In 2016, over 42,000 Americans overdosed on opioids — more than double the number from 2010, according to the Centers for Disease Control and Prevention. This precipitous rise in deaths indicates how severe the nation’s opioid epidemic has become. In response to the crisis, Surgeon General Vice Admiral Dr. Jerome Adams released an advisory to community members in contact with at-risk users last week. In it, he recommended that those who know addicts familiarize themselves with naloxone, an opioid antidote used to reverse the effects and revive overdose victims.
Adams followed this announcement with multiple public and television appearances where he emphasized the proper use of the naloxone (Narcan) rescue inhaler. His advisory and media appearances will doubtless help raise public awareness of a devastating public-health issue and encourage public participation. There’s no reason that anyone who comes in contact with an addict can’t have a tool (naloxone) available for use in an emergency to temporarily reverse the devastating effects of a drug (either prescribed or illicit) that is much more powerful than the user is expecting. Naloxone carriers should be trained to recognize the signs of opioid overdose (unresponsiveness, shallow or no breathing, pinpoint pupils), as well as how to perform rescue breathing and CPR. This advisory is public participation in public health at its finest and has the potential to save thousands of lives.
Pharmacies are planning to follow suit and provide the naloxone over the counter in 49 states: The Surgeon General also tweeted that CVSHealth and Walgreens have announced that they will “stock Narcan Nasal spray nationwide, provide training of their pharmacists and educate patients about risks of high dose opioids and benefits of having naloxone in the home.”
The fact that Adams felt compelled to put out the announcement is telling. Although the surgeon general normally acts as an adviser to the secretary of health and human services and the larger American public on matters of health policy, actual advisories issued from the office are rare. The last one was delivered by Surgeon General Carmona in 2005 warning of the effects of drinking alcohol during pregnancy, but this was actually an update on a previous advisory dating to 1981. (Unfortunately, this advisory had limited impact. As of 2015, 10 percent of women still consumed alcohol during their pregnancies, as compared to the 12 to 15 percent who reported some use back in 2005, when Carmona’s advisory was released.)
Back in 1986, at the heart of the AIDS epidemic, Surgeon General C. Everett Koop released a report that reassured Americans that AIDS could not be spread casually, called for a nationwide education program, increased used of condoms, and voluntary testing. The report was praised by AIDS activists for advocating a nationwide conversation at a time of great stigma and controversy — and for putting public health ahead of politics.
The most influential of all Surgeon General Reports was of course the 1964 Report on Smoking and Health, in which Surgeon General Dr. Luther Terry announced that cigarettes were a cause of lung cancer and laryngeal cancer in men and a probable cause of lung cancer in women, and the most common cause of chronic bronchitis. In drafting the report, a committee of ten members met at the National Library of Medicine and reviewed more than 7,000 scientific articles with the help of over 150 consultants. The committee determined that cigarette smoking was responsible for a 70 percent increase in mortality rate and a close to tenfold increased risk of lung cancer.
The paper had a huge impact on public attitudes. A Gallup survey in 1958 found that only 44 percent of Americans believed smoking caused cancer, whereas 78 percent believed so by 1968. Follow-up steps that emanated from the report including warnings on cigarette packages, banning on advertising in broadcast media, and ongoing reports on health consequences along with programs to reduce tobacco use and disseminate research that have saved millions of lives.
Do not expect the current advisory to have anywhere near the scope or impact of the 1964 report. But there is one similarity. A surgeon general is once again front and center, fingering a deadly disease and providing a public approach towards treatment. As with smoking or HIV, we must bring those who are addicted or suffering out of the shadows and into the spotlight of prevention, intervention, and potential cure.