The Pharmacy Shuffle: Navigating the Opioid Shortage Again

By Crystal Lindell

The pain medication I take daily was completely out of stock at my pharmacy, as well as every other pharmacy near us in northern Illinois this week. 

The first replacement my doctor prescribed would cost me $529 out-of-pocket – even with a GoodRx coupon. 

Let me take you through what it’s like to navigate the morphine extended-release (ER) shortage as a pain patient who depends on this medication to function. And yes, this is the second time I’ve had to deal with the shortage in the last few months.

But this time, it was much worse. 

The whole saga really started last week, when I sent a MyChart message to my doctor’s office letting them know that I was due for a refill on Monday, March 31. They sent the refill prescription to my pharmacy on Friday, with the fill date set for Monday. 

Despite the fact that my pharmacy had this prescription in their system all weekend, they waited until 11 Monday morning to tell me that morphine ER was out of stock at their store and every other pharmacy in the area – and that there was no way to order it. 

After the pharmacy tech explained that to me, she said, “Did you want me to transfer the prescription somewhere else?”

Um, you just said it was out of stock everywhere? Where the heck would you transfer it to?

I asked her what alternatives they did have in stock, so that I could let my doctor know the best options. Because morphine ER and all of the alternatives are controlled substances, she immediately started acting like I was an armed gunman asking for details so that I could rob their narcotics safe later. 

Finding an Alternative

At that point, I realized that this situation was going to take at least the rest of the day to navigate, so I was growing impatient. I told her, “Sorry, I’m just trying to avoid having to make 17 phone calls about this, playing phone tag with you and my doctor’s office.”

She relented, and finally told me that they did have morphine instant-release (IR) available. 

I then got to work calling other local pharmacies hoping for a miracle. Unfortunately, I got the same information from all of them: Morphine ER was out of stock, they had no way to order more, and they had no idea when they might be able to get it. 

So then I called my doctor and left a message explaining the situation and that morphine instant-release was probably the best alternative. I called him 2 more times because I didn’t hear back.

Finally, the nurse called me back at 5:13 pm – just 17 minutes before the doctor was slated to leave for the day. And it was not great news. She told me that my doctor did not want to prescribe the instant-release version because he was worried it would be too strong for me. 

I suggested that he prescribe oxycodone extended-release, but that I was worried about the cost. I don’t currently have health insurance. 

My doctor sent in the oxycodone replacement at 5:28 pm, just minutes before he left for the day. 

At this point, I naively assumed that the oxycodone ER would cost around $200, which is significantly more expensive than the $60 I usually pay for morphine ER. 

Sadly, my guess of $200 was pathetically low.

My pharmacy gave me two pieces of bad news: One, they didn’t have the oxycodone in stock, but they could get it tomorrow, and two, the cash price with GoodRx would be $529. 

For some reason, the pharmacist thought this was a good time to have a conversation with me about my patient profile. He said that I needed to have my doctor prescribe a non-controlled medication for me because I only get prescriptions for controlled substances from them. That’s a red flag for the DEA, which could impact him – as if patients get to decide for their doctor what they’re prescribed.

I don’t have insurance and was on the verge of going into withdrawal without pain medication, and the pharmacist thought that was the best time to tell me that I needed to get an unnecessary medication to protect him? 

At this point, I did what any sane person would do: I started crying. 

I couldn’t afford the $529 oxycodone and now I also had the added stress of knowing that my pharmacist thinks I’m a “red flag” patient. 

I immediately called my doctor again, knowing that I was making the phone call in vain, because he was gone for the day. I was routed to the on-call service. The on-call doctor didn’t feel “comfortable” prescribing a controlled substance after hours to a patient they had never met.. 

By now, any patience I had was as unavailable as the morphine ER tablets were – so I used it as an opportunity to tell him that perhaps their “policy” should consider how dangerous it is to send patients into morphine withdrawal. 

He said I could go to the emergency room if it gets really bad, and I reminded him that I don’t have insurance. At that point, I accepted the fact that I will have to wait until day 2, and just hope it’s resolved then.

That night was awful. It’s not a good idea to go from 3 morphine ER tablets down to zero in one day, and I spent all night in and out of a fitful sleep, before finally deciding to get up for the day at 3 am. 

I called my doctor’s office as soon as they opened and left a message with his receptionist explaining the $529 price tag. I also let them know that I had already called additional pharmacies that morning and I was still getting the same excuse about them being out of stock with no way to order more morphine ER.

I called my doctor back again in the afternoon, because I still hadn’t gotten a response. Finally, at 3:24 pm, my doctor’s nurse called back. I had to explain this entire situation again. She gasped when I told her about the $529 price tag, said she would talk to the doctor, and call me back. 

Less than an hour later, she calls to tell me that they are sending in the prescription for morphine instant-release – the same medication they could have sent in the day before, which would have saved me from a night of unnecessary suffering. 

By that point, I was thankful that I was finally closer to getting this resolved. I call the pharmacy, they tell me they got the new script, and that they’d start working on it. It’s ready when I get there, and the price is just $52.60 – far cheaper than the oxycodone replacement. 

I Got Lucky, Other Patients May Not

The whole situation was just an awful chain of events, where I felt like I was failed by every single person in the healthcare system. Why didn’t the pharmacy tell me on Friday that my medication was out of stock? Why did my doctor’s office wait until the end of the day Monday to call me back? Why did the on-call doctor shrug me off?

I say all of this knowing that I’m one of the “lucky” ones who was actually able to get this situation resolved. Thousands of other patients are also dealing with shortages of  morphine ER and other opioids. I suspect most of them won’t get an alternative medication at all. 

My last prescription for morphine ER was manufactured by Rhodes Pharmaceuticals, which did not provide a reason for the shortage to the American Society of Health-System Pharmacists (ASHP). Neither did Major, Mallinckrodt, Sun Pharma or Teva Pharmaceuticals. The drug makers would only say the medication is on “back order.”  

You might still be able to get MS Contin, a branded version of morphine ER, but it costs more and most insurers won’t pay for it, according to the ASHP, so pharmacies don’t usually keep it in stock.

At this point, I’m genuinely wondering if generic morphine ER will ever be available again. Drug makers don’t make a lot of money selling generics and opioids come with the added risk of liability, so some manufacturers have quietly discontinued production.  

I think sometimes people believe that opioid pain medications are a want, not a need. But I need morphine ER to deal with my chronic pain. It allows me to work, shower, make dinner, clean my house, and spend time with my loved ones. Most of all, it allows me to get through the day without suicidal levels of physical pain. 

If you’re a patient trying to navigate this shortage, just know that my heart goes out to you. 

And if you're a physician or a pharmacist trying to deal with this from the other end of things, I hope you’ll treat morphine ER the same way you’d treat any other necessary, daily medication. If you wouldn’t do it to a patient who needs insulin, don’t do it to a patient who needs pain medication.

Cannabis Oil Has Long-Term Benefits for Chronic Health Conditions

By Pat Anson

Patients suffering from chronic pain and other chronic health conditions showed significant improvement in their quality of life, fatigue and sleep after taking cannabis oil over a one-year period, according to a new Australian study published in the journal PLOS One. Anxiety, depression and pain also improved during the course of the study, one of the first to demonstrate the long-term benefits of medical cannabis.

Researchers at the University of Sydney followed over 2,350 patients from across Australia who ingested cannabis oils containing both THC and CBD. Nearly two-thirds of the participants suffered from chronic musculoskeletal or neuropathic pain. Others lived with insomnia, depression, fatigue and anxiety. Participants did not get adequate relief from conventional treatments.   

Researchers found that the initial improvements in health over three months were maintained over 12 months. Because there was no control or placebo group, the improvements can’t be directly attributed to cannabis oil. But researchers noted that most of the participants stopped or reduced their use of opioid pain medication by the end of the study.

“This is promising news for patients who are not responding to conventional medicines for these conditions," said lead author Margaret-Ann Tait, a Research Manager and PhD Student at Sydney Nursing School, University of Sydney. 

The ratio of THC and CBD in the cannabis oil varied. Patients with conditions like fatigue or insomnia did better with oils that contained more THC; while those with chronic pain did better with higher ratios of CBD.

“We observed differences in the degree of improvement in fatigue, insomnia, anxiety, and depression depending on the ratio of CBD and THC in average daily MC (medical cannabis) doses. For these outcomes, average daily doses of THC-dominant MC was associated with greater odds of improvement than CBD:THC-balanced MC,” researchers said.

“Our findings suggest that people with chronic pain conditions experience better outcomes over time on lower doses of CBD when combined with smaller amounts of THC at a ratio of 10:1.”

Because this was an observational study, with different ratios of THC and CBD, researchers said they could not draw definitive conclusions about which ratios work best for each condition. The oils are made by Little Green Pharma , which funded the Quality of Life Evaluation Study (QUEST).

A 2023 survey of Australian patients with chronic illness found significant improvements in their physical and mental health after they started using medical cannabis. Most of the cannabis products in that study were oils containing CBD and/or THC.   

Sickest Patients Face Insurance Denials Over Prior Authorization

By Lauren Sausser, KFF Health News

Sheldon Ekirch spends a lot of time on hold with her health insurance company.

Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her phone. It was recommended by her psychologist to help with the depression associated with a stressful and painful medical disorder.

In 2023, Ekirch was diagnosed with small fiber neuropathy, a condition that makes her limbs and muscles feel as if they’re on fire. Now she takes more than a dozen prescriptions to manage chronic pain and other symptoms, including insomnia.

“I don’t feel like I am the person I was a year and a half ago,” said Ekirch, who was on the cusp of launching her law career, before getting sick. “Like, my body isn’t my own.”

Ekirch said specialists have suggested that a series of infusions made from blood plasma called intravenous immunoglobulin — IVIG, for short — could ease, or potentially eradicate, her near-constant pain.

But Ekirch’s insurance company has repeatedly denied coverage for the treatment, according to documents provided by the patient.

Patients with Ekirch’s condition don’t always respond to IVIG, but she said she deserves to try it, even though it could cost more than $100,000.

“I’m paying a lot of money for health insurance,” said Ekirch, who pays more than $600 a month in premiums. “I don’t understand why they won’t help me, why my life means so little to them.”

SHELDON EKIRCH

For patient advocates and health economists, cases like Ekirch’s illustrate why prior authorization has become such a chronic pain point for patients and doctors. For 50 years, insurers have employed prior authorization, they say, to reduce wasteful health care spending, prevent unnecessary treatment, and guard against potential harm.

The practice differs by insurance company and plan, but the rules often require patients or their doctors to request permission from the patient’s health insurance company before proceeding with a drug, treatment, or medical procedure.

The insurance industry provides little information about how often prior authorization is used. Transparency requirements established by the federal government to shed light on the use of prior authorization by private insurers haven’t been broadly enforced, said Justin Lo, a senior researcher for the Program on Patient and Consumer Protections at KFF, a health information nonprofit that includes KFF Health News.

Yet it’s widely acknowledged that prior authorization tends to disproportionately impact some of the sickest people who need the most expensive care. And despite bipartisan support to reform the system, as well as recent attempts by health insurance companies to ease the burden for patients and doctors, some tactics have met skepticism.

Some insurers’ efforts to improve prior authorization practices aren’t as helpful as they would seem, said Judson Ivy, CEO of Ensemble Health Partners, a revenue cycle management company.

“When you really dive deep,” he said, these improvements don’t seem to touch the services and procedures, such as CT scans, that get caught up in prior authorization so frequently. “When we started looking into it,” he said, “it was almost a PR stunt.”

The ‘Tipping Point’

When Arman Shahriar’s father was diagnosed with follicular lymphoma in 2023, his father’s oncologist ordered a whole-body PET scan to determine the cancer’s stage. The scan was denied by a company called EviCore by Evernorth, a Cigna subsidiary that makes prior authorization decisions.

Shahriar, an internal medicine resident, said he spent hours on the phone with his father’s insurer, arguing that the latest medical guidelines supported the scan. The imaging request was eventually approved. But his father’s scan was delayed several weeks — and multiple appointments were scheduled, then canceled during the time-consuming process — while the family feared the cancer would continue to spread.

EviCore by Evernorth spokesperson Madeline Ziomek wrote in an emailed statement that incomplete clinical information provided by physicians is a leading cause of such denials. The company is “actively developing new ways to make the submission process simpler and faster for physicians,” Ziomek said.

In the meantime, Shahriar, who often struggles to navigate prior authorization for his patients, accused the confusing system of “artificially creating problems in people’s lives” at the wrong time.

“If families with physicians are struggling through this, how do other people navigate it? And the short answer is, they can’t,” said Shahriar, who wrote about his father’s case in an essay published last year by JAMA Oncology. “We’re kind of reaching a tipping point where we’re realizing, collectively, something needs to be done.”

The fatal shooting of UnitedHealthcare CEO Brian Thompson on a New York City sidewalk in December prompted an outpouring of grief among those who knew him, but it also became a platform for public outrage about the methods insurance companies use to deny treatment.

An Emerson College poll conducted in mid-December found 41% of 18- to 29-year-olds thought the actions of Thompson’s killer were at least somewhat acceptable. In a NORC survey from the University of Chicago conducted in December, two-thirds of respondents indicated that insurance company profits, and their denials for health care coverage, contributed “a great deal/moderate amount” to the killing.

Instagram accounts established in support of Luigi Mangione, the 26-year-old Maryland suspect accused of murder and terrorism, have attracted thousands of followers.

“The past several weeks have further challenged us to even more intensely listen to the public narrative about our industry,” Cigna Group CEO David Cordani said during an earnings call on Jan. 30. Cigna is focused on “making prior authorizations faster and simpler,” he added.

The first Trump administration and the Biden administration put forth policies designed to improve prior authorization for some patients by mandating that insurers set up electronic systems and shortening the time companies may take to issue decisions, among other fixes.

Hundreds of House Democrats and Republicans signed on to co-sponsor a bill last year that would establish new prior authorization rules for Medicare Advantage plans. In January, Republican congressman Jefferson Van Drew of New Jersey introduced a federal bill to abolish the use of prior authorization altogether.

Meanwhile, many states have passed legislation to regulate the use of prior authorization. Some laws require insurers to publish data about prior authorization denials with the intention of making a confusing system more transparent.

Reform bills are under consideration by state legislatures in Hawaii, Montana, and elsewhere. A bill in Virginia approved by the governor March 18 takes effect July 1. Other states, including Texas, have established “gold card” programs that ease prior authorization requirements for some physicians by allowing doctors with a track record of approvals to bypass the rules.

No one from AHIP, an insurance industry lobbying group formerly known as America’s Health Insurance Plans, was available to be interviewed on the record about proposed prior authorization legislation for this article.

But changes wouldn’t guarantee that the most vulnerable patients would be spared from future insurance denials or the complex appeals process set up by insurers. Some doctors and advocates for patients are skeptical that prior authorization can be fixed as long as insurers are accountable to shareholders.

Kindyl Boyer, director of advocacy for the nonprofit Infusion Access Foundation, remains hopeful the system can be improved but likened some efforts to playing “Whac-A-Mole.” Ultimately, insurance companies are “going to find a different way to make more money,” she said.

‘Unified Anger’

In the weeks following Thompson’s killing, UnitedHealthcare was trying to refute an onslaught of what it called “highly inaccurate and grossly misleading information” about its practices when another incident landed the company back in the spotlight.

On Jan. 7, Elisabeth Potter, a breast reconstruction surgeon in Austin, Texas, posted a video on social media criticizing the company for questioning whether one of her patients who had been diagnosed with breast cancer and was undergoing surgery that day needed to be admitted as an inpatient.

The video amassed millions of views.

In the days following her post, UnitedHealthcare hired a high-profile law firm to demand a correction and public apology from Potter. In an interview with KFF Health News, Potter would not discuss details about the dispute, but she stood by what she said in her original video.

“I told the truth,” Potter said.

The facts of the incident remain in dispute. But the level of attention it received online illustrates how frustrated and vocal many people have become about insurance company tactics since Thompson’s killing, said Matthew Zachary, a former cancer patient and the host of “Out of Patients,” a podcast that aims to amplify the experiences of patients.

For years, doctors and patients have taken to social media to shame health insurers into approving treatment. But in recent months, Zachary said, “horror stories” about prior authorization shared widely online have created “unified anger.”

“Most people thought they were alone in the victimization,” Zachary said. “Now they know they’re not.”

Data published in January by KFF found that prior authorization is particularly burdensome for patients covered by Medicare Advantage plans. In 2023, virtually all Medicare Advantage enrollees were covered by plans that required prior authorization, while people enrolled in traditional Medicare were much less likely to encounter it, said Jeannie Fuglesten Biniek, an associate director at KFF’s Program on Medicare Policy.

Furthermore, she said, Medicare Advantage enrollees were more likely to face prior authorization for higher-cost services, including inpatient hospital stays, skilled nursing facility stays, and chemotherapy.

But Neil Parikh, national chief medical officer for medical management at UnitedHealthcare, explained prior authorization rules apply to fewer than 2% of the claims the company pays. He added that “99% of the time” UnitedHealthcare members don’t need prior authorization or requests are approved “very, very quickly.”

Recently, he said, a team at UnitedHealthcare was reviewing a prior authorization request for an orthopedic procedure when they discovered the surgeon planned to operate on the wrong side of the patient’s body. UnitedHealthcare caught the mistake in time, he recounted.

“This is a real-life example of why prior authorization can really help,” Parikh said.

Even so, he said, UnitedHealthcare aims to make the process less burdensome by removing prior authorization requirements for some services, rendering instant decisions for certain requests, and establishing a national gold card program, among other refinements. Cigna also announced changes designed to improve prior authorization in the months since Thompson’s killing.

“Brian was an incredible friend and colleague to many, many of us, and we are deeply saddened by his passing,” Parikh said. “It’s truly a sad occasion.”

The Final Denial

During the summer of 2023, Ekirch was working full time and preparing to take the bar exam when she noticed numbness and tingling in her arms and legs. Eventually, she started experiencing a burning sensation throughout her body.

That fall, a Richmond-area neurologist said her symptoms were consistent with small fiber neuropathy, and, in early 2024, a rheumatologist recommended IVIG to ease her pain. Since then, other specialists, including neurologists at the University of Virginia and Virginia Commonwealth University, have said she may benefit from the same treatment.

There’s no guarantee it will work. A randomized controlled trial published in 2021 found pain levels in patients who received IVIG weren’t significantly different from the placebo group, while an older study found patients responded “remarkably well.”

“It’s hard because I look at my peers from law school and high school — they’re having families, excelling in their career, living their life. And most days I am just struggling, just to get out of bed,” said Ekirch, frustrated that Anthem continues to deny her claim.

In a prepared statement, Kersha Cartwright, a spokesperson for Anthem’s parent company, Elevance Health, said Ekirch’s request for IVIG treatment was denied “because it did not meet the established medical criteria for effectiveness in treating small fiber neuropathy.”

On Feb. 17, her treatment was denied by Anthem for the final time. Ekirch said her patient advocate, a nurse who works for Anthem, suggested she reach out to the drug manufacturer about patient charity programs.

“This is absolutely crazy,” Ekirch said. “This is someone from Anthem telling me to plead with a pharmacy company to give me this drug when Anthem should be covering it.”

Her only hope now lies with the Virginia State Corporation Commission Bureau of Insurance, a state agency that resolves prior authorization disputes between patients and health insurance companies. She found out through a Facebook group for patients with small fiber neuropathy that the Bureau of Insurance has overturned an IVIG denial before. In late March, Ekirch was anxiously waiting to hear the agency’s decision about her case.

“I don’t want to get my hopes up too much, though,” she said. “I feel like this entire process, I’ve been let down by it.”

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

HHS Cuts Signal Seismic Shift in Public Health Policy

By Simon Haeder

Department of Health and Human Services Secretary Robert F. Kennedy, Jr. recently announced plans to dramatically transform the department. HHS is the umbrella agency responsible for pandemic preparedness, biomedical research, food safety and many other health-related activities.

In a video posted last week, Kennedy said the cuts and reorganization to HHS aim to “streamline our agency” and “radically improve our quality of service” by eliminating rampant waste and inefficiency. “No American is going to be left behind,” the health secretary told the nation.

As a scholar of U.S. health and public health policy, I have written about administrative burdens that prevent many Americans from accessing benefits to which they are entitled, including those provided by HHS, like Medicaid.

Few experts would deny that the federal bureaucracy can be inefficient and siloed. This includes HHS, and calls to restructure the agency are nothing new

Combined with previous reductions, these cuts may achieve some limited short-term savings. However, the proposed changes dramatically alter U.S. health policy and research, and they may endanger important benefits and protections for many Americans. They may also have severe consequences for scientific progress. And as some policy experts have suggested, the poorly targeted cuts may increase inefficiencies and waste down the line.

What HHS Does

HHS is tasked with providing a variety of public health and social services as well as fostering scientific advancement.

Originally established as the Department of Health, Education, and Welfare in 1953, HHS has seen substantial growth and transformation over time. Today, HHS is home to 28 divisions. Some of these are well known to many Americans, such as the National Institutes of Health, the Food and Drug Administration and the Centers for Disease Control and Prevention. Others, such as the Center for Faith-Based and Neighborhood Partnerships and the Administration for Community Living, may fly under the radar for most people.

HHS oversees Medicare, through which 68 million Americans, primarily adults age 65 and older, receive health insurance benefits. Richard Bailey/Corbis Documentary via Getty Images

With an annual budget of roughly US$1.8 trillion, HHS is one of the largest federal spenders, accounting for more than 1 in 5 dollars of the federal budget.

Under the Biden administration, HHS’s budget increased by almost 40%, with a 17% increase in staffing. However, 85% of that money is spent on 79 million Medicaid and 68 million Medicare beneficiaries. Put differently, most of HHS’ spending goes directly to many Americans in the form of health benefits.

Layoffs Affect 25% of HHS Workforce

From a policy perspective, the changes initiated at HHS by the second-term Trump administration are far-reaching. They involve both staffing cuts and substantial reorganization.

Prior to the March 27 announcement, the administration had already cut thousands of positions from HHS by letting go probationary employees and offering buyouts for employees to voluntarily leave.

Now, HHS is slated to lose another 10,000 workers. The latest cuts focus most heavily on a handful of agencies. The FDA will lose an additional 3,500 employees, and the NIH will lose 1,200. The CDC, where cuts are steepest, will lose 2,400 positions.

In all, the moves will reduce the HHS workforce by about 25%, from more than 82,000 to 62,000. These changes will provide savings of about $1.8 billion, or 0.1% of the HHS budget.

Along with these cuts comes a major reorganization that will eliminate 13 out of 28 offices and agencies, close five of the 10 regional offices, reshuffle existing divisions and establish a new division called the Administration for a Healthy America.

In his latest message, Kennedy noted that this HHS transformation would return the agency to its core mission: to “enhance the health and well-being of all Americans”. He also announced his intention to refocus HHS on his Make America Healthy Again priorities, which involve reducing chronic illness “by focusing on safe, wholesome food, clean water and the elimination of environmental toxins.”

‘Painful Period’ for HHS

Kennedy has said the HHS overhaul will not affect services to Americans. Given the magnitude of the cuts, this seems unlikely.

HHS reaches into the lives of all Americans. Many have family members on Medicaid or Medicare, or know individuals with disabilities or those dealing with substance use disorder. Disasters may strike anywhere. Bird flu and measles outbreaks are unfolding in many parts of the country. Everyone relies on access to safe foods, drugs and vaccines.

The plan to restructure HHS will trim its budget by 0.1%.

In his announcement, the health secretary highlighted cuts to HHS support functions, such as information technology and human resources, as a way to reduce redundancies and inefficiencies. But scaling down and reorganizing these capacities will inevitably have implications for how well HHS employees will be able to fulfill their duties – at least temporarily. Kennedy acknowledged this as a “painful period” for HHS.

However, large-scale reductions and reorganizations inevitably lead to more systemic disruptions, delays and denials. It seems implausible that Americans seeking access to health care, help with HIV prevention or early education benefits such as Head Start, which are also administered by HHS, will not be affected. This is particularly the case when conceived rapidly and without transparent long-term planning.

These new cuts are also further exacerbated by the administration’s previous slashes to public health funding for state and local governments. Given the crucial functions of HHS – from health coverage for vulnerable populations to pandemic preparedness and response – the American Public Health Association predicts the cuts will result in a rise in rates of disease and death.

Already, previous cuts at the FDA – the agency responsible for safe foods and drugs – have led to delays in product reviews.

Overall, the likelihood of increasing access challenges for people seeking services or support as well as fewer protections and longer wait times seems high.

Fewer Benefits and Services

The HHS restructuring should be viewed in a broader context. Since coming to office, the Trump administration has aggressively sought to reshape the U.S. public health agenda. This has included vast cuts to research funding as well as funding for state and local governments. The most recent cuts at HHS fit into the mold of rolling back protections and reshaping science.

The Trump administration has already announced plans to curtail the Affordable Care Act and roll back regulations that address everything from clean water to safe vaccines. State programs focused on health disparities have also been targeted.

HHS-funded research has also been scaled back dramatically, with a long list of projects terminated in research areas touching on health disparities, women’s and LGBTQ-related health issues, COVID-19 and long COVID, vaccine hesitancy and more.

The HHS reorganization also revamps two bodies within HHS, the Office of the Assistant Secretary for Planning and Evaluation and the Agency for Healthcare Research and Quality, that are instrumental in improving U.S. health care and providing policy research. This change further diminishes the likelihood that health policy will be based on scientific evidence and raises the risk for more politicized decision-making about health.

More cuts are likely still to come. Medicaid, the program providing health coverage for low-income Americans, will be a particular target. The House of Representatives passed a budget resolution on Feb. 25 that allows up to $880 billion in cuts to the program.

All told, plans already announced and those expected to emerge in the future dramatically alter U.S. health policy and roll back substantial protections for Americans.

Regulation has emerged as the most prolific source of policymaking over the last five decades, particularly for health policy. Given its vast responsibilities, HHS is one of the federal government’s most prolific regulators. Vast cuts to the HHS workforce will likely curtail this capability, resulting in fewer regulatory protections for Americans.

At the same time, with fewer experienced administrators on staff, industry influence over regulatory decisions will likely only grow stronger. HHS will simply lack the substance and procedural expertise to act independently. More industry influence and fewer independent regulators to counter it will also further reduce attention to disparities and underserved populations.

Ultimately, the Trump administration’s efforts may lead to a vastly different federal health policy – with fewer benefits, services and protections – than what Americans have become accustomed to in modern times.

Simon F. Haeder, PhD, is an Associate Professor of Public Health in the Department of Health Policy & Management in the School of Public Health at Texas A&M University. 

Dr. Haeder studies the politics and policies surrounding health access issues, with a particular focus on health access for vulnerable populations, the impact of provider networks on health access, and school-based health access. 

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

Pain Makes Young Adults More Likely to Mix Cannabis with Alcohol

By Crystal Lindell

A new study reveals that being in pain as a young adult makes you more likely to mix cannabis and alcohol. 

The research, published in the journal Alcohol, looked at 18 to 24 year olds. They found that those with moderate to severe pain were 1.4 times more likely to engage in the co-use of alcohol and cannabis over the next four years, compared to those with no pain. 

The Binghamton University researchers say this is the first study to examine pain as a predictor for co-using alcohol and cannabis. 

Previous research has shown that young adults who mix alcohol and cannabis are more likely to engage in impaired driving, risky sexual behavior, and/or experience mental health problems. 

But that begs the question, which causes which? 

I don’t think we should assume that using cannabis and alcohol together causes mental health issues. Perhaps it is the stress and anxiety of young adulthood – and poorly treated pain – that cause people to seek relief with things like alcohol and cannabis.

Previous studies have shown that about two-thirds (67%) of young adults in the U.S. reported pain in the past six-months, and more than 2 million of them had chronic pain. 

Physical pain in young adulthood can have long-lasting consequences. 

"Pain is of particular concern during emerging adulthood because it directly impacts developmental milestones across multiple domains, and emerging adults with chronic pain report greater isolation from their peers, fewer educational and occupational opportunities, greater anxiety and depression, and a poorer overall quality of life," the authors write. 

All of this really highlights why it’s so important that we fully treat pain in young adults – and really, in everyone who suffers from it. 

Unfortunately, that’s not the framing the authors chose to go with in their paper. Instead, they write that “pain is a unique risk factor for substance use.”

The choice to use “risk factor” in that sentence speaks volumes, although I am glad that they then used “substance use” as opposed to the more judgemental “substance abuse.”

Because that’s the thing, using a substance to treat something is not inherently bad. People use ibuprofen to treat headaches. But we don’t have research papers claiming that “headaches are a risk factor for Advil use.” Or even “having diabetes is a risk factor for insulin use.” 

Like yeah, you think? People use medications that treat their ailment in order to treat their ailment. 

Pain is definitely an aliment – and cannabis and alcohol are substances that do indeed relieve pain. The only reason anyone believes otherwise is because of government framing. 

We have drastically reduced the amount of opioids prescribed, but that doesn’t mean we have drastically reduced the amount of pain that people endure. It’s only natural that people will seek out alternatives. Younger people tend to have a more difficult time convincing doctors to treat their pain, meaning they are more likely to be left to fend for themselves. 

Alcohol and cannabis may not be the best choices for pain relief, but they may be the only ones available.

People in pain — at any age — will always look for ways to alleviate that pain. And the more options people in pain have, the more likely it is that they’ll find what works best for their body and their circumstances, while causing the least amount of negative side effects. 

If their only effective option is alcohol mixed with cannabis, then that’s what they’ll use. If the government and medical community don’t like that, then they should give them more options. 

My Use of Opioids Is None of Your Business

By Neen Monty

It seems like everyone these days has an unsolicited opinion about my pain management. Physical therapists, pharmacists, even my dentist has decided they need to weigh in on my opioid use.

Why do health care professionals who do not specialise in pain management feel entitled to comment on the way I manage my severe, long-standing pain? They clearly know nothing about opioids, have not read the studies, and are getting their knowledge from media headlines. If they actually read the studies, they wouldn’t be expressing these ignorant opinions.

But even so, it’s none of their business. If they are not treating my pain, why do they feel entitled to lecture me on a treatment plan that is well outside their expertise?

My rheumatologist doesn’t comment on my gastroenterologist’s treatment plan. My neurologist has zero interest in the way my immunologist is managing my symptoms. So why do health care professionals feel the need to comment on my use of opioids for pain relief?

For years, my pain was well controlled under the guidance of my GP — whom, I might add, is more than capable of managing pain. I never needed a pain specialist. I never needed to jump through ridiculous hoops or prove that my pain was “real enough” to deserve relief. And yet, thanks to the manufactured opioid crisis here in Australia, I was forced into a system that treats pain patients like criminals.

Let’s be clear: I am not an addict. I am a person with severe, incurable and excruciatingly painful diseases. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a progressive neurological disease that attacks my nerves. Refractory rheumatoid arthritis means my immune system is at war with my joints – all of them - and it’s winning.

These are not minor aches and pains. This is not pain that comes and goes. This is constant, severe pain. Pain when I’m at rest and even more pain when I move.  

These are not conditions that can be fixed with a little physio, deep breathing, or positive thinking. They are devastating, life-altering diseases, and pain relief is essential to my ability to function.

And yet, here we are. Every healthcare professional I encounter suddenly thinks my pain medication is their business.

My dentist, who is supposed to focus on my teeth, thinks it’s appropriate to lecture me on opioids.

My physiotherapist, whose job is to help me maintain muscle strength and mass, feels the need to moralise about my use of opioids. He is an expert in physiology and movement science, but knows nothing about pharmacology. Yet he believes that he does. And he's happy to tell me so.

Pharmacists, who definitely should know better, jump on the bandwagon with their judgmental takes. Yes, I have a supply of naloxone, even though it’s the biggest waste of money the government has ever been conned into spending by addiction researchers. I am at zero risk of needing it.

And no, I do not want information about how to taper my pain medicine. I actually need my pain medicine. I take it because I live with neuropathic and nociceptive chronic pain. You should try it sometime. I don’t think you’d enjoy it, but you’d be a better clinician. And person.

All of this unsolicited advice amounts to little more than bullying. Just the mention of an opioid turns some health care professionals into the high school bully. Do you want my lunch money as well?

What is this obsession with controlling other people’s pain relief? Why do you even have an opinion, when it is far outside of your area of practice? How can you possibly think it’s appropriate for you to judge how I treat my disease or my pain, when you met me two minutes ago?

Most of all, where is your empathy? Your compassion? Your human decency?

Lecturing and hectoring me is not compassionate, person-centred care.

Do you have an opinion on whether I take methotrexate or baricitinib for my rheumatoid arthritis? Does it matter, to you, which cDMARD or bDMARD I am taking? You’ve never heard of them, have you? They rarely make media headlines. Yet they are both riskier medications than opioids, and are more likely to cause serious adverse events. Yet you don’t care about those at all.

Do you care about my IVIG infusions? It’s extremely expensive medication. Unlike opioids, which are very cheap.

What about my steroid dose? You should care about that. All health care professionals know that high dose steroids, taken long term, are very dangerous. They often end up killing people. But because ignorant medical practitioners have taken my opioids away, I have been forced to live on high dose steroids. And all the side effects they bring.

But that’s fine with you. You don’t care about my steroid use. Only my poor endocrinologist does. Lovely gentleman. I can tell he truly cares about me as a patient. It shows in the way he treats me. With calm, gentle respect. He also stays in his lane. The only comment he has made about my opioid use is something akin to “I’m sorry you’re in so much pain.”

That’s a good doctor. After my first appointment with him, I went to my car and cried for 15 minutes straight. I’m not used to receiving that kind of compassion and empathy.

I normally get lectures. Unsolicited advice. And scare tactics: “Those drugs will kill you, you know!”

Or disgusted disbelief: “The pain can’t be that bad!”

Or, very commonly, abandonment: “You’re just going to have to learn to live with it.”

But why should I learn to live with pain that is easily treatable? Because you refuse to read the science? Because you like to get your medical knowledge from politicians, corrupt psychiatrists on the take, and researchers who misreport their own data to keep the grant money flowing?

Yeah, I know. At first, I thought all that was a conspiracy theory – no one would be so evil as to harm people who live with horrifically painful diseases just to further their own career, right? Of course not. No one would do… oh wait. Yes, they would.

Opioids are not for everyone. And thankfully, most people will never experience the kind of pain that requires around-the-clock opioids.

But when opioids are the only thing that reduces pain enough so that a person can survive and have a life, then opioids should be given. And in doses that actually relieve the pain, not a dose that some regulator or politician decided would be enough for everyone. Severe pain is a medical emergency. It does not matter if that pain is acute or chronic.

But let’s go back a step. I am in constant, severe pain. My nerves are being destroyed by my immune system, as are my joints. This is a documented and very painful disease process. Yet there is not an ounce of empathy. Not anymore, anyway.

Back in 2011, I went to a GP in absolute distress. I could not cope with the pain anymore and was crawling along the floor to get to the bathroom. The GP was compassionate. He knew that severe RA is a horrifically painful disease. He prescribed oxycodone and I got my life back.

And now? Health care professionals only have one thing to say: “Stop taking those opioids!”

It’s clear that these clinicians do not believe my pain is severe. It’s clear they don’t believe anything warrants long term opioid use. It’s clear that some think I only want opioids to get high.

Most clear of all is that they feel an entitlement to lecture me about it. When they know nothing about my pain.

The stigma created by the manufactured opioid crisis has turned us into the type of patients no doctor wants to treat. We are seen as liabilities. Nuisances. Whiners. Complainers. Time wasters. We’re seen as problems to be managed, rather than human beings in desperate need of help.

“Heartsink patients.” Are you familiar with that term? Google it. Heartsink patients are said to “exasperate, defeat, and overwhelm their doctors.”

I don’t fit that profile. Not even close. Very few people do. The profile was created so that doctors can feel they have the right to save the patient from themselves. Every single healthcare professional seems to think they have the right to weigh in, to judge and to lecture pain patients.

Here’s a radical idea: Mind your own business. Even better, educate yourself.

Read some recent science. Some peer reviewed science. Even read the studies that are referenced in the opioid prescribing guidelines. I promise you, they don’t say what you think they say.

Unless you are my GP or the prescribing doctor actively involved in my pain management, my opioid pain medication is not your concern. Yes, I need to tell you about it, in case you want to prescribe something that interacts with opioids. But that does not give you the right to judge me.

Pain is not a moral failing.

Taking opioids to manage pain is not a character flaw.

And it is none of your business.

Neen Monty is a writer and patient advocate in Australia who is dedicated to challenging misinformation and promoting access to safe, effective pain relief. Drawing on lived experience and scientific research, Neen has created a website for Pain Patient Advocacy Australia that is full of evidence that opioids can be safe and effective, even when taken long term. You can also subscribe to her free newsletter on Substack, “Arthritic Chick on Chronic Pain.”

Nearly All Hemp Products Could Get You High

uy Crystal Lindell

The promise of legalized hemp products was always that you couldn’t high on them, and they would be more regulated and thus safer for consumers. But a new white paper reveals that most hemp products contain intoxicants like THC, synthetic cannabinoids, kratom or even hallucinogenic mushrooms.

Hemp products have only been sold legally in the United States since 2021, the result of hemp being legalized as part of the 2018 Farm Bill. The thinking at the time was that hemp contained such minuscule amounts of THC that farmers could grow hemp again as a cash crop to make things like rope, fuel and horse feed. 

But it didn’t take long for the cannabis industry to figure out how to tweak the chemical composition of hemp to make delta-8 tetrahydrocannabinol (THC) and other potent synthetic cannabinoids, which you can get high on.

The white paper, called The Great Hemp Hoax, examined the composition and potency of hemp products sold in two southern California counties, focusing on chemically synthesized cannabinoids. The results reveal the hemp market has evolved far beyond what lawmakers and regulators intended. 

In an analysis of 104 hemp-based products from 68 brands, researchers found that 95 percent contain synthetic cannabinoids, which are illegal in California. These compounds are often far more potent than naturally occurring THC.  

More than half of the tested products exceeded the federal 0.3 percent THC limit, technically classifying them as cannabis rather than hemp under federal law. In fact, researchers found that many of these products vastly exceeded THC potency limits imposed on regulated cannabis products. 

Some hemp gummies contained up to 325 milligrams of synthetic THC per serving — which is way over the 10mg cap in California’s legal market.

You could also get high on hemp-derived vape products, which had an average THC equivalency level 268% above the state’s threshold for adult-use cannabis.

Some hemp products — such as Cheech & Chong’s “Kosmic Chews” — even contain psychoactive additives like kratom, while others include hallucinogenic mushrooms.

THE GREAT HEMP HOAX

“Much of what’s being sold as ‘hemp’ today isn’t hemp at all — it’s a cocktail of synthetic intoxicants and illicit THC masquerading as a natural, legal product. It's essentially the ultra-processed junk food of cannabis, but far more dangerous," said Tiffany Devitt, Director of Regulatory Affairs at Groundwork Holdings, which helped establish the cannabis industry in California and is trying to protect it from hemp competitors. 

"These companies aren't just skirting regulations – they're putting consumers at serious risk with designer drugs that look a whole lot more like ‘Spice’ than natural hemp."

Devitt and other authors of the white paper believe the contamination is not accidental. They said that filtering out or reducing the amount of delta-8 or delta-9 THC in hemp products is inefficient and cost-prohibitive, incentivizing companies to not do it.

“Because of these inefficiencies, most so-called ‘hemp-derived’ THC products are, in reality, synthetic cannabis — reminiscent of illegal products like ‘Spice’ that flooded California a decade ago,” they wrote. 

The lack of oversight also results in tax evasion. Over 90% of the hemp products analyzed were sold without collecting California’s sales tax, and none of the vendors paid the state’s cannabis excise tax. 

“The failure to ensure tax accountability allows unregulated ‘hemp’ products to undercut the legal cannabis market while depriving the state of revenue meant for public health, environmental mitigation, and enforcement,” the authors concluded. 

The white paper calls for all hemp products containing THC to be regulated as cannabis within California, to protect consumers and workers.

“These illicit operations aren’t just dangerous — they’re undercutting California’s regulated cannabis businesses and workers,” said Kristin Heidelbach, Legislative Director of the United Food and Commercial Workers Union, which helped pay for the white paper.

“While licensed cannabis businesses provide good union jobs and comply with strict labor standards, many synthetic ‘hemp’ producers manufacture out-of-state or import from overseas, dodging California’s labor laws and tax obligations.”

This isn’t just a California issue. A recent study found that nationwide sales of hemp products reached $2.8 billion in 2023. They are legally sold to minors in many U.S. states, even in those where cannabis is illegal. In 2023, about 11% of 12th graders said they had used hemp products containing Delta-8 THC.  

Magic Mirror on the Wall, Do I Look Healthy in This Selfie?

By Madora Pennington

What if gazing into your smartphone’s camera did more than make content for your Instagram? What if it could assess your health?

By analyzing the blood flow in your face, an app claims to do just that.

Your facial blood flow says a lot about you --- whether you are at rest, concentrating, happy or sad. And thanks to advances in artificial intelligence, it can also assess the state of your health.

The Anura MagicMirror uses transdermal optical imaging technology to gage cardiac and blood flow activity. It then processes this information to assess your overall health, as well as your risk of developing chronic conditions like diabetes, hypertension, and cardiovascular disease.

The app, which can be downloaded on a smartphone, records the face for thirty seconds. The facial blood flow — imperceptible to the human eye — is then compared to AI models from tens of thousands of individuals. From this data, it churns out individual health feedback. While not as accurate as having a blood pressure cuff or blood test, Anura makes an educated guess about your health indicators.

How accurate is Anura?

“All measurements have been validated using medical grade devices and following established scientific research protocols.  We have ten peer reviewed papers published in scientific journals detailing the methods and procedures used and the corresponding results,” says Marzio Pozzuoli, CEO of NuraLogix, which developed the Anura MagicMirror.

I downloaded a free version of the app – called Anura Lite -- and tried it for myself.

I have Ehlers-Danlos Syndrome, a connective tissue disorder, so I have “invisible” health challenges that don’t easily fall under the gaze of this app.

Anura focuses on the main issues that affect everyone: heart health, metabolic health, and mental health — which are leading indicators for chronic conditions that can end in death: cardiovascular disease, hypertension, diabetes and stroke. 

The app collects data on 30 different health parameters, including your breathing, blood pressure, heartbeat, vascular capacity, body mass index, facial skin age, waist-to-height ratio, body shape index, and mental stress index.

With this data, it then estimates the risk of cardiovascular disease, diabetes, fatty liver disease, and stroke over the next ten years.

The app also asked about my gender, age, weight and height, so I’m assuming it used this self-reported information to answer some of its questions about my health. Here are some of the scores the app gave my health and general wellness:

True, I don’t have a high BMI and am not overweight, so I’m not at high risk for metabolic disease. I already knew that.

I do have heart issues, but they are monitored and managed by my cardiologist -- successfully, it seems, if we believe Anura.

I felt relaxed when I used the app, and the MagicMirror reassuringly agreed.

One thing it got wrong was my skin age. It’s been a while since I was 31. I confess that to get my age lower, I put on makeup and laid on my back for the facial scan. I hope this didn’t affect the overall results. I am always risking my mental health when I focus the painfully high-definition iPhone camera on myself.

For metric junkies, Anura might be as fun as popping on the scale every morning or using a Fitbit.

The app doesn’t have a pain score, but for a patient with chronic pain or illness, it might be insightful to do a scan in times of physical or mental stress to see what, if anything, could be learned and addressed.

Currently, NeuroLogix is finding customers for its technology in the life insurance industry. Instead of accepting the assertions of an applicant at face value or requesting medical records and lab tests, an app like Anura could provide a health assessment more quickly – and cheaply — to the insurer.

It is easy to imagine a place for technology like this in telehealth, where a doctor has no opportunity to put a blood pressure cuff or pulse oximeter on a patient. Clinicians could then gather health data through a remote scan, improving the quality of remote telehealth appointments.

Telehealth is of enormous benefit to disabled people and the elderly, especially in rural areas without easy access to medical care or specialists. That is, if the technology proves reliable. For now, NeuroLogix admits its health assessments are “only estimates and are not a substitute for the judgment of the healthcare professional.”

But in the future, with more research, it might be possible to measure pain by using technology like this instead of relying on flawed methods like the pain scale. Pain is a subjective experience that currently has no objective and reliable way to measure, because it varies from person to person. MagicMirror may someday give us an alternative.

Health Insurance Premiums Rising Faster Than Inflation

By Phillip Reese, KFF Health News

Kirk Vartan pays more than $2,000 a month for a high-deductible health insurance plan from Blue Shield on Covered California, the state’s Affordable Care Act marketplace. He could have selected a cheaper plan from a different provider, but he wanted one that includes his wife’s doctor.

“It’s for the two of us, and we’re not sick,” said Vartan, general manager at A Slice of New York pizza shops in the Bay Area cities of San Jose and Sunnyvale. “It’s ridiculous.”

Vartan, who is in his late 50s, is one of millions of Californians struggling to keep up with health insurance premiums ballooning faster than inflation.

Average monthly premiums for families with employer-provided health coverage in California’s private sector nearly doubled over the last 15 years, from just over $1,000 in 2008 to almost $2,000 in 2023, a KFF Health News analysis of federal data shows. That’s more than twice the rate of inflation. Also, employees have had to absorb a growing share of the cost.

The spike is not confined to California. Average premiums for families with employer-provided health coverage grew as fast nationwide as they did in California from 2008 through 2023, federal data shows. Premiums continued to grow rapidly in 2024, according to KFF.

Small-business groups warn that, for workers whose employers don’t provide coverage, the problem could get worse if Congress does not extend enhanced federal subsidies that make health insurance more affordable on individual markets such as Covered California, the public marketplace that insures more than 1.9 million Californians.

Premiums on Covered California have grown about 25% since 2022, roughly double the pace of inflation. But the exchange helps nearly 90% of enrollees mitigate high costs by offering state and federal subsidies based on income, with many families paying little or nothing.

Rising premiums also have hit government workers — and taxpayers. Premiums at CalPERS, which provides insurance to more than 1.5 million of California’s active and retired public employees and family members, have risen about 31% since 2022. Public employers pay part of the cost of premiums as negotiated with labor unions; workers pay the rest.

“Insurance premiums have been going up faster than wages over the last 20 years,” said Miranda Dietz, a researcher at the University of California-Berkeley Labor Center who focuses on health insurance. “Especially in the last couple of years, those premium increases have been pretty dramatic.”

Dietz said rising hospital prices are largely to blame. Consumer costs for hospitals and nursing homes rose about 88% from 2009 through 2024, roughly double the overall inflation rate, according to data from the Department of Labor. The rising cost of administering America’s massive health care system has also pushed premiums higher, she said.

Insurance companies remain highly profitable, but their gross margins — the amount by which premium income exceeds claims costs — were fairly steady during the last few years, KFF research shows. Under federal rules, insurers must spend a minimum percentage of premiums on medical care.

Rising insurance costs are cutting deeper into family incomes and squeezing small businesses.

The average annual cost of family health insurance offered by private sector companies was about $24,000, or roughly $2,000 a month, in California during 2023, according to the U.S. Department of Health and Human Services. Employers paid, on average, about two-thirds of the bill, with workers paying the remaining third, about $650 a month. Workers’ share of premiums has grown faster in California than in the rest of the nation.

Many small-business workers whose employers don’t offer health care turn to Covered California. During the last three decades, the percentage of businesses nationwide with 10 to 24 workers offering health insurance fell from 65% to 52%, according to the Employee Benefit Research Institute. Coverage fell from 34% to 23% among businesses with fewer than 10 employees.

“When an employee of a small business isn't able to access health insurance with their employer, they're more likely to leave that employer,” said Bianca Blomquist, California director for Small Business Majority, an advocacy group representing more than 85,000 small businesses across America.

Kirk Vartan said his pizza shop employs about 25 people and operates as a worker cooperative — a business owned by its workers. The small business lacks negotiating power to demand discounts from insurance companies to cover its workers. The best the shop could do, he said, were expensive plans that would make it hard for the cooperative to operate. And those plans would not offer as much coverage as workers could find for themselves through Covered California.

“It was a lose-lose all the way around,” he said.

Mark Seelig, a spokesperson for Blue Shield of California, said rising costs for hospital stays, doctor visits, and prescription drugs put upward pressure on premiums. Blue Shield has created a new initiative that he said is designed to lower drug prices and pass on savings to consumers.

Even at California companies offering insurance, the percentage of employees enrolled in plans with a deductible has roughly doubled in 20 years, rising to 77%, federal data shows. Deductibles are the amount a worker must pay for most types of care before their insurance company starts paying part of the bill. The average annual deductible for an employer-provided family health insurance plan was about $3,200 in 2023.

During the last two decades, the cost of health insurance premiums and deductibles in California rose from about 4% of median household income to about 12%, according to the UC Berkeley Labor Center, which conducts research on labor and employment issues.

As a result, the center found, many Californians are choosing to delay or forgo health care, including some preventive care.

California is trying to lower health care costs by setting statewide spending growth caps, which state officials hope will curb premium increases. The state recently established the Office of Health Care Affordability, which set a five-year target for annual spending growth at 3.5%, dropping to 3% by 2029. Failure to hit targets could result in hefty fines for health care organizations, though that likely wouldn’t happen until 2030 or later.

Other states that imposed similar caps saw health care costs rise more slowly than states that did not, Dietz said.

“Does that mean that health care becomes affordable for people?” she asked. “No. It means it doesn’t get worse as quickly.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Most Treatments for Low Back Pain Don’t Work

By Crystal Lindell

While I’ve struggled with relatively mild lower back pain for years now, a few months ago I threw my back out for the first time. I literally could not get out of bed on my own, and I spent almost a week on the couch recovering while my lower back spasmed. 

It was horrible, and even my usual pain relief methods and doses of pain meds did not help much. In the end, for me, it was mostly just time and rest that seemed to help the most. 

Now a new study confirms just how difficult it is to treat low back pain. 

In fact, only about 10 percent of treatments for low back pain actually work, according to new research published this week in the journal BMJ Evidence-Based Medicine. 

The study by an international team of researchers looked at 301 placebo-controlled clinical trials for 56 different treatments for low back pain. The team found that most non-surgical and non-interventional treatments did not work. Those that did work provided only small analgesic effects better than a placebo.

Specifically, they found that NSAIDs were the only treatment that worked for acute low back pain, while five treatments for chronic low back pain provided relief: exercise, spinal manipulative therapy (chiropractic), taping, antidepressants, and transient receptor potential vanilloid 1 agonists, which are topical patches like Qutenza (capsaicin).  

As for the treatments that did not work, the researchers found that three treatments for acute low back pain – exercise, glucocorticoid injections, and paracetamol (acetaminophen) – and two treatments for chronic low back pain (antibiotics and anaesthetic drugs) were ineffective. 

They didn’t have enough good quality evidence for the remaining treatments to determine if they worked or not. 

For acute low back pain, 10 non-pharmacological treatments had “low to very low certainty evidence” that they actually worked, including: acupuncture, behavioral health education, extracorporeal shockwave, heat, laser and light therapy, massage, mobilization, osteopathic, spinal manipulative therapy, and transcutaneous electrical nerve stimulation (TENS). 

They also found that 10 pharmacological treatments had inconclusive evidence about their effectiveness for acute low back pain, including: cannabinoids, colchicine, immunoglobulin, muscle relaxants, muscle relaxants + NSAIDs, nucleoside, opioids, ozone injections, pyrazolone derivatives, and topical rubefacients.

For chronic low back pain, over three dozen treatments had inconclusive evidence to support their efficacy, which included everything from bee venom and TENS to dry cupping and muscle relaxants.

The bottom line is that there’s not much evidence to support the use of many treatments that are commonly prescribed and promoted for lower back pain — even the ones recommended in medical guidelines.

“Our review did not find reliable evidence of large effects for any of the included treatments,” researchers concluded. “There are also common treatments for which no placebo-controlled trials have been conducted despite being commonly recommended in clinical practice guidelines.”

The study ends as many often do, with a plea for more high-quality evidence to give patients and doctors real choices and effective options for treating back pain. 

“While we would like to provide more certain recommendations for where to invest and disinvest in treatments, it is not possible at this time,” researchers said.

Why Are Doctors Reluctant to Recommend Mobility Aids?

By Crystal Lindell 

There’s a common thought process among doctors when it comes to opioid pain medications. 

They usually don’t prescribe them unless you specifically ask for them, because they don’t want to “encourage” you to use them. But also, if you do ask for opioids, then they label you as a drug seeker and assume you’re looking for “the easy way out” or to get high.

In short, most doctors try very hard to avoid giving patients opioids, unless they want to treat addiction with Suboxone – which ironically contains the opioid buprenorphine.

While I strongly disagree with every part of that thought process, in that situation doctors at least have the excuse that they have to worry about the DEA and losing their medical licenses. 

I’ve also noticed that many doctors have the same thought process when it comes to prescribing and/or recommending mobility aids like walking canes, crutches and wheelchairs. 

They don’t like to suggest them to patients because they don’t want to “encourage” their use. However, on the other end, if a patient does ask for them, doctors also bristle at that. They seem to think that mobility aids are, like opioids, “the easy way out.” 

Of course, there’s nothing easy about either opioids or mobility aids. If a patient has gotten to a point where they feel the need to use either one, chances are they are needed. 

I noticed these anti-mobility aid attitudes among doctors myself, when I had pain from a bone spur on my heel. My doctors never suggested crutches, and I had to figure out for myself that not using my foot was the only thing that seemed to help relieve the pain. I had some crutches at home from a previous injury, and using them allowed me to still function while also not putting weight on my foot. They also allowed my body to heal. 

Years ago, when my fiancé had a severe hip injury, he had to go out and buy his own cane because his doctors had not even suggested one, much less prescribed one – despite the very clear need. 

Online you’ll find multiple Reddit threads of patients expressing frustration at how doctors approach mobility aids. About a year ago in the “Mobility Aids” section of Subreddit, a poster asked, “Why are doctors so hesitant to let patients use mobility aids?”

“I use forearm crutches because I struggle to walk sometimes because of how much my pain hurts and my doctor thinks I have [an] autoimmune disorder that causes this pain which I'm getting more testing for but he goes ‘you're 19 you don't need mobility aids.’ But I have literally fallen over before. Laid in bed in agony barely able to move. Cried from how much it hurts and so much more yet they want to deny me what helps me get around?”

The post then has multiple responses from readers lamenting that they have had the same experience with doctors.

“I’ve had the same issues with doctors and just got mobility aids on my own, not through a doctor. I don't understand why doctors avoid it though because there’s been days at a time where I couldn’t leave my bed and it was hard to go anywhere or do anything on bad days [and] even on good days I still have troubles,” one poster wrote.

There is research that seems to confirm those fears.

A recent study in The Lancet found demographic, socioeconomic and social barriers impacted how much access people had to "mobility assistive products" or MAPs. They surveyed 12,080 people over age 50 in England and found that 42% had an unmet need for a mobility aid. 

Researchers found that women were more likely to have difficulty accessing mobility aids when they have a need for them. They also found that older patients who were unemployed or had a low education level had more trouble accessing MAPs.

Interestingly, having a romantic partner also increased the chances of having an unmet need for a mobility aid, whereas being single actually made patients more likely to have them. My guess is that single people are more likely to advocate for access to mobility aids, because they don’t have a partner at home to help them with daily tasks.  

Other studies have shown a prejudice toward patients with mobility aids among doctors. 

For example, a 2023 study published in the National Library of Medicine looked at physicians' attitudes about caring for disabled patients. They interviewed doctors in focus groups and found many had medical offices that presented “physical barriers to providing health care for people with disabilities, including inaccessible buildings and equipment.”

Some doctors openly admitted the lack of accessibility in their clinics. For example, one rural primary care physician said, “I know for a fact our building is not accessible.” 

If a doctor doesn’t even offer an accessible building to patients, odds are that they don’t prioritize mobility aids for the patients either. 

It seems that doctors assume that if patients start using a mobility aid, they’ll end up using it for the rest of their lives. But in my case and my fiance’s case, that’s not what happened. We both used them short term, and stopped as soon as we were healthy enough to do so. 

Regardless, who cares if people use mobility aids for the rest of their lives? Would that be such a bad thing? Being alive and independent with mobility aids is preferable to being confined at home and/or losing your independence. 

Perhaps some doctors see patients with mobility aids as a failure on their part. After all, if a patient needs them, then the doctor must not be doing enough to treat them. 

Mobility aids are exactly what the name implies – an aid that gives people more mobility, and by extension, more independence and freedom. They can greatly improve someone’s quality of life, whether they are used long or short-term. 

There’s no reason for doctors to gate-keep mobility aids, other than their own ablest bias. If they actually want to help patients, they should be suggesting them a lot more often. 

The Fine Art of ‘Knowing’ Your Body

By Cynthia Toussaint  

Three times in my life I knew something big, tragic and seemingly illogical was going to happen to me. All were trauma and health related, though I didn’t know that when my gut spoke to me with complete assuredness. 

Against all naysayers and doubters, my first two premonitions were eerily on target and heartbreakingly so. Trouble is, my third intuition is knocking at the door, and if I can’t change fate, I won’t survive to see my next birthday.

Can I turn my future around to save myself?

I don’t think there’s anything supernatural about my success at prognostication. The only special power I possess is an ability to tune into my inner wisdom and to trust it. As I learned more about the connection between mind and body – the bodymind, if you will – I’ve come to believe that my body unconsciously speaks to my mind and the premonitions are the conscious expression of that communication.       

My first hunch started when I was 17. With great interest, I read a magazine article about anorexia, as I’d almost died from this eating disorder five years prior. At the end of the piece, when the writer incorrectly stated that some anorexics can’t have children after being cured, my gut knew, unequivocally, that would be me.

I became obsessed, speaking endlessly about this knowing to friends and family, always landing on deaf ears because I appeared perfectly healthy. I then shared this fear with my gynecologist and even sought out a psychologist. After both assured me I’d have as many children as I wanted when the time was right, I knew they were wrong. My reasoning for not being able to have a child would morph from anorexia to a future, unknown health problem, one that would rear its head years later.

Meanwhile, at age 20, I regained my footing and was living a seemingly perfect life. I was in college, studying my great passions (singing, dancing and acting), got an agent and was auditioning for TV and film roles. Then out of the blue, another obsessive, dreadful foreknowledge came to me: my show business career would end when I was 21.

Again, my certainty landed on incredulous ears. “You’re making no sense, Cynthia” and “You’ve got your whole career ahead of you” and other reassurances came from all directions. But, again, I knew they were wrong.      

To meet the deadline that was amplifying in my head, I hustled to get my headshots and resumes done. I even recall yelling over the phone at my photographer for taking too much time. He couldn’t fathom my rush, especially when I paid to have someone drive my precious pics from his Bay Area studio to my LA dorm overnight.          

Like a cosmic special delivery, three months before my 22nd birthday, a ballet injury triggered Complex Regional Pain Syndrome (CRPS). Though it would be 13 years before my diagnosis, piece by piece, CRPS dismantled my performing career.

I managed to dance some in a Las Vegas illusion act, posed for Playboy and tried like hell to get hired as a TV host in LA. As a last-ditch effort, I sent hundreds of letters to industry folk and got an agent to represent me for sitting jobs as a “special booking,” all to no avail. No one would hire me due to my significant disability and limitations.           

Back on the baby front, my first premonition was still bubbling away. Just before my partner John and I planned to get pregnant, my gynecologist advised I needed a LEEP procedure to remove dysplasia. Tragically, that procedure spread CRPS into my cervix and vagina, lighting the area on neuropathic fire. As a result, I was unable to have intercourse through the rest of my child-bearing years.

No career, no child. My premonitions were two for two, batting a thousand. 

You can imagine my concern when in my early 40’s a new premonition took hold. I started sharing with John that I knew I would die before reaching age 65. This time around, there were no doubters.

My foretelling seemed to be playing out right on schedule, when at 59 I developed the most aggressive form of breast cancer – and then again two years later when I experienced a recurrence, followed by a year of painful, life-threatening complications caused by my overactive immune system.

But this time, unlike my previous two knowings, I’m pushing back.

I’m certain I’m still alive because I now understand that trauma drives illness, and since my first cancer diagnosis, I continue to do a ton of trauma release work while devoting myself to self-care.

If my next PET/CT scan is clean, I’ll reach the three year disease-free mark, which is considered by most oncologists to be a cure for Triple Negative breast cancer. Free and clear, as they say.

Still, I’m praying that nine months down the road, on New Year’s Eve, I’ll be blowing out candles on my 65th birthday cake. If I do, I’ll know that trauma release, self-care, and giving myself the agency and action to plot my course, allowed me to change my fate.

As those candles go out, my wish for all of us seemingly fated to suffer with chronic pain and other illness, will be that we will listen intimately to our whispering intuitions.  And maybe, just maybe, their words will light our way.  

Cynthia Toussaint is the founder and spokesperson at For Grace, a non-profit dedicated to bettering the lives of women in pain. She has lived with CRPS and multiple co-morbidities for over four decades. Cynthia is the author of “Battle for Grace: A Memoir of Pain, Redemption and Impossible Love.” 

Experimental Cannabis Extract Has ‘Potential to Replace Opiates’

By Pat Anson

A German biotech company says it is seeking regulatory approval in Europe and the United States for an experimental cannabis extract that could be an alternative to opioid pain medication.

Vertanical recently completed two Phase 3 studies of its new drug – called VER-01 – on over 1,000 patients with chronic low back pain who didn’t get sufficient relief from non-opioid analgesics.

One study compared VER-01 to a placebo, while the second trial compared the drug’s safety and tolerability to patients treated with opioids. The company told The Times it was awaiting publication of the studies’ findings in The Lancet before making them public.

“VER-01 reduces pain without creating dependency or having an abuse potential,” said Clemens Fischer, MD, Vertanical’s CEO. “It has the full potential to replace opiates as it’s more effective. It’s a real alternative for chronic patients — the first one.

“Pain patients around the world are trapped in a vicious cycle of pain, insomnia, limited mobility, and depression. VER-01 has the potential to successfully break this cycle.”

VER-01 is a “full-spectrum” extract derived from cannabis sativa leaves and flowers. Although it contains THC, the main psychoactive substance in cannabis, Fischer says patients enrolled in the studies didn’t become high or intoxicated. About 25 percent did “feel a bit dizzy” for two weeks after they started taking it.

Participants also didn’t get “the munchies” or gain weight, a well-known side effect of cannabis.

“We were looking very carefully, because that’s what we hear from cannabis smokers — that the appetite increases as well their weight. But we haven’t seen any increase in weight,” Fischer told The Times.

Vertanical is seeking regulatory approval of VER-01 in Europe and with the UK’s Medicines and Healthcare Products Regulatory Agency. If granted, VER-01 would be the first cannabis-based medicine approved for chronic pain. It would be sold under the brand name Exilby and be taken orally in drops.

The timeline for approval in Europe may be as soon as this summer, but it’s likely to take longer in the U.S.

“We are seeking regulatory approval in the US and are in talks with the FDA. For approval in the US, a further phase 3 study with US patients in the indication of chronic low back pain will start in Q2 2025,” Merit Renner, Senior Manager of Business Development at Vertanical, told PNN in an email. “This, together with the phase 3 study successfully conducted in Europe, will form the basis for approval in the US.”

Vertanical also plans further studies of VER-01 on patients with osteoarthritis and peripheral neuropathy.

Research into the pain-relieving properties of cannabis has been slow in the U.S., in large part because of marijuana’s status as a Schedule 1 Controlled Substance, the same classification as LSD and heroin. The DEA recently allowed more marijuana to be used for research purposes, but has dragged its feet about reclassifying marijuana as a Schedule 3 substance that could be used for medical purposes. Until marijuana is rescheduled, VER-01 is unlikely to get FDA approval.

Some recent studies have shown that certain cannabinoids found in marijuana -- cannabidiol (CBD), cannabigerol (CBG), and cannabinol (CBN) – block pain signals in the peripheral nervous system, not the brain, and don’t have a psychoactive effect that could lead to abuse.

“These findings open new avenues for the development of cannabinoid-based therapies,” said Mohammad-Reza Ghovanloo, PhD, lead author of a study published in PNAS and a research scientist at Yale School of Medicine. “Our results show that CBG in particular has the strongest potential to provide effective pain relief without the risks associated with traditional treatments.”

The cannabinoids in the Yale study interact with a protein in cell membranes called Nav1.8, which blocks peripheral nerves from transmitting pain signals. Inhibiting Nav1.8 is the same method used by Journavx (suzetrigine), a non-opioid analgesic recently approved by the FDA for relieving moderate to severe acute pain in adults.

States Wrestle with Kratom Regulation

By Mara Silvers, KFF Health News

Montana lawmakers are grappling with how — if at all — the state should rein in kratom, an unregulated plant-derived substance with addictive properties sold mainly as a mood and energy booster at gas stations, vape shops, and elsewhere.

Kratom, which originates from the leaves of a tree native to Southeast Asia, is also touted for helping relieve pain and opioid withdrawal symptoms. But it can have wide-ranging mental and bodily effects, according to the federal Drug Enforcement Administration, addiction medicine experts, and kratom researchers. Reports of deadly kratom overdoses have surfaced in recent years, though often in combination with other substances.

But the drug is in a gray federal regulatory area: It’s designated by the DEA as a “drug and chemical of concern,” but it is not considered a controlled substance. Legislation introduced in Congress in 2023 to study kratom has not advanced.

The lack of federal regulation and congressional action has left it to states to step into the complex debate over how to clean up supply chains and protect users.

The kratom industry itself wants to help address this regulatory void. A bill drafted by the American Kratom Association, a national industry lobbying group, is pending in the Montana Legislature. In its current form, the industry-dubbed “Kratom Consumer Protection Act” would ban sales to people under 18 and restrict which products can be labeled as “kratom” based on the amount and potency of two chemical components, mitragynine, and 7-hydroxymitragynine.

Similar industry-backed bills have passed in 14 states, including Oregon, Texas, Kentucky, and Maryland, according to the American Kratom Association website. Other states, including Wisconsin and Arkansas, have enacted kratom bans by listing it as a Schedule I controlled substance.

Oliver Grundmann, a University of Florida researcher who has studied kratom since 2016, said industry-written bills often hinge on producers accurately representing what’s in their products. Lawmakers and the public in Montana may not be convinced that the proposed legislation will put public health considerations above commercial interests.

“Naturally, a company is driven by profits and making sure that they can retain their profits,” Grundmann said. “I’m skeptical of self-regulation.”

Whether the Montana bill will be effective hinges on the state’s having enough resources to regulate the industry, as well as industry retailers honestly testing and marketing their products, he said.

The bill’s sponsor, Republican Rep. Nelly Nicol, said she’s trying to bring her fellow lawmakers up to speed on a substance that few people understand. Nicol said she delayed House Bill 407’s first committee hearing to give herself more time to speak with legislators and to hear from groups that support and disagree with the industry’s suggested approach. She indicated she’s open to amending the bill, though it has not yet been rescheduled for a committee hearing.

“We’re going to be changing our minds and learning things and molding this as we’re going,” Nicol said in a February interview.

Potentially Addictive

Researchers and addiction medicine experts have struggled in recent years to pin down kratom’s health effects and patterns of use. A federal survey from 2021 estimated that 1.7 million Americans age 12 and older used the substance in some way the year before the study.

Medical providers and addiction researchers in Montana say patients often don’t disclose their kratom use to health care providers. Some consider it an herbal supplement, a perception driven by its accessibility in gas stations and vape shops, rather than a mind-altering and potentially addictive drug.

Megan Zawacki, a physician assistant and addiction medicine specialist in Helena, said many of her patients seek help for misuse of other substances and aren’t easily convinced of kratom’s negative side effects.

“The majority of my patients that are using it can’t even quantify to me how much they’re using,” Zawacki said.

But if their use spirals into addiction, she said, the consequences of the substance become clearer. At her clinic in Helena, Zawacki said, more of her patients are currently being treated for kratom addiction than for opioid use disorder.

“I’ve had two patients specifically in the last calendar year tell me, ‘We need to bring legislation against kratom,’” she said. “Because it is so readily available and so misunderstood that it just is wreaking havoc on their lives.”

Depending on how it’s manufactured and how much users consume, kratom can function as a stimulant or a sedative.

Though not an opioid, its key chemical components can target opioid receptors in the brain, leading some advocates to cite its potential for helping opioid users manage withdrawal.

Zawacki and other Montana providers say they have prescribed buprenorphine to help patients stop using kratom — the same treatment often used to manage opioid addiction.

“What we have seen in recent years is even stronger extracts that focus specifically on mitragynine and 7-hydroxymitragynine. These should not be seen as ‘kratom’ any longer.”

— Dr. Oliver Grundmann, University of Florida

Some Montana advocacy groups that work to prevent substance misuse have also flagged concerns about kratom use among minors. Beth Price Morrison, with the Alliance for Youth in Great Falls, said her organization has pressured gas stations in the area to stop carrying kratom products or at least keep them behind the counter.

“Our youth are really struggling with mental health right now, and they turn to substances to cope. And this stuff is easily accessible,” Price Morrison said.

Price Morrison and Nicol expressed support for raising the age limit on kratom sales to users 21 and older, rather than 18, which is in the current draft of the American Kratom Association bill.

The legislation would allow state regulators to screen kratom products coming on the market in Montana and create a registry of permitted distributors. Vendors would be banned from selling or promoting kratom products whose concentration of 7-hydroxymitragynine exceeds 2% of the total alkaloid content.

The American Kratom Association and other supporters say that such a restriction would help weed out natural forms of kratom from synthetic, higher-potency concoctions. Some kratom researchers have endorsed this type of market regulation, citing the chaotic array of products currently allowed to sport kratom labels.

Grundmann, the University of Florida researcher, said there has been an “evolution” in the United States of products being labeled and sold as kratom.

“The kratom that was on the market then was basically ground-up leaf powder that was not further concentrated,” Grundmann said. “What we have seen in recent years is even stronger extracts that focus specifically on mitragynine and 7-hydroxymitragynine. These should not be seen as ‘kratom’ any longer.”

Grundmann, who supported a similar version of legislation in Arizona in 2019, said Montana’s bill is a starting point for regulation. He said other states, including Colorado, began with a common framework and put more guardrails in place in recent years.

Price Morrison, the youth prevention advocate, said she has broader misgivings about any bill that normalizes the sale of kratom in Montana. In an ideal world, she said, she would like to see the product banned completely.

“We know that availability drives use. And when a product is marketed as regulated, it gains legitimacy,” Price Morrison said. “And more people, including those who are vulnerable, end up using it.”

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

Virtual Nature Scenes May Help Relieve Minor Pain

By Crystal Lindell

Nature scenes may help relieve minor acute pain – even if you only “see” the nature scene in a virtual reality program. That’s according to new research published this week in, appropriately, the journal Nature Communications. 

Researchers administered mild electric shocks to cause a pain response in 49 healthy volunteers, and then showed them a virtual reality scene that was either a nature scene of a lake, an urban cityscape, or an indoor office setting.  

The researchers then used both brain scans and self-reported pain reactions to analyze whether any of the scenes reduced pain. 

NATURE COMMUNICATIONS

They found that areas of the brain that handle physical pain signals were less active when people saw the virtual nature scene. Self-reported pain also was lower in the nature vs. urban and indoor settings. 

I will admit that, at first, I didn’t want to believe that “virtual nature scenes” could have the same mental effect as actual, living nature. But then I quickly realized that I did enjoy virtual nature scenes, fake or not. 

Every morning, after watching the news, I open the YouTube app on my Roku and select a calming nature scene to play on the TV throughout the day. In the winter, it’s a roaring fire; in the spring, a calming rainy scene; in the summer, ocean waves; and in the fall, autumn leaves rustling. 

While I’m not sure if any of the YouTube nature scenes help my physical pain, I do think they help calm my anxiety – in the same way that watching the news usually increases my anxiety. 

Of course, the mostly Austrian research team couldn’t resist slipping in a little anti-opioid messaging, writing: 

“Besides advancing our basic knowledge, such research may have considerable importance for efforts to complement pharmaceutical treatment approaches, with their well-documented negative side effects and addictive properties.”

While I’m glad they used the word “complement” instead of “replace,” it’s their mention of “negative side effects and addictive properties” that makes it clear that they do want this research to eventually lead to non-opioid pain treatments. 

But when you actually look at the study, you’ll see that it very specifically looks only at minor, acute pain. So this research should not be used to reduce pain medications for people with chronic pain. 

I’m not accusing the authors of wanting that, since they clearly think more studies are necessary. But in our current opioid-phobia environment, I do have concerns about doctors seeing the study headline and giving patients “go look at a lake” advice to reduce medication-based pain treatments.

Ideally, research like this would be used responsibly, inspiring healthcare providers to add more natural elements to places like doctor’s offices and even nursing homes – whether those nature elements are virtual, digital or physical paintings. 

Previous research has found that patients recovering from surgery used fewer analgesics and recovered faster if their hospital window gave them a view of trees, rather than a brick wall.

However, I remain extremely doubtful that this type of research will ever result in finding a way to use nature elements as an effective pain treatment in any way that even reduces the need for pain medication.