Policy Amidst a Plague: On Leadership During the Opioid Epidemic with Surgeon General Dr. Jerome Adams
By Justin Kaplan
In 2018, everyone in America has an opioid story — a neighbor prescribed OxyContin after a debilitating car wreck, a relative struggling to recover from an addiction behind bars, a former classmate whose Facebook page has become a tribute. This tragic epidemic continues to ravage communities across the nation; according to the Commissioner of the Massachusetts Department of Public Health, Dr. Monica Bharel:
“In Massachusetts, we haven’t seen this kind of death rate from a single disease since the beginning of HIV.”
Since 2000, more than 600,000 individuals have perished from opioid overdoses in the United States. Yet as harrowing statistics continue to dominate media coverage, public health practitioners cannot forget the importance of evidence-based leadership when combating a health crisis this severe and stigmatized.
The Voices in Leadership series was honored to welcome Vice Admiral Dr. Jerome M. Adams, the 20th Surgeon General of the United States, to the Harvard T.H. Chan School of Public Health to discuss tangible, bipartisan strategies for combating the opioid epidemic on January 24th, 2018. Dr. Adams, a board-certified anesthesiologist who previously served as Health Commissioner of Indiana during the state’s staggering 2015 HIV outbreak, is no stranger to epidemic control. Working closely with the CDC, Dr. Adams delivered science-informed recommendations that were pivotal in convincing then Governor Mike Pence to implement a temporary clean needle exchange program in Scott County, Indiana.
Serving as the nation’s “top doc,” as head of the 6,700 person U.S. Public Health Service, and as the Trump administration’s foremost health content expert, Dr. Adams is as busy as he is inspirational. His credo, “better health through better partnerships,” underscores his challenging endeavor to unify non-traditional partners, from business leaders to law enforcement, to prioritize the public’s health.
Interviewed by Dr. Robert Blendon, Richard L. Menschel Professor of Public Health and Professor of Health Policy and Political Analysis, the friendly and frank Surgeon General doled out tangible tips for public health leaders seeking to influence bipartisan policy, and succinctly detailed what he feels must to be done to stymie America’s opioid epidemic.
The Doctor’s Doctrines
Dr. Adams began the event by enumerating his “core beliefs,” a set of tenets he feels are vital for effective leadership in the political sphere.
Know (and address) your audience. Whether developing a community-based intervention or drafting nationwide policy, it is essential to involve and communicate with the beneficiaries of your actions from the start. As public health professionals, we cannot perform stakeholder analyses from within an ivory tower and expect meaningful change to occur.
Recognize the difference between science and policy. Blunt and realistic, Dr. Adams made it abundantly clear that even the most rigorous and validated evidence does not always equate to feasible policy, saying:
“We’ve got to understand that [science and policy] don’t always overlap. What we’re looking for is that sweet spot where they do overlap.”
Pinpointing these “sweet spots” requires immense political strategy, patience, and oftentimes, significant concessions. But, they do exist — as Dr. Adams proved in Indiana with his needle exchange program.
Learn how to influence. The Surgeon General reminded the audience that in order to sell politicians, policymakers, and the general public on scientific recommendations, we must first understand the art of persuasion. He explained:
“We’ve got to do a better job promoting the science of influencing policy, figuring out how we can be more effective, and not just beating people over the head with science, science, science, and doing what Einstein said is insanity — doing the same thing and expecting a different result.”
As he spoke to Dr. Blendon, Harvard’s preeminent scholar on public opinion polling, Dr. Adams urged public health professionals to consider voter priorities when developing their own policy goals:
“We know that the top issue people vote on, Democrat or Republican, more often than not, is jobs and the economy. So how can we help folks understand that focusing on health will really help them promote the economy, bring jobs to their community, and again, ultimately, for us to accomplish the things that the voters want us to accomplish?”
Prescriptions for the Future
When asked about next steps for addressing the opioid epidemic, the Surgeon General succinctly summarized what he feels healthcare providers and the public must do to control this crisis.
Naloxone is a necessity. Dr. Adams was abundantly clear of his stance on Naloxone (Narcan), the life-saving opioid antagonist that, when given early enough, can effectively reverse an opiate-induced overdose. A strong advocate for “increasing the availability of naloxone”, he poignantly described its role in emergency response:
“As a physician, when people are dying, when you come across a trauma scene, you’ve got to put on a tourniquet. Naloxone is that tourniquet.”
Prevention is a priority. Stressing the importance of primary prevention, Dr. Adams insisted that all Americans — and not just doctors — can be proactive and valuable advocates:
“It’s got to be all hands on deck — everyone, the mother, the father, even the child. I tell my 12- and 11-year-old, you have a responsibility to educate your classmates about the dangers of opioids and the reason why we need to avoid [them]. […] There’s a role for every single one of us to play.”
However, he made sure to emphasize that healthcare providers must take the reins for secondary and tertiary prevention. Appealing to clinicians, he encouraged providers to:
“Dig out from under this epidemic by following the CDC guidelines, by prescribing responsibly, by becoming trained in how to treat substance use disorder and getting DATA waivered, so that [you] can prescribe buprenorphine and methadone and naltrexone and the substances that we know, from an evidence base, help folks recover from opioid use disorder.”
Treatments must be trustworthy. While unwavering in his belief that recovery programs are essential to ending this epidemic, the Surgeon General was acutely aware that many treatment centers are not living up to the standard of care, noting:
“Treatment absolutely is effective […]. However, we need to help folks understand how to discern the fly-by-night charlatans from the effective treatment programs.”
Cautioning consumers against programs that take a “one-size-fits-all approach,” Dr. Adams recommended looking for treatments that are highly personalized, offer the “full array” of FDA-approved options, including medication-assisted treatment, include outpatient recovery support services, such as housing or job placement, and treat addiction as a chronic disease. Though he admitted that locating comprehensive treatment programs is often difficult and that compiling a database of such programs is a priority of his office, the Surgeon General suggested visiting the Substance Abuse and Mental Health Services Administration (SAMHSA) website when searching for treatment options.
In an ideal world, public health would undoubtedly be a top priority for politicians and voters alike. But in reality, the field of work often takes a back seat to hot-button issues. In order to enact positive change, public health professionals must think scientifically, plan strategically, and work collaboratively to ensure that vital messages reach the right audiences.
For more from the Voices in Leadership (@VoicesHSPH) series at the Harvard T.H. Chan School of Public Health (@HarvardHSPH), visit www.hsph.harvard.edu/voices.
Story by Justin Kaplan, a first year student in the Master of Public Health program in Health and Social Behavior at the Harvard T.H. Chan School of Public Health, interested in health communication, behavioral economics, and health policy.
Story edited by Sohini Mukherjee, a second year student in the Master of Science program in Global Health and Population at the Harvard T.H. Chan School of Public Health, interested in gender equity, maternal health, and health policy and governance.
