Attorney General Jeff Sessions spoke to a group of U.S. Attorneys in Tampa, Fla., last week, and demonstrated his ignorance about the root causes of the opioid overdose crisis.
“I am operating on the assumption that this country prescribes too many opioids,” Sessions said. “People need to take some aspirin sometimes.” A day earlier, Sessions told a gathering celebrating the birthday of President Ronald Reagan, “Sometimes you just need to take two Bufferin or something and go to bed.”
Bob Twillman, the executive director of the Academy of Integrative Pain Management, said, “That remark reflects a failure to recognize the severity of pain in some patients.” Twillman went on, “It further illustrates how out of touch parts of the administration are with opioids and pain management.”
I think “out of touch” is an understatement.
Sessions seems unaware that high‐dose opioid prescriptions are down 41% since 2010, and that the majority of overdose deaths are due to heroin and fentanyl. He probably doesn’t know that the overdose rate from street fentanyl rose by 88% per year from 2013 to 2016; for heroin it rose by an average of 32% per year from 2010 to 2016. Yet it remained unchanged and stable for prescription opioids from 2009 to 2016.
What’s even more disturbing to me as a doctor is the attorney general’s demonstrated lack of compassion for patients suffering in pain. Many have been severely impacted by the restrictive policies that have pressured doctors to curtail or cut off their patients in pain. Some are so desperate that they turn to the black market in search of relief, where they sometimes wind up with heroin and fentanyl. Some even resort to suicide.
I have performed major operations on patients with complex intra‐abdominal diseases who return home in agonizing, debilitating pain that lasts for weeks. Sometimes they need several days — sometimes weeks — of strong opioids to help them recover at home and resume a normal life. Aspirin won’t do the trick. I hope the attorney general never has to experience such pain.
In what is beginning to sound like a broken record, New York City recently reported that in 2016 nearly three‐quarters of all overdoses deaths were from heroin or fentanyl, and 97% involved multiple drugs; 46% of the time, cocaine was involved. By contrast, last month a Harvard study of one million postoperative patients given prescription opioids showed a “misuse” rate of just 0.6%.
Yet Sessions, like most policymakers, seems oblivious to the evidence. Most still focus their efforts on the wrong target — in reality, it has always been about nonmedical users seeking drugs in the illicit market.
The war on drugs is the real killing machine.
If they can’t bring themselves to end this war, policymakers should follow the lead of most developed nations, and at least redirect efforts to harm reduction measures. This means removing obstacles to the expansion of what’s known as Medication Assisted Treatment, so that more health care practitioners can prescribe substitution drugs like methadone and suboxone to help addicts avoid withdrawal and gradually detoxify.
It means allowing for the proliferation of needle‐exchange and supervised injection facilities, endorsed by the Centers for Disease Control and Prevention, and proven to prevent the spread of disease, reduce overdose deaths, and steering addicts into rehab programs. The overdose antidote naloxone, already used by thousands of first responders and laymen with minimal training, should be re‐classified as an over‐the‐counter drug to enhance its dissemination.
And although Congress may not lead on these issues, at the very least the attorney general should leave states free to go their own way.
As long as policymakers remain as clueless as Sessions about the causes and remedies of the rising overdose death rate, look for the rate to continue to climb. The least they can do, though, is speak about this problem like adults.