In a bold position paper released in May 2017, American College of Physicians affirms the severity and pervasiveness of addictive disease and calls for more evidence-based treatment, more access to treatment and novel public policy reform.
The American College of Physicians (ACP) is a prestigious, worldwide professional medical organization of 148,000 internists, sub-specialists, post-doctoral fellows and medical students. Their recent position paper (May 2017) affirms previous work by myself and other addictive disease specialists and experts for the Center for Alcohol and Substance Abuse at Columbia University in New York. (June 2012)
The ACP confirms that Substance Use Disorders (SUDs) are among our nation’s most confounding and stubborn problems. Nearly 23 million Americans over age 12 are now addicted to an illicit or prescription drug and/or alcohol, which is more than those with heart disease or cancer.
SUD is a chronic, progressive, multifaceted and neurobiological disease associated with multiple and serious co-morbidities and high mortality. Approximately one in four deaths in the U.S. are now attributable to SUDs, and the economic toll exceeds half a trillion dollars per year. Additionally, hospitalizations stemming from opioid use alone rose from nearly 302,000 in 2002 to more than 520,000 in 2012, with a price tag of over $15 billion. Yet the economic costs pale in comparison to the human suffering endured by those with this disease and their families.
This well-conceived and timely report accurately describes addictive disease and highlights the costly consequences of the current epidemic of opioid addiction and overdose deaths, as well as how the devolving legal status of cannabis use has confounded the issue and created a formidable stumbling block for ongoing prevention, confusion among adolescents, and numerous education and intervention challenges. The authors concur with recent peer reviewed findings that addiction is a chronic brain disease and responsive to evidence-based treatment of adequate intensity and duration.
The ACP’s recommendations:
- The expansion of high quality, evidence-based treatment programs.
- Assuring both insurance-driven and public funding for SUD and mental health treatment.
- Forging collaborative partnerships between physicians, educators, community leaders, public health systems, patient advocacy groups and law enforcement.
- Additional training in addiction medicine for physicians and other health professionals.
- Further research on the neuroscience of addiction and the effectiveness of current and new treatment modalities.
- Developing court-supervised alternatives and diversion programs that provide SUD treatment that allows non-violent and well-motivated drug addicted offenders to have their sentence adjudicated while attending treatment.
Why Does This Matter?
In spite of these data, there is an apathy and ambivalence about SUDs among some professionals and far too many of our leaders. Improving treatment is always a good idea and current research is finding new and novel treatments for SUDs. But only 10-18% of the near 23 million addicts will ever receive any type of treatment. Even worse, each day 8,000 people, mostly teens, will try an illicit drug or addictive prescription for the first time in their lives. We can and we must do a better job of prevention, education and deterrence. This will require unprecedented collaboration between many disparate groups, but parents remain the best obstacle between their kids and drugs, if they choose to be.
Lastly, I was very proud when I was invited to speak at the ACP in 2009. I enjoyed speaking and interacting with the ACP members in the past and would like to thank my friends and colleagues at the ACP for their bold position statement and commitment to advancing this most worthy cause.