I rarely say anything supportive of Jeff Sessions. In fact, this is probably the first time it has ever happened. Unsurprisingly, I can’t do so without some major caveats. What Sessions said was fine but the way he said it was insensitive.
U.S. Attorney General Jeff Sessions has drawn jeers for suggesting that people in pain should consider over-the-counter Bufferin instead of opioids.
On Wednesday, Sessions was in Tampa, touting the Trump administration’s efforts to combat drug abuse and trafficking.
This time, he broadened his suggestion to aspirin.
“I am operating on the assumption that this country prescribes too many opioids,” Sessions said. “People need to take some aspirin sometimes.”
Sessions delivered a 25-minute address at the U.S. Attorney’s Office in Tampa, speaking to local police and federal prosecutors about the devastating impact of opioid abuse, including heroin and its high-powered cousin, fentanyl.
On a subject like this, glibness is inappropriate. There are plenty of people who take opioids for debilitating and excruciating chronic pain, and it’s insulting to suggest that they can get by with a couple of aspirin.
Yet, there is no doubt that opioids are overprescribed and inappropriately prescribed, and this has caused more death and suffering in this country than the AIDs crisis or the crack epidemic.
There are countless people at this point whose lives have been ruined by addiction or who have died because they took prescription drugs as prescribed by a doctor. Many of these people took the drugs for postoperative pain, including dental procedures or arthroscopic surgeries that were treated, prior to the introduction of Oxy-Contin in the 1990s, with non-opioids or far less powerful opioids, and for shorter periods of time.
For example, in 1986 I had four impacted wisdom teeth removed and was given codeine. My suffering was excruciating despite the medication and I didn’t think it was doing anything until I ran out and discovered that it had been dulling the worst of my pain. I was a very unhappy camper who would have done almost anything to get some relief, but I toughed it out and I’m alive today. If I’d had that surgery ten years later, I might now be living under a bridge after stealing everything I could from my parents and loved ones to feed an addiction no doctor sufficiently warned me about when they gave me my scrip. Or, maybe, I would have died twenty years ago after I discovered that heroin was a cheaper way to relieve my withdrawals than buying expensive black market pills.
There is no doubt that we need to find a balance between helping people with legitimate chronic pain or postoperative pain and also letting people feel some pain again, if it’s bearable. What seems unbearable often can be endured, at least if there’s a prospect that it will only last a short time, as was the case with my dental surgery.
For too long, doctors were afraid to tell anyone to tough it out, and it’s obviously a hard thing to do since no one can tell just how much someone else is suffering or if they’re lying about their pain just to feed a preexisting addiction.
The fact that this problem is complicated is precisely why Sessions shouldn’t be glib about it. Yes, people need to be willing to suffer more pain to avoid the risks of opioids and doctors need to say ‘no’ more often. But there’s no simple way to do that without causing suffering that could be alleviated. The chronic pain sufferer can become a victim, too, if new regulations cause lapses in their supply of pain relieving drugs.
On balance, we have to weigh the tens of thousands of annual deaths and the hundreds of thousands if not millions of ruined lives very heavily in this scenario. It’s been too high of a price to pay for people never having to grin and bear the painful but fleeting moments in life. It’s been too high even to offset the legitimate benefits of these drugs for people who get relief that wasn’t legally available before the 1990s.
So, Sessions is trying to tell a hard but needed truth, but he’s doing it in assholish way.
One of the most promising medicines for chronic pain is readily available, non-physically-addictive, relatively inexpensive, AND it is still illegal under Federal law, and Sessions wants to keep it that way.
What a jerk . . . er, typical republican.
Indeed.
The cat is out of that bag. And the cat is now off somewhere having kittens.
Sessions can believe what he wants to believe, but he’s too late.
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I think you are referring to Marijuana, which is still being denied to terminal cancer patients because it leads to heroin. Horrors! They might sneak out of the hospital the last month of their life and do a deal in an alley!
Morons. it must those “Jesus rode a dinosaur” morons. You know, the ones railing about short skirts while they are bopping every woman in their congregation.
Different people react differently to drugs. As best I can tell, aspirin has no detectable effect on me.
I have always needed morphine to get through broken bones.
I am kind of pain insensitive though – I didn;t bother filling the Percodan scrip I was sent home with after my last fracture/hospitalization.
Ah yes, opioid addiction is now killing white people so it’s time for a national moral panic and the solution is to stop treating people in pain.
Got it.
And if you consider pain from dental surgery as anything akin to ‘chronic pain’ I sincerely hope you never have to suffer real chronic pain under the regime of ‘it’s ok to make people feel some pain’. I remember the bad old days when a friend was literally dying from cancer and they wouldn’t prescribe opioids ‘because he might get addicted’, and the DEA would then come after the doctor.
By the way, the ACTUAL data on people taking prescribed opioids and turining into addicts STILL shows it’s relatively rare, but because the press and pols love themselves a wonderful moral panic, we’re treated to endless hand curated artisanal data anecdotal accounts of “Oh I was given a prescription of oxy for a week and here I am injecting heroin”.
well, it can’t be THAT rare
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It’s not actually rare at all. In fact, what’s incredibly rare is for someone to just decide out of the blue that it would be a good idea to take up an intravenous heroin habit. Far more common is that people do one of two things.
Most opioid deaths in this country actually take place when people overdose on pharmaceutically-approved and dose-reliable pills. Heroin and fentanyl overdoses are rising but still the exception rather than the rule. But almost all of these latter overdoses are caused by addiction that began with pills.
Also, having four impacted wisdom teeth removed is not your ordinary dental surgery. It is invasive, as they slice open your gums and dig out teeth that are embedded there, causing gaping oozing wounds that take weeks to heal, plus substantial tissue damage in our of the most used and most sensitive parts of the body. I can’t really remember how much it hurt, but it hurt worse than anything I can remember.
WJC notwithstanding, no one else can really feel your pain. I have felt pain like you describe. Sometimes the pills are needed. But some people want to use them if they cut themselves shaving. I don’t know how many people asked for my leftover pills “to have a party”. I hope they were joking.
I had one removed. Pretty bad. I can’t imagine four at once.
No, the risk is quite high. Even a 10-day prescription is enough for a 20% chance of becoming a long term user and a 10% chance of permanent addiction. Outside of terminal illness there’s not much pain bad enough to justify that kind of risk.
“For too long, doctors were afraid to tell anyone to tough it out, and it’s obviously a hard thing to do since no one can tell just how much someone else is suffering or if they’re lying about their pain just to feed a preexisting addiction.”
Doctors were indeed “afraid to tell anyone to tough it out” but only because they spent decades telling patients to “tough it out”. That is, until research indicated that was counterproductive, because pain relief allowed faster recovery.
The worst of the current public health disaster is due to prescriptions being cut off without addressing patient dependency, then the patient turns to the street for their fix.
Ultimately, Sessions wasn’t telling any truth about opiate addiction, he was simply servicing his zero tolerance fetish to promote policy.
You’re right that cutting off the availability of a snortable or injectable Oxy pill led people to the street to get their fix. That was already happening due to price differentials, but the supposedly safe Oxy came too late, when more than a million Americans were already hooked. This was a boon to Mexican heroin dealers and for Trump’s wall.
But I wouldn’t agree that the biggest public health problem is that people are getting their fix on the street. It’s dangerous because it’s criminal, run by criminals, and because doses vary so much and can be deceptively lethal. But, still, most deaths come from people overdosing on the pills. It’s shocking how many little old ladies die from overdoing on their prescriptions.
Also, an astonishing number of people overdoes in nursing homes from errors made by staff, including doubling applying the fentanyl patch. One ambulance driver I met said he gets that kind of call almost daily, usually because of shift changes.
The biggest problem as with guns is that there are too many pills in our society being used by people who don’t understand their danger and shouldn’t be trusted with them. Yes, guns often come in handy for self-protection, but it’s more common for someone in your household to shoot himself or a sibling than it is from an invader to be repelled. The legit opioid user exists and benefits. He is a distinct minority.
I have a friend in the postal service, an ex-Marine (they are never really ex- ), who is a collector and avid target shooter. He can rattle off facts and figures and describe various minute technical details. I have absolutely no fear of him. I fear the untrained cowboy who wants to pack a gun “for protection”. And I knew a few of them. One was a jerk in High School who went on a pheasant hunting trip, negligently pointing his shotgun anywhere.
Note the key part where I say “without addressing dependency”. The whole issue of seeing addiction as a moral failing needs to change.
Also, when I’m referring to “the street” I’m not just talking about smack, but the black market for pills. Which are often stolen from unused stashes, so I’m not disagreeing with you at all about the over-prescription bit. Just that like a lot of other medical issues, the approach tends to have a pendulum effect.
well, I may have misinterpreted you a bit and if so I apologize.
there still is a big black market for the pills, obviously, and you can overdose from ingesting them (the little old lady example), obviously.
usually, at least with younger people, the pills become unsatisfactory when used orally. and that’s what the safe-oxy was supposed to fix. people couldn’t mash them up and snort or shoot them anymore.
without pills to do, the addict searched out heroin which was far cheaper anyway.
the pills remain a huge problem not only because they’re dangerous in and of themselves and create a criminal market, but because they truly are the mother of all gateway drugs to heroin and fentanyl. And heroin and fentanyl are more dangerous because no one can predict the dose. fentanyl is semi-lethal even in small doses which is why its a leading killer in nursing homes where the problem is usually created by staff overdosing the patients through error.
fewer people taking opioid for bearable pain is definitely a huge part of the answer here, and that’s what happens in every other country where the opioid problem is let problematic.
Based on numbers it is clear that opiates are over-prescribed to the point where certain communities are being flooded with them. It is easy to abuse something when you have a lot of it.
Personal story: I suffer from migraines a few times a year. When I get hit with a Big One, the only medicine that offers any relief is Oxycontin. (For those who have never had a migraine, it is just a headache in the same sense that a compound fracture is a minor scratch.I have had broken bones, torn tendons, and a ruptured spinal disc, and none of that compares to the pain of a migraine.)
Fortunately, my doctor prescribes me ten pills at a time, so I am not tempted to take one unless I literally feel like I will die from the pain. Ten pills usually lasts me about 3-5 years.
To your point, I often wonder what my use would have been if I had been given a scrip for 30 or 50 pills. It would be easy to pop a pain pill for something minor if you had a big jar of them.
I am a personal friend of one of the world’s most renowned neurosurgeons. He said a major problem he dealt with was people with personal problems (marital, employment, children, etc.) who feigned neurological pain because they couldn’t deal with their other issues.
How does a neurosurgeon deal with that? If it’s psychological problem, he/she isn’t trained to treat such a problem. If there’s no obvious physical cause, surgery isn’t indicated.
The research showing benefits from opiates was on extremely short-term use, up to a few days, not using pills, in a hospital setting. Nobody’s ever found health benefits for take-home opiate pills.
He’s an asshole. A very nasty piece of work. An asshole to whom empathy is an utterly unknown and unfathomable concept.
Also too, a racist (duh!), though that’s not obviously implicated here . . . not obviously, but . . .
And did I mention he’s an asshole? Hope I didn’t forget that one! It’s central.
I don’t know the answer to reducing the “problem” of the medications themselves — the disparity between here and Europe seems concerning with regard to overprescription. Maybe there’s reasonable explanations for this.
However, someone like Jeff Sessions, and most Republicans (75%+) are incapable of addressing the problem in a way that will do actual good. The only thing they understand is force, jail, cops, border police, and cutting public services. This will not only not work, it will make the problem worse. Even if they don’t do cuts, ramping up the drug war will lead to more deaths. Period.
Philadelphia is the only city with some fucking guts to do what’s necessary to stop people from dying:
The Country’s First Safe Injection Facility May Soon Open in Philadelphia.
No, fuck that. He used that same speech to go after proven pain reliever marijuana as a “gateway drug”. He has zero interest in helping people in pain. “Just take an aspirin” is not an answer to people who are suffering.
Opioids are unacceptably habit forming and dangerous but they fulfill a real need. Attacking alternative methods of managing chronic pain or worse, telling people to “suck it up” is a recipe for expanding the opioid crisis.
Sessions racializes drug use; only he can’t racialize opioid use at the moment because it has hit whites in Trump country hard.
Marijuana might work for some, but I’ve used it for chronic back pain and it didn’t do squat.
It’s not some panacea, but the fact that Sessions chooses to attack it speaks volumes.
I have personal experience with it, relieving migraines due to a neck injury. It’s not something you can take like a pill once and a while when you are hurting, it’s more like therapy that has to be done daily. I find it relaxes the muscles that pinch the nerves that cause the migraines.
The challenge is dosage, because too much and you learn why they call it “dope”, too little and it’s not doing “squat” as you say. I vape just once or twice a day, usually in the late afternoon after work, and it seems to work for me.
Dosage is one area that research would do wonders for. If research could freely be done…
True. But Americans seem intolerant of any pain.
When my gallbladder was removed I was prescribed Vicodin. I took one. When I needed another the time interval wasn’t up so I took a plain Tylenol (prescription strength). It worked almost as well and I never went back to the Vicodin. I didn’t have the dreamy pleasure experience that others describe so I assume that some people are more sensitive to the drug than others. Keep the opiods unless they amputate your arm or you have a spike shot through your gut.
When my jaw was drilled for dental implants I quit arguing with the oral surgeon about the opiod he insisted on prescribing. I just took the prescription and never filled it. Each time I just bought a bottle or two of generic acetaminophen. Yeah. It hurt a lot. You know what? Pain tells us that we are still alive. Drugging yourself until you feel no pain at all is not good for you.
I do understand extreme pain. When I had the gallbladder attacks I didn’t know if they were heart attacks or not. I just wanted them to end one way or the other. I didn’t particularly care which way. Being dead was better than the pain, like a knife in my chest. That still doesn’t negate the fact that most Americans are afraid of any pain at all.
When I had my first two wisdom teeth extracted, in Britain, decades ago, the dentist gave me a single shot of morphine. I was already more than mildly conversant with hash and acid … and the high was soooooo good that I immediately, while still high, resolved never to try it again (and didn’t, even in situations where it was very available). I am highly educated and have a very strong sense of self-preservation. I have enormous sympathy for junkies. It IS, however, possible to stop; it’s just difficult.
I had two friends that couldn’t stop smoking cigarettes die from lung cancer. These were men much more disciplined and stronger willed than I. I told them “If I can do it, why can’t you? You are stronger willed than I?” No answer.
The one guy i can understand, his wife was a smoker. you can’t quit while breathing smoke all day. The other was unmarried with no live in partner. An amazing guy. Very smart, a brilliant engineer, one of the smartest I’ve ever known. He was brave, a battlefield medic in VietNam. So why couldn’t he quit?
It isn’t will power per se that allows the addict to quit; you have to reach a place in your mind where you just… don’t. Won’t. Don’t want to do this any more, won’t do it, no, right down to the core of how your mind works. It’s layers and layers down, and at every layer the physical and habituated mental cravings fight like rabid wolverines to get back in control.
At least, that’s how it was for me when I finally kicked my 20-year smoking habit. After years of semiseriously wanting to, trying and failing to, one particular thing clicked the “won’t” into place and I could finally do it.
I started smoking in 1958 when I was 13. I quit in 1986 when I was 41. That’s 28 years of smoking. I never wanted to quit until then. I would up in a hospital for a week because I couldn’t breathe. I wasn’t really conscious until Tuesday morning. I had entered Sunday night because I didn’t have enough lung strength to keep my cigarette lit. The doctors told me that i had a choice. I could stop smoking or I could breathe. I thought about for fifteen minutes (really!) and decided to breathe. I did fall off the wagon once, but my wife gave me holy hell. “I’m not going through that again, you idiot!”, as she crumbled the pack that she found.
Maybe the others hadn’t had that happen until too late.
Bill had gone through chemo and radiation for a different cancer but resumed smoking after it was gone.
Doug died of lung cancer in Texas. A mutual friend sent me an e-mail link to the obituary.
In 1954, the US took over the war in Indochina from France. In 1955, Frank Sinatra starred in The Man with the Golden Arm.
In the 1980s, the US conducted a subversive war in Nicaragua. In the 1980s, the US became the market for major shipments of cocaine and its “high-tech” derivative called “crack”.
In 2001, the US invaded Afganistan in search of Osama bin Laden. In 2017, the US had a health crisis and a moral panic about opioids and the addiction to cheap heroin.
Substantially cutting the defense budget ends these misadventures, the pain resulting from military wounds, PTSD, and the propagation of those effects into civilian society through militarized policing, domestic abuse, and financially dysfunctional families.
But instead we get more of what we invest in — war, crime, and abuse. Because a caring society is now too “wussy” and feminine.
We don’t get peace because we no longer even pretend to want peace. And that has lots of by-products.
Precisely.
Thank you.
Karma is real.
What goes around always comes around.
AG
One more historical item. The prohibition movement started out of the epidemic of alcoholism and domestic abuse that followed the US Civil War. By the 1920s, prohibition has created the organized crime networks and polite rumrunners that caused widespread scofflaw attitudes and the first marijuana panic (associated with the popularity of jazz). One suspects a bit of WWI PTSD was in involved in all of the Roaring 20s phenomena, including the crash and Great Depression. The Bonus Army was about more than just veterans benefits.
I always chuckle when I think about how the Taliban had pretty much shut down opium farming in Afghanistan. Now? It’s the worlds biggest supplier. So, we traded some human rights violations for a world flooded with heroin…
“…but he’s doing it in assholish way.”
His behavior is not at all surprising, of course. Sessions is a racist authoritarian who is incapable of empathy and helping to develop constructive solutions to our nation’s chronic problems. That’s why he was attracted to his soulmate Trump in the first place.
His comment comes across in the same tone as Don Rumsfeld’s comment about torture positions and making prisoners stand for hours and hours when he said, not a big deal, I have to stand for hours a day and I’m fine.
This is not exactly true. Doctors were perfectly willing to tell patients to tough it out until a number of physicians started writing op-eds about the moral and legal obligation physicians have to treat pain. Their cases were (and are) compelling, but you can see why the old ways predominated for so long.
Another misconception is that the surge in opioid abuse comes from patients being treated for pain (acute or chronic) becoming addicted to their treatments. It turns out that this may not be the case. Obviously it happens, but diversion seems to be a bigger problem. It’s hard to figure out because a significant population of abusers go out of their way to “shop” for prescriptions. But that approach is risky and takes a relatively high amount of effort. It’s probably just easier to steal or buy pills.
Related to that second point, this is why I think opioid disposal programs are bound to fail. Those drugs are worth a lot of money! The government buys back guns, and if they want pills off the street they’ll have to pay for those, too. That’s just economics.
Lastly, I think it’s worth pointing out that no pain relief regimen is particularly safe:
Critical reference.
I wanted to share a column recently published by our friends at Lawyers Guns & Money. It’s a bit long but worth the read and tells the other side of the story – The people in legitimate pain who now are being cut off from the only thing that has helped them cope with their debilitating situation.
“I’d love to take more time and tell the stories of people I’ve met during my pain journey, people way more fucked up than me, way more vulnerable than me. I’m a rich, white businessman, and I’ve been made to feel like a criminal or pill-seeker literally dozens of times by doctors, nurses and pharmacists – I cannot imagine what some of the people I’ve met along the way have experienced…”
http://www.lawyersgunsmoneyblog.com/2017/12/the-other-side-of-opioids
I sent this to a friend of mine in a similar situation and he wrote back: “I could simply add my signature to this and it would be my story. I’m not alone.”
I have tremendous empathy for those stuck in the opioid cycle, having experienced opioid withdrawal firsthand post-surgery in 2014. It would have been so easy to take another pill to feel better and end the nastiness. Unless you’ve gone through it, you have no idea. The only thing that kept me going was the website communities where I read about people way more effed up than I was, sharing and fighting through it together.
Booman is correct: “What seems unbearable often can be endured, at least if there’s a prospect that it will only last a short time..” This was the case for me. However for my friend and Paul Campos friend, there is no end in sight and our reaction to this epidemic has taken away their only known means for having a normal life.
There is so much that can be done in this area – starting with less than 30% of American physicians are trained in Pain Management – without being an asshole.