated multiple widely accepted standards of medical evidence and research. The only ethically sound way forward is immediate repeal of those guidelines with a re-write by a consultants working group led by pain management specialists in community practice and pain patients themselves.

      See these articles published by the Journal of Medicine of the US National College of Physicians:

      The CDC’s Fictitious Opioid Epidemic, Part 1 (January 15, 2017)

      https://www.ncnp.org/journal-of-medicine/1929-doctors-fleeing-pain-management-dumping-patients.html

      The CDC’s Fictitious Opioid Epidemic, Part 2 (April 15, 2017)

      This article is re-published from its original appearance on the National Pain Report under the title “How Would Prescription Opioid Guidelines Read if Patients Wrote Them?” It has also been introduced in the April 11th online issue of PAINWeek, with the title “What if Prescribing Guidelines Were Patient Centered?”

      https://www.ncnp.org/journal-of-medicine/1980-the-cdcs-fictitious-opioid-epidemic-part-2.html

  • Let us not use euphemisms. Suboxone (buprenorphine) is not Medically Assisted Therapy. Buprenorphine is a substitute opioid. A physicians motto is “First Do No Harm”. Putting addicts on replacement opiates will tether them to perhaps something worse than their original addiction. In fact, addicts continue to use while being prescribed Suboxone, often selling their sub in order to obtain funds to use heroin. They cleverly will then restart sub just in time for it to show up on their urine tests. The answer is not to substitute one addiction for another. Tapering off suboxone is more brutal than dope sickness. Vivitrol, a non-addicting injectable which blocks opiate receptors and cravings, is truly Medically Assisted Therapy and there is good science to support its use. Vivitrol is the answer, for extended periods, probably continuing therapy for 2 years or longer. Of course, Vivitrol isn’t going to work unless the addict is highly motivated and continues to “work” hard on recovery.
    http://www.nejm.org/doi/full/10.1056/NEJMoa1505409#t=article

  • How about opioid “sanctuary cities”? It would be cheaper and safer for the tax payers to concentrate users by providing free drugs to addicted people. You laugh but- to combat opioids you have to attack the source or the destination. You can beef up the police into paramilitary units, or you can arrest and jail users for lengthy periods of time. Either way tax payers are on the hook:
    – tax payers are placed in dangerous situations as users seek funding for their next fix.
    – tax payers fund paramilitary police forces to combat dealers and that network.
    – tax payers fund the undercover cops, the prosecutors, the courts, the jails…

  • Some also believed that Lead could be turned into Gold. Leeches treated many illnesses and Pasteurization destroyed the “Good humors” in raw milk. Examples of ignorance were legion even before Price uttered his piece. Such foolishness would be laughable if it were not deadly. Some docs need to stick to their objectively evaluated area of expertise or shut up and sit down.

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