New Guideline Recommends Against Injections for Chronic Back Pain

By Pat Anson

An international panel of experts has released a new guideline strongly recommending against injections for chronic back pain, saying the procedures provide little or no pain relief and there is little evidence to support their use.

The guideline, published in The BMJ, covers 13 commonly used interventional procedures, including epidural injections, joint injections, intramuscular injections, nerve blocks, and radiofrequency ablation. The injections usually involve steroids, a local anesthetic, or a combination of the two.

The expert panel conducted an analysis of dozens of clinical trials and studies, and found “no high certainty evidence” of pain relief for any of the procedures. There was only low or moderate evidence that injections work better than a placebo or sham procedure.

Injections for chronic axial or radicular spine pain have become increasingly common in recent years, and are often touted as safer alternatives to opioid medication.

However, the injections also come with risks, including infections, prolonged pain and stiffness, accidental punctures of the spinal membrane, and rare but “catastrophic complications” such as paralysis. The risks are magnified because many of the procedures are performed multiple times on the same patient.

“The panel had high certainty that undergoing interventional procedures for chronic spine pain was associated with important burden (such as travel, discomfort, productivity loss), which would be recurring as these interventions are typically repeated on a regular basis, and that some patients would bear substantial out-of-pocket costs,” wrote lead author Jason Busse, DC, a professor of anesthesia at McMaster University in Ontario, Canada.

“The panel concluded that all or almost all informed patients would choose to avoid interventional procedures for axial or radicular chronic spine pain because all low and moderate certainty evidence suggests little to no benefit on pain relief compared with sham procedures, and these procedures are burdensome and may result in adverse events.”

Chronic back pain is the leading cause of disability worldwide. Over 72 million U.S. adults suffer from chronic low back pain, according to a 2022 Harris Poll. About a third of those surveyed rated their pain as severe and nearly half said they experienced chronic back pain for at least five years. The vast majority (80%) rated opioids as the most effective treatment.

Pain Management Needs ‘Major Rethink’

In an editorial also published in The BMJ, Jane Ballantyne, MD, an anesthesiologist and retired professor at the University of Washington, said the new guideline raises questions about whether interventional procedures should even be used to treat chronic back pain. 

“The question this recommendation raises is whether it is reasonable to continue to offer these procedures to people with chronic back pain. Chronic back pain is highly prevalent, a great deal of money is spent on the injections, and a lot of patient hopes and expectations are vested in this type of treatment,” wrote Ballantyne. 

“One might ask how the situation arose whereby we spend so much of our healthcare capital on a treatment for a common condition that compromises the lives of so many people but seemingly does not work.”

For Ballantyne to ask that is more than a little ironic. She is a longtime anti-opioid activist, a former president of Physicians for Responsible Opioid Prescribing (PROP), and was a key advisor to the CDC when it drafted guidelines that strongly recommend against opioid therapy.

With opioids increasingly difficult to obtain, many patients with chronic back pain have no alternative but to have interventional procedures, spinal surgeries, or implanted medical devices such as pain pumps and spinal cord stimulators.

Some doctors and pain clinics welcome the opportunity to bill for those expensive procedures, and refuse to give opioids to patients unless they agree to become “human pin cushions.”

“One might ask how the situation arose whereby we spend so much of our healthcare capital on a treatment for a common condition that compromises the lives of so many people but seemingly does not work.”

— Jane Ballantyne, MD

One might ask Ballantyne what patients with chronic back pain are supposed to do without injections or opioids. Her editorial provides no answers.

“This (new guideline) will not be the last word on spine injections for chronic back pain, but it adds to a growing sense that chronic pain management needs a major rethink,” Ballantyne wrote.

Earlier this month, the American Academy of Neurology released a new evidence review that found epidural steroid injections have limited efficacy, and only modestly reduce chronic back pain for some patients with radiculopathy or spinal stenosis.

Covid Contrarians Are Now in Power

By Arthur Allen, KFF Health News

In October, Stanford University professor Jay Bhattacharya hosted a conference on the lessons of covid-19 in order “to do better in the next pandemic.” He invited scholars, journalists, and policy wonks who, like him, have criticized the U.S. management of the crisis as overly draconian.

Bhattacharya also invited public health authorities who had considered his alternative approach reckless. None of them showed up.

Now, the “contrarians” are seizing the reins: President Donald Trump has nominated Bhattacharya to lead the National Institutes of Health and Johns Hopkins University surgeon Marty Makary to run the Food and Drug Administration. Yet the polarized disagreements about what worked and what didn’t in the fight against the biggest public health disaster in modern times have yet to be aired in a nonpartisan setting — and it seems unlikely they ever will be.

“The whole covid discussion turned into culture war dialogue, with one side saying, ‘I believe in the economy and liberty,’ and the other saying, ‘I believe in science and saving people’s lives,’” said Philip Zelikow, a scholar and former diplomat based at Stanford’s Hoover Institution.

Frances Lee, a Princeton University political scientist, has a book coming out that calls for a national inquiry to determine the lockdown and mandate approaches that were most effective.

“This is an open question that needs to be confronted,” she said. “Why not look back?”

For now, even with the threat of an H5N1 bird flu pandemic on the horizon, and some other plague waiting in the wings of a bat or goose in a far-flung corner of the world, U.S. public health officials face ebbing public trust as well as a disruptive new health administration led by skeptics of established medicine. On Feb. 7, the Trump administration announced devastating NIH budget cuts, although a judge put them on hold three days later.

Zelikow led the 34-member Covid Crisis Group, funded by four private foundations in 2021, whose work was intended to inform an independent inquiry along the lines of the 9/11 Commission, which Zelikow headed.

The covid group published a book detailing its findings, after Congress and the Biden administration abandoned initiatives to create a commission.

That was a shame, said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, because “while there are some real ideological battles over covid, there’s also lots of stuff that potentially could be fixed related to government efficiency and policy.”

Bhattacharya, Makary, and others in 2023 called for a larger study of the pandemic. It’s not known whether the Trump administration would support one, Lee said.

The new CIA director, John Ratcliffe, however, has reopened the Wuhan lab leak theory, an issue that Republicans have used to try to cast blame on Anthony Fauci, an infectious disease expert and a top covid adviser to both the first Trump and Biden administrations. Sen. Ron Johnson (R-Wis.), the new head of the Senate’s Permanent Subcommittee on Investigations, says he’ll investigate what he described as a cover-up of covid vaccine safety problems.

Bhattacharya declined to respond to questions for this article. Makary did not respond to requests for comment.

Stanford epidemiologist John Ioannidis said his colleague Bhattacharya has an opportunity to advance understanding of the pandemic.

“Until now it has been mostly a war on impressions and media, kind of mobilizing the troops. That’s not really how science should be done,” Ioannidis said. “We need to move forward with some calm reflection, with no retaliation.”

Mistakes Were Made

In October 2020, Bhattacharya co-authored the “Great Barrington Declaration” with Trump White House support. It called for people to ignore covid and go about their business while protecting the old and vulnerable — without specifics about how.

Bhattacharya and Makary championed the policies of Sweden, which did not impose a harsh lockdown but emerged with a death rate far lower than that of the United States. The Swedes had advantages including lower poverty rates, greater access to health care, and high levels of social trust. For instance, by April 2022, 87% of Swedes ages 12 and over were vaccinated against covid — without mandates. The U.S. figure, for adults over 18, was 76% at the time.

After Bhattacharya’s earlier research was rebuffed by most of the public health establishment, he “curdled into a theological position that the risk wasn’t that severe and the economic costs were so high that we had to roll the dice, or segregate the elderly — which you cannot do,” Zelikow said.

Ten experts interviewed for this article largely agreed that the health establishment lost public trust after bungling the initial handling of the pandemic. Existing pandemic plans were faulty or ignored. Shortages of protective gear and inadequate testing rendered containment of the virus impossible. As time wore on, government scientists failed to emphasize that their recommendations would change as new data came in.

“We totally blew it,” former NIH Director Francis Collins said, in a discussion sponsored by Braver Angels, a group that promotes dialogue among political opponents. Though he blamed disinformation about vaccines for many deaths, he also wished public health officials had said “we don’t know” more often.

Collins said he didn’t pay enough attention to the socioeconomic impact of lockdowns. “You attach infinite value to stopping the disease and saving a life,” he said. “You attach zero value to whether this actually totally disrupts people’s lives, ruins the economy, and has many kids kept out of school in a way that they never quite recover from.”

While Fauci and other public health officials did express worries about collateral damage from mandates, U.S. measures were stricter than in much of the world. That’s left unresolved issues, such as how long schools should have been shuttered, whether mask mandates worked, and whether the public was misled about the efficacy of vaccines.

At the same time, U.S. officials failed to communicate clearly that vaccines prevented most deaths and hospitalizations. An estimated 232,000 unvaccinated Americans died from covid during the first 15 months in which shots were freely available.

Experiences with HIV control taught public health officials not to moralize about behavior, to focus on harm reduction, and to use the least restrictive methods possible, Nuzzo said. Yet politicization led to shaming of people who wouldn’t mask or refused vaccination.

Harm reduction was top of mind for infectious disease doctor Monica Gandhi when she defied lockdown orders by keeping open Ward 86, the clinic she runs for 2,600 HIV patients at Zuckerberg San Francisco General Hospital. Her patients — many poor or homeless — had to be treated in person to keep their HIV in check, she said.

In general, the lockdowns hurt low-income people most, she said. The wealthy “were happy to be shut down, and the poor struggled and struggled.” Gandhi’s two children attended a private school that quickly reopened, she said. Yet she recalled how a medical assistant burst into tears when asked how her family was doing.

“My 8-year-old is at home, on Zoom, all by himself,” the woman told Gandhi. “I have to work and he doesn’t know how to learn that way. There’s no one to give him food.”

Despite strictures, including school closures that were longer than in most European countries, the U.S.’ death rate from covid was the highest in the world, except for Bulgaria, according to an Ioannidis study of countries with reliable data.

Part of the blame lies with the first Trump administration, which “more or less just said, ‘You states manage this crisis,’” Zelikow said. “They went through a lot of somersaults. They did a lot of feckless things and then they basically just gave up,” he said. Pandemic deaths peaked in the four months after the November 2020 election that Trump lost.

Ioannidis, a critic of lockdowns, said the United States was doomed to a bad outcome in any case because of vulnerabilities in the population including poverty, inequality, lack of health care access, poorly protected nursing homes, high rates of obesity, and low levels of trust.

But the disappearance of viral diseases such as respiratory syncytial virus and flu in late 2020 showed how much worse it could have been without lockdowns, said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who has noted that, while children were the least vulnerable to covid, it killed 1,700 of them by April 2023. More than a million American children had long covid by 2022, according to a new Centers for Disease Control and Prevention study.

Still Disagreement

After arising by accidental passage from bats and other animals to humans (or, alternatively, from a Chinese lab accident), the coronavirus was uncannily adept at frustrating containment efforts — and aggravating political tensions. Its ability to infect up to 50% of people asymptomatically, infection outcomes ranging from sniffles to death, waning immunity after infection and vaccination, and the shifting health impact of new variants meant “the deck was stacked against public health,” said biology professor Joshua Weitz of the University of Maryland.

In the end, teams formed along political lines. Conservatives attacked governors for depriving them of liberty, and Trump’s erroneous ramblings about curing the disease with bleach and ultraviolet light inspired intolerance on the left.

“If anyone else was president we would have had a better result,” Gandhi said. “But if Trump said the sky was blue, then goddamn it, the infection disease doctors disagreed.”

The right and left don’t even agree on the correct questions to ask about the pandemic, said Josh Sharfstein, a vice dean of the Bloomberg School of Public Health at Johns Hopkins University.

“Everyone knew that 9/11 was a terrorist attack,” he said. “But what the pandemic was and represents — there’s so much disagreement still.”

“We let children down, we let poor people down,” Ioannidis said in closing remarks at the Stanford conference. “We let our future down.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues. 

Gretchen’s Journey Into Chronic Pain and Death

By Maria Higginbotham

I write this on behalf of one of my dearest friends, Gretchen Lont, a fellow pain warrior whose spirit I cherished deeply. I made a promise to her to ensure her pain story is told. Gretchen’s last hope was that by sharing her experience, we might alleviate the needless suffering of others grappling with untreated or undertreated pain.

We call ourselves pain warriors, having fought tirelessly since 2016 for the rights of those struggling with painful conditions to receive adequate pain treatment. According to the CDC, over 24% of U.S. adults — 60 million people — suffer from chronic pain, surpassing the combined numbers of Americans afflicted by heart disease, diabetes, and cancer.

Tragically, Gretchen passed away on January 19, 2025 at the age of 59, after enduring years of unbearable undertreated pain. Despite persistent pleas to her doctors, Gretchen’s words fell on deaf ears. Just days before her death, she received a devastating diagnosis: ALS, also known as Lou Gehrig’s Disease.

This story in no way reflects all the beauty and individuality that was Gretchen. It defines her struggles with untreated pain, but there was an entire life in which she lived and loved. Her children and her family were her world.

I only ask that you respect her family’s privacy during this difficult time. She was a bright light that will never be erased from our hearts. I am heartbroken at the loss of a beautiful soul and dear friend.

Before her disability, Gretchen lived life vibrantly. She adored her three sons — Zach, Jordan and Nathan — and cherished every moment with her family, including her father John, her sisters Stacy and Kristen, and brother Michael.

She worked tirelessly to provide for her children and always carved out time for joy and laughter. She lived life to the fullest.

GRETCHEN LONT IN 2019

Gretchen embodied the belief that giving is a greater blessing than receiving. Her generosity knew no bounds, and her radiant smile could light up any room. With a feisty spirit, she was a fierce protector of her loved ones. She found solace in crafting — painting and making jewelry — each piece a testament to her incredible talent.

Animals had a special place in her heart. Gretchen’s social media was filled with adorable animal pictures. She often fed the squirrels and birds in her yard and adopted a special needs cat named Cleo saying, “We’re two damaged bodies just trying to survive, and we’ll do it together.”

Gretchen's journey into pain began with an accident at an upscale restaurant in Tacoma, WA. A spill that had gone uncleaned caused her to slip and fall, resulting in a severe back injury which later required surgery. This injury ushered in years of excruciating pain, followed by joint pain, more surgeries, and a possible diagnosis of Rheumatoid Arthritis at the age of 57.

Desperate for relief, Gretchen explored every alternative pain treatment available, yet none eased her suffering. Living with chronic pain is akin to living with a chronic illness: you feel invisible. On the outside, you might appear fine, but inside your body is screaming in agony.

Eventually, she found a compassionate pain management doctor who, for many years, treated her as an individual. With the help of opioid pain medication, she managed to regain a semblance of life — spending time with her family, painting and crafting, celebrating holidays, and enjoying the beauty of nature. Her passion for art blossomed, allowing her to create stunning jewelry and amazing paintings.

A Wasteland for Pain Patients

Sadly, Gretchen’s doctor, after years of facing scrutiny from medical agencies, decided to retire, joining many other physicians who closed their doors due to the hostile environment surrounding pain management. In 2021, she gave her patients a year’s notice about her plans, in the hope it would be enough time to find new care.

Unfortunately, the state of Washington proved to be a wasteland for chronic pain patients. Most physicians here are unwilling to take on new patients who are on opioid therapy, and those who do will often refuse to continue the opioids and force the patients to try previously failed methods.

Gretchen’s only option was to have an invasive surgery for a pain pump. To qualify, she had to undergo extensive psychological and physical evaluations, which she passed. However, she was then told she had to reduce her opioid dosage by 75%. This drastic cut left her bedridden, trapped in a cycle of agonizing pain.

After months of suffering, the pain specialist told her that her insurance, Medicaid, would not cover the cost of the pain pump or surgery. In desperation, Gretchen asked if her opioid medication could be increased to a dose that would provide some relief from the agonizing pain. Unfortunately, she only received a minimal increase, leaving her to continue suffering in unbearable agony.

On October 3, 2023, Gretchen felt a deep despair settle over her. Bedridden and in relentless pain, she questioned why a person should be forced to suffer this way. There was always a battle to fight -- like finding a doctor willing to provide adequate pain treatment, dealing with pharmacists who were choosing whether or not to fill a valid prescription for medication, and insurance companies not covering prescribed pain treatment.

She felt like a burden, unable to spend time with her family or do any of the things that brought pleasure in life. The pain specialist seemed indifferent to her deteriorating condition. Gretchen made the heartbreaking decision to take all her medications in an attempt to end her suffering. Fear gripped her and she confided in her son, who immediately called 911.

Resuscitated through CPR, the ER team noted that this tragic episode could have been avoided had her pain been managed appropriately. They had seen this happen many times. Gretchen was discharged with the recommendation to consult her pain specialist about increasing her medication.

The following day, during a virtual visit, her pain specialist expressed sympathy and promised to improve her pain management. Yet, hope quickly faded the next day at an in-person meeting. The doctor declined to increase her dosage, and Gretchen continued her downward spiral.

A friend referred her to a new doctor who specialized in both primary care and pain management. This physician was willing to help, but insisted on a cautious approach. They tried various medications, which provided minimal relief, but Gretchen’s health continued to decline.

The years of untreated pain had caused irreparable damage. She was losing 5-8 pounds weekly, struggled with swallowing, and faced increasingly severe breathing difficulties. She was a mere shadow of the vibrant person she had been two years prior.

A New Diagnosis

By late December 2024, Gretchen's breathing worsened, leading her doctor to recommend a visit to the Emergency Department at UW Medical Center for treatment of suspected pneumonia and a neurology consult.

That’s when Gretchen was diagnosed with ALS and learned that the suffering she endured for so many years stemmed from that incurable, painful, and deadly disease.

gretchen 3 days before she passed

It should be known that chronic pain patients often go decades struggling with intractable pain without a definitive diagnosis. Like Gretchen, many of us are diagnosed with a rare disease or medical condition when it’s too late to do anything. 

Admitted to the hospital on January 1, 2025, Gretchen was discharged to home hospice on January 17. Just an hour after returning home, she suffered a coughing fit and anxiety attack. Gretchen had realized she was dying.

I happened to call her at that moment and the only 2 words I could make out were “hospice” and “dying.” She was immediately sent to a nearby hospital, her body frozen in fear; her eyes and mouth wide open, arms outstretched. She stayed like that for just over 24 hours before she stopped breathing.

Long before she passed, Gretchen shared these words with me:

“Please help patients like me who have no options. We did not choose to have medical conditions that cause pain. No doctors will take you if you’re a chronic pain patient. It’s devastating to be in such a vulnerable position and feel abandoned. Our medical system is supposed to provide us with compassionate care and treat us as unique individuals. Instead, pain patients have become pariahs.

I share my story because I want those in power to understand that we are not just individuals suffering in pain. We are family members with loved ones who care for us and have loved ones that we care for. We deserve to live our lives filled with laughter and joy, not confined to a bed, incapacitated, and suffering in agonizing pain. There is an easy answer: treat our pain!

Please stop punishing those who suffer in pain. Our lives matter.”

Gretchen has her angel wings now, flying free from pain — a bright light in our lives whose flame will never be extinguished

Maria Higginbotham is a patient advocate and chronic pain sufferer who has an aggressive form of degenerative disc disease. Multiple surgeries not only failed to relieve her pain, but left her with adhesive arachnoiditis, a chronic inflammation of spinal nerves. Maria has also been diagnosed with Ehlers-Danlos disease and Scleroderma.

New Illinois Law Gives Doctors Freedom to Prescribe Opioids Without Dosage Limits

By Crystal Lindell

Illinois State Senator Laura Fine (D) has seen the unintended consequences of the 2016 CDC opioid guideline first-hand. 

After Fine’s husband Michael lost his arm in a horrific head-on collision, he suffered from chronic, residual pain known as “phantom limb” pain. She watched as he often struggled to get adequate pain care because his doctors were too scared to prescribe enough opioid medication. 

 “[His] pain is real. It’s so debilitating some days that he literally cannot get out of bed,” Fine told PNN. “His doctor needs the freedom to treat that pain.”

The 2016 CDC guideline, which was meant to address opioid overprescribing, ended up being too much of an overcorrection, and led many doctors to start under-prescribing pain medication, regardless of patient need. The guideline recommended that daily doses not exceed 90 morphine milligram equivalents (MME), a threshold that was soon adopted by Illinois and dozens of other states.  

So when a state bill meant to address this issue came through the Illinois House and needed a Senate sponsor, Fine jumped at the chance.

The measure, which was approved unanimously by both chambers and signed into Illinois State law by Governor Pritzker on February 7, allows physicians to authorize prescriptions for opioids and other controlled substances without strict dosage limits:

“Provides that decisions regarding the treatment of patients experiencing chronic pain shall be made by the prescriber with dispensing by the pharmacist in accordance with the corresponding responsibility as described in federal regulations and State administrative rules. 

Provides that ordering, prescribing, dispensing, administering, or paying for controlled substances, including opioids, shall not be predetermined by specific morphine milligram equivalent guidelines. 

The Illinois law also seeks to protect patient confidentiality by preventing the release of prescription and treatment information without a legal order verified by the Illinois Department of Human Services or an administrative subpoena from the Illinois Department of Financial and Professional Regulation. 

Many states currently allow the DEA and other law enforcement agencies access to patient information in their prescription drug monitoring programs (PDMPs). Some pharmacy chains even provide that information without a warrant or subpoena.

“Just because you’re in pain, that doesn’t mean you’re doing something wrong,” Fine said. “The last thing we want to do is to make the doctors or patients feel like criminals.”

Fine also said part of why the measure was so important to her was that when patients don’t have access to prescribed opioids, it can drive them to take extreme measures, such as self-medicating, self-harm, or going to the black market.

She hopes the new law will help people suffering from chronic pain receive the care they need, without barriers or misunderstandings.

Fine said she was surprised by how many pain patients wanted to work with her to get the law passed and how important the issue was to them. She’s happy to send the message that political advocacy does work. 

STATE SEN. LAURA FINE (d)

“Getting this legislation passed, for them, was life changing,” Fine said. 

One of those advocates was Kat Hatz, who posted about the Illinois legislation on Facebook after it passed, writing:

“This was a labor of love, & we had incredible sponsors, but it’s also a testament to the fact that people’s voices were heard. It will protect a vulnerable community, chronic pain patients & their healthcare practitioners, & it helps to address disparities in healthcare that pertain to the under-treatment of pain (for) women, people of color, disabled folks, & other traditionally disenfranchised communities.”

The Illinois State Medical Society (ISMS), which backed the bill, also wrote about the importance of the law as it was moving through the legislation process. 

“The passage of this bill by the General Assembly is a win for physicians and patients, as too many doctors have become reluctant to prescribe opioid treatments to patients suffering from chronic pain out of fear of being criminalized or having their license suspended or revoked,” the society said in a statement.

The ISMS said many prescribers were worried that regulators and law enforcement would consider them “pill pushers” without understanding that the 2016 guideline is outdated. The CDC released an updated guideline in 2022 that gives doctors more flexibility in writing prescriptions.

“Every patient is different,” the ISMS said. “Pain treatment should be tailored to the needs of the individual.”

Fine said she hasn’t heard about other states taking up similar measures, but she hopes that Illinois can be an example. 

“We all need an advocate,” she told me. “Being in pain isn’t something to be ashamed of.”

Could a Popular Weight Loss Drug Reduce Pain?

By Madora Pennington

“When I look around at this room, I can't help but wonder. Is Ozempic right for me?” Jimmy Kimmel quipped to his audience of beautiful people when he hosted the Academy Awards last year.

It seems like everyone is taking Ozempic or drugs like it and losing weight. That class of drugs, known as GLP-1 medications for the hormones they enhance, slow digestion and promote feelings of satiety or fullness. As a result, people eat less and lose weight without the struggle of trying to stick to a diet. You feel fuller more quickly, eat less, and shed pounds.

GLP-1s are proving to have a lot more beneficial effects on the body than just weight loss. A recently published study found that low doses of semaglutide (the active ingredient in Ozempic and Wegovy) reduced alcohol cravings in people diagnosed with alcohol use disorder. When taking the weight-loss drugs, their alcohol intake was less.

In addition to food and alcohol, semaglutides also seem to reduce cravings for nicotine, cocaine, amphetamines and opioids, as well as problematic behaviors like gambling and compulsive shopping. Because the drugs reduce the reward chemical dopamine in the brain, those taking them are less motivated by their own brain signals to have another drink, put another item in their cart, have a hit of a drug, and so on.

Could GLP-1s also help pain patients?

The most obvious way a GLP-1 might reduce pain is through weight loss. Carrying excess weight causes additional wear-and-tear on the back and joints in the lower body. Every extra pound translates to four pounds of force on the knees, so even a modest amount of weight loss has the potential to reduce joint damage and pain.

Excess weight also limits range of motion, restricting joints and making it difficult for a person to exercise. Losing weight can lead to more physical activity, which can lessen pain and help keep the brain, joints and body healthy.

Another benefit of GLP-1 medications is that they lessen inflammation. In a recent study published in The New England Journal of Medicine, semaglutide provided substantial pain relief for patients with obesity and knee osteoarthritis. The exact mechanism of action is unclear, but researchers think its because the drug reduces inflammation and loss of cartilage in the knee joint.

“The findings confirm that substantial weight loss causes an often dramatic reduction in pain. If the effects shown in this trial are mediated by factors other than weight loss alone, new therapeutic avenues may be available,” David Felson, MD, a Professor of Rheumatology at Boston University School of Medicine, wrote in an editorial.

Other studies suggest that semaglutide could be a possible treatment for Alzheimer’s and Parkinson’s disease, as it lowers neuroinflammation, reduces plaque deposits in the brain, and helps generate new neurons. However, it’s only a supposition at this point that GLP-1s could mitigate the damage that chronic pain causes to the brain.

GLP-1s might help modulate pain in other ways. Both humans and animals turn to sweets and fat rich foods when in pain. Because GLP-1s regulate hunger and digestion, it’s possible they can improve pain. Tests on mice indicate that these drugs influence a certain nerve pain receptor. While definite answers and proof are a long way off, this discovery suggests new approaches to treating pain.

Before you run out to try them, be aware that Ozempic and other GLP-1 drugs carry risks. They often cause nausea and vomiting, and rare but serious problems such as pancreatitis, gastroparesis (paralysis of the stomach), and blindness.

They are also expensive. Insurance tends to limit semaglutide coverage to diabetics, so if you pay in cash without any discounts, 2 mg of Ozempic will cost about $1,050. Cheaper, generic semaglutides made overseas are available, as well as compounded versions made in-house by pharmacies. But those formulations have not been evaluated by the FDA and their quality is uncertain. 

Pain Clinics Used Patients as ‘Human Pin Cushions’ for Injections

By Brett Kelman, KFF Health News

Each month, Michelle Shaw went to a pain clinic to get the shots that made her back feel worse — so she could get the pills that made her back feel better.

Shaw, 56, who has been dependent on opioid painkillers since she injured her back in a fall a decade ago, said in both an interview with KFF Health News and in sworn courtroom testimony that the Tennessee clinic would write the prescriptions only if she first agreed to receive three or four "very painful" injections of another medicine along her spine.

The clinic claimed the injections were steroids that would relieve her pain, Shaw said, but with each shot her agony would grow. Shaw said she eventually tried to decline the shots, then the clinic issued an ultimatum: Take the injections or get her painkillers somewhere else.

"I had nowhere else to go at the time," Shaw testified, according to a federal court transcript. "I was stuck."

Shaw was among thousands of patients of Pain MD, a multistate pain management company that was once among the nation's most prolific users of what it referred to as "tendon origin injections," which normally inject a single dose of steroids to relieve stiff or painful joints.

As many doctors were scaling back their use of prescription painkillers due to the opioid crisis, Pain MD paired opioids with monthly injections into patients' backs, claiming the shots could ease pain and potentially lessen reliance on painkillers, according to federal court documents.

Now, years later, Pain MD's injections have been proved in court to be part of a decade-long fraud scheme that made millions by capitalizing on patients' dependence on opioids.

The Department of Justice has successfully argued at trial that Pain MD's "unnecessary and expensive injections" were largely ineffective because they targeted the wrong body part, contained short-lived numbing medications but no steroids, and appeared to be based on test shots given to cadavers — people who felt neither pain nor relief because they were dead.

Four Pain MD employees have pleaded guilty or been convicted of health care fraud, including company president Michael Kestner, who was found guilty of 13 felonies at an October trial in Nashville, Tennessee. According to a transcript from Kestner's trial that became public in December, witnesses testified that the company documented giving patients about 700,000 total injections over about eight years and said some patients got as many as 24 shots at once.

"The defendant, Michael Kestner, found out about an injection that could be billed a lot and paid well," said federal prosecutor James V. Hayes as the trial began, according to the transcript. "And they turned some patients into human pin cushions."

The Department of Justice declined to comment for this article. Kestner's attorneys either declined to comment or did not respond to requests for an interview. At trial, Kestner's attorneys argued that he was a well-intentioned businessman who wanted to run pain clinics that offered more than just pills. He is scheduled to be sentenced on April 21 in a federal court in Nashville.

According to the transcript of Kestner's trial, Shaw and three other former patients testified that Pain MD's injections did not ease their pain and sometimes made it worse. The patients said they tolerated the shots only so Pain MD wouldn't cut off their prescriptions, without which they might have spiraled into withdrawal.

"They told me that if I didn't take the shots — because I said they didn't help — I would not get my medication," testified Patricia McNeil, a former patient in Tennessee, according to the trial transcript. "I took the shots to get my medication."

In her interview with KFF Health News, Shaw said that often she would arrive at the Pain MD clinic walking with a cane but would leave in a wheelchair because the injections left her in too much pain to walk.

"That was the pain clinic that was supposed to be helping me," Shaw said in her interview. "I would come home crying. It just felt like they were using me."

‘Medically Unnecessary’ Injections

Pain MD, which sometimes operated under the name Mid-South Pain Management, ran as many as 20 clinics in Tennessee, Virginia and North Carolina throughout much of the 2010s. Some clinics averaged more than 12 injections per patient each month, and at least two patients each received more than 500 shots in total, according to federal court documents.

All those injections added up. According to Medicare data filed in federal court, Pain MD and Mid-South Pain Management billed Medicare for more than 290,000 "tendon origin injections" from January 2010 to May 2018, which is about seven times that of any other Medicare biller in the U.S. over the same period. 

Tens of thousands of additional injections were billed to Medicaid and Tricare during those same years, according to federal court documents. Pain MD billed these government programs for about $111 per injection and collected more than $5 million from the government for the shots, according to the court documents.

More injections were billed to private insurance too. Christy Wallace, an audit manager for BlueCross BlueShield of Tennessee, testified that Pain MD billed the insurance company about $40 million for more than 380,000 injections from January 2010 to March 2013. BlueCross paid out about $7 million before it cut off Pain MD, Wallace said.

These kinds of enormous billing allegations are not uncommon in health care fraud cases, in which fraudsters sometimes find a legitimate treatment that insurance will pay for and then overuse it to the point of absurdity, said Don Cochran, a former U.S. attorney for the Middle District of Tennessee.

Tennessee alone has seen fraud allegations for unnecessary billing of urine testing, skin creams and other injections in just the past decade. Federal authorities have also investigated an alleged fraud scheme involving a Tennessee company and hundreds of thousands of catheters billed to Medicare, according to The Washington Post, citing anonymous sources.

Cochran said the Pain MD case felt especially "nefarious" because it used opioids to make patients play along.

"A scheme where you get Medicare or Medicaid money to provide a medically unnecessary treatment is always going to be out there," Cochran said. "The opioid piece just gives you a universe of compliant people who are not going to question what you are doing."

"It was only opioids that made those folks come back," he said.

The allegations against Pain MD became public in 2018 when Cochran and the Department of Justice filed a civil lawsuit against the company, Kestner, and several associated clinics, alleging that Pain MD defrauded taxpayers and government insurance programs by billing for "tendon origin injections" that were "not actually injections into tendons at all."

Kestner, Pain MD and several associated clinics have each denied all allegations in that lawsuit, which is ongoing.

Scott Kreiner, an expert on spine care and pain medicine who testified at Kestner's criminal trial, said that true tendon origin injections (or TOIs) typically are used to treat inflamed joints, like the condition known as "tennis elbow," by injecting steroids or platelet-rich plasma into a tendon. Kreiner said most patients need only one shot at a time, according to the transcript.

But Pain MD made repeated injections into patients' backs that contained only lidocaine or Marcaine, which are anesthetic medications that cause numbness for mere hours, Kreiner testified.

Pain MD also used needles that were often too short to reach back tendons, Kreiner said, and there was no imaging technology used to aim the needle anyway. Kreiner said he didn't find any injections in Pain MD's records that appeared medically necessary, and even if they had been, no one could need so many.

"I simply cannot fathom a scenario where the sheer quantity of TOIs that I observed in the patient records would ever be medically necessary," Kreiner said, according to the trial transcript. "This is not even a close call."

Jonathan White, a physician assistant who administered injections at Pain MD and trained other employees to do so, then later testified against Kestner as part of a plea deal, said at trial that he believed Pain MD's injection technique was based on a "cadaveric investigation."

According to the trial transcript, White said that while working at Pain MD he realized he could find no medical research that supported performing tendon origin injections on patients' backs instead of their joints.

When he asked if Pain MD had any such research, White said, an employee responded with a two-paragraph letter from a Tennessee anatomy professor — not a medical doctor — that said it was possible to reach the region of back tendons in a cadaver by injecting "within two fingerbreadths" of the spine. This process was "exactly the procedure" that was taught at Pain MD, White said.

During his own testimony, Kreiner said it was "potentially dangerous" to inject a patient as described in the letter, which should not have been used to justify medical care.

"This was done on a dead person," Kreiner said, according to the trial transcript. "So the letter says nothing about how effective the treatment is."

Patient Treated ‘Like a Dartboard’

Pain MD collapsed into bankruptcy in 2019, leaving some patients unable to get new prescriptions because their medical records were stuck in locked storage units, according to federal court records.

At the time, Pain MD defended the injections and its practice of discharging patients who declined the shots. When a former patient publicly accused the company of treating his back "like a dartboard," Pain MD filed a defamation lawsuit, then dropped the suit about a month later.

"These are interventional clinics, so that's what they offer," Jay Bowen, a then-attorney for Pain MD, told The Tennessean newspaper in 2019. "If you don't want to consider acupuncture, don't go to an acupuncture clinic. If you don't want to buy shoes, don't go to a shoe store."

Kestner's trial told another story. According to the trial transcript, eight former Pain MD medical providers testified that the driving force behind Pain MD's injections was Kestner himself, who is not a medical professional and yet regularly pressured employees to give more shots.

One nurse practitioner testified that she received emails "every single workday" pushing for more injections. Others said Kestner openly ranked employees by their injection rates, and implied that those who ranked low might be fired.

"He told me that if I had to feed my family based on my productivity, that they would starve," testified Amanda Fryer, a nurse practitioner who was not charged with any crime.

Brian Richey, a former Pain MD nurse practitioner who at times led the company's injection rankings, and has since taken a plea deal that required him to testify in court, said at the trial that he "performed so many injections" that his hand became chronically inflamed and required surgery.

"'Over injecting killed my hand,'" Richey said on the witness stand, reading a text message he sent to another Pain MD employee in 2017, according to the trial transcript. "'I was in so much pain Injecting people that didn’t want it but took it to stay a patient.'"

"Why would they want to stay there?" a prosecutor asked.

"To keep getting their narcotics," Richey responded, according to the trial transcript.

Throughout the trial, defense attorney Peter Strianse argued that Pain MD's focus on injections was a result of Kestner's "obsession" with ensuring that the company "would never be called a pill mill."

Strianse said that Kestner "stayed up at night worrying" about patients coming to clinics only to get opioid prescriptions, so he pushed his employees to administer injections, too.

"Employers motivating employees is not a crime," Strianse said at closing arguments, according to the court transcript. "We get pushed every day to perform. It's not fraud; it's a fact of life."

Prosecutors insisted that this defense rang hollow. During the trial, former employees had testified that most patients' opioid dosages remained steady or increased while at Pain MD, and that the clinics did not taper off the painkillers no matter how many injections were given.

"Giving them injections does not fix the pill mill problem," federal prosecutor Katherine Payerle said during closing arguments, according to the trial transcript. "The way to fix being a pill mill is to stop giving the drugs or taper the drugs."

KFF Health News is a national newsroom that produces in-depth journalism about health issues. 

Physicians and Pharmacists Fear the DEA. Should Patients Sympathize?

By Crystal Lindell

Many doctors and pharmacists are scared about giving patients opioid pain medication because they are worried about getting in trouble. 

They worry about facing consequences from the Drug Enforcement Administration or about breaking local laws and in-house policies. That could mean losing their license, going to prison, or being reprimanded.  

The question is, how much sympathy should this elicit from patients? How understanding should we be of their plight?

Because if you ask doctors and pharmacists, they think the potential consequences should elicit mountains of sympathy – to the point that patients should be able to completely ignore their own physical pain.. 

Whenever I interact with healthcare professionals online or in real life, they will often quickly cite these hypothetical consequences as their reason for limiting opioid prescriptions or administering none at all.

And make no mistake, they are definitely limiting opioid prescriptions. As someone who’s helped many family members navigate the healthcare system, I’ve seen first-hand doctors refusing to prescribe opioids for chronic pain, acute pain, post-op pain, cancer pain, and even hospice pain. 

Meanwhile, even if patients get a prescription, pharmacists seem to do everything possible to avoid filling it. They claim your insurance won’t cover it, that they ran out of your medication, or that they can’t find the prescription that your doctor sent over. 

Doctors and pharmacists will justify these excuses with something along the lines of “I could lose my license! I could be arrested! I could face fines!”

It’s not just my anecdotal evidence though. A study looked at how a 2018 West Virginia law limiting initial doses of opioid medication to a 4-day supply impacted physician attitudes toward opioids. 

In a series of interviews with primary care providers, researchers found that the law “exacerbated the pre-existing fear of disciplinary action and led many prescribers to further curtail opioid prescriptions.”

As one participant, a male primary care physician with 14 years of practice, said:

“[It] really started to scare a lot…of providers into feeling that it wasn't worth the risk to continue to prescribe for fear of being labeled as an over-prescriber or being outside of the norm or, you know, the potential liability that goes along with it.“ 

“Liability.” That’s the key word in that quote. They are worried about themselves. 

The researchers said many providers “felt that taking on patients who legitimately required opioids could jeopardize their career.”

“Their career.” Again, it’s about them.

It’s as though doctors and pharmacists are expecting people in pain to nod their heads sympathetically and respond with something along the lines of: “Oh wow! I didn’t realize how difficult this was for you! But now that you’ve explained your hypothetical consequences, I’ll just go ahead and endure my debilitating pain that’s making me suicidal! Sorry I have burdened you! I sincerely apologize!”

It’s also especially interesting to me that the researchers noted that many of the patients they were talking about "legitimately required opioids.” So it’s not like doctors have some delusion that all these patients they are refusing to treat are "illegitimately" looking for pain meds. 

Medical need is apparently irrelevant when a doctor or pharmacist may get in trouble. 

So I have to tell you, as a patient, I feel about as much sympathy for them as they feel for the patients that they are denying care to – which is to say, almost none. 

The most obvious problem with their reasoning is that these doctors and pharmacists are always citing the potential consequences that they could face when it comes to opioids, while ignoring the very real harm they are causing their patients. 

Make no mistake, they are definitely causing very real and immediate harm to patients when they refuse to treat their pain. People with untreated pain actually do lose their careers, because their pain makes it impossible to hold a job. And when pain patients are forced onto the black market to find relief, they risk losing their lives or their freedom if they get arrested. 

Not to mention the fact that prescription opioids do more than just make the patient feel a little better. They can help patients rest when their bodies need that rest to heal. And they can help patients get through needed treatments like physical therapy. 

This isn’t just a problem for pain patients though. The speed at which doctors and pharmacists have made it clear that they will forgo medical reasoning in favor of “just following orders” should concern all of us.

When doctors start to act as police, we are all in trouble.

RIP Melissa Brooks: ‘It Starts with Pain and It Ends with Pain’

By Ann Marie Gaudon

Melissa Brooks wanted me to tell her story once she was dead. She wanted others in pain to know her experience in trying to access medically assisted death in Canada.

Melissa was in pain -- severe, intractable pain -- and if she met the criteria for Canada’s Medical Assistance in Dying (MAID) program, she’d be able to end her life with dignity and mercy.  Melissa suffered from multiple chronic conditions, was mostly wheelchair bound, and legally blind. Euthanasia is what she desired, but applying for MAID wasn’t easy.

“It starts with pain and it ends with pain. And there’s a bunch of medical system mess-ups in the middle,” Melissa told me.

Melissa was free with her words, so honest and articulate. She had different personas she’d use to tell people about her desire for death, because if she shared how deep her misery was, Melissa thought she’d lose friends. On the days she couldn’t hide her pain, she didn’t interact with people and expressed to me that this was a lonely place to be. Melissa felt that no one knew what she was going through.

“The quickest way to lose friends is to be honest about how much pain you’re in,” she said.

Curiously, once she requested MAID, Melissa felt a newness in her relationships. Her friends now knew they had a limited time to grieve and they no longer had to carry the “nitty gritty” of her for an extended time.

Most of our conversations happened as Melissa went through the strict process that MAID requires for medical assistance in dying to be granted.

I wrote a column about the many difficulties my friend Maggie Bristow had accessing MAID to end her life, after nearly three decades with chronic pain.

Melissa’s struggles with MAID were different. This intrigued me – what is going on here?  Why isn’t there a standard protocol? You meet the criteria and then you are approved. But that’s not what happened.

You need two doctors to assess your application for MAID. Melissa's first assessor pissed her off by repeatedly saying her medical condition was “complicated.”

Of course it was – all MAID cases are complicated.

MELISSA BROOKS AND HER SERVICE DOG, RUBY

“I’m complicated, my case is complicated, my pain is complicated. I think it’s medical BS and I almost fell for it, like I was asking for too much,” Melissa said. “I didn’t feel that complicated until these people were telling me that I was. I have been suffering for decades, my quality-of-life sucks, and I don’t want to do this anymore.”

‘A Moral Dilemma’

In 2016, Canada’s Parliament passed legislation that allows eligible adults to request medical assistance in dying. However, a person’s death had to be “reasonably foreseeable.” This was challenged and Parliament amended the legislation in 2020 to create the current two-track system.

MAID still requires a “grievous and irremediable medical condition,” but a reasonably foreseeable natural death is no longer necessary. If you’re likely to die soon, you’re on track one. If you aren’t and you still want an assisted death, you’re on track two.

With my friend Maggie Bristow, nothing was that simple. It took years for her request to be approved.

Melissa also went through struggles with MAID, with her first assessor questioning her mental well-being. The problem for them was that Melissa was not mentally ill.  The first assessor, not having found any reason to deny Melissa’s request except for her own conscience, did eventually say yes. But that did not come without a price.

“When the first assessor called me well after 8pm – when she knows that is not a good time for me -- she called to assassinate my character,” Melissa said. “She was so mean and made the process so much worse. She accused me of lying and yelled at me over the phone, ‘You’ve put me in a moral dilemma!’”

Poor Melissa was so upset. We talked about how this truly had nothing to do with her and that this particular assessor should not be working for MAID. Not all assessors are equipped to deal with life and death decisions.

This first assessor was so enraged and upset that she told Melissa she would next be seeing “the cream of the crop” assessor -- the one who teaches the others. It was bad news from the beginning, as his treatment was also less than desirable. He sent a psychiatrist to Melissa’s home to assess her mental health. 

The psychiatrist made it a point to tell Melissa that he preferred to begin with a clean slate and never searched or looked up anyone’s history before meeting them. That was a blatant lie. Melissa was an abuse survivor, but that was not the reason she was seeking MAID. The psychiatrist asked questions that only someone who had done a deep dive into her medical history would be asking.

It was all so fake, and Melissa fired this second assessor and his psychiatrist. She was back to having one yes.

‘Killed Me With Kindness’

Next came the third assessor and Melissa was hopeful. She seemed open and progressive. She told Melissa she identified as queer (I’m not sure why or how that would have mattered), but she was kind and that was an improvement.

The process of requesting and receiving MAID should take 90 days. Melissa’s case was taking much longer. In terrible pain and desperate, Melissa tried to take her own life. It did not work, but landed her in the psychiatric ward of her local hospital. I believe this is what sealed her fate with the oh-so-nice third assessor.

“(She) killed me with kindness after not even spending an hour with me, just to tell me she would be saying no,” Melissa said. Now Melissa was in limbo. She had a “yay” and a “nay” from two assessors.

That made Melissa even more frustrated. She met MAID’s criteria of being over age 18 and having an “irrevocable and grievous medical diagnosis” that could not be cured or treated.

“MAID’s job is not to fix the patient,” she told me. “Their job is to say, ‘Yes, they met the criteria’ and to move forward, not ‘This is icky because they’re young and they don’t look like they have a terrible life. They don’t look like they’re suffering or that they want to die.’”

Now Melissa had no help, no guidance, no nothing. She wanted to put in a complaint. But to whom?

A few miserable weeks later, she did get something. It seemed to begin as a urinary tract infection (UTI), which could be quite dangerous for Melissa as she was so physically vulnerable to begin with. Then she started to cough. I asked her if she would call her practitioner for treatment and she agreed, but I saw the writing on the wall.  Her doctor said she had a UTI, plus pneumonia, but agreed with Melissa that this could be treated from home.

You may have already figured out what came next. Melissa did not take the antibiotics she was prescribed, and stopped eating and drinking. She had a “Do Not Resuscitate” order from before she even applied for MAID. Can you blame her? I sure didn’t.

On January 30, while I was working, I had a voicemail message from Melissa telling me that she was going to begin palliative sedation that night and to say a gracious goodbye. She left her friend’s number to call should I need anything.

Melissa Brooks died on January 31, 2025. You might think for a moment that is what she wanted, but it is not. In the end, MAID was an epic fail for her. She wanted to die at home, perhaps with a friend like me, and for sure with her beloved service dog.

I am so sorry Melissa that everyone failed you. My hope is that you somehow find peace in the afterlife. You were one-of-a-kind and I shall never forget you. Blessings.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.   

Do Cats With Bird Flu Pose a Health Risk to Humans?

By Sarah Boden, KFF Health News

More than 80 domestic cats, among many other types of mammals, have been confirmed to have had bird flu since 2022 — generally barn cats that lived on dairy farms, as well as feral cats and pets that spend time outdoors and likely caught it by hunting diseased rodents or wild birds.

Now, a small but growing number of house cats have gotten sick from H5N1, the bird flu strain driving the current U.S. outbreak, after eating raw food or drinking unpasteurized milk. Some of those cats died.

The strain of bird flu currently circulating has not adapted to efficiently spread among people. And there have been no known cases of cat-to-human transmission during the current outbreak of H5N1.

Still, there’s always been the risk that cats, which are arguably only semi-domesticated, could bring home a disease from a midnight prowl.

“Companion animals, and especially cats, are 100% a public health risk in terms of the risk of zoonotic transmission to people,” said virologist Angela Rasmussen, who studies disease progression in emerging viruses at the University of Saskatchewan’s Vaccine and Infectious Disease Organization.

This is because we snuggle with and sleep in bed with our cats. When we’re not looking, cats drink from our water glasses and walk on kitchen counters. So, cat owners should be aware of the ongoing spread of bird flu. “By reducing the risk to your cats, you reduce the risk to yourself,” Rasmussen said.

Rasmussen doesn’t think pet owners should be afraid their cats will give them bird flu but said taking precautions is good for pets, and for public health.

Signs of bird flu in cats include runny nose and discharge around the eyes, explained Michael Q. Bailey, president-elect of the American Veterinary Medical Association.

H5N1 also causes neurological problems like dizziness and seizures, which are symptoms of rabies, too. Rabies is almost always fatal, and it poses a threat to human health, so any animal suspected of having the viral disease must be euthanized. Bailey encourages people to ensure pets are up-to-date on their vaccinations.

Veterinarian Jane Sykes, who specializes in infectious diseases in cats and dogs at the University of California-Davis School of Veterinary Medicine, said people should not assume it’s bird flu if their cat is sick — even if their animal spends time outdoors or eats a raw diet. Upper-respiratory illnesses are common in cats, while H5N1 is “still pretty rare.”

Sykes gives her indoor cat, Freckles, regular kibble exclusively. She told NPR and KFF Health News she has no concerns about Freckles getting H5N1 because the heating process of making dry or canned pet food kills viruses.

‘This Is a Very Scary Virus’

Some people feed their pets raw meat or unpasteurized milk because they think it’s a more nutritious or natural diet. The American Veterinary Medical Association’s website discourages this due to foodborne pathogens like salmonella and listeria, and now the highly pathogenic H5N1.

By keeping pets healthy, veterinarians play an essential role in protecting humans from zoonotic diseases. The American Veterinary Medical Association says the risk of H5N1 spilling over from a pet to a person is “considered extremely low, but not zero.”

State and local public health agencies, including those in Los Angeles County and Washington state, have issued similar warnings against raw food diets for pets.

Concerns for human health are partly why the FDA announced last month it is now requiring cat and dog food companies to update their safety plans to protect against bird flu.

This came after the Oregon Department of Agriculture discovered a cat that was “strictly an indoor cat” had contracted H5N1 and died after consuming a frozen turkey product made by the raw pet food brand Northwest Naturals. It stated that “tests confirmed a genetic match between the virus in the raw and frozen pet food and the infected cat.”

Northwest Naturals voluntarily recalled that batch of its frozen turkey-based product. The company told KFF Health News and NPR that the recall involved “a small product run” and that it has concerns about the accuracy of the Oregon Agriculture Department’s testing.

Los Angeles County’s public health department said five cats from two households tested positive for bird flu after drinking unpasteurized raw milk from the Raw Farm dairy in California’s Central Valley.

Raw Farm voluntarily recalled its milk and cream after retail products tested positive for H5N1, but it denies any food safety issues, calling the concern “a political issue.”

Veterinarians also warn pet owners not to allow cats unsupervised time outside as there’s the risk of them getting H5N1 by interacting with other animals that might carry the disease.

“This is a very scary virus, given that it can infect so many different host species,” said Bruce Kornreich, director of Cornell University’s Feline Health Center.

At least one instance of a cat infecting a person with bird flu occurred in 2016. As NPR reported, a veterinarian in New York City caught the virus after having close contact with infected cats. The vet experienced mild symptoms and quickly recovered.

In that case, the strain of bird flu was H7N2, not the H5N1 that is now circulating in the U.S.

H7N2 is a very different type of virus, Sykes explained. But she said it shows that cat-to-human transmission of avian influenza is theoretically possible.

There isn’t a lot of research on transmission of bird flu from companion animals like cats or dogs to humans, though Rasmussen agreed it’s definitely a concern: The more infections you have in animals, “the more your luck is potentially going to run out.”

Most people who have caught H5N1 are agricultural workers who had direct contact with infected poultry or cattle. Of at least 67 confirmed human cases of H5N1 in the U.S., there’s been one fatality in an immunocompromised person who had contact with birds.

In general, zoonotic disease researchers want more H5N1 surveillance in companion animals of all types. Even if the human death toll of H5N1 remains relatively low, it remains a public health risk.

Virus Mutation

Part of the concern with this H5N1 outbreak is that bird flu viruses change. Just a few mutations could make this strain adept at spreading between people. And the more people who catch H5N1, the more likely it would adapt to be more efficient, said Suresh Kuchipudi, a virologist at the University of Pittsburgh School of Public Health, where he researches zoonotic diseases. Kuchipudi has studied H5N1 in cats.

Another concern is something called reassortment. If an animal or person is infected with two viruses at once, the viruses can trade genetic material, creating something new. This is common in influenza, so virologists are on the lookout for a case in which the bird flu reassorts to make a virus that’s far more contagious, and potentially more virulent.

Virologist Rasmussen is way more worried about this happening in pigs. Human respiratory physiology is more like that of swines than felines. So far, the current outbreak of H5N1 has not reached commercial hog operations. Rasmussen hopes it stays that way.

Kuchipudi said that reassortments are relatively rare events, but the outcome is completely unpredictable. Sometimes the results are benign, though it was likely a reassortment that involved an avian virus that led to the 1918 flu pandemic, which killed an estimated 50 million people. In the century since, virologists have established a global surveillance network to monitor influenza viruses. Scientists say continued investment in this network is key to preparing for and hopefully preventing another pandemic.

Winter is “reassortment season” because of all the influenza viruses circulating, Rasmussen said. A reassortment in cats could technically be possible since these pets occasionally get seasonal flu, but it’s highly unlikely. Rather, Rasmussen said, it’s more likely that a cat would pass H5N1 to a human who already has seasonal flu, and then a reassortment happens in the sick person. While the risk isn’t zero, Rasmussen doubts this will happen. It would depend on how ill the human was, and how much virus they’re exposed to from their cat.

“Unless the cat is really shedding a ton of virus, and you’re kind of making out with the cat, I think it would be hard,” she said.

Rasmussen and Kuchipudi caution there isn’t enough research to know for sure how much virus cats shed, or even how they shed the virus.

The Centers for Disease Control and Prevention was poised to release a new study about H5N1 in cats, but that was delayed when the Trump administration paused the Morbidity and Mortality Weekly Report. That investigation, revealed through emails obtained by KFF Health News in a public records request, found that house cats likely got bird flu from dairy workers.

Scientists and public health agencies should question previously held assumptions about bird flu, Kuchipudi urged. He noted that 20 years ago nobody would have predicted that bird flu would infect dairy cattle as it is now.

Dogs Have Lower Risk

The FDA says other domesticated animals, including dogs, can get bird flu infections. There are no confirmed cases of H5N1 among dogs in the U.S., though in other countries they have died from the virus.

There’s some disagreement and an overall lack of research on whether cat biology makes them more susceptible to H5N1 than other mammals, including humans, pigs, or dogs.

But cat behaviors, such as their love of dairy and predation of wild birds, put them at higher risk, Kuchipudi said. Also, living in groups might play a role as there are more feral cat colonies in the U.S. than packs of stray dogs.

There’s very little people can do about the H5N1 circulating in wild birds. As Rasmussen explained, “It’s flying around in the skies. It’s migrating north and south with the seasons.”

But she said there’s a lot people can do to keep the virus out of their homes.

That includes limiting a pet’s exposure to H5N1 by not feeding them raw food or unpasteurized milk, and trying to keep them from interacting with animals like rodents and wild birds that could be infected with the virus.

This article is from a partnership that includes NPR and KFF Health News, a national newsroom that produces in-depth journalism about health issues.  

The Best Advice I Got From My Therapist About Chronic Pain

By Crystal Lindell

I started having chronic pain at 29 years old, and the speed at which it upended my life left me with what felt like body-wide whiplash. 

I developed intercostal neuralgia seemingly overnight, which resulted in daily chronic pain in my ribs. 

At the time, I was working two jobs, maintaining an over-active social life, and living on almost no sleep. It’s a lifestyle I tried to maintain well after my body was telling me to stop.  

My mindset had not caught up with the new reality of my body yet, and I paid the price: I kept ending up in either the emergency room or immediate care. My body now had limits, and I was doing my best to ignore them. 

Because the pain was so severe and made me feel so hopeless, around this time I also asked my primary care doctor for a referral to a psychologist. The pain was making me suicidal. I needed help. 

In one of the best gifts of fate, the psychologist I was paired with had a lot of experience in helping people navigate chronic illness. She very likely saved my life. 

The first appointment I went to, I spent the entire hour sobbing about my new reality. 

Eventually, after we started meeting every other week, I came out of the fog, and her advice and guidance were what helped me finally start to see clearly. 

While I’m grateful for her tips about things like keeping a daily gratitude journal, and techniques she shared about how to communicate to my boss and my loved ones about my limitations, there was one piece of advice that helped the most. 

My therapist taught me about activity pacing. 

It sounds so obvious now that I understand the concept, but after living the first 29 years of my life at full speed and only sleeping when I physically could not stay awake a second longer -- pacing was revolutionary for me. 

The Basics of Pacing

In short, pacing is basically approaching activity levels in a more intentional way -- not doing too much and not doing too little. It also means that you don’t wait to rest until you need to. Instead, you rest proactively. 

So, rather than staying awake for 24 hours straight trying to get everything done for my two jobs, I started to stay awake for a more manageable 14 hours and then sleep for 9 hours. After waking up, I learned to slowly ease myself back into activities. 

Because I grew up in a culture where I was constantly told that working well past my limits made me a better person, pacing felt almost illegal. Until my therapist explained it to me, it had literally never occurred to me before that I could rest proactively.  

Making sure I was getting enough sleep made a drastic difference in the severity of my physical pain, and it also helped give me mental clarity for dealing with the shock and challenges of my new body. 

However, it did take me a couple years to fully understand the foundational principle of pacing: It’s not just doing too much that’s a problem, it’s also doing too little. 

Yes, therapy helped me to stop pushing myself beyond my limit, but for about a year after that, I went to the other extreme. I was so scared of aggravating my pain, that I spent every day in the house, doing work from home, and then sleeping – with little else mixed in. 

Around this time I found out that my vitamin D levels were dangerously low – the lowest my doctor had ever seen in a patient. I think it was because I was getting almost no exposure to sunlight for days on end. 

So that is what spurred me to learn that balance goes both ways. I started to understand the importance of doing some activities sometimes, and resting other times, without eliminating either one.

Pacing has become the foundation of my life these days, more than 10 years after I first started having daily chronic pain. It’s a huge factor in keeping me both physically and mentally healthy. 

You don’t have to just take my word for all this though. A small 2021 study showed how helpful pacing can be. 

According to a “Very Well Health” article about the study, the researchers taught participants – who all had chronic health issues – the basics of pacing.

The pacing framework included:

• Recognizing current unhelpful behaviors

• Finding baselines

• Practicing self-compassion

• Being flexible

• Gradually progressing activities

The study found that the pacing results happened fast. Some of the patients who attended a rehabilitation center for issues related to chronic pain and fatigue experienced the benefits of pacing after just two sessions. 

The study also included quotes from the participants talking about how it impacted them. 

“Before going to the programme I was just stuck in a situation where I'd do what work I could when I could…and then suffered for it; and I didn't really think about it the same way as when it's explained to you,” one patient said. “So, whereas I thought I was pacing myself naturally, in a sense I wasn't.”

Indeed, that’s the magic of good therapy. It gives you a new perspective, and if you’re really lucky, it gives you tools that help you live a better life. 

I’m not here to tell you that pacing in our society is easy.. As I’ve said, it took me years to truly implement it into my life. And I still struggle with days when I over do it, or even rest too much. 

Overall though, as a foundational principal, pacing is the most important thing I do to manage my chronic pain. And I think if you try it too, you’ll find out first-hand just how helpful it can be.

A Pained Life: My Fantasy Trip to Nowhere

By Carol Levy

I'm watching TV. An ad comes on for a cruise to a tropical port. It looks so inviting.

At the store I overhear someone describing the “wonderful” trip they recently took to Europe, touring Paris and dining in a real Italian trattoria. Their joy in describing the trip is hard to miss.

For a minute, even two, my mind churns out fantasies of going on a trip of my own. Maybe a safari in Africa or a trip to France to see the Eiffel Tower and eat real French pastry. 

For a moment, my mind flies with the excitement of it, before crashing back to earth

In my mind I can take those trips. Because in my mind, in my fantasies and dreams, I have no pain. I'm just a regular normal person. Then the facts come rushing in, slamming me. What? You’re going to leave the pain behind?

I don't have this fantasy much anymore, after all these decades of living with pain. But, once in a while, I see myself without pain. I'm out in the world. I have a job again, making friends and socializing.

For a fleeting second, I even see myself -- not the old lady I am now -- but 26 again, before the pain started and ripped away any chance of being “normal.”

Then the final slap in the face: You're 72. Twenty-six is long gone, never to return.

So many articles are written abbot how to cope with pain without drugs: meditation, mindfulness, and relaxation techniques. They may work for some of us. And it's great when they do. But they don't work for me because my trigeminal neuralgia pain is not in my body, it’s only in my face.

It's frustrating when I read these articles, many in medical journals or on medical websites, because invariably they don't have relevance for many of us. The advice telling us to exercise more and to not “give in” to the pain, but to do what hurts in order to help our bodies realize we can move more and do more.

That doesn't help for cranial neuralgias, many of the people with CRPS, or the pain associated with lupus, multiple sclerosis and arachnoiditis. The suggestions are as frustrating to me as the ridiculous idea that I can go on a ship or a safari.

I want the pain to go away. I want to be a “normal” person who can do pretty much whatever I want, whenever I want. Even go on a trip. The pain always tells me: No, ain't gonna happen.

I keep waiting for the articles and doctors to finally say, “Here's what we can do to minimize your pain.” Stopping it entirely may be a step too far to hope for.

But please, medical community, stop with the cliches, especially ones that imply it is my fault that I have chronic pain. If I could exercise or think it away, I surely would.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here. 

6 Things to Try If Your Doctor Won’t Prescribe Opioid Pain Medication

By Crystal Lindell

Many doctors are extremely resistant to prescribing opioid pain medication for any reason these days. Whether it’s for post-operative pain, chronic pain or even pain from terminal cancer, patients are finding that doctors shrug their shoulders and tell them to go home and take ibuprofen.

Unfortunately, over-the-counter pain medication is just not effective in many cases, and that can leave patients in desperate situations. 

As someone who’s been navigating my own chronic illness for more than a decade, as well as helping my loved ones with their health issues, I do have some very realistic advice I can offer.

If you ever find yourself in extreme pain, but your doctor won’t give you pain medication, here are 6 things you can try. 

1. Doctors Expect You To Negotiate

Many doctors now have an unwritten policy where they will only give you opioid medication if you ask a certain number of times, especially when it comes to acute trauma like a broken bone or post-op pain. 

Doctors believe that this helps them to make sure that you really need it. 

So just because your doctor tells you no one time, two times or even three times, that doesn’t mean you should just accept the response. If your pain is severe enough that OTC medication is not working, then ask again. And again. Ideally, they eventually relent and will send in at least a small opioid prescription for you. 

This also helps future patients. Many doctors assume that if patients don’t ask repeatedly for pain medication after a surgery then that means that the surgery doesn’t result in severe pain for anyone. By showing them that you need it, you make it more likely for doctors to believe the next patient.  

2. Tell Your Doctor You’re Unable To Work Due to Pain

Unfortunately, under our current financial structures, much of our worth as humans is still tied to our ability to be productive at our jobs. So telling your doctor that you’re in too much pain to work may inspire them to finally send in an opioid prescription for you. 

They do not want you missing work, which could mean you losing health insurance and being unable to pay them. 

3. Threaten To Go to the ER

Another option when your doctor refuses to give you opioid medication is to tell them that you’re going to go to the emergency room then. This will often spur them to send in a prescription.to your pharmacy.

When it comes to something like post-surgical care, many doctors feel like it makes them look bad when their patients have to go to the ER for after-care. 

I have also seen this work for chronic pain as well, especially if you’re in their office when you bring it up. One time, for example, after explaining that I was going to go to the ER because my pain had spiked, my doctor gave me stronger pain medication in his office.

As an aside: Just make sure that if you get something very strong, like a hydromorphone shot, that you also get medication for nausea, like Zofran. While most ERs do this as a matter of policy, sometimes a doctor will skip it if it’s administered in their office. 

This is something I learned the hard way after an in-office hydromorphone shot left me vomiting for more than 24 hours because I wasn’t used to the strength of the medication. The whole thing could have been prevented with some Zofran.

4. Go to the Emergency Room

If telling your doctor that you want to go to the ER doesn’t motivate them to send in an opioid prescription, then the next step is to actually go to the emergency room. 

In my experience, ER doctors will, at the very least, usually give you a dose of pain medication to take on site. That can help you get the pain down to a level where you can at least think clearly and then figure out next steps and/or get some needed sleep. 

Depending on the situation, sometimes you can also convince ER doctors to give you a small prescription for at-home use too, especially if it’s for something like post-op pain or a severe injury.  

5. Consider a Pain Management Doctor 

If you have chronic pain, many times your best option is getting a referral to a doctor who specializes in pain management. 

This is not ideal because pain management doctors tend to be quite different from primary care doctors. That’s because many pain specialists believe they are being watched by the Drug Enforcement Administration. The DEA has no medical expertise, but has targeted hundreds of doctors for what it calls “unlawful” opioid prescribing.  

Because of that, many pain management doctors act more like probation officers than medical professionals, requiring invasive and expensive monitoring like drug tests and pill counts on a regular basis. This means the patient experience tends to be more like being on probation than getting healthcare. The only thing missing is an ankle monitor.

That said, pain specialists are usually willing to prescribe a low-dose opioid if it doesn’t exceed medical guidelines, which could get them in trouble. For many patients, even a low dose can literally be life saving. 

If you can’t get pain treatment anywhere else, then it can be worth it to put up with the draconian atmosphere. 

6. Try Kratom or Cannabis

The two most effective pain treatments you can get without a prescription are kratom and cannabis, although your mileage may vary and their legal status varies a lot by jurisdiction. 

While I am not sure how effective kratom or cannabis is at treating short-term intense pain, like a broken bone, I have personally found kratom to be the only substance I can get without a prescription that helps my chronic intercostal neuralgia pain. I would describe kratom as having an extremely mild opioid effect. 

Personally, I use it by taking a spoonful of kratom powder with a swig of Gatorade, as I find that to be the most effective delivery method. However, there are many options, ranging from capsules to kratom candy and even kratom seltzer. 

I also know many others who have found relief by using cannabis, which is thankfully legal in many places now. THC gummies seem to be especially helpful to anyone who’s new to cannabis use and doesn’t want to smoke. Cannabis dispensaries are also usually staffed with knowledgeable, friendly employees who are happy to guide you to the best option. 

I always say pain will make you crazy much faster than you expect. Within just three days of severe pain, I have seen people openly saying they were ready to die. 

It’s a true shame that in 2025, when effective and cheap pain medication exists, so many people are still left to suffer simply because of opioid-phobia and an overzealous DEA. 

However, that doesn’t mean you should be forced to suffer through pain just because you may not know how to navigate the healthcare system. You do have options. 

And if you’re in a situation where you’re denied pain care that you need, I hope you’ll use it to inspire more compassion in yourself. Pain treatment is a human right, and the more people who support it, the more likely we are to get it. 

Can Aching Joints Predict the Weather?

By Michelle Spear

For centuries, people have claimed that their aching joints can predict changes in the weather, often reporting increased discomfort before rain or cold fronts. Given the scale and duration, there is a sense of legitimacy to these anecdotes – but this phenomenon remains scientifically contentious.

From shifts in barometric pressure to temperature fluctuations, many theories attempt to explain how environmental factors might influence joint pain. But is there an anatomical basis for this claim, or is it simply an enduring weather-related myth? Are our joints any more reliable than the Met Office?

At the heart of this debate lies barometric pressure, also known as atmospheric pressure – the force exerted by air molecules in the Earth’s atmosphere. While invisible, air has mass, and the “weight” pressing down on us fluctuates with altitude and weather systems.

Higher barometric pressure often signals fair-weather conditions with clear skies and calm winds, whereas lower pressure typically precedes unsettled weather, such as cloudy skies, precipitation and humidity.

Moveable joints are intricate structures cushioned by synovial fluid, the viscous liquid that lubricates joints, and encased in capsules rich in nerve endings. In healthy joints, these components should allow smooth, pain-free movement. However, when joints are compromised by cartilage damage (as in osteoarthritis) or inflammation (as in rheumatoid arthritis), even subtle changes in the environment may be acutely felt.

One leading hypothesis suggests that changes in barometric pressure may directly influence joint discomfort. When atmospheric pressure drops ahead of storms, it can allow inflamed tissues within joints to expand slightly, increasing stress on surrounding nerves and amplifying pain. Conversely, rapid increases in pressure, characteristic of fair-weather systems, may compress already sensitive tissues, leading to discomfort in some people.

Scientific studies offer some support for these claims, though results remain mixed. For instance, a 2007 study published in the American Journal of Medicine found a slight but significant correlation between dropping barometric pressure and increased knee pain in osteoarthritis patients. However, this pattern is not universally observed across all joint conditions.

A 2011 systematic review in Arthritis Research & Therapy examined the relationship between weather and pain in rheumatoid arthritis patients. It revealed highly variable responses: while some people reported increased pain under low-pressure conditions, others noted no change. A few even experienced discomfort during high-pressure fronts.

More recently, a 2019 citizen-science project called Cloudy with a chance of pain used app-based pain tracking to explore this connection. The study found a modest association between falling pressure and heightened joint pain, but it also highlighted substantial individual differences in how people perceive weather-related pain.

These findings suggest that while changes in barometric pressure may influence joint pain for some, responses are far from uniform and depend on a complex interplay of factors, including the individual’s underlying joint condition and overall pain sensitivity.

Why Responses Differ

Barometric pressure rarely acts in isolation. Fluctuations in temperature and humidity often accompany pressure changes, complicating the picture.

Cold weather can have a pronounced effect on joints, particularly in people with existing joint conditions. Low temperatures cause muscles to contract and become stiffer, which can lead to reduced flexibility and a greater risk of strain or discomfort.

Ligaments, which connect bones to one another, and tendons, which anchor muscles to bones, may also lose some of their elasticity in colder conditions. This decreased pliability can make joint movement feel more restricted and exacerbate pain in conditions like arthritis.

Cold weather can also cause blood vessels to narrow — particularly in the extremities, as the body prioritises maintaining core temperature. This reduced blood flow can deprive affected areas of essential oxygen and nutrients, slowing the removal of metabolic waste products like lactic acid, which may accumulate in tissues and exacerbate inflammation and discomfort.

For people with inflammatory conditions, the reduced circulation can aggravate swelling and stiffness, especially in small joints like those in the fingers and toes.

Cold also slows the activity of synovial fluid. In lower temperatures, the fluid becomes less effective at reducing friction, which can heighten joint stiffness and make motion more painful, particularly for people with degenerative conditions such as osteoarthritis.

Sudden temperature changes may also play a role. Rapid shifts can challenge the body’s ability to adapt, which might worsen pain in people with chronic conditions. Similarly, high humidity can intensify sensations of heat or dampness in already inflamed areas, further complicating the experience of pain.

However, isolating a single variable – whether humidity, temperature or pressure –proves difficult because of the interplay of overlapping factors.

Responses to weather also depend on individual factors, including the extent of joint damage, overall pain sensitivity and psychological expectations. This variability makes it difficult to link a single meteorological factor to a biological response.

Still, the evidence suggests that people with joint conditions tend to be more attuned to environmental changes, particularly pressure fluctuations.

While the relationship between weather and joint pain remains an imperfect science, the collective evidence indicates that there may be some truth to the age-old belief. For those with chronic joint conditions, shifts in barometric pressure and accompanying weather changes might indeed serve as nature’s warning system – albeit one that’s far from foolproof.

Michelle Spear, PhD, is a Professor of Anatomy at the University of Bristol in the UK.

This article originally appeared in The Conversation and is republished with permission.

Can Disabled People Be Political Activists?

By Crystal Lindell

The world feels very broken these days – politically, economically and socially. Many of us already deal with broken bodies. Can people with disabilities do anything to fix a broken world?

The short answer is: Yes. 

The longer answer is: Not just yes, but that we must.  

While it can feel overwhelming to get involved in politics, even when you’re at peak health, there are a lot of ways you can fight back if you have chronic pain or other health issues that limit your capabilities.

Disabled people, including the chronically ill, bring a special expertise to political movements. For decades, we’ve been dealing with governments that often do not care about us. 

That apathy was made especially apparent when the 2016 CDC opioid guideline was released. Our concerns about the guideline were ignored and many pain patients were subsequently abandoned by doctors and the healthcare system.

But it’s even deeper than that. 

Disabled people learned first-hand that government regulators and our for-profit healthcare system do not actually care about anyone’s health. We were left largely on our own to fight off COVID. Not to mention how little the government does to make sure disabled people have access to basic necessities, as they make applying for government benefits nearly impossible. 

Now though, oppression is moving outward. Groups that were traditionally more protected from horrible governmental policies are also noticing how bad things have gotten, because it’s starting to affect them directly. 

What can disabled people do about any of this? Shouldn’t we just focus on our own lives for now? 

That would be a mistake. In fact, it is right now, when things are changing so rapidly, that it is most important for us to pay attention and advocate for better conditions for ourselves and others. 

The first step there is seeking out reliable news sources. In our current political climate, staying informed is, in itself, an act of resistance. While I understand the urge to check out of political news, it’s important to remember that it’s those who have information who have power. 

This is made especially clear by the fact that people in power work diligently to limit our access to accurate information through censorship, distraction and propaganda. 

Seeking and gathering accurate information is one way to fight back. Sharing it is also important. Communication is one of the foundations of political activism. 

This column is an example. I’ve been advocating for pain patients for more than a decade. While I haven’t personally changed any legislative policy that I know of, I do know that I’ve had an impact on people’s lives – which is what political activism is all about. I have helped people cope with life under our draconian drug laws and crumbling healthcare system. Many readers have reached out to tell me as such.

Giving people practical tips for living day-to-day can go a long way toward saving lives. And telling them how you’ve coped with adversity yourself can be extremely important. 

In our wellness-focused society, where health is often seen as a moral virtue, it can feel shameful to tell people about your health problems. But, in my experience, sharing our stories can be exactly the kind of thing other people need to hear.

If you can’t physically attend a protest march due to health reasons, that doesn’t mean you can’t be politically active. You can still donate to non-profits and advocacy organizations. If you’re not in a position to donate, you can help amplify their messages by sending emails, writing letters, sharing stories online, or even just talking to someone – all at little to no cost. 

Personally, I have found it to be really important to dive in and help locally. I volunteer at a local cat shelter every week, but it doesn’t have to be something that formal. I also cook meals for my elderly grandmother, my mom and their caretaker, because I know it helps lift a burden for them. 

Maybe you’ll find that you enjoy baking for a neighbor in need or checking on an elderly relative more regularly. 

When we help others, we really help ourselves. Human souls yearn to be in service to others Our desire to serve and our inevitable need to eventually be served are what stitches all of us together on the planet. 

Now is not the time to zone out and give up. Despite the physical battles many of us fight daily, we can fight back politically. More than that, we must.

Trump’s Tariffs Won’t Stop Illicit Drug Use

By Rodney Coates

Americans consume more illicit drugs per capita than anyone else in the world; about 6% of the U.S. population uses them regularly.

One such drug, fentanyl – a synthetic opioid that’s 50 to 100 times more potent than morphine – is the leading reason U.S. overdose deaths have surged in recent years. While the rate of fentanyl overdose deaths has dipped a bit recently, it’s still vastly higher than it was just five years ago.

Ending the fentanyl crisis won’t be easy. The U.S. has an addiction problem that spans decades – long predating the rise of fentanyl – and countless attempts to regulate, legislate and incarcerate have done little to reduce drug consumption. Meanwhile, the opioid crisis alone costs Americans tens of billions of dollars each year.

With past policies having failed to curb fentanyl deaths, President Donald Trump is turning to another tool to fight America’s drug problem: trade policy.

During his presidential campaign, Trump pledged to impose tariffs on Canada and Mexico if they didn’t halt the flow of drugs across U.S. borders, and on China if it didn’t do more to crack down on the production of chemicals used to make fentanyl. Trump reiterated his plan on his first day back in office, and on Feb. 1, he made good on that threat, imposing tariffs on all three counties and citing fentanyl as a key reason.

Speaking as a professor who studies social policy, I think both fentanyl and the proposed import taxes represent significant threats to the U.S. While the human toll of fentanyl is undeniable, the real question is whether tariffs will work – or worsen what’s already a crisis.

In 2021, more than 107,000 Americans died from overdoses – the most ever recorded – and nearly seven out of 10 deaths involved fentanyl or similar synthetic opioids.

In 2022, fentanyl was killing an average of 200 people each day. And while fentanyl deaths declined slightly in 2023, nearly 75,000 Americans still died from synthetic opioids that year. In March of that year – the most recent for which full-year data on overdose deaths is available – the then-secretary of homeland security declared fentanyl to be “the single greatest challenge we face as a country.”

Drug Regulation Doesn’t Work

But history shows that government efforts to curb drug use often have little success.

The first real attempt to regulate drugs in the U.S. occurred in 1890, when, amid rampant drug abuse, Congress enacted a law taxing morphine and opium. In the years that followed, cocaine use skyrocketed, rising 700% between 1890 and 1902. Cocaine was so popular, it was even found in drinks such as Coca-Cola, from which it got its name.

This was followed by a 1909 act banning the smoking of opium, and, in 1937, the “Marihuana Tax Act.” The most comprehensive package of laws was instituted with the Controlled Substances Act of 1970, which classified drugs into five categories based on their medical uses and potential for abuse or dependence.

A year later, then-President Richard Nixon launched the “War on Drugs” and declared drug abuse as “public enemy No. 1.” And in 1986, Congress passed the Anti-Drug Abuse Act, directing US$1.7 billion for drug enforcement and control.

These policies have generally failed to curb drug supply and use, while also causing significant harm to people and communities of color. For example, between 1980 and 1997, the number of incarcerations for nonviolent drug offenses went from 50,000 to 400,000. But these policies hardly put a dent in consumption. The share of high school seniors using drugs dipped only slightly over the same period, from 65% in 1980 to 58% in 1997.

Tariffs Can Backfire

In short, past U.S. efforts to reduce illegal drug use haven’t been especially effective. Now, it looks like the U.S. is shifting toward using tariffs – but research suggests that those will not lead to better outcomes either, and could actually cause considerable harm.

America’s experiments with tariffs can be traced back to the founding era with the passage of the Tariff Act of 1789. This long history has shown that tariffs, industrial subsidies and protectionist policies don’t do much to stimulate broad economic growth at home – but they raise prices for consumers and can even lead to global economic instability.

History also shows that tariffs don’t work especially well as negotiating tools, failing to effect significant policy changes in target countries. Economists generally agree that the costs of tariffs outweigh the benefits.

Over the course of Trump’s first term, the average effective tariff rate on Chinese imports went from 3% to 11%. But while imports from China fell slightly, the overall trade relationship didn’t change much: China remains the second-largest supplier of goods to the U.S.

The tariffs did have some benefit – for Vietnam and other nearby countries with relatively low labor costs. Essentially, the tariffs on China caused production to shift, with global companies investing billions of dollars in competitor nations.

This isn’t the first time Trump has used trade policy to pressure China on fentanyl – he did so in his first term. But while China made some policy changes in response, such as adding fentanyl to its controlled substances list in 2019, fentanyl deaths in the U.S. continued to rise. Currently, China still ranks as the No. 1 producer of fentanyl precursors, or chemicals used to produce illicit fentanyl. And there are others in the business: India, over that same period, has become a major producer of fentanyl.

Drugs have been pervasive throughout U.S. history. And when you investigate this history and look at how other nations are dealing with this problem rather than criminalization, the Swiss and French have approached it as an addiction problem that could be treated. They realized that demand is what fuels the illicit market. And as any economist will tell you, supply will find a way if you don’t limit the demand. That’s why treatment works and bans don’t.

The U.S. government’s ability to control the production of these drugs is limited at best. The problem is that new chemical products will continually be produced. Essentially, failure to restrict demand only places bandages on hemorrhaging wounds. What the U.S. needs is a more systematic approach to deal with the demand that’s fueling the drug crisis.

Rodney Coates, PhD, is a public sociologist and Professor of Critical Race and Ethnic Studies at Miami University

This article originally appeared in The Conversation and is republished with permission.