Attorney General Jeff Sessions drew criticism last week when he suggested the opioid epidemic could be eased if people “take some aspirin sometimes and tough it out a little bit.”
The attorney general’s point was that doctors are giving out too many painkillers, and that this had contributed to people becoming addicted to opioids.
Some saw the comments as insensitive. But to others, he was essentially on the mark.
{mosads}“He’s absolutely correct. There are too many opioids being prescribed,” said Dr. Martin Makary, the director of the Center for Opioid Research and Education and a Johns Hopkins University professor of surgery.
It’s been well documented that the overprescription of painkillers has, in part, fueled the opioid epidemic.
Story after story has been told of patients who underwent relatively routine medical procedures, received prescriptions for a hefty amount of painkillers and became addicted to the drug.
Sessions’s remarks reveal the larger debate the country is grappling with over how to combat the opioid epidemic.
This includes how to curb the overprescription of opioids, the ways to treat pain, and the need for better prescriber and patient education, as well as for more alternative treatments for pain.
“We do need to have better treatment for pain, and clearly we need to address overprescribing,” said Regina LaBelle, who served as the Office of National Drug Control Policy’s chief of staff during the Obama administration.
But it’s complex, she said, because “you have to get doctors to understand the inherent risk of overprescribing, as well as how to identify addiction” and “patients need to be treated appropriately for their pain.”
In a 25-minute speech at the U.S. Attorney’s Office in Tampa, Fla., Sessions discussed the Department of Justice’s efforts to combat drug trafficking and curb the opioid crisis with a group of local police and federal prosecutors.
Halfway through the speech, he appeared to go off script.
“I’m operating under the assumption that this country prescribes too many opioids,” Sessions said. “People need to take some aspirin sometimes and tough it out a little bit.”
Sessions described a time when President Trump’s chief of staff, John Kelly, had surgery on his hands.
Sessions described it as “painful surgery,” but quickly added that the retired Marine general refused to take drugs. “You can get through these things,” Sessions said.
His remarks rankled Bob Twillman, the executive director of the Academy of Integrative Pain Management, who said he felt they were “a little bit flippant and certainly insensitive to the plight of people who have pain.”
“To oversimplify it to such a degree as to think that people can use aspirin instead of opioids is really unfortunate, and it sends the wrong message about what needs to be done in treating pain appropriately,” he said.
It’s true that some patients can do well without opioids for smaller procedures, such as wisdom tooth removal, he said. But he and other critics argue that Sessions was being too broad with his pronouncement.
“It’s hard to paint the brush for all patients like that,” said Steven Stanos, president of the American Academy of Pain Medicine.
The Justice Department declined to clarify what type of pain Sessions was suggesting that aspirin be taken for.
Ian Prior, a department spokesman, wrote in an email that “it should go without saying that if opioids were not over prescribed, fewer people would become addicted and there would be fewer overdoses” and pointed to the Justice Department’s launch of an Opioid Fraud and Abuse Detection Unit.
Christin Veasley, co-founder and director of the Chronic Pain Research Alliance, cautioned that she wasn’t exactly sure what kind of pain Sessions was referring to — such as chronic, post-surgical or acute pain.
But if his “intention [was] to talk about overprescribing after routine procedures or for mild acute pain, I understand where he was coming from. I think he could have said it better, so that it was more clear and not offensive to certain people.”
The national conversation over curbing the opioid crisis is going hand-in-hand with talk of how to clamp down on the overprescription of opioids and how to manage a patient’s pain.
“This definitely reveals the larger debate that’s going on in America right now, and we can’t fall into this false dichotomy that it’s an either/or situation,” said Patrick Kennedy, a former Democratic congressman from Rhode Island who is now a vocal addiction and mental health advocate.
“Some people really do need stronger pain medication, but our first response — our default mode — to this point in history has been to give people the stronger medication when in fact less stronger medication that’s over the counter is often all that’s required, and frankly that’s the message [Sessions] was hopefully sending,” Kennedy, who served on Trump’s opioid commission, said.
The Centers for Disease Control and Prevention issued opioid prescribing guidelines in 2016, and other stakeholders are working to examine how to limit opioid prescriptions. For instance, Makary, the professor of surgery, helped convene a group of physicians, nurses, pharmacists and patients to create Johns Hopkins Opioid Guidelines, a list of surgeries corresponding with a maximum number of opioids they believe should be given if any are needed at all.
Those in the pain community say there needs to be more of a national understanding around treating pain.
“It’s very complex because there’s so many different causes of pain,” Stanos said.
A balanced approach to pain management is needed, said Penney Cowan, founder and CEO of the American Chronic Pain Association.
She describes pain as a car with four flat tires. One medication or treatment only puts air in one of the wheels, she says; the other three can be filled up with tools like physical therapy, counseling, goal-setting, acupuncture and more.
“It’s definitely a time of significant struggle,” Stanos said, “in trying to figure out how we’re going to decrease and stop this growing overdose epidemic, and it’s also a time for us to reconsider how do we do a better job of treating pain and also educating society about it.”