February 12th, 2018

I will start by giving credit to DOJ Attorney General Sessions for highlighting that non-opioid pain relievers can be effective. They avoid the risk of addiction associated with the opioid medications, whose overuse has led to consequences with which our country is still struggling. Except for that point, however, his comments and those of other members of the Trump administration strike me as dangerously misguided. Two key elements are notably in short supply.

Compassion for the pain being experienced by people suffering from substance use disorders – the starting point for successfully addressing the problem – has been notably missing in the public comments of Federal officials. The policy pendulum appears to be swinging toward an emphasis on law enforcement rather than treatment.

Another key – using interventions based on good evidence – also appears to be lacking, as Sessions continues to confidently identify marijuana as being a source of the opioid problem. The paradox is that his attacks on the liberalization of marijuana laws may, in fact, intensify the opioid problem that he is intending to moderate. The dilemma is that the Federal marijuana laws were flawed from the start and need revision. Accomplishing this is no easy matter, but resuming aggressive enforcement of a flawed law, as Sessions is attempting to do, only serves to exacerbate a situation which the country was slowly extricating itself.

In addition to the ignoring of evidence about effective treatment and public health interventions, reports emerge about two attacks on expertise. First, an unqualified young man had been appointed to a high position in ONDCP “drug czar’s” office. Secondly, the current head of ONDCP was left out of deliberations regarding opioid policy being carried out by an “opioid cabinet” lacking addiction expertise, led by Kellyanne Conway. The latest reports are that a White House aide with experience prosecuting drug crimes will be the next nominee by the Administration to stabilize that beleaguered agency.

Given these developments, I am no longer disappointed at the lack of action on the recommendations of the Trump Opioid Commission. I think that the best that can be hoped for regarding intervention at a Federal level regarding addiction problems in this country is for the Federal government to ignore them and let the states do the best that they can. The last thing that is needed is more counterproductive actions such as those initiated by AG Sessions. In this area of drug policy, I would invoke the warning to the medical profession, “Above all do no harm.”

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