The unexpected resignation last week of U.S. Surgeon General Vivek Murthy could signal a setback on recent progress to combat the opioid crisis, experts say.
Murthy was asked to step down by President Donald Trump late Friday after a little over two years in the role. Appointed during the Obama administration, Murthy spent a bulk of his time as surgeon general advocating for greater awareness and more aggressive tactics to decrease opioid prescribing nationwide. Rear Adm. Sylvia Trent-Adams, a 24-year veteran of the U.S. Public Health Service Commissioned Corps and a former chief nurse officer of the Public Health Service, will fill the role on an interim basis. Surgeon general is a confirmed post and requires full Senate approval.
Murthy called the opioid epidemic one of the Obama administration's highest priorities; he urged physicians to change how they prescribe pain medication and worked to diminish the stigma associated with addiction. In a landmark report last November, he said it was one of the biggest public health problems of the past 50 years.
So the decision by the Trump administration to let Murthy go has some opioid addiction experts concerned strides made to tackle the epidemic will be stalled or squashed.
"I have a serious concern we are going to be stepping backwards," said Andrew Kolodny, co-director of opioid policy research at Brandeis University.
Kolodny said he questions the Trump administration's goals for combating the crisis in light of the recent appointment of Dr. Scott Gottlieb as FDA commissioner as well as the rumored pick to head the Office of National Control Drug Policy, U.S. Rep. Tom Marino (R-Pa.). Both have pharmaceutical industry ties.
These pharma connections could tarnish the messages Murthy helped shape, Kolodny said. Murthy was the first surgeon general to encourage physicians to change how they prescribe opioids, especially pushing them to avoid using them when treating chronic disease. This message is opposite from the one touted by the drug industry, which argues the opioid epidemic isn't fueled by overprescribing but by people who get access to drugs illegally.
"I am worried that we've just finally started to see the real driver of the problem—overprescribing," Kolodny said. "If we lose the focus on that, I'm worried the epidemic will never come to an end."
Dr. Krisda Chaiyachati, a physician and researcher at the University of Pennsylvania who has studied opioid use, said there is comfort in the fact that the opioid crisis is a "bipartisan" concern that Trump addressed while campaigning. But, he added, "We haven't received clarity on the strategy moving forward" by the Trump administration to combat the epidemic. As a candidate, Trump pledged to "give people struggling with addiction access to the help they need."
Some of the tactics Trump tossed around while on the campaign trail were increasing access to the overdose-reversal drug naloxone for first responders and caregivers and ending Medicaid policies that obstruct inpatient treatment.
But one of Trump's plans in particular—increasing mandatory minimum prison sentences for drug offenders—was criticized by public health advocates.
Trump's concern for the crisis was also questioned when a commission to curb the number of overdoses didn't include the FDA commissioner. Advocates say the FDA can help tighten regulations over drugmakers that have contributed to the epidemic.
There are also concerns that proposed cuts to the National Institutes of Health will slow down work on the crisis.
The president proposed cutting about 20% of NIH's $30 billion budget. The budget blueprint proposes $500 million to help states expand opioid prevention efforts and to increase access to treatment and recovery services. HHS Secretary Tom Price recently confirmed that those are not new dollars, but were previously authorized under the 21st Century Cures Act.
"It's not clear where these cuts will be, but certainly cutting from the NIH and the CDC would affect the ability to handle the opioid epidemic," Chaiyachati said.
