Trump’s Tariffs Won’t Stop Illicit Drug Use

By Rodney Coates

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

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

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

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

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

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

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

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

Drug Regulation Doesn’t Work

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

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

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

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

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

Tariffs Can Backfire

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

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

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

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

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

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

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

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

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

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

FDA Approves New Non-Opioid Pain Reliever

By Pat Anson

Despite lackluster results in clinical trials, the U.S. Food and Drug Administration has approved a new non-opioid pain reliever for moderate to severe acute pain in adults.

Journavx (suzetrigine) is the first new medication for acute, short-term pain in over two decades. Unlike opioids, Journavx blocks pain signals in the peripheral nervous system, not in the brain, so it doesn’t have the same “liking” effects of opioids, which can lead to dependence or addiction.

The FDA calls its approval “an important public health milestone.”

"A new non-opioid analgesic therapeutic class for acute pain offers an opportunity to mitigate certain risks associated with using an opioid for pain and provides patients with another treatment option. This action and the agency's designations to expedite the drug's development and review underscore FDA's commitment to approving safe and effective alternatives to opioids for pain management," said Jacqueline Corrigan-Curay, MD, acting director of the FDA's Center for Drug Evaluation and Research.

Journavx was developed by Vertex Pharmaceuticals, which anticipates the drug to be used primarily for relieving post-operative pain or trauma. It is also being studied as a treatment for diabetic peripheral neuropathy and other types of chronic pain.

“This is an incredible day for patients and physicians alike who now have an approved non-opioid treatment that delivers effective acute pain relief and a favorable safety profile without addictive potential,” said Jessica Oswald, MD, a Vertex consultant and Associate Physician in Emergency Medicine and Pain Medicine in San Diego.

“I believe Journavx could redefine the management of pain and become a foundational treatment option for people with all types of moderate-to-severe acute pain, where options aside from opioids have been so desperately needed.”

VERTEX IMAGE

The results from clinical trials suggest that Journavx is a mild pain reliever, at best.

In Phase 3 clinical studies of acute pain after minimally invasive surgeries, Journavx was no more effective than a low-dose combination of hydrocodone and acetaminophen, more commonly known as Vicodin.

In a recent Phase 2 study, Journavx was essentially no better than a placebo in relieving chronic back and hip pain caused by lumbosacral radiculopathy.

A recent report by ICER, an independent, non-profit research institute, said there were “uncertainties” about the efficacy and safety of Journavx.

“We have concerns about as-yet-unknown harms of suzetrigine as we would for any drug with a new mechanism of action; we are particularly concerned about whether there could be an increased risk for cardiac arrhythmias… and possible acute renal injury given a study in people with diabetes,” ICER said. “The above uncertainties inform our ratings that the evidence for suzetrigine for the treatment of acute pain in comparison with no systemic treatment, in comparison with opioid analgesics, and in comparison with NSAIDs are all promising but inconclusive.”

Journavx is being priced by Vertex at a wholesale cost for $15.50 per 50mg pill. When taken twice a day for acute pain, ICER estimates the cost at $420 for a one-week course. By comparison, a supply of 100 Vicodin tablets costs about $142.

The FDA’s approval of Journavx coincides with implementation of the NOPAIN Act, which makes non-opioid analgesics in outpatient surgical settings eligible for higher Medicare reimbursement rates.  

The risk of a surgery patient misusing opioids or becoming addicted is less than one percent. One study found that patients who received no opioids during surgery were more likely to have post-operative pain and require opioids during recovery.

Trump Administration Delays Release of Bird Flu Studies

By Amy Maxmen, KFF Health News

The Trump administration has intervened in the release of important studies on the bird flu, as an outbreak escalates across the United States.

One of the studies would reveal whether veterinarians who treat cattle have been unknowingly infected by the bird flu virus. Another report documents cases in which people carrying the virus might have infected their pet cats.

The studies were slated to appear in the official journal of the Centers for Disease Control and Prevention, the Morbidity and Mortality Weekly Report. The distinguished journal has been published without interruption since 1952.

Its scientific reports have been swept up in an “immediate pause” on communications by federal health agencies ordered by Dorothy Fink, the acting secretary of the Department of Health and Human Services. Fink’s memo covers “any document intended for publication,” she wrote, “until it has been reviewed and approved by a presidential appointee.” It was sent on President Donald Trump’s first full day in office.

That’s concerning, former CDC officials said, because a firewall has long existed between the agency’s scientific reports and political appointees.

“MMWR is the voice of science,” said Tom Frieden, a former CDC director and the CEO of the nonprofit organization Resolve to Save Lives.

“This idea that science cannot continue until there’s a political lens over it is unprecedented,” said Anne Schuchat, a former principal deputy director at the CDC. “I hope it’s going to be very short-lived, but if it’s not short-lived, it’s censorship.”

White House officials meddled with scientific studies on covid-19 during the first Trump administration, according to interviews and emails collected in a 2022 report from congressional investigators. Still, the MMWR came out as scheduled.

“What’s happening now is quite different than what we experienced in covid, because there wasn’t a stop in the MMWR and other scientific manuscripts,” Schuchat said.

Neither the White House nor HHS officials responded to requests for comment. CDC spokesperson Melissa Dibble said, “This is a short pause to allow the new team to set up a process for review and prioritization.”

News of the interruption hit suddenly last week, just as Fred Gingrich, executive director of the American Association of Bovine Practitioners, a group for veterinarians specializing in cattle medicine, was preparing to hold a webinar with members. He planned to disclose the results of a study he helped lead, slated for publication in the MMWR later that week.

Back in September, about 150 members had answered questions and donated blood for the study. Researchers at the CDC analyzed the samples for antibodies against the bird flu virus, to learn whether the veterinarians had been unknowingly infected earlier last year.

Although it would be too late to treat prior cases, the study promised to help scientists understand how the virus spreads from cows to people, what symptoms it causes, and how to prevent infection. “Our members were very excited to hear the results,” Gingrich said.

Like farmworkers, livestock veterinarians are at risk of bird flu infections. The study results could help protect them. And having fewer infections would lessen the chance of the H5N1 bird flu virus evolving within a person to spread efficiently between people — the gateway to a bird flu pandemic.

At least 67 people have tested positive for the bird flu in the U.S., with the majority getting the virus from cows or poultry. But studies and reporting suggest many cases have gone undetected, because testing has been patchy.

Just before the webinar, Gingrich said, the CDC informed him that because of an HHS order, the agency was unable to publish the report last week or communicate its findings. “We had to cancel,” he said.

Another bird flu study slated to be published in the MMWR last week concerns the possibility that people working in Michigan’s dairy industry infected their pet cats. These cases were partly revealed last year in emails obtained by KFF Health News. In one email from July 22, an epidemiologist pushed to publish the group’s investigation to “inform others about the potential for indirect transmission to companion animals.”

Jennifer Morse, medical director at the Mid-Michigan District Health Department and a scientist on the pending study, said she got a note from a colleague last week saying that “there are delays in our publication — outside of our control.”

A person close to the CDC, speaking on the condition of anonymity because of concerns about reprisal, expected the MMWR to be on hold at least until Feb. 6. The journal typically posts on Thursdays, and the HHS memo says the pause will last through Feb. 1.

“It’s startling,” Frieden said. He added that it would become dangerous if the reports aren’t restored. “It would be the equivalent of finding out that your local fire department has been told not to sound any fire alarms,” he said.

In addition to publishing studies, the MMWR keeps the country updated on outbreaks, poisonings, and maternal mortality, and provides surveillance data on cancer, heart disease, HIV, and other maladies. Delaying or manipulating the reports could harm Americans by stunting the ability of the U.S. government to detect and curb health threats, Frieden said.

The freeze is also a reminder of how the first Trump administration interfered with the CDC’s reports on covid, revealed in emails detailed in 2022 by congressional investigators with the House Select Subcommittee on the Coronavirus Crisis. That investigation found that political appointees at HHS altered or delayed the release of five reports and attempted to control several others in 2020.

In one instance, Paul Alexander, then a scientific adviser to HHS, criticized a July 2020 report on a coronavirus outbreak at a Georgia summer camp in an email to MMWR editors, which was disclosed in the congressional investigation.

“It just sends the wrong message as written and actually reads as if to send a message of NOT to re-open,” he wrote. Although the report’s data remained the same, the CDC removed remarks on the implications of the findings for schools.

Later that year, Alexander sent an email to then-HHS spokesperson Michael Caputo citing this and another example of his sway over the reports: “Small victory but a victory nonetheless and yippee!!!”

Schuchat, who was at the CDC at the time, said she had never experienced such attempts to spin or influence the agency’s scientific reports in more than three decades with the agency. She hopes it won’t happen again. “The MMWR cannot become a political instrument,” she said.

Gingrich remains hopeful that the veterinary study will come out soon. “We’re an apolitical organization,” he said. “Maintaining open lines of communication and continuing research with our federal partners is critical as we fight this outbreak.”

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

Doctors Feel Helpless When It Comes to Patient Medical Debt

By Crystal Lindell

A new study looked at medical debt from the point of view of doctors and other medical professionals. What researchers found offers insights into how burdensome medical debt has become on the healthcare system as a whole in the United States – and how helpless doctors feel in the face of it. 

According to the Census Bureau, about 14 million Americans owe over $1,000 in medical debt and about 3 million owe more than $10,000.  

The new report – released by Undue Medical Debt, a nonprofit funded by the Robert Wood Johnson Foundation – found that medical debt is a serious problem for clinicians and their patients, and that it’s impacting how, when and if patients receive care.  

In short, doctors feel they are forced to weigh bad financial health versus bad physical health in their treatment decisions. 

For the study, Undue Medical Debt, held four focus groups in early 2024. Each group consisted of a diverse group of participants, including family doctors, internists, hospitalists, nurse practitioners and community health workers, who shared their experiences with patients struggling with medical debt. 

They found that cost-of-care conversations with patients were relatively common and that patients were less afraid to talk about their medical debt than anticipated. However, clinicians feel they have very limited training and few resources to offer patients 

Most focus group participants reported having regular conversations with patients about medical debt and that patients were concerned about paying for their care. But the healthcare system is so replete with confusing and often disparate policies that it is difficult to be a fully informed consumer. 

One clinician said that when patients take on medical debt, they end up deferring their healthcare, which is bad for them, their families and for the healthcare system as a whole. 

“Because you have someone that, if they could have come in a year and a half before, you’re treating elevated cholesterol and blood pressure, but they push off their care and a year and a half after that, they’re showing up in your emergency room with a stroke,” the clinician said. 

“That costs them more money, that costs the system more money, and so it’s a very negative perpetuation of bad value; when you put debt upon debt people stay away from healthcare.” 

Clinicians said that they hope the importance of physical health will win out, but those decisions are often out of their control. They worry about the patient who disappears from care, particularly those who show up months, years or even decades later with advanced disease that could have been successfully treated earlier. 

Several clinicians thought the healthcare system as a whole was on the verge of collapse. 

“I’m not sure how much power I have. I’m sure there’s something that I can do more of, maybe from a top level. I guess sit on a board, talk to some of our administrators,” one clinician lamented. “But in general, healthcare has just unfortunately become such a machine. You know, it’s just such a machine.”

They added that they’re trying to give people the best care they can, but time constraints hold them back. Many felt helpless. 

“We’re trying to address unbelievable amounts of problems, five and six different comorbid problems that are really, really serious and trying to prioritize, and we do that for probably, some of us, myself, 14 to 19 people a day, in some cases sometimes more,” one provider said.  

Undue Medical Debt said that the business of medicine has pulled clinicians away from practicing medicine, forcing them to become financial counselors on top of their other duties. While many note this is outside their purview, they also understand they have “no choice” but to play this role. 

Doctors and nurses in the focus groups blamed multiple actors for the state of the healthcare industry, such as insurers, pharmaceutical companies and health system bureaucracy.  

When testing policy fixes with clinicians, the most popular ones included: presumptive financial aid screening; hiring people to help patients access resources and financial aid in multiple languages; capping interest rates, and making home foreclosures due to medical debt illegal. 

The Consumer Financial Protection Bureau recently adopted a rule that bans all medical debt from credit reports and prohibits lenders from using medical information in their lending decisions. That will remove an estimated $49 billion in medical bills from the credit reports of about 15 million Americans. 

Veterinarians Know. Why Can’t Doctors?

As a patient, I have long bemoaned the fact that the cost of medical services is so far removed from providers. There aren’t many other businesses that operate in such a way. Usually the person selling a service has to be aware of the cost of that service. And make no mistake, in a for-profit healthcare system, doctors are selling you healthcare.  

There’s one example that highlights how absurd the situation has gotten – veterinarians. When I take my cat to the vet – a medical office where most customers pay out of pocket – the veterinarians and their staff are always acutely aware of the cost of each procedure, and they always provide an estimate up front. 

It’s a system that makes me believe such care is possible for human patients, too. However, anytime I’ve seen a doctor and brought up pricing before agreeing to a test or procedure, the doctor has looked at me like I was speaking in an alien language. They can’t fathom that they would ever be asked to provide a cost estimate for their own services, much less factor it into treatment options. 

I don’t currently have health insurance, so cost is an enormous factor for me now. However, even when I did have what people would consider “good” health insurance, co-pays and out of pocket expenses ruined my credit. 

Yet anytime I tried to get cost estimates in advance of treatments or procedures, they would imply that I must not value my body if I am concerned with such petty things as money. 

To be honest, even that was somewhat understandable a few years ago. But recently, many hospitals and doctors have resorted to what Undue Medical Debt calls “Extreme Collection Actions.” That’s when hospitals and doctors used collection methods such as suing people, taking their homes, or garnishing wages. 

For many patients in the United States, the system is set up so that when you see a doctor, they order tests and treatments without telling you any sort of price range at all. Then they send you an opaque bill that lacks any sort of price breakdown. And then they’ll report you to a credit collector if you don’t pay them. 

The fact that any of this is legal shows how broken healthcare has gotten. 

While many doctors quoted in the Undue Medical Debt study said they don't want to be bothered with talk about money, that’s a luxury their patients don’t have. 

Undue Medical Debt has a free downloadable toolkit designed to help healthcare workers have conversations about cost and medical debt with their patients.

“Our toolkit lays the groundwork to not only help clinicians assist their patients in avoiding the unjust burden of medical debt, but it also encourages clinicians to leverage their expertise and lived experience to champion upstream solutions to stymie the creation of unpayable medical debts to begin with,” said Eva Stahl, Undue Medical Debt’s Vice President of Public Policy and Program Management.

Here’s hoping doctors actually use it. 

Is the Opioid Epidemic Really Ending?

By Dr. Charles LeBaron 

From all the self-congratulations by outgoing Biden administration officials about a 15% decrease in overdose deaths last year, one might conclude that the opioid epidemic is coming to an end. However, drug overdoses remain the #1 killer of adults aged 15 to 45, causing more deaths than automobiles and firearms combined.

So even if this “disappearing epidemic” continues at its current pace – about 98,000 fatal overdoses annually -- nearly a million Americans will die of overdoses within the next ten years. 

The carnage is taking place amid a startling paradox: many severely ill persons with a clearly legitimate need for pain control have grave difficulties obtaining opioid medications adequate to make their existence less of a living hell. This worst-case scenario is the legacy of past policy failures – failures that need not be repeated, if incoming Trump administration officials can take a moment to consult our history and apply its lessons. 

In the 1990s, as has been extensively chronicled, large pharmaceutical companies began aggressively promoting proprietary opioid preparations. By the mid-2010s, the United States, with 5% of the world’s population, was estimated to consume 80% of the world’s opioids. For Americans recovering from surgery, 91% received opioids, compared to just 5% in the rest of the world for the same operations.  

Opioid overdose deaths rose in parallel to opioid prescriptions – which became so numerous that the number of pills prescribed was technically enough to kill every American. Whereupon the Centers for Disease Control and Prevention (CDC) stepped in. The CDC’s 2016 opioid guideline, developed with almost no meaningful input from clinicians who treat pain, laid out a series of recommendations on who should get opioids, at what dosage, and for what duration. 

Essentially no attention was paid at the time to antidotes for overdoses or the treatment of dependence. Public and private insurers, eager for cost savings, rapidly adopted the CDC’s dosage restrictions, as did pharmacy chains under attack for their lucrative role in opioid sales. The Drug Enforcement Administration also lent a hand by imposing manufacturing caps on the five major opioid pain medications.  

Within two years, opioid prescribing rates had decreased dramatically in major specialties: for primary care clinicians they dropped 40%, cancer specialists down 60%, and ER docs down 71%. Overall prescription rates fell back to 1990s levels. Success was proclaimed. 

‘Inhuman Punishment’

Then the full consequences of inflexible dosage limits by non-clinicians became apparent. More than 80% of chronic pain patients said they now had more pain and a worse quality of life. The number of cancer patients and survivors with opioid prescriptions decreased by more than half. Suicides by patients cut off from opioids increased. And almost 80% of primary care physicians reported they were reluctant to prescribe opioids for any reason.  

Even when opioids were prescribed, patients often found that their opioid medication was unavailable because of the artificial scarcity created by opioid litigation and the DEA’s manufacturing caps. Patient and professional organizations protested. A group of 274 academic experts (including two former “drug czars”) sent a protest petition to CDC.  

Human Rights Watch, an organization best known for exposing torture by totalitarian regimes, issued a hundred-page report, suggesting that CDC policies could be considered to violate basic human rights by imposing “cruel, degrading, and inhuman punishment” on those whose only crime was to be in severe pain.  

But CDC held the line, pointing proudly to a drop of a few percent in the 2018 overdose rate. Lost in the triumphalism was the fact that the overdose rate was creeping up from a little-known opioid called fentanyl, which is 100 times more potent than morphine.

The 2018 overdose downturn proved to be a pause, during which a new set of entrepreneurs entered the market, acquiring fentanyl components from suppliers in China, using pill presses to make them look like FDA-approved medications, and then transporting them to a gig distribution system in the US.

The Mexican cartels were meeting an unmet need. The pharmaceutical companies had helped create the need. And rigid implementation of the restrictive CDC guidelines, aided by DEA manufacturing caps, helped assure the need went unmet.

Overdoses, primarily from illicit fentanyl, exploded after the 2018 pause, doubling in the six years following implementation of the CDC recommendations, a surge particularly acute right in the CDC’s own backyard of Georgia.

So here we are in 2025, with a few percent reduction in overdoses and once again a repetition of 2018 triumphalism.

Meanwhile, overdoses have increased seven-fold from illicit carfentanil, a veterinary opioid so potent that a delivery box could overdose the entire US population.

We remain in the paradoxical situation where evermore dangerous illicit opioids from abroad are easily purchased on a street corner, while medically-prescribed opioids, manufactured under the FDA’s safety and purity standards, are hard to obtain by those who legitimately need them.

We Could Do Better

I worked for more than 28 years at CDC as an epidemic control specialist, during which time I also did clinical work with addicts and drug dealers in Appalachia and in the federal penal system.

Several years ago, as a patient with life-threatening staph spinal abscesses, I received months of high-dose opioids for severe pain. Many pain patients wake up each morning, as I did then, praying that the day’s struggle for some semblance of pain control will succeed against odds that seem so perversely, so specifically, so implacably stacked against them.

Out of these personal and professional experiences, I concluded that we could do better by the millions currently in severe inescapable pain, as well as the million projected to die by overdose in the upcoming decade. I wrote a book about the opioid crisis, "Greed to Do Good: The Untold Story of CDC's Disastrous War on Opioids."

In brief, here’s what I suggest should be minimal elements of an effective opioid epidemic response:

• We have an ongoing mass poisoning. We have an antidote. Naloxone (Narcan) should be deployed on a scale equivalent to the mass poisoning.

• For the estimated 50 million Americans with chronic pain, and especially the 17 million for whom pain limits life and basic functioning, opioids prescribed by a physician should not be so difficult to obtain that patients turn to cartels as America’s pharmacist.

• Standards guiding pain treatment should come from medical organizations with clinical expertise – not from pharmaceutical marketers, government bureaucrats, or the police.

• Artificial scarcity for legitimate opioids through DEA caps on manufacturing merely shifts demand to illicit opioids. This policy should be abandoned.

• For the estimated 6 million Americans with opioid use disorder, only 20% are in treatment. Addiction is a relapsing-remitting condition, with treatment outcomes similar to those for other chronic conditions, such as diabetes, asthma and hypertension, where behavioral setbacks are also common. To really wreak havoc on cartel profits, while saving American taxpayers millions of dollars in unnecessary incarceration costs, treatment needs to be made as accessible as it is for other chronic conditions

One-in-ten American families has lost an immediate family member to a drug overdose. The dead are our brothers, sisters, husbands, wives, children and newborns. The sooner we recognize that our policies result in more deaths and more persons in pain, the sooner we will bring this self-inflicted massacre to a close. 

A graduate of Princeton University and Harvard Medical School, Charles W. LeBaron, MD, is board certified in both internal medicine and pediatrics. For more than 28 years, he worked as a medical epidemiologist at the CDC.  

Dr. LeBaron’s book “Greed to Do Good: The Untold Story of CDC’s Disastrous War on Opioids” can be purchased from online booksellers or the publisher (Amplify Publishing in Herndon VA). For book reviews, see Kirkus or BlueInk.

Long Covid Patients Frustrated by Lack of New Treatments

By Sarah Boden, KFF Health News

Erica Hayes, 40, has not felt healthy since November 2020 when she first fell ill with covid.

Hayes is too sick to work, so she has spent much of the last four years sitting on her beige couch, often curled up under an electric blanket.

“My blood flow now sucks, so my hands and my feet are freezing. Even if I’m sweating, my toes are cold,” said Hayes, who lives in Western Pennsylvania. She misses feeling well enough to play with her 9-year-old son or attend her 17-year-old son’s baseball games.

Along with claiming the lives of 1.2 million Americans, the covid-19 pandemic has been described as a mass disabling event. Hayes is one of millions of Americans who suffer from long covid.

Depending on the patient, the condition can rob someone of energy, scramble the autonomic nervous system, or fog their memory, among many other symptoms.

In addition to the brain fog and chronic fatigue, Hayes’ constellation of symptoms includes frequent hives and migraines. Also, her tongue is constantly swollen and dry.

“I’ve had multiple doctors look at it and tell me they don’t know what’s going on,” Hayes said about her tongue. 

ERICA HAYES

Estimates of prevalence range considerably, depending on how researchers define long covid in a given study, but the Centers for Disease Control and Prevention puts it at 17 million adults.

Despite long covid’s vast reach, the federal government’s investment in researching the disease — to the tune of $1.15 billion as of December — has so far failed to bring any new treatments to market. 

This disappoints and angers the patient community, who say the National Institutes of Health should focus on ways to stop their suffering instead of simply trying to understand why they’re suffering.

“It’s unconscionable that more than four years since this began, we still don’t have one FDA-approved drug,” said Meighan Stone, executive director of the Long COVID Campaign, a patient-led advocacy organization. Stone was among several people with long covid who spoke at a workshop hosted by the NIH in September where patients, clinicians, and researchers discussed their priorities and frustrations around the agency’s approach to long-covid research.

Some doctors and researchers are also critical of the agency’s research initiative, called RECOVER, or Researching COVID to Enhance Recovery. Without clinical trials, physicians specializing in treating long covid must rely on hunches to guide their clinical decisions, said Ziyad Al-Aly, chief of research and development with the VA St Louis Healthcare System.

“What [RECOVER] lacks, really, is clarity of vision and clarity of purpose,” said Al-Aly, saying he agrees that the NIH has had enough time and money to produce more meaningful progress.

Now the NIH is starting to determine how to allocate an additional $662 million of funding for long-covid research, $300 million of which is earmarked for clinical trials. These funds will be allocated over the next four years. At the end of October, RECOVER issued a request for clinical trial ideas that look at potential therapies, including medications, saying its goal is “to work rapidly, collaboratively, and transparently to advance treatments for Long COVID.”

This turn suggests the NIH has begun to respond to patients. This has stirred cautious optimism among those who say that the agency’s approach to long covid has lacked urgency in the search for effective treatments. Stone calls this $300 million a down payment. She warns it’s going to take a lot more money to help people like Hayes regain some degree of health.“There really is a burden to make up this lost time now,” Stone said.

The NIH told KFF Health News and NPR via email that it recognizes the urgency in finding treatments. But to do that, there needs to be an understanding of the biological mechanisms that are making people sick, which is difficult to do with post-infectious conditions.

That’s why it has funded research into how long covid affects lung function, or trying to understand why only some people are afflicted with the condition.

Good Science Takes Time

In December 2020, Congress appropriated $1.15 billion for the NIH to launch RECOVER, raising hopes in the long-covid patient community.

Then-NIH Director Francis Collins explained that RECOVER’s goal was to better understand long covid as a disease and that clinical trials of potential treatments would come later.

According to RECOVER’s website, it has funded eight clinical trials to test the safety and effectiveness of an experimental treatment or intervention. Just one of those trials has published results.

On the other hand, RECOVER has supported more than 200 observational studies, such as research on how long covid affects pulmonary function and on which symptoms are most common. And the initiative has funded more than 40 pathobiology studies, which focus on the basic cellular and molecular mechanisms of long covid.

RECOVER’s website says this research has led to crucial insights on the risk factors for developing long covid and on understanding how the disease interacts with preexisting conditions. It notes that observational studies are important in helping scientists to design and launch evidence-based clinical trials.

Good science takes time, said Leora Horwitz, the co-principal investigator for the RECOVER-Adult Observational Cohort at New York University. And long covid is an “exceedingly complicated” illness that appears to affect nearly every organ system, she said. 

This makes it more difficult to study than many other diseases. Because long covid harms the body in so many ways, with widely variable symptoms, it’s harder to identify precise targets for treatment.

“I also will remind you that we’re only three, four years into this pandemic for most people,” Horwitz said. “We’ve been spending much more money than this, yearly, for 30, 40 years on other conditions.”

NYU received nearly $470 million of RECOVER funds in 2021, which the institution is using to spearhead the collection of data and biospecimens from up to 40,000 patients. Horwitz said nearly 30,000 are enrolled so far.

This vast repository, Horwitz said, supports ongoing observational research, allowing scientists to understand what is happening biologically to people who don’t recover after an initial infection — and that will help determine which clinical trials for treatments are worth undertaking.

“Simply trying treatments because they are available without any evidence about whether or why they may be effective reduces the likelihood of successful trials and may put patients at risk of harm,” she said.

‘I’m Just Disgusted’

The NIH told KFF Health News and NPR that patients and caregivers have been central to RECOVER from the beginning, “playing critical roles in designing studies and clinical trials, responding to surveys, serving on governance and publication groups, and guiding the initiative.” But the consensus from patient advocacy groups is that RECOVER should have done more to prioritize clinical trials from the outset. Patients also say RECOVER leadership ignored their priorities and experiences when determining which studies to fund.

RECOVER has scored some gains, said JD Davids, co-director of Long COVID Justice. This includes findings on differences in long covid between adults and kids. But Davids said the NIH shouldn’t have named the initiative “RECOVER,” since it wasn’t designed as a streamlined effort to develop treatments.

“The name’s a little cruel and misleading,” he said.

RECOVER’s initial allocation of $1.15 billion probably wasn’t enough to develop a new medication to treat long covid, said Ezekiel J. Emanuel, co-director of the University of Pennsylvania’s Healthcare Transformation Institute.

But, he said, the results of preliminary clinical trials could have spurred pharmaceutical companies to fund more studies on drug development and test how existing drugs influence a patient’s immune response.

Emanuel is one of the authors of a March 2022 covid roadmap report. He notes that RECOVER’s lack of focus on new treatments was a problem. “Only 15% of the budget is for clinical studies. That is a failure in itself — a failure of having the right priorities,” he told KFF Health News and NPR via email.

And though the NYU biobank has been impactful, Emanuel said there needs to be more focus on how existing drugs influence immune response.

He said some clinical trials that RECOVER has funded are “ridiculous,” because they’ve focused on symptom amelioration, for example to study the benefits of over-the-counter medication to improve sleep. Other studies looked at non-pharmacological interventions, such as exercise and “brain training” to help with cognitive fog.

People with long covid say this type of clinical research contributes to what many describe as the “gaslighting” they experience from doctors, who sometimes blame a patient’s symptoms on anxiety or depression, rather than acknowledging long covid as a real illness with a physiological basis.

“I’m just disgusted,” said long-covid patient Hayes. “You wouldn’t tell somebody with diabetes to breathe through it.”

Chimére L. Sweeney, director and founder of the Black Long Covid Experience, said she’s even taken breaks from seeking treatment after getting fed up with being told that her symptoms were due to her diet or mental health.

“You’re at the whim of somebody who may not even understand the spectrum of long covid,” Sweeney said.

Insurance Battles Over Experimental Treatments

Since there are still no long-covid treatments approved by the Food and Drug Administration, anything a physician prescribes is classified as either experimental — for unproven treatments — or an off-label use of a drug approved for other conditions. This means patients can struggle to get insurance to cover prescriptions.

Michael Brode, medical director for UT Health Austin’s Post-COVID-19 Program — said he writes many appeal letters. And some people pay for their own treatment.

For example, intravenous immunoglobulin therapy, low-dose naltrexone, and hyperbaric oxygen therapy are all promising treatments, he said.

For hyperbaric oxygen, two small, randomized controlled studies show improvements for the chronic fatigue and brain fog that often plague long-covid patients. The theory is that higher oxygen concentration and increased air pressure can help heal tissues that were damaged during a covid infection.

However, the out-of-pocket cost for a series of sessions in a hyperbaric chamber can run as much as $8,000, Brode said.

“Am I going to look a patient in the eye and say, ‘You need to spend that money for an unproven treatment’?” he said. “I don’t want to hype up a treatment that is still experimental. But I also don’t want to hide it.”

There’s a host of pharmaceuticals that have promising off-label uses for long covid, said microbiologist Amy Proal, president and chief scientific officer at the Massachusetts-based PolyBio Research Foundation. For instance, she’s collaborating on a clinical study that repurposes two HIV drugs to treat long covid.

Proal said research on treatments can move forward based on what’s already understood about the disease. For instance, she said that scientists have evidence — partly due to RECOVER research — that some patients continue to harbor small amounts of viral material after a covid infection. She has not received RECOVER funds but is researching antivirals.

But to vet a range of possible treatments for the millions suffering now — and to develop new drugs specifically targeting long covid — clinical trials are needed. And that requires money.

Hayes said she would definitely volunteer for an experimental drug trial. For now, though, “in order to not be absolutely miserable,” she said she focuses on what she can do, like having dinner with her family. At the same time, Hayes doesn’t want to spend the rest of her life on a beige couch. 

RECOVER’s deadline to submit research proposals for potential long-covid treatments is Feb. 1.

(Update: The Trump administration recently ordered an “immediate pause” on all communications, reports, scientific meetings, and funding reviews by federal health agencies. It’s not clear how long the order will last or affect long covid research.)

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

How I Set Up My Daily Life To Manage Chronic Pain

By Crystal Lindell

I’ve been dealing with severe chronic pain for more than a decade now, most of which is due to the intercostal neuralgia I have in my ribs. So, at this point, my entire life is basically set up to accommodate that. 

While some people may read that paragraph and assume that I have a sad life consumed by pain, I prefer to think of it as my way of fighting back. 

By planning for and accepting my pain, I can live without added stress and burdens. As a result, I don’t let my pain lead – instead I get to lead my pain. 

My daily schedule is flexible, so that I can adjust it to my pain as I’m able, doing more when I can and resting when I need to. I keep things as stress-free as possible because stress escalates my pain. And I try to work with my body instead of against it. 

So what does that look like on a typical day in my life?

Well, I usually wake up for the first time at around 4:30 am to the sound of my orange cat Goose screaming at the top of his lungs because he’s hungry. I take a second to see how much my back hurts today and decide the best method for getting out of bed. My goal is always to get out of bed without needing help from my fiancé Chris.

Then I go to the kitchen to feed Goose and our other three cats – Princess D, Basil, and Goldie. I love them, so they get wet food before I even eat my own morning breakfast: Two Advil; one pain pill; a spoonful of kratom washed down with orange Gatorade; and a cup of hot coffee. 

I go to sleep at about 8 pm most nights, so I check my phone first thing to catch up on any messages I get from loved ones overnight. I also throw the news on our TV so I can catch up on the slew of horrible things that likely happened in the world overnight. 

After “breakfast” I lay out a yoga mat and grab my pillow so I can lay on the floor for a bit as the news continues in the background. There’s something about laying on the ground that helps alleviate the vicious back pain I’ve been dealing with ever since throwing out my back a few weeks ago.

Anytime I try to skip this new floor ritual, I regret it, so I have now built it into my daily schedule to stare at the ceiling multiple times a day. Our black cat Basil always curiously crawls around my head wondering what I’m doing in her realm of the house – the floor. 

Then I get the food dishes ready for the outside cats that I take care of and run those outside to help them survive the long, cold Midwest winter. 

Depending on how busy my day ahead is, I’ll then sometimes lay down for another hour or so while letting my morning medication cocktail kick in. 

When I get back up, I make another cup of coffee, which usually ends up sitting half-finished on our coffee table until it gets cold and I give up on it. Despite the fact that this happens almost every day, I still keep making that second cup of coffee thinking today will be the day I finally finish it.

I don’t work full time in large part due to my health, so I don’t have to get ready to leave the house most days. But that doesn’t mean I just sit around watching TikTok all day. I make ends meet by doing freelance writing work, and by running an online Lego store with Chris via a website called Bricklink. 

If I have writing assignments due, I start mulling that over in my brain, while simultaneously checking in on our Bricklink store to see if any orders came in overnight. Chris handles most of the packing and shipping, but if we are especially busy, I jump in and help pull orders. 

Because my rib pain gets worse the longer I’m awake, I also try to cook any food for the day in the morning because cooking is a very draining task in and of itself. That means I’ll often start a pot of soup or a casserole by 9 a.m. Personally, I actually like dinner food for breakfast, so depending on how long that takes to make, I’ll generally have a serving to start my day. 

I also try to make double batches of any meals, and then freeze them in a portion-size silicone ice cube tray to essentially make my own homemade frozen dinners. That way, when I’m having an especially bad pain day, I have quick meal options. 

After cooking, I head to my couch and figure out the rest of my plans for the day.

This time of year, when the temperatures here in northern Illinois are almost always below freezing, I do a lot of life from my couch under a heated blanket, with our long-hair tortoiseshell cat Princess D on my shoulder. 

Sometimes that means I even do some writing directly on my phone, if I’m in too much pain to pull out my laptop. 

After a few hours of work, I usually have another round of ibuprofen, prescription pain meds, and kratom in the afternoon with my lunch, which is often another serving of whatever food I made that morning. 

CRYSTAL AND PRINCESS D

Then I’ll try to shower. I don’t know if it’s because of the way that I have to move my arms to wash my hair or because there’s just a lot of standing involved, but showers genuinely wipe me out, so I have to set aside time to both take a shower and then recover for a bit on the couch.  After I get dressed, I have to lay on the floor again for about 15 minutes for my back. 

Most days I wear extremely comfortable clothing because I can’t risk any additional discomfort to my ailing body. So if I’m staying home for the day I’ll just directly opt for pajamas, but if I’m visiting my mom — who lives a couple blocks away — I’ll throw on some lounge pants and T-shirt.

In both cases though, I’ll also throw on some compression socks just to keep my feet from swelling up because of all the ibuprofen I take. 

I’ll also throw on some very light makeup just to give myself a little pick me up. Then, I will often run over to my mom’s house to drop off some food for her and my grandma to eat for dinner.

After I get home, I’ll spend time catching up on social media, which helps me feel like I have a social life despite the fact that I spend most of my time at home. 

I also am still trying to avoid catching COVID because I don’t want to risk adding to my health issues, so I limit my time at large social gatherings as much as possible. That means most of my communication with loved ones is via text and the occasional FaceTime call. 

So I take some time in the later afternoon on the couch, while Chris rubs my feet, to catch up with people I care about while also playing the daily New York Times Connections and Wordle Games. 

Part of running the Bricklink store means that, aside from pulling orders, our other big task is adding Lego parts to our inventory, so I try to work on that in the evening before feeding the cats dinner and then winding down the night. 

Then, like I said, I’m in bed by about 8 pm because dealing with chronic pain is exhausting. So after one last round of Advil, pain medication, and kratom, I’ll get under the heated blanket in our bed and scroll social media on my phone for a bit before falling asleep with our tabby cat Goldie cuddled up next to my head.

I could see how a healthy person might read this day-in-the-life story and come away thinking I have a pretty plain existence. But I love spending my days in my cozy, small-town apartment, cuddling my cats on-demand and running an online Lego store with my fiancé. 

It’s back when I was trying to pretend that pain didn’t exist that I was miserable, constantly overdoing it, and ending up either in the emergency room sobbing in pain, or at home awake all night with pain-somnia. 

Pain forces you to go with the flow, to embrace the world as it is and work with it, instead of against it. It’s only when I accepted that fact, that I found true happiness. 

Note: Pain News Network makes a small commission on any Amazon links in this article. 

Where Have All the Pain Doctors Gone?

By Pat Anson

In recent years, it’s become increasingly difficult for a patient in pain to find a new doctor. Many physicians have stopped treating pain, retired early or switched specialties, rather than run the risk of being investigated or even put in prison for prescribing opioids.

In a recent PNN survey, one in five patients said they couldn’t find a doctor to treat their pain. Others said they were abandoned or discharged by a physician (12%) or had a doctor who retired from clinical practice (14%).   

“All the doctors in this area are justifiably terrified to involve themselves at all with opiates,” one patient told us. “It's now going on 6 months that I've been hunting for a doctor who isn't afraid to continue my former opiate regimen, which only made my pain tolerable, allowing me some small quality of life. I don't know what to do next and I am truly at my wits end.”

“This year my doctor retired, then 8 months later the hospital closed the pain clinic. I'm waiting to get into a new pain clinic that is 200 miles away. Every local doctor refuses to prescribe my pain meds, so now I'm forced to travel 4 hours each way to see a new doctor,” another patient said.

“I have to fly to another state for my medical care,” said another person in pain. “Many patients I’ve met over the last ten years have not had the same care. They can’t afford the medical treatment and can’t find doctors to help.”

A new study suggests the problem is only going to get worse, because medical schools are seeing fewer anesthesiology residents applying for fellowships in pain medicine. The number of applications fell 45% from 2019 to 2023.

“While the demand for pain specialists is growing in the U.S., the pipeline of new doctors to fill these roles is drying up,” says lead author Scott Pritzlaff, MD, an associate professor in the UC Davis Department of Anesthesiology and Pain Medicine and director of the school’s Pain Medicine Fellowship program.

Pritzlaff and his colleagues analyzed data from the National Resident Matching Program (NRMP), Electronic Residency Application Service (ERAS) and a special report from the American Association of Medical Colleagues (AAMC) to see trends in medical specialties.

Their findings, recently published in the journal Pain Practice, show significant changes in specialties that are being driven by market forces and professional preferences. While demand and pay scales for general anesthesiologists have increased, the number of anesthesiology trainees applying for pain medicine fellowships is dropping. The trend is most notable among female residents applying for the specialty, which has fallen by 27.5%, compared to a 9.8% decline in male applicants.

“Fewer doctors choosing pain medicine means longer wait times, rushed care and fewer treatment options for patients suffering from chronic pain,” Pritzlaff said. “In a country already grappling with an opioid crisis, this could leave millions without the specialized care they need to manage their pain safely and effectively.”

Co-author Chinar Sanghvi, MD, says the drop in applications is partially driven by opioid lawsuits against drug makers and criminal cases against doctors, which have made medical residents and trainees leery about practicing pain medicine.

“For trainees observing this during their formative years, it may have created a perception of pain medicine as a high-risk specialty — both legally and ethically,” said Sanghvi, an assistant clinical professor in the UC Davis Department of Anesthesiology who mentors first and second year-medical students. “This fear of litigation, coupled with the stigma surrounding opioid prescribing, could discourage aspiring physicians from entering the field.”

The data also revealed some upward trends. Applications from residents for physical medicine and rehabilitation fellowships rose almost 33%, while residents specializing in emergency medicine increased by 190%.

General anesthesiologists have some of the best paying jobs in medicine, with median salaries of nearly $499,000 a year. For an anesthesiologist to specialize in pain medicine requires an additional year of training and pays less. With high demand and higher salaries, many doctors skip the extra training and enter the workforce right after completing their anesthesiology residency.

To help attract new residents, the UC Davis Health Division of Pain Medicine increased its recruiting efforts and became more active on social media. The efforts helped UC Davis fill its fellowship slots in pain medicine despite the national downturn.

“Pain medicine is caught in a strange paradox. On one hand, pain is one of the biggest public health problems in America, costing billions annually. On the other, the field is underappreciated and underfunded,” said senior author David Copenhaver, MD, a professor in the UC Davis Department of Anesthesiology and Pain Medicine and chief of the Division of Pain Medicine. “This decline isn’t just about numbers — it’s a wake-up call for the future of pain care in America.”

Trump’s Early Moves Could Raise Drug Costs and Reduce Insurance Coverage

By Julie Appleby and Stephanie Armour, KFF Health News

President Donald Trump’s early actions on health care signal his likely intention to wipe away some Biden-era programs to lower drug costs and expand coverage under public insurance programs.

The orders he issued soon after reentering the White House have policymakers, health care executives, and patient advocates trying to read the tea leaves to determine what’s to come. The directives, while less expansive than orders he issued at the beginning of his first term, provide a possible road map that health researchers say could increase the number of uninsured Americans and weaken safety-net protections for low-income people.

However, Trump’s initial orders will have little immediate impact. His administration will have to take further regulatory steps to fully reverse Biden’s policies, and the actions left unclear the direction the new president aims to steer the U.S. health care system.

“Everyone is looking for signals on what Trump might do on a host of health issues. On the early EOs, Trump doesn’t show his cards,” said Larry Levitt, executive vice president for health policy at KFF, the health policy research, polling, and news organization that includes KFF Health News.

A flurry of executive orders and other actions Trump issued on his first day back in office included rescinding directives by his predecessor, former President Joe Biden, that had promoted lowering drug costs and expanding coverage under the Affordable Care Act and Medicaid.

Executive orders “as a general matter are nothing more than gussied up internal memoranda saying, ‘Hey, agency, could you do something?’” said Nicholas Bagley, a law professor at the University of Michigan. “There may be reason to be concerned, but it’s down the line.”

That’s because making changes to established law like the ACA or programs like Medicaid generally requires new rulemaking or congressional action, either of which could take months.

Trump has yet to win Senate confirmation for any of his picks to lead federal health agencies, including Robert F. Kennedy Jr., the anti-vaccine activist and former Democratic presidential candidate he has nominated the lead the Department of Health and Human Services. On Monday, he appointed Dorothy Fink, a physician who directs the HHS Office on Women’s Health, as acting secretary for the department.

During Biden’s term, his administration did implement changes consistent with his health orders, including lengthening the enrollment period for the ACA, increasing funding for groups that help people enroll, and supporting the Inflation Reduction Act, which boosted subsidies to help people buy coverage. After falling during the Trump administration, enrollment in ACA plans soared under Biden, hitting record highs each year. More than 24 million people are enrolled in ACA plans for 2025.

The drug order Trump rescinded called on the Centers for Medicare & Medicaid Services to test ways to lower drug costs, such as setting a flat $2 copay for some generic drugs in Medicare, the health program for people 65 and older, and having states try to get better prices by banding together to buy certain expensive cell and gene therapies.

That might indicate Trump expects to do less on drug pricing this term or even roll back drug price negotiation in Medicare.

The White House did not respond to a request for comment.

Biden’s experiments in lowering drug prices didn’t fully get off the ground, said Joseph Antos of the American Enterprise Institute, a right-leaning research group. Antos said he’s a bit puzzled by Trump’s executive order ending the pilot programs, given that he has backed the idea of tying drug costs in the U.S. to lower prices paid by other nations.

“As you know, Trump is a big fan of that,” Antos said. “Lowering drug prices is an easy thing for people to identify with.”

In other moves, Trump also rescinded Biden orders on racial and gender equity and issued an order asserting that there are only two sexes, male and female. HHS under the Biden administration supported gender-affirming health care for transgender people and provided guidance on civil rights protections for transgender youths. Trump’s missive on gender has intensified concerns within the LGBTQ+ community that he will seek to restrict such care.

“The administration has forecast that it will fail to protect and will seek to discriminate against transgender people and anyone else it considers an ‘other,’” said Omar Gonzalez-Pagan, senior counsel and health care strategist at Lambda Legal, a civil rights advocacy group.

“We stand ready to respond to the administration’s discriminatory acts, as we have previously done to much success, and to defend the ability of transgender people to access the care that they need, including through Medicaid and Medicare.”

Trump also halted new regulations that were under development until they are reviewed by the new administration. He could abandon some proposals that were yet to be finalized by the Biden administration, including expanded coverage of anti-obesity medications through Medicare and Medicaid and a rule that would limit nicotine levels in tobacco products, Katie Keith, a Georgetown University professor who was deputy director of the White House Gender Policy Council under Biden, wrote in an article for Health Affairs Forefront.

“Interestingly, he did not disturb President Biden’s three executive orders and a presidential memorandum on reproductive health care,” she wrote.

However, Trump instructed top brass in his administration to look for additional orders or memorandums to rescind. (He revoked the Biden order that created the Gender Policy Council.)

Democrats criticized Trump’s health actions. A spokesman for the Democratic National Committee, Alex Floyd, said in a statement that “Trump is again proving that he lied to the American people and doesn’t care about lowering costs — only what’s best for himself and his ultra-rich friends.”

Medicaid Cuts

Trump’s decision to end a Biden-era executive order aimed at improving the ACA and Medicaid probably portends coming cuts and changes to both programs, some policy experts say. His administration previously opened the door to work requirements in Medicaid — the federal-state program for low-income adults, children, and people with disabilities — and previously issued guidance enabling states to cap federal Medicaid funding. Medicaid and the related Children’s Health Insurance Program cover more than 79 million people.

“Medicaid will be a focus because it’s become so sprawling,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative policy group. “It’s grown after the pandemic. Provisions have expanded, such as using social determinants of health.”

The administration may reevaluate steps taken by the Biden administration to allow Medicaid to pay for everyday expenses some states have argued affect its beneficiaries’ health, including air conditioners, meals, and housing.

One of Trump’s directives orders agencies to deliver emergency price relief and “eliminate unnecessary administrative expenses and rent-seeking practices that increase healthcare costs.” (Rent-seeking is an economic concept describing efforts to exploit the political system for financial gain without creating other benefits for society.)

“It is not clear what this refers to, and it will be interesting to see how agencies respond,” Keith wrote in her Health Affairs article.

Policy experts like Edwin Park at Georgetown University have also noted that, separately, Republicans are working on budget proposals that could lead to large cuts in Medicaid funding, in part to pay for tax cuts.

Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a left-leaning research group, also pointed to Congress: “On one hand, what we see coming from the executive orders by Trump is important because it shows us the direction they are going with policy changes. But the other track is that on the Hill, there are active conversations about what goes into budget legislation. They are considering some pretty huge cuts to Medicaid.”

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

Walgreens Joins CVS in Fighting DOJ Opioid Lawsuits

By Crystal Lindel

Walgreens is fighting back against a new Department of Justice lawsuit, using a tactic that mirrors CVS’s public response to a similar DOJ lawsuit filed last month. 

In both lawsuits, the DOJ claims that Walgreens and CVS knowingly filled “unlawful prescriptions” for opioids and other controlled substances, and then sought reimbursement for them from federal healthcare programs like Medicaid and Medicare.

CVS and Walgreens are also accused of pressuring their pharmacists into filling prescriptions for opioids and other controlled substances without a thorough review. 

In a statement however, Walgreens said many of the federal rules governing pharmacies are so vague as to be impossible to follow. 

“We are asking the court to clarify the responsibilities of pharmacies and pharmacists and to protect against the government’s attempt to enforce arbitrary ‘rules’ that do not appear in any law or regulation and never went through any official rulemaking process,” Walgreens said. “We will not stand by and allow the government to put our pharmacists in a no-win situation, trying to comply with ‘rules’ that simply do not exist.

“Walgreens stands behind our pharmacists, dedicated healthcare professionals who live in the communities they serve, filling legitimate prescriptions for FDA-approved medications written by DEA-licensed prescribers in accordance with all applicable laws and regulations.”

Both CVS and Walgreens are accused of filling prescriptions for “dangerous and excessive quantities of opioids,” filling prescriptions too early, and filling prescriptions for opioids, benzodiazepines and muscle relaxants, a three-drug combination known as the “Holy Trinity” that the feds consider dangerous.

The DOJ alleges that, from 2012 through the present, Walgreens knowingly filled millions of prescriptions for controlled substances that lacked a “legitimate medical purpose, were not valid, and/or were not issued in the usual course of professional practice.” The complaint against CVS is nearly identical.

It’s noteworthy that the DOJ claims that both Walgreens and CVS have been filling these prescriptions “through the present,” because when it comes to getting an opioid prescription filled, pain patients find CVS and Walgreens to be the two most difficult pharmacies to work with. 

In 2023, PNN conducted a large survey of nearly 3,000 pain patients, and when respondents were asked which pharmacy chain was the most difficult to get an opioid prescription filled, more than half the patients in our survey selected either Walgreens (30%) or CVS (26%). 

“Every month when I have to get my medication renewed there is always an issue,” explained one patient. “Walgreens always give people a hard time. I've seen many people standing in line and just walk out.” 

“CVS continually gives me a hard time to fill my Rx even though I have been on it for over 7 years. It is either out of stock, or they argue with me about filling it,” another patient told us.

That difficulty is likely tied to the fact that Walgreens and CVS signed the National Opioid Settlement in 2022. As part of the settlement, they agreed to pay more than $10 billion to states, cities and counties that sued them for their alleged roles in causing the opioid epidemic. 

The nation’s two biggest pharmacy chains also agreed to watch for suspicious orders, report any “problematic” prescribers, and to strictly limit the amount of opioid pain medication they can dispense in any given month.

Opioids, in effect, are now being rationed to their customers, yet the DOJ is claiming that both pharmacies continue to fill opioid prescriptions too easily. 

As a pain patient, I use a small local pharmacy specifically to avoid the issues that are common for patients at large pharmacy chains like Walgreens and CVS. However, that alone doesn’t protect me. When the DOJ goes after large pharmacies, the fear trickles down to the smaller ones as well. 

Nearly every month I have some issue getting my prescription filled. They claim they can’t find the prescription in their system, and only “find it” after I go back and forth with them and my doctor on multiple phone calls. Or they claim it’s out of stock, which unfortunately I have no way of checking to see if they’re telling the truth. 

Just yesterday I spent all day trying to get my pain medication refilled because the pharmacist claimed she accidentally deleted it from the system. I had to get my doctor to resend it. 

Dealing with chronic pain is a struggle in and of itself. The last thing pain patients need is another battle to fight at the pharmacy. If Walgreens and CVS are unsuccessful in fighting back against their respective DOJ lawsuits, it’s likely that pain patients will suffer even more as a result. 

RFK Jr. Wants to Create Drug Rehab ‘Wellness Farms’

By Pat Anson

Confirmation hearings for Robert F. Kennedy Jr., President Trump’s nominee to be Secretary of Health and Human Services, are expected to begin next week, with senators likely to ask about his controversial views on vaccines, fluoride, abortion and other hot-button health issues.  

Less well known is Kennedy’s ambitious plan for drug rehabilitation “wellness farms” for people addicted to illicit drugs or prescription medications such as opioids, antidepressants, stimulants and anti-anxiety medications. Kennedy outlined his plans to treat addiction and “re-parent” people with substance use problems during a “Latino Town Hall” last July, when he was running for president and had yet to endorse Trump.

“I’m going to make it so people can go, if you’re convicted of a drug offense, or if you have a drug problem, you can go to one of these places for free,” said Kennedy, adding that he would pay for the wellness farms with a tax on cannabis sales, if and when marijuana is removed as a prohibited Schedule One controlled substance.    

“I’m going to move it off Schedule One and I’m going to start collecting taxes on it. That’s going to bring in $8.5 billion dollars in revenue. I’m going to dedicate that revenue to creating wellness farms, drug rehabilitation farms, in rural areas all over this country.”

Kennedy released a documentary called “Recovering America” last year, in which he tours the country looking for innovative drug treatment programs. The issue is close to his heart because Kennedy was addicted to heroin as a young man. He’s been in recovery for 40 years and regularly attends 12-step meetings.

“We have a whole generation of kids who are dispossessed, they’re alienated, they’re marginalized, their suicide rates are exploding. The second largest killer for young people is drug addiction,” Kennedy said.

“I’m going to create these wellness farms where they can go to get off of illegal drugs, off of opiates, but also legal drugs, psychiatric drugs, if they want to, to get off of SSRIs, to get off of benzos, to get off of Adderall, and to spend time, as much time as they need — three or four years if they need it — to learn to get re-parented, to reconnect with communities, to understand how to talk to people.”

Participants at the wellness farms would also receive job training and grow their own organic food. Kennedy has long blamed pesticides and processed food for America’s “chronic disease epidemic.”

If confirmed as HHS secretary, Kennedy would oversee a vast bureaucracy and supervise agencies such as the Food and Drug Administration, Centers for Medicare and Medicaid Services, National Institutes of Health, and the Centers for Disease Control and Prevention.

It’s not clear what his views are about the CDC’s opioid guideline, which led to many patients in pain losing access to opioids. But Kennedy has been outspoken about the influence drug makers and lobbyists have on public health policy, saying Trump gave him instructions to end the “corruption and the conflicts” at federal health agencies.

“FDA’s war on public health is about to end,” Kennedy wrote in an October 25 tweet. “If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.”

Trump also said he would let Kennedy “go wild” on healthcare, but according to Politico, his transition team is intent on surrounding RFK Jr. at HHS with conservative aides who have more experience in government and remain loyal to Trump.

The Washington Post reported that the Office of Government Ethics is still looking into Kennedy's financial disclosure statements, which were recently amended. That may delay his confirmation hearings until late January.

Anxiety Medications Decline in States Where Marijuana Is Legal

By Ashley Bradford

In states where both medical and recreational marijuana are legal, fewer patients are filling prescriptions for medications used to treat anxiety. That is the key finding of my recent study, published in the journal JAMA Network Open.

I am an applied policy researcher who studies the economics of risky behaviors and substance use within the United States. My collaborators and I wanted to understand how medical and recreational marijuana laws and marijuana dispensary openings have affected the rate at which patients fill prescriptions for anti-anxiety medications among people who have private medical insurance.

These include:

• Benzodiazepines, which work by increasing the level of gamma-aminobutyric acid, or GABA, a neurotransmitter that elicits a calming effect by reducing activity in the nervous system. This category includes the depressants Valium, Xanax and Ativan, among others.

• Antipsychotics, a class of drug that addresses psychosis symptoms in a variety of ways.

• Antidepressants, which relieve symptoms of depression by affecting neurotransmitters such as serotonin, norepinephrine and dopamine. The most well-known example of these is selective serotonin re-uptake inhibitors, or SSRIs.

We also included barbiturates, which are sedatives, and sleep medications – sometimes called “Z-drugs” – both of which are used to treat insomnia. In contrast to the other three categories, we did not estimate any policy impacts for either of these types of drugs.

We find consistent evidence that increased marijuana access is associated with reductions in benzodiazepine prescription fills. “Fills” refer to the number of prescriptions being picked up by patients, rather than the number of prescriptions doctors write. This is based on calculating the rate of individual patients who filled a prescription in a state, the average days of supply per prescription fill, and average prescription fills per patient.

Notably, we found that not all state policies led to similar changes in prescription fill patterns.

Why It Matters

In 2021, nearly 23% of the adult U.S. population reported having a diagnosable mental health disorder. Yet only 65.4% of those individuals reported receiving treatment within the past year. This lack of treatment can exacerbate current mental health disorders, leading to increased risk for additional chronic conditions.

Marijuana access introduces an alternative treatment to traditional prescription medication that may provide easier access for some patients. Many state medical laws allow patients with mental health disorders such as post-traumatic stress disorder, or PTSD, to use medical cannabis, while recreational laws expand access to all adults.

Our findings have important implications for insurance systems, prescribers, policymakers and patients. Benzodiazepine use, like opioid use, can be dangerous for patients, especially when the two classes of drugs are used together. Given the high level of opioid poisonings that also involve benzodiazepines – in 2020, they made up 14% of total opioid overdose deaths – our findings offer insights into potential substitution with marijuana for medications where misuse is plausible.

What Still Isn’t Known

Our research does not clarify whether the changes in dispensing patterns led to measurable changes in patient outcomes.

There is some evidence that marijuana acts as an effective anxiety treatment. If this is the case, moving away from benzodiazepine use – which is associated with significant negative side effects – toward marijuana use may improve patient outcomes.

This finding is critical given that about 5% of the U.S. population is prescribed benzodiazepines. Substituting marijuana has the potential to result in fewer negative side effects nationwide, but it’s not yet clear if marijuana will be equally effective at treating anxiety.

Our study also found evidence of a slight – albeit somewhat less significant – increase in antipsychotic and antidepressant dispensing. But it’s not clear yet whether marijuana access, particularly recreational access, increases rates of psychotic disorders and depression.

While we found that, overall, marijuana access led to increased antidepressant and antipsychotic fills, some individual states saw decreases.

There is a lot of variation in the details of state marijuana laws, and it’s possible that some of those details are leading to these meaningful differences in outcomes. I believe this difference in outcomes from state to state is an important finding for policymakers who may want to tailor their laws toward specific goals.

Ashley Bradford, PhD, is an Assistant Professor of Public Policy at the Georgia Institute of Technology. Her research focuses on how public policies shape health outcomes within the United States.

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

Medical Schools Do a Poor Job Teaching About Disability

By Crystal Lindell

Medical schools don’t teach their students well about disability, which can have negative effects for both disabled patients and disabled medical students, according to a new study published in the Journal of General Internal Medicine.

Researchers found that medical school curriculum often treats disability as a problem, leading students to make negative assumptions about the health and quality of life of people with disabilities. That makes them ill-prepared for treating disabled patients.

The overall attitude also results in fewer disabled people becoming doctors.

“Doctors do not know how to care for people with disabilities because they never learned,” lead author Carol Haywood, PhD, assistant professor at Northwestern University’s Feinberg School of Medicine, said in a press release.

“Ultimately, our work reveals how medical education may be playing a critical role in creating and perpetuating ideas that people with disabilities are uncommon and unworthy in health care.”

Haywood and her colleagues hosted virtual focus groups for both medical school faculty and students. They found four recurring themes in the discussions:

1. Disability is often neglected in medical education 

Participants said disability was only mentioned in select lectures and elective coursework, largely relegating the training to students and faculty who are already familiar with or have a personal interest in disability. 

One faculty participant said: “The fact that [disability training] is not required, and it’s not seen as a core part of the medical school curriculum … reinforces the idea that these aren’t really your patients or they’re not important enough for you to learn about.”

2. Disability is often framed as a “problem” in medical school 

Most medical schools define disability as a condition where an individual is simply diagnosed and treated, rather than something rooted in physical barriers, social bias and stigmatization. 

One student said: “Just seeing how biases can be sort of continued on through generations of doctors … whether that means that thinking of disability as a tragedy or … a medical condition.”

3. Negative ideas about disability limit diversity in medicine 

Participants described a neglect of disability training as being part of a “hidden curriculum” in medical education that teaches students that disability does not belong in society. Students with disabilities are often viewed as weak or incapable of excelling in medical practice. 

One participant said: “We're just sending the message from the get-go that you’re not welcome, which is so damaging in every possible way.”

4. There’s an over-reliance on faculty and student-led efforts to cultivate change 

When their training fell short, faculty and students sought mentorship and communities to discuss and understand disability-related healthcare. 

One student said: “It’s hard to be mad at physicians …. Because they weren’t taught how to do it or taught to ask the questions, or it wasn’t emphasized.”

Insufficient support from institutional and licensing authorities has also stymied efforts to improve disability training. Disability is often not included in studies focused on mitigating healthcare disparity — despite well-known vulnerabilities of people with disabilities.

“While we have known about physician bias and discrimination against people with disabilities in health care for some years now, this new work emphasizes the need for medical schools and regulating bodies… to take on the responsibility of educating future physicians about the care of people with disabilities,” said co-author Tara Lagu, MD, adjunct professor of medicine and medical social sciences at Feinberg.

Improving disability-related medical education will require systemic reform, such as adding a “disability-competent” to medical education to make students more aware of abelism – a tendency to think that everyone has the same mental and physical abilities.

Other remedies include having disabled guest speakers share their experiences navigating the healthcare system; having physical therapists, occupational therapists and speech language pathologists discuss their treatment of people with disabilities; and having students participate in the care of disabled patients during patient rounds, physical exams, documentation, and clinical decision making.

Opioid Pain Medication Used Infrequently by NFL Players

By Pat Anson

As many football fans know, the odds of a National Football League player getting injured during a practice or game are high. A concussion, Achilles rupture, ligament tear or musculoskeletal injury can cause a player to miss a game or even an entire season.

Given the pressure to compete and be ready to play, perhaps it’s not surprising then that nearly 70% of NFL players were prescribed a pain medication during the 2021-2022 seasons.

What is surprising is the type of analgesics they were using.

A new study found that only 2.9% of the pain medications used by NFL players were opioids. The vast majority (86%) of medications, both prescribed and over-the-counter, were nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or diclofenac. Other non-opioids used by players were muscle relaxants, corticosteroids, gabapentin, acetaminophen and migraine medication.  

The study, recently published in Current Sports Medicine Reports, is based on data from a prescription drug monitoring program (PDMP) that was launched by the NFL in 2019 for all players.

“NFL athletes are exposed to very physical contact and to the development of pain during or after games due to injuries. There’s always been a concern from a safety and health perspective about what are they using to treat their pain,” said co-author Kurt Kroenke, MD, a researcher-clinician at the Regenstrief Institute and Indiana University School of Medicine.

“The good news is of all medicines prescribed to league players for pain, opioids account for only 3 percent. Moreover, only 10 percent of NFL athletes received even a single prescription for an opioid during a one-year period. I think there's been much greater attention to what can be done in the training room for NFL athletes for their injuries and pain that doesn't rely on medicines.”

The findings are remarkable, given the long history of opioid use in the NFL. A 2010 survey of retired players found that over half (52%) used prescription opioids during their careers, with 71% of them reporting misuse. Many continued to use opioids after they stopped playing, with 81% of the retired players reporting their chronic pain was moderate to severe.

Hall of Fame quarterback Brett Farve, an iron man who often played through injuries, admitted taking 15 hydrocodone (Vicodin) pills at a time, and even resorted to asking teammates for their pills.

The NFL’s laissez-faire attitude about opioids started to change after 1,800 former players sued the league in 2016, alleging that team doctors routinely disregarded DEA rules about controlled substances and encouraged players to use opioids and anti-inflammatory drugs.  It was not uncommon at the time for a player to get 6-7 pain pills or injections per week.

Injuries are still common in the NFL, but the league watches drug use much more closely. Every NFL player is tested for drugs at least once a year, usually before the season starts. The league also relaxed its policy about marijuana, effectively allowing players to consume cannabis during the off-season. Moderate consumption is tolerated during the season, as long as a player doesn’t have high levels of THC.   

“Professional football is a very physical sport. But anyone who watches professional hockey or NBA basketball or big league soccer and even college and high school sports, realizes how these players also are prone to injuries and pain,” said Kroenke. “I think how we treat pain safely, using opioid pain medications very infrequently, applies across all sports.”

Stem Cell Marketers Ordered to Pay $5 Million for Misleading Health Claims

By Crystal Lindell

The co-founders of the Stem Cell Institute of America (SCIA) misled seniors and the disabled about the benefits of stem cell therapy, according to a recent federal court ruling that orders them to pay $5.1 million in civil penalties and refunds to consumers. A separate order permanently bans them from future marketing and advertisements.

In 2021, the Federal Trade Commission and the Georgia Attorney General sued SCIA co-founders Steven Peyroux and Brent Detelich for promoting stem cell treatments through deceptive marketing schemes with chiropractors and healthcare providers. 

The promotions claimed that stem cell injections were superior to surgery, steroids and pain medication in treating arthritis, joint pain and other orthopedic conditions. The injections cost as much as $5,000 per joint, with patients often getting multiple injections.

The FTC says the marketing was aimed almost exclusively at elderly and disabled people.

“The founders of the Stem Cell Institute of America and their network of companies tricked people who needed real medical help into buying expensive, unproven stem cell therapy,” Samuel Levine, Director of the FTC’s Bureau of Consumer Protection, said in a press release.

“The court’s orders hold them accountable, refund consumers, and permanently ban the defendants from offering stem cell therapy and other regenerative medicine treatment in the future.”

SCIA ADVERTISEMENT

In 2015, Peyroux, a chiropractor, and Detelich, a former chiropractor, founded SCIA, a company that trained chiropractors and other healthcare practitioners how to recruit patients through advertising and “educational seminars.” SCIA also provided them with a “vault” of sample advertisements rife with baseless claims of efficacy, and the appearance of being part of a nationwide SCIA network.

The defendants also used deceptive marketing materials and seminars to attract stem cell patients to their own chiropractic clinic. 

‘FDA’s War on Public Health’

Coincidentally, news of the court order comes just days before President-elect Donald Trump is sworn in for a second term. 

During his first term, Trump was a strong supporter of “Right to Try” legislation that gave terminally ill patients the right to try stem cells and other experimental treatments that were not yet approved by the government.

The FDA under President Trump also gave the stem cell industry three years to show whether regenerative medicine treatments were safe and effective before regulators started cracking down on them. The move effectively gave stem cell providers a huge break, allowing hundreds of new clinics to open up and offer stem cell treatments with little oversight.

The 3-year grace period was then extended six months due to COVID, which had the effect of giving the clinics free range for most of Trump’s first term. 

Robert F. Kennedy, Jr., Trump’s nominee to head the Health and Human Services Department, has also pledged to loosen the FDA’s tight control over stem cells and other innovative treatments.

“FDA’s war on public health is about to end,” Kennedy wrote in an October 25 tweet. “This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can't be patented by Pharma.” 

In a November interview with NPR, RFK Jr. said Trump had given him instructions to stop the “corruption and the conflicts” at federal health agencies and to end the “chronic disease epidemic” with measurable progress within two years.