Physicians react to surgeon general’s opioid plea

In what is believed to be the first such action by someone holding his post, U.S. Surgeon General Vivek Murthy, MD, is sending a letter to the nation’s 2.3 million prescribing physicians urging them to help solve the growing opioid epidemic.

U.S. Surgeon General Vivek Murthy, MD

In the letter (bit.ly/Murthy-opioids), Murthy asks physicians to sign an online pledge to educate themselves to treat pain safely and effectively, better screen patients for opioid use disorder and talk about and treat addiction “as a chronic illness, not a moral failing.”

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We asked members of the Medical Economics’ Reader Reactor Panel, a group of more than 250 physicians nationwide who assist our editorial team, about this historic plea from the nation’s top doctor and if they thought the voluntary action could actually make a difference in the U.S. opioid crisis. Here are some of their replies:

Further reading: What should physicians do about the opioid crisis?

“I think it is a very effective strategy for the opioid epidemic. Opioid overprescribing is a difficult problem that medical providers face every day. The surgeon general’s letter to medical providers about strategies for opioid prescribing can be very helpful in determining proper opiate dosing, medication selection and consideration for alternative medications and treatments.”

Sachin Parekh, MD

Family medicine

Hartford, Connecticut

Next: "A piece of paper or pledge is only as good as the action it promotes"

“I deal with pain issues every day in my specialty. I do not plan on taking a pledge although I see no harm in doing so. A piece of paper or pledge is only as good as the action it promotes. I do plan to continue using narcotic analgesics for patients’ pain in a responsible manner as all physicians should. I can honestly say I have never promoted long-term narcotic use and have no chronic users after 36 years in practice. I am certain that there are numerous medical conditions in other areas of medicine that require long term treatment.”

Daniel B. Miller
Urology
Dayton, Ohio

Further reading: Top 4 ways the US is combating the opioid epidemic

“Unfortunately, we have seen a spike in heroin cases since the cut down on narcotics. The only benefit is that the doctors don't get the blame for this. What changed since they were pushing the idea of the "fifth vital sign [pain]" and [said] everyone should be getting narcotics for anything that ailed them? Sounds like the funding for the lobbyist pushing for narcotics ran out or the politicians didn't need the supply anymore. I have no need to pledge. I never got on the bandwagon to begin with.”

Marc Feinberg, MD
Neurology
Boca Raton, Florida

Next: "Does any prudent physician think that a ‘pledge’ is going to fix this problem?"

“… Why don't more physicians treat opiate dependency? It shouldn't be seen as a specialty/addiction specialist issue. Nor should Suboxone "clinics" tarnish this disease. Family physicians should treat it alongside their diabetics and children in their offices. …Treating opiate dependency is less challenging than [diabetes], hypertension, coronary artery disease or COPD. I welcome more physicians embracing medication-assisted treatment. I'm the only one in our county of 38,000 people.”

Dan Logan, DO
Family medicine
Dayton, Tennessee

ICYMI: Dissecting the new opioid prescribing guidelines
 

“I have known Dr. Murthy for many years. He is a well-meaning, smart and caring man. Unfortunately, academics and public policy-oriented physicians like himself have no clue how to deal with this problem. Does any prudent physician think that a ‘pledge’ is going to fix this problem? …Chemical dependency is a disease. We should focus on it in a public health-directed approach and invest in effective rehab with the mental health and continued 12-step approaches that have been demonstrated to work. We must fully fund treatment. We must explore and research prevention. We must legalize the use and redirect the law enforcement, criminal justice and war on drugs funding 100% into our health system to deal with this national crisis and epidemic.”

Howard C. Mandel MD
OB/GYN
Los Angeles, California 

Next: “This sounds great, but to put it in practice is not that easy"

“This sounds great, but to put it in practice is not that easy. We can be aware of the problem and screen our patients, but finding evidence-based treatment after diagnosing the problem is next to impossible for the patients we see. I am the residency director for a family medicine rural training track [at the University of Arkansas] in Magnolia, Arkansas. …I do not have the answer and this pledge is a start, but having good intentions will not solve the problem. We actively monitor patients on a pain contract and if they are negative for the medication we prescribe for them, we no longer give them the medication. Other physicians have just stopped giving any opioid medications and I think this is contributing to the turn to heroin. So many patients want that quick solution and refuse to try alternatives.”

M.G. Garrett-Shaver, MD
Family medicine
Magnolia Arkansas

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