Drug Policy

Surgeon General’s Report Mistakenly Treats All Drug Use As a Problem

Vivek Murthy does not acknowledge the possibility that nonmedical consumption of psychoactive substances could be beneficial.

|

Office of the Surgeon General

You might think Surgeon General Vivek Murthy, who acknowledges marijuana's medical utility, has relatively enlightened views on drug policy. But a report he released yesterday reveals that Murthy is utterly conventional in his attitude toward drinking and other kinds of recreational drug use, which he views as a problem to be minimized by the government. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health claims "addiction is a chronic brain disease" caused by exposure to psychoactive substances, even while acknowledging that the vast majority of people who consume those substances do not become addicted to them. The report describes even low-risk, harmless, and beneficial drug use as "misuse," giving the government broad license to meddle with personal choices through policies aimed at making drugs more expensive and less accessible. Murthy argues that driving down total consumption, rather than focusing on problematic use, is the most effective way to reduce the harm caused by alcohol and other drugs. As he sees it, every drinker and drug user, no matter how careful, controlled, or responsible, is a legitimate target of government intervention.

Murthy's report eschews the term substance abuse, explaining that the phrase "is increasingly avoided by professionals because it can be shaming." Instead the report talks about "substance misuse," which "is now the preferred term." But substance misuse is just as judgmental, vague, and arbitrary as substance abuse. In fact, Murthy cannot quite decide what it means. On page 5 of the introduction, he says misuse occurs when people use drugs "in a manner that causes harm to the user or those around them." But elsewhere (including the very next page), the report uses a much broader definition. "Although misuse is not a diagnostic term," Murthy says, "it generally suggests use in a manner that could cause harm to the user or those around them." Could cause harm? That definition is wide enough to cover all drug use.

Murthy does seem to think drug use is problematic even when it causes no problems. As an example of drug misuse, Murthy repeatedly cites a 2015 survey in which 25 percent of the respondents, representing 66.7 million Americans, reported that they had engaged in "binge drinking" during the previous month. "By definition," Murthy says, "those episodes have the potential for producing harm to the user and/or to those around them, through increases in motor vehicle crashes, violence, and alcohol poisonings." But the government's definition of a binge—five or more drinks "on an occasion" for a man, four or more for a woman—encompasses patterns of consumption that do not harm anything except the sensibilities of public health officials. If a man at a dinner party drinks a cocktail before the meal, a few glasses of wine during it, and a little bourbon afterward, he is drinking too much, according to Murthy, even if he takes a cab home. By that standard, at least 44 percent of past-month drinkers are misusing alcohol.

Murthy also counts all consumption of federally proscribed drugs as misuse, no matter the context or consequences. As far as he is concerned, all 36 million Americans who consumed cannabis last year misused it, even if they lived in states where the drug is legal for medical or recreational purposes (which is now most states). Unauthorized use of prescription drugs also counts as misuse, whether or not harm results. "In 2015," Murthy says, "12.5 million individuals misused a pain reliever in the past year—setting the stage for a potential overdose." That makes the risk sound much bigger than it is. According to the CDC, there were 18,893 deaths involving opioid analgesics in 2014, the most recent year for which data are available. That year, according to the National Survey on Drug Use and Health, 10.3 million Americans used prescription painkillers for nonmedical purposes. On average, they ran a 0.2 percent change of dying as a result. For those who avoided mixing narcotic painkillers with other depressants (a typical factor in opioid-related deaths), the risk was even smaller—on the order of 0.02 percent, judging from New York City data.

Murthy also seems confused when he talks about addiction. "We now know from solid data that substance abuse disorders don't discriminate," he recently told NPR. "They affect the rich and the poor, all socioeconomic groups and ethnic groups. They affect people in urban areas and rural ones." But according to Murthy's report, "Prevalence of substance misuse and substance use disorders differs by race and ethnicity and gender." Furthermore, "genetic, social, and environmental risk factors" increase a person's vulnerability to addiction, while "protective factors" reduce it. Risk factors include "low parental monitoring," "high levels of family conflict or violence," "current mental disorders," "low involvement in school," and "a history of abuse and neglect." Protective factors include "involvement in school, engagement in healthy recreational and social activities, and good coping skills." Pace Murthy, it sounds like substance abuse disorders do discriminate, since they are more common among troubled people in difficult circumstances.

The fact that everyone is not equally prone to addiction tells us that Murthy's account, in which a "substance abuse disorder" is "a medical illness caused by repeated misuse of a substance or substances," cannot be accurate. According to the report, "prolonged, repeated misuse of any of these substances can produce changes to the brain that can lead to a substance use disorder, an independent illness that significantly impairs health and function and may require specialty treatment" (emphasis added). Those cans are carrying a lot of weight. In fact, as Murthy concedes, drug use typically does not "lead to a substance use disorder"; controlled use is much more common. "For a wide range of reasons that remain only partially understood," says the executive summary, "some individuals are able to use alcohol or drugs in moderation and not develop addiction or even milder substance use disorders, whereas others—between 4 and 23 percent depending on the substance—proceed readily from trying a substance to developing a substance use disorder." By saying "some" and "others" instead of "most" and "a minority," the report obfuscates the point that the vast majority of drinkers and drug users are not addicts.

Murthy's equation of addiction with cancer and diabetes is also misleading. "Now we understand that these disorders actually change the circuitry in your brain," he tells NPR. "They affect your ability to make decisions, and change your reward system and your stress response. That tells us that addiction is a chronic disease of the brain, and we need to treat it with the same urgency and compassion that we do with any other illness." All experiences change the brain; that does not make them diseases. Although the medical terminology is supposed to reduce the stigma associated with drug addiction and encourage people to seek help, it is not clear that describing the problem as an illness rather than a habit makes it any easier to change. Arguably it does the opposite, by depicting harmful patterns of drug use as something that happens to people rather than something that they do.

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

66 responses to “Surgeon General’s Report Mistakenly Treats All Drug Use As a Problem

  1. It’s not a mistake. It’s deliberate.

    1. Precise definitions obfuscate their real purposes, cracking down on human rights and lining their own pockets.

      1. Start earning $90/hourly for working online from your home for few hours each day… Get regular payment on a weekly basis… All you need is a computer, internet connection and a litte free time.. Read More Here… http://www.Trends88.Com

      2. My best friend’s sister makes $90 an hour on the internet . She has been out of a job for six months but last month her check was $14750 just working on the internet for a few hours. Go this website and click tech tab to start your work?this website?…. http://www.Trends88.com

    2. Dr. Lonny Shavelson found that 70% of female heroin users were sexually assaulted in childhood.

      Their addiction is no doubt caused by drugs.

      People in chronic pain chronically take pain relievers.

    3. Just Relaks – If This Sound Good For You – Popcorn First !!!
      Latest Update More HD Quality Movie Complete Available Here:
      ? ? ? http://bit.ly/2g6t4Gl ? ? ?
      Happy & Enjoy to Watch For Free

  2. Vivek is a living introduction to state-forged cognoscenti. The sterile type that bristles with rash repudiations of the alternative and unaligned.

    Classic Yale drool in a tight suit flung from the vicious lips of hoary heads psychotic with dominating tendencies.

    If you wish to make a civilization thrive one can start by burning schools of management to the ground.

    These lizard gardens farm bondage governors and penal system purveyors.

    1. Poetic and accurate. “Yale drool” in particular is wonderful.

      You wanna get high?

      1. This is such a great idea.

        Maybe I should get a little high.

        -Towelllleeeee

  3. “As he sees it, every drinker and drug user, no matter how careful, controlled, or responsible, is a legitimate target of government intervention.”

    When you are a bureaucrat or law enforcement official, making things vague and inconsistent allows them to make up the rules as they go. You could apply the same logic to the EPA, Title IX, etc., etc. and you see the shit show we have.

  4. Addiction is an epidemic!!!!!! It affects 100% of humans and only government can fix you.

    Gotta go. I feel hungry.

    1. Which addiction will you be feeding?????

      1. First food, then drink, then sex, then urinate, then deficate.

        Gubmint, please help!

  5. How would pot’s being legal affect whether it’s abusive to consume it?

    1. How does it being illegal do the same?

      1. You’re more likely to get beaten by thugs when its illegal.

        1. You think legalization is going to stop the cops beating on people for disrespect of cop? Nah. Although I guess they’ll have to find something besides simple possession.

      2. Never said it did. At all.

    2. Because some of the official criteria for substance use disorder may be dependent on the law. It’s circular logic. For example in DSM 5, some criteria are:

      Spending a lot of time getting the substance (translation: If you can’t buy your drug quickly at the drug store you are an addict)

      Continuing to use when it causes problems in a relationship (translation: If your significant other thinks pot is immoral because it’s illegal and gets mad at you for using it, you are an addict).

      Using a substance again and again even when it puts you in danger (Translation: if you buy drugs in the black market, you are an addict)

      Giving up important occupational activities because of substance use (Translation: If you are don’t get a job because you smoked pot 2 weeks ago and it shows up on a drug test, you are an addict).

      1. That is indeed what it means. If you’re willing to break the law & invite adverse consequences such as those to use a drug (or do anything, really), that’s an indicator that the activity is a strong motivator for you (& others), & therefore an object of “abuse” or “addiction”. It’s considered akin to self-mutilation.

        1. You clearly don’t know what it’s like to live in severe chronic pain. Hopefully you never do.

  6. Mr. Vivek Murthy is holding my tiny baby hand as he guides me through life.

    Tank u Mr Murthy for helping me cross the street!

    Your welcome, and now I will show you how to potty!

  7. If a man at a dinner party drinks a cocktail before the meal, a few glasses of wine during it, and a little bourbon afterward, he is drinking too much, according to Murthy, even if he takes a cab home.

    5 drinks over three hours? Are you trying to die!?

    Of course, by their definition having that third pint of craft beer is a binge. (5%x12oz being one “standard” drink. 7%x16ozx3 is approximately 5 standard drinks)

    1. If you’re not binge drinking, why bother?

      1. Trying to drink your meal?

  8. Just shut up Jacob and let the government fix you.

  9. I apparently overdosed on Percocet last night when I took that one pill from an old prescription to deal with some kidney stone pain.

    1. some kidney stone pain

      *winces*

      1. At this point I’ve had so many that it’s really more extreme discomfort than severe pain like the first few were. I think my ureters are like old socks with worn out elastic.

    2. Kidney stones are exactly why I always keep some pain meds in the house. When that pain hits, there is no time to go asking permission to go to a pharmacy to deal with it.

      1. Or you could go down to the street corner and score some smack. Cheaper, more effective, and no paperwork.

        1. Unless you get smacked. The its expensive, less effective and there might be police and/or hospital paperwork.

    3. That pains me to hear that.

      Don’t get too stoned from those pills.

  10. Why isn’t he wearing a sailor suit? It makes me long for the days of C. Everett Coop, who looked like he should have been shouting, “Damn the Torpedoes, Full Speed Ahead!” as he steams into Mobile Bay.

    Or maybe that’s just me thinking that.

    1. I look like the Koopster. My lady gets once a year that I shave my beard to look like the way he had it. I put on my sailors uniform and we addictively do “it”

      C. Everett Koop pic

  11. You might think Surgeon General Vivek Murthy, who acknowledges marijuana’s medical utility, has relatively enlightened views on drug policy.

    Why would you *ever* think tha … oh. OHHH!!

  12. I think the world would be a far better place if everyone were able to smoke a joint or take 10mg of Vicodin a couple times a week. Just like having a couple drinks, but actually less harmful to the body.
    It is really frustrating what they have done in making hydrocodone a Schedule II drug. There is so much difference between 10 mg of Vicodin and wearing a fentenyl patch or getting a hold of dilaudid. And yet by making it harder for docs to prescribe Vicodin (like for tooth pain) it makes it more appealing to go black market. And then if there is a risk of going to jail, go big or go home so let’s go straight to morphine or heroin.

  13. Another example that the scolds and prudes on the Left are as bad (if not worse) than those on the right.

    1. Complementary scolds, I’d say. There is some overlap, such as this war on drugs stuff, and between them, they have pretty much everything covered.

      When it comes to moral scolding, it seems like the left is getting worse and the right (generally speaking) is getting marginally better (less focus on traditional socon issues, becoming more open to personal freedom arguments for legalization of drugs, etc.).

      1. Yep. I am not saying the socons are all libertarian now. Obviously not, look at Jeff Sessions. But I think on the everyday level, the average religious conservative is more willing nowadays to live and let live as long as they don’t have to participate. While the left is more and more about controlling all areas of behavior (except abortion). Even sex, (unless it is gay sex), is becoming increasingly more of a control issue. And many of them want to WOD harder than the Republicans so they can show they are tough on crime too (or like this article, where it isn’t about tough on crime, it is about compassion for addicts. Of course it all results in the same thing: jail and ruining lives).

  14. If you’re addicted to a substance and it isn’t ruining your life or the lives of those around you who cares? The penalties associated with addictive substances are often far more harmful than the substances themselves. God save us from public health moralizers.

  15. Why even have an office of the Surgeon General? Seems like an easy place to start cutting some government.

    1. Top men need a top doctor!

      1. Jocelyn Elders. (clicks link) Yup.

      2. I always thought it amusing that masturbation was something that had to be taught.
        Aren’t most kids autodidacts on that subject ?

        1. Hmmm.. what does this do?

          *masturbates constantly ever since

  16. Muthy looks high in that picture.

  17. Power addiction is far worse than drug addiction. Power misuse is far far worse than drug misuse.

  18. Remind me again how Obama and the democrats are so much better on pot then the republicans.

    1. States voted to allow recreation marijuana in the state…. so Obama!

  19. Murthy’s one of the progressive leftists who considers guns to be a public health issue, WITHOUT counting how many lives are saved/defended using guns.

    Imagine if a medical researcher counted all the times that a drug had harmful effects on a patient but refused to count all the times it saved lives and then deemed the drug a poison. That’s Murthy’s approach to guns.

  20. RE: Surgeon General’s Report Mistakenly Treats All Drug Use As a Problem
    Vivek Murthy does not acknowledge the possibility that nonmedical consumption of psychoactive substances could be beneficial.

    Hmmm…sounds like another bureaucrat telling me what I should or should not ingest into my body.
    No thanks Surgeon General.
    I’ll make my own decisions.

  21. Still can’t find that section in the Constitution that authorizes the federal government to be my Mommy & Daddy.

  22. until I looked at the paycheck saying $4730 , I did not believe that…my… brother woz like actualy bringing in money part time from there computar. . there friend brother started doing this for less than 7 months and resently paid for the morgage on there home and bought a new Cadillac …….

    >>>>>>>>>http://www.centerpay70.com

  23. until I looked at the paycheck saying $4730 , I did not believe that…my… brother woz like actualy bringing in money part time from there computar. . there friend brother started doing this for less than 7 months and resently paid for the morgage on there home and bought a new Cadillac …….

    >>>>>>>>>http://www.centerpay70.com

  24. until I looked at the paycheck saying $4730 , I did not believe that…my… brother woz like actualy bringing in money part time from there computar. . there friend brother started doing this for less than 7 months and resently paid for the morgage on there home and bought a new Cadillac …….

    >>>>>>>>>http://www.centerpay70.com

  25. Any definition of freedom that doesn’t include control of your own body chemistry is manifestly absurd. The drug war is a failure on almost every level, but government having a stake and a say in what we choose to ingest being treated as a premise by all the “adults” in the room was kind of a huge success.

  26. I get Paid over ?80 per hour working from home with 2 kids at house. I Never thought I would be able to do it but my best friend earns over ?9185 a month doing this and she convinced me to try. The potential with this is endless.

    ??..>>>>>> http://www.jobmax6.com

  27. Facebook gives you a great opportunity to earn 98652$ at your home.If you are some intelligent you makemany more Dollars.I am also earning many more, my relatives wondered to see how i settle my Life in few days thank GOD to you for this…You can also make cash i never tell alie you should check this I am sure you shocked to see this amazing offer…I’m Loving it!!!!
    ????????> http://www.factoryofincome.com

  28. until I looked at the paycheck saying $4730 , I did not believe that…my… brother woz like actualy bringing in money part time from there computar. . there friend brother started doing this for less than 7 months and resently paid for the morgage on there home and bought a new Cadillac …….

    >>>>>>>>>http://www.centerpay70.com

  29. I get Paid over ?80 per hour working from home with 2 kids at house. I Never thought I would be able to do it but my best friend earns over ?9185 a month doing this and she convinced me to try. The potential with this is endless.

    ??..>>>>>> http://www.jobmax6.com

  30. Facebook gives you a great opportunity to earn 98652$ at your home.If you are some intelligent you makemany more Dollars.I am also earning many more, my relatives wondered to see how i settle my Life in few days thank GOD to you for this…You can also make cash i never tell alie you should check this I am sure you shocked to see this amazing offer…I’m Loving it!!!!
    ????????> http://www.factoryofincome.com

  31. Start working at home with Google! It’s by-far the best job I’ve had. Last Wednesday I got a brand new BMW since getting a check for $6474 this – 4 weeks past. I began this 8-months ago and immediately was bringing home at least $77 per hour. I work through this link, go? to tech tab for work detail
    +_+_+_+_+_+_+_+_+ http://www.factoryofincome.com

  32. Everyone with common sense knows the difference between use and abuse, whether of alcohol or marijuana. The same people observe that people who stick needles in their bodies are doing something quite different than having a few drinks or smoking a joint or two. Evidently this Surgeon General, a Democrat appointee, doesn’t have the same ability to discriminate.

  33. Everybody can earn 150$+ daily… You can earn from 4000-9000 a month or even more if you work as a full time job…It’s easy, just follow instructions on this page, read it carefully from start to finish… It’s a flexible job but a good earning opportunity.. go to this site home tab for more detail
    +_+_+_+_+_+_+_+_+ http://www.factoryofincome.com

Please to post comments

Comments are closed.