Where Pain Research Is Headed and Why I’m Hopeful

By Dr. Lynn Webster

If you live with pain, you’ve probably heard promises that “something better is coming.” At this month’s Pain Therapeutics Summit in San Diego, you could see that promise taking shape. For two days, clinicians, scientists, companies and advocates compared notes on what’s working, what’s not, and what’s next.

Threaded through much of it was the National Institutes of Health’s Helping to End Addiction Long-Term (HEAL) Initiative -- an NIH-wide push launched in 2018 to accelerate better pain care and reduce opioid-related harms.

HEAL exists because of the opioid crisis; Congress gave NIH an initial $500 million in fiscal year 2018 to jump-start a coordinated research plan, and the NIH has since invested several billion dollars to keep the effort moving. In other words, HEAL is a rare silver lining: a tragedy spurring a sustained, practical response.

(The HEAL Initiative was not directly hit by any funding cuts in 2025. However, the Trump administration has proposed cutting the NIH budget by 40% next year, which could potentially impact HEAL funding.)

Since its launch, HEAL has grown into a national engine for discovery. NIH reports a cumulative investment approaching $4 billion, supporting more than 2,000 projects across all 50 states, and helping advance 40-plus new drugs and devices to FDA investigational status.

This is a sign that the pipeline is broader and closer to patients than it has been in years. Think of HEAL as scaffolding: trial networks, shared data standards, and coordinated teams that help good ideas climb faster from lab to bedside.

A decade ago, analgesic research often looked like isolated bets. Today, it feels more like a coordinated campaign. That doesn’t guarantee success, but it raises the odds that something useful will reach doctors and patients.

Just as important, what’s coming isn’t a single “miracle drug” but a wider toolkit. You’ll see more non-opioid medicines designed around the biology of different pain types; safer use of existing tools that can lower the need for higher doses when opioids are used; devices and neuromodulation approaches that calm overactive nerves or brain circuits; smarter drug delivery systems that make treatments last longer or act locally at lower doses; and digital health that captures how people actually live -- including their sleep, activity, and pain flares -- so that care decisions track real life, not just clinic visits.

The studies themselves are changing, too. Many people don’t have just one pain condition; they have overlapping problems. Newer trials are beginning to mirror that reality and to focus on outcomes you can actually experience -- walking farther, sleeping better, and participating more in life -- rather than only chasing a number on a pain scale.

Researchers are also building better signposts, such as biomarkers and other objective measures, to predict who will benefit from which therapy and who may be at risk of long-term pain after injury or surgery.

Signposts aren’t a substitute for what people tell us about their pain. In research and development, objective measures help compare treatments and identify who is most likely to benefit. Once a therapy reaches the clinic, those measures become guides, not verdicts, and should be read alongside the patient’s narrative so that care reflects how the person actually lives and feels.

HEAL has made these shifts a priority by funding large, practical datasets and endpoints that regulators and payers can use.

Here’s the clear-eyed part: many of the drugs and devices discussed at meetings like this will not make it past the investigational stage. That’s how science works. But when trials are well designed and data are shared, today’s misses can more quickly lead to tomorrow’s wins -- and the lessons won’t vanish into a file drawer.

Some analgesic candidates will cross the finish line, and even modest gains -- better sleep, fewer flares, less brain fog, or an extra hour of activity -- can change a life. Across millions of people, small wins add up to something transformative.

What does this mean if you’re living with pain right now? Expect more choices and more personalization. Conversations with your clinician may start to include options that didn’t exist a few years ago, and you may hear about clinical studies built around everyday life rather than rigid clinic schedules. If a trial is a good fit, participating in one will help move the field forward.

Most of all, there’s a reason for hope that is grounded in real progress, not hype.

None of this happened by accident. The NIH HEAL Initiative has been the engine behind much of it -- steady funding, coordination, and a focus on solutions that reach the bedside. Keeping that engine running is how promising ideas become practical relief.

Lynn R. Webster, MD, is a pain and addiction medicine specialist and serves as Executive Vice President of Scientific Affairs at Dr. Vince Clinical Research, where he consults with pharmaceutical companies.

Dr. Webster is the author of the forthcoming book, “Deconstructing Toxic Narratives -- Data, Disparities, and a New Path Forward in the Opioid Crisis,” to be published by Springer Nature. Dr. Webster is not a member of any political or religious organization.

5 Ways to Support a Loved One With Chronic Pain

By Crystal Lindell

Recently I wrote that one of the most important things you need to enjoy life with chronic pain is supportive loved ones.

But what does that look like in practice?

Below are some tips on how to realistically help loved ones who deal with chronic pain.

And if you’re the person in pain reading this, perhaps you can pass this on to your friends, family and other loved ones. Afterall, sometimes getting advice from a third party can help it land better.

Also, of course, if you have your own tips to share, we’d love to read them in the comments!

1. Keep in Touch With Them

If you care about someone with pain, maybe the most important thing you can do is to just stay in contact with them.

Having chronic pain makes it difficult to attend in-person events, but that doesn’t mean we lose the need for human connection. In fact, it just makes that need much stronger.

Sometimes friends fall off because they don’t see you as often, but other times it’s because they don’t want to have to talk to someone with chronic health issues. Those conversations can force them to face the fact that their own body is also fragile and mortal.

But if you actually care about someone, I encourage you to push past all that.

Texting and phone calls can be a lifeline for people with chronic pain — as can in-person visits.

Your interactions with them may be the majority of human interaction they have, and it can be enough to keep them going for another day.

2. Give Them Meals and Help with Chores

When I first started having chronic pain, one of my friends did one of the nicest things anyone has ever done for me – either before or since. She drove 2 hours to come visit me and then cleaned my entire apartment, including the bathroom.

It is not possible to express how grateful I was and how much of a difference that made in my ability to keep going through one of the darkest times in my life. Just having a clean space to exist was like having a weight lifted off my very painful ribs.

While healthy people can take for granted the ability to do daily household tasks like cooking meals and doing the dishes — a person with chronic pain knows how easy it is to fall behind on those things.

And when that happens, on top of the stress of dealing with a broken body, you also have to deal with a messy house. That can come with a lot of guilt and even physical discomfort.  

So, if you’re able to help them with housework in any capacity, that can also lift a truly heavy burden.

Having someone make or drop off meals once a week, or even once a month can also be a massive help. There’s also the option of sending meals with services like DoorDash or Uber Eats, or giving them food delivery gift cards.

It may seem like cooking and cleaning for someone is no big deal, but when you do it for someone with chronic pain, it can be as helpful as the best medication.

3. Don’t Be Offended If Someone Needs Rest

I need more sleep than the average person, I assume because my body is using so much energy to just exist with chronic pain. I also need more time to recover after big events like parties.

It can mean that I can’t respond to calls or text, and that I need a lot of time alone to sleep and rest.

But even my most well-meaning loved ones can take this need for rest as some sort of indictment — as though I just don’t want to be around them or to interact with them.

It’s not about them though, it’s about me and my defective body.

If someone you love has chronic pain and they need a nap, or a couple days to respond to a text, don’t take it personally. It probably just means they needed some extra rest.

4. Go to Doctor’s Appointments With Them

Chronic pain can make it more important than ever to have productive doctor appointments — but it can also make that task more difficult.

That’s why having a loved one attending doctor’s appointments with you is truly invaluable.

A second person being there to focus on what the doctor is saying and to ask questions on your behalf can mean the difference between finding treatments that actually work or not.

It also usually makes doctors take a patient more seriously when they know that a loved one is keeping tabs and will be holding them to account for their treatment outcomes.

So, if you’re able to go to doctor appointments with your loved one with chronic pain, I highly recommend doing so.  

5.  Be Accepting of their Use of Pain Medications

A lot of people face stigma for using pain medications, especially opioids.

But oftentimes, pain medication can become a point of friction between patients and loved ones, who don’t fully understand the importance of alleviating chronic pain.

Other people’s pain is always easy to endure, so it’s always easy to tell someone else that they don’t need to treat their pain.

While loved ones who say such things are usually well-meaning, those conversations can cause a lot of unnecessary stress for people in pain.

It’s best just to assume that if someone is using pain medication, then they need that pain medication.  

In the end, the best advice for supporting a loved one with chronic pain is to treat them how they want to be treated. And to accept that whatever they are going through is at least as bad as they are describing.

When you approach help from that mindset, you’ll often naturally find the best ways to support them.

Having support from loved ones can mean the difference between being able to endure a life with chronic pain or not. It’s just as important for their health as a good doctor is, and it can have just as much impact. 

It’s a Bird! It’s a Plane! It’s a Chemtrail? New Conspiracy Theory Takes Wing at HHS

By Stephanie Armour

While plowing a wheat field in rural Washington state in the 1990s, William Wallace spotted a gray plane overhead that he believed was releasing chemicals to make him sick. The rancher began to suspect that all white vapor trails from aircraft might be dangerous.

He shared his concern with reporters, acknowledging it sounded a little like “The X Files,” a science fiction television show.

Academics cite Wallace’s story as one of the catalysts behind a fringe concept that has spread among adherents to the Make America Healthy Again, or MAHA, movement and is gaining traction at the highest levels of the federal government. Its treatment as a serious issue underscores that under President Donald Trump, unscientific ideas have unusual power to take hold and shape public health policy.

The concept posits that airplane vapor trails, or contrails, are really “chemtrails” containing toxic substances that poison people and the terrain. Another version alleges planes or devices are being deployed by the federal government, private companies, or researchers to trigger big weather changes, such as hurricanes, or to alter the Earth’s climate, emitting hazardous chemicals in the process.

Several GOP lawmakers and leaders in the Trump administration remain convinced the concepts are legitimate, though scientists have sought to discredit such claims.

Health and Human Services Secretary Robert F. Kennedy Jr. is planning to investigate climate and weather control, and is expected to create a task force that will recommend possible federal action, according to a former agency official, an internal agency memo obtained by KFF Health News, and a consultant who helped with the memo.

The plans, along with comments by top GOP lawmakers, show how rumors and conspiracy theories can gain an air of legitimacy due to social media and a political climate infused with falsehoods, some political scientists and researchers say.

“When we have low access to information or low trust in our sources of information, a lot of times we turn to our peer groups, the groups we are members of and we define ourselves by,” said Timothy Tangherlini, a folklorist and professor of information at the University of California-Berkeley. He added that the government’s investigation of conspiracy theories “gives the impression of having some authoritative element.”

HHS is expected to appoint a special government employee to investigate climate and weather control, according to Gray Delany, former head of the agency’s MAHA agenda, who said he drafted the memo. The agency has interviewed applicants to lead a “chemtrails” task force, said Jim Lee, a blogger focused on weather and climate who Delany said helped edit the memo, which Lee confirmed.

“HHS does not comment on future or potential policy decisions and task forces,” agency spokesperson Emily Hilliard said in an email.

The memo alleges that “aerosolized heavy metals such as Aluminum, Barium, and Strontium, as well as other materials such as sulfuric acid precursors, are sprayed into the atmosphere under the auspices of combatting global warming,” through a process of stratospheric aerosol injection, or SAI.

“There are serious concerns SAI spraying is leading to increased heavy metal content in the atmosphere,” the memo states.

The memo claims, without providing evidence, that the substances cause elevated heavy-metal content in the atmosphere, soil, and waterways, and that aluminum is a toxic product used in SAI linked to dementia, attention-deficit/hyperactivity disorder, asthma-like illnesses, and other chronic illnesses. The July 14 memo was addressed to White House health adviser Calley Means, who didn’t respond to a voicemail left by a reporter seeking comment.

High-level federal government officials are presenting false claims as facts without evidence and referring to events that not only haven’t occurred but, in many cases, are physically impossible, said Daniel Swain, a climate scientist at the University of California.

“That is a pretty shocking memo,” he said. “It doesn’t get more tinfoil hat. They really believe toxins are being sprayed.”

Kennedy has previously promoted debunked chemtrail theories. In May, he was asked on “Dr. Phil Primetime” about chemicals being sprayed into the stratosphere to change the Earth’s climate.

“It’s done, we think, by DARPA,” Kennedy said, referring to a Department of Defense agency that develops emerging technology for the military’s use. “And a lot of it now is coming out of the jet fuel. Those materials are put in jet fuel. I’m going to do everything in my power to stop it. We’re bringing on somebody who’s going to think only about that.”

DARPA officials didn’t return a message seeking comment.

‘This Really Matters to MAHA’

Deploying chemtrails to poison people is just one of many baseless conspiracy theories that have found traction among Trump administration health policy officials led by Kennedy, a longtime anti-vaccine activist before entering politics. He continues to promote a supposed link between vaccines and autism, as well as make statements connecting fluoride in drinking water to arthritis, bone fractures, thyroid disease, and cancer. The World Health Organization says fluoride is safe when used as recommended.

Delany, who was ousted in August from HHS, said Kennedy has expressed strong interest in chemtrails.

“This is an issue that really matters to MAHA,” said Delany, referring to the informal movement associated with Kennedy that is composed of people who are skeptical of evidence-based medicine.

The memo also alleges that “suspicious weather events have been occurring and have increased awareness of the issue to the public, some of which have been acknowledged to have been caused by geoengineering activities, such as the flooding in Dubai in 2024.” Geoengineering refers to intentional large-scale efforts to change the climate to counteract global warming.

“It is unconscionable that anyone should be allowed to spray known neurotoxins and environmental toxins over our nation’s citizens, their land, food and water supplies,” Delany’s memo states.

Scientists, meteorologists, and other branches of the federal government say these assertions are largely incorrect. Some points in the memo are accurate, including concerns that commercial aircraft contribute to acid rain.

“I expected there were documents like this, but seeing it in print is nevertheless shocking. Our government is being driven by nonsensical dreck from dark corners of social media.”

— David Keith, PhD, University of Chicago.

But critics say the memo builds on kernels of truth before veering into unscientific fringe theories. Efforts to control the weather are being made, largely by states and local governments seeking to combat droughts, but the results are modest and highly localized. It isn’t possible to manipulate large-scale weather events, scientists say.

Severe flooding in the United Arab Emirates in 2024 couldn’t have been caused by weather manipulation because no technology could create that kind of rainfall event, Maarten Ambaum, a meteorologist at the University of Reading who studies Gulf region rainfall patterns, said in a statement on the floods. Similar debunked claims emerged this year after central Texas experienced devastating floods.

The Government Accountability Office concluded in a 2024 report that questions remain as to the effectiveness of weather modification.

Research into changing the climate has been conducted, including work by one private company that engaged in field tests. Still, federal agencies say no ongoing or large-scale projects are underway. Study of the concept remains in the research phase. The Environmental Protection Agency says there are no large-scale or government efforts to affect the Earth’s climate.

“Solar geoengineering is not occurring via direct delivery by commercial aircraft and is not associated with aviation contrails,” the agency says on its website.

Widespread Misinformation

Misperceptions about weather, climate control, and airplane contrails extend beyond the Trump administration, scientists said.

In September, a congressional House committee hearing titled “Playing God With the Weather — A Disastrous Forecast” involved two hours of debate on the once-fringe idea. Rep. Marjorie Taylor Greene (R-Ga.), who chaired the hearing, has introduced legislation to ban weather and climate control, with a fine of up to $100,000 and up to five years in prison.

Some Democrats objected to the nature of the discussion. Rep. Melanie Stansbury (D-N.M.) accused Greene of using “the platform of Congress to proffer anti-science theories, to platform climate denialism.”

Frequently citing chemtrails, GOP lawmakers have introduced legislation in about two dozen states to ban weather modification or geoengineering. Florida passed a bill to establish an online portal so residents can report alleged violations.

“The Free State of Florida means freedom from governments or private actors unilaterally applying chemicals or geoengineering to people or public spaces,” GOP Florida Gov. Ron DeSantis said in a press statement this spring.

Meanwhile, the chemtrail conspiracy has permeated popular culture. The title track on singer Lana Del Ray’s seventh studio album is entitled “Chemtrails Over the Country Club.” Bill Maher dove into the chemtrail myth on his podcast “Club Random,” saying, “This is nuts. It’s just nuts.” And “Chemtrails,” a psychological thriller, wrapped filming in July.

Social media has given wing to the chemtrails concept and other fringe ideas involving public health. They include an outlandish belief that Anthony Fauci, who advised both Trump and President Joe Biden on the government response to the covid-19 pandemic, created the AIDS epidemic. There is no evidence of such a link, public health leaders say.

Researchers say another false belief by those on the far right holds that people who received covid vaccines could shed the virus, causing infertility in the unvaccinated. There is no evidence of such a connection, scientists and researchers say.

More severe weather events due to global warming may be driving some of the baseless theories, scientists say. And risks occur when such ideas take hold among the general population or policymakers, some public health leaders say. Climate researchers, including Swain, say they’ve received death threats.

Lee, the blogger, said he disagrees with some of the more far-fetched beliefs and is aware of the harm they can cause.

“There are people wanting to shoot down planes because they think they are chemtrails,” said Lee, adding that some believers are afraid to venture outside when plane vapor trails are visible overhead.

There is also no evidence that plane contrails cause health problems or are related to intentional efforts to control the climate, according to the EPA and other scientists.

The memo and focus at HHS on climate and weather control are alarming because they perpetuate conspiracies, said David Keith, a professor of geophysical sciences at the University of Chicago.

“It’s unmoored to reality,” he said. “I expected there were documents like this, but seeing it in print is nevertheless shocking. Our government is being driven by nonsensical dreck from dark corners of social media.”

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

3 Things You Need to Enjoy Life, Even With Chronic Pain

By Crystal Lindell

If you want to enjoy life again while also living with chronic pain, you need just three things.

1. An effective pain medication.
2. The ability to pace your activity level
3. Supportive loved ones

If you have all three of those things, it’s very possible to enjoy life while also enduring chronic pain. In fact, you could have a very happy life even with severe, debilitating pain every single day.

Unfortunately, of course, many chronic pain patients do not have all three of those things.

Even if they have access to opioids and other pain medications, they may not have the option to pace their activity levels due to things like work and parenting commitments. Or they may not have loved ones who show sympathy for what you’re going through and offer accommodations to make your life easier.

Sadly though, most doctors don’t recognize the importance of having all three things when they are treating chronic pain patients.

“Enjoying life” is usually not something doctors measure during treatments or appointments.  

Personally, I don’t think I have ever had a medical doctor ask me how much I’m enjoying life. Rather, they ask you to rate your pain level, and then either ignore you or send you off to another random specialist.

It’s why they don’t value the importance of prescribing pain medications that actually work, and why they rarely offer education for loved ones about how to better support the people in their life who have chronic pain.

It’s also why doctors rarely explain the importance of pacing your activity levels.

While I have had medical doctors tell me to quit working, I’ve had only one psychologist explain to me that instead of fully quitting, I could just cut back on some activities and plan more rest days.

In other words, stop pushing myself to the point of exhaustion before taking time to rest.

I assume that many doctors don’t grasp the concept of pacing, in large part because of their medical training. Residency scheduling makes it so that they are often working 24-hour shifts, with little time to recover before the next one.

In other words, the exact opposite of pacing.

When you have chronic pain, you can’t live that way though. Of course, technically, you can live that way, but you won’t enjoy life if you do.

If you accept the fact that you need to rest your body from time-to-time, you can actually do more activities in the long run.

However, under a capitalist system that prizes work, sometimes that is just not possible, no matter how much you want to pace yourself. In fact, the same applies to the other two things you need to enjoy life: Sometimes doctors just won’t give you pain medication and sometimes loved ones just will not support you.

There is good news though.

Even if you don’t have all three of those things, you can still find some joy in a life with chronic pain, as long as you are very stubborn and tenacious.

You just have to find alternative pain medications, like kratom or cannabis. And insist on creating a life that allows for pacing, whether that means changing jobs or moving in with family to help with daily life tasks. 

Then you have to educate your loved ones on how they can better accommodate you – and be prepared to pull back if they are mean or rude about it.

When I first developed chronic pain, I genuinely thought life was not worth living. That was more than a decade ago, and I’ve experienced countless joys since then: trips to Europe, meeting the love of my life, getting cats, and hugging my new niece.

Not to mention all the little joys, like fresh baked bread, cozy heated blankets on a cold winter night, and getting lost in a corn maze with my family.

I am very lucky to now have effective pain medication, a life that allows for pacing, and supportive loved ones. But I didn’t start that way. I rearranged my priorities to make it so. And it is possible that you can do the same.

You just have to stop trying to fight the pain, and instead learn to accept it. Then you can be free to live your life, while finding as many joys as you can along the way. 

No Healthcare for Lawmakers Until Every American Has Affordable Health Insurance

By Dr. Lynn Webster

Millions of Americans stand on the brink of losing the Affordable Care Act (ACA) subsidies that make their health insurance barely affordable. Without congressional action to extend those subsidies, families will face staggering premium hikes — forcing impossible choices between health coverage and rent, groceries or prescription drugs. Many will simply go without insurance.

Meanwhile, every member of Congress continues to enjoy taxpayer-funded health insurance, untouched by the very uncertainty they allow their constituents to endure. That disparity is indefensible.

A simple idea that would change the equation is that no elected representative in Congress should receive taxpayer-funded health care until every American has access to affordable health care.

If lawmakers had to share the same risks as their constituents, the urgency of reform would shift overnight. They would feel, in their own lives, the dread of losing coverage or facing premiums that devour a paycheck. They would no longer be insulated from the hardships they are sworn to alleviate.

This is not about punishment — it is about accountability and alignment. When lawmakers see their own well-being depends on fixing the system, solutions would rise above partisan theater.

Skeptics will point out that the Constitution protects congressional compensation, and they are right. Courts might interpret health benefits as part of that protection. That is why this should not be ordinary legislation. It should be a constitutional amendment — one that makes the principle unambiguous: members of Congress cannot enjoy taxpayer-funded health coverage until the people they serve have genuine access to affordable care.

Passing an amendment is never easy. But history shows it can be done when fairness demands it. Women’s suffrage, civil rights, and lowering the voting age all required constitutional change. Each once seemed out of reach — until public demand made it unstoppable.

This proposal does not dictate the specific policy mechanism — whether through extended subsidies, a public option, or another path. It sets only the principle that Congress must solve the problem before claiming benefits for itself. That principle is fairness.

And fairness should transcend party lines. At a time when the nation feels divided on nearly every issue, the idea that our leaders should not receive what they deny their constituents ought to unite, not separate us.

Making congressional health care contingent on achieving affordable care for all Americans could become a rare opportunity to bridge political divides and move the country toward greater unity.

Healthcare is not a privilege reserved for the political class. It is a necessity for every family. Across the nation, millions face losing coverage while their elected representatives remain fully protected. The injustice is clear.

Until every American has access to affordable healthcare, no member of Congress should accept it either. If they want the benefits, they must deliver them for the people they represent.

Anything less is a betrayal of public trust.

Lynn R. Webster, MD, is a pain and addiction medicine specialist and serves as Executive Vice President of Scientific Affairs at Dr. Vince Clinical Research, where he consults with pharmaceutical companies. He is the author of the forthcoming book, “Deconstructing Toxic Narratives -- Data, Disparities, and a New Path Forward in the Opioid Crisis,” to be published by Springer Nature. Dr. Webster is not a member of any political or religious organization.

Amazon Is Putting Pharmacy Kiosks in Its Own Medical Clinics

By Crystal Lindell

Have you ever dreamed of skipping the hassle of going to a pharmacy to pick up a prescription after you’ve seen your doctor?

Amazon wants to eliminate that extra trip by putting pharmacy kiosks — vending machines — in its One Medical clinics to dispense drugs on site. The move will increase Amazon’s growing share of U.S. pharmacy sales, at a time when many retail pharmacies are struggling. 

It also raises questions about a conflict of interest when doctors at One Medical – a wholly owned subsidiary of Amazon – steer their patients to Amazon Pharmacy kiosks to fill their prescriptions on the spot. 

In an Amazon promotional video, a One Medical doctor does just that:

Amazon is framing this as an issue of convenience that will improve the healthcare of One Medical patients, pointing out that nearly a third of all prescriptions are never filled.

"As clinicians, we see firsthand how delays in starting medication can impact treatment outcomes," Andrew Diamond, MD, Chief Medical Officer at One Medical, said in a press release. "The ability to know a patient is leaving our office with their medication in hand – especially for conditions requiring immediate treatment like infections – can make a meaningful difference in their care journey."

Starting in December, Amazon Pharmacy kiosks are being installed at One Medical clinics in the Los Angeles area, with expansion to additional clinics soon after.   

"By bringing the pharmacy directly to the point of care, we're removing a critical barrier and helping patients start their treatment when it matters most — right away," said Hannah McClellan, Vice President of Operations at Amazon Pharmacy.

To use the kiosks, patients must already have an account with Amazon Pharmacy, which requires them to provide their insurance information and other payment options. 

Once a prescription is scanned at a kiosk and the patient is verified, an Amazon pharmacist will begin to process the prescription remotely and be available to answer questions. If the prescription is approved, a robotic arm will pick out the medication from a vault inside the kiosk, label it, and drop it through a bay door for the patient to pick up.

The kiosks won’t carry controlled substances like opioids or drugs that need to be refrigerated, but that still leaves a lot of medication options for One Medical doctors to prescribe.

One Stop Shopping

Will Amazon’s doctors be incentivized to prescribe unnecessary or high-cost medications just to make extra money for their parent company?

Unfortunately, that’s not a far-fetched question to ask, given the well-known influence of pharmaceutical sales reps. The reps often give free meals, paid speaking engagements, and other financial incentives to doctors in hopes of getting them to prescribe their company’s medications. 

Amazon Pharmacy currently has a small market share compared to big chain pharmacies like CVS and Walgreens, but its home delivery system is rapidly growing and gaining in popularity. Amazon Pharmacy sales were projected to reach $1.8 billion in 2024 and some analysts say it could eventually be the leading drug store in the U.S.  

I fear that adding Amazon Pharmacy kiosks to One Medical clinics is just the first step. The company could place kiosks in other non-Amazon locations such as hospitals, medical offices, and urgent care clinics. Amazon admitted as much when it said its kiosk expansion plans include “additional One Medical offices and other locations.”

Amazon, which has a market cap of over $1 trillion, could wind up doing to pharmacies what it did to book stores 30 years ago: drive them out of business. Of course, chain pharmacies have already done a good job of doing that to themselves.

Millions of low-income and rural Americans already live in "pharmacy deserts" and have to drive long distances to fill a prescription. What will happen to them when additional pharmacies close? Or the patients who need controlled substances or refrigerated medications that the kiosks don’t dispense and Amazon won’t deliver? 

In the end, when it comes to healthcare, we should be extra cautious about the financial incentives at work and putting too much power in the hands of one company. 

Maybe the pharmacy kiosks will be convenient. Maybe Amazon’s doctors won’t prescribe unnecessary medications just to reach a kiosk sales goal. But I’m not willing to bet my health on that.

Placebos Don’t Work If You Know It’s a Placebo

By Crystal Lindell

Migraine patients who knew they were getting a placebo did not get any pain relief from it.

That’s a short summary of an actual study that was published in JAMA Network Open.

And to be honest, as a pain patient and a former migraine sufferer myself, I’m annoyed that they even wasted their time and resources on this research.

So how did they reach this very obvious conclusion? They recruited 120 chronic or episodic migraine patients for a three-month trial at two headache centers in Germany. About half the participants were given an “open-label placebo” twice a day — fake pills that the patients knew were fake — along with their usual treatments. The other patients just received treatment as usual and served as a control group..

Not surprisingly, they found that the open label placebos did not reduce monthly headache days, pain intensity, or days needing rescue medication compared to the control group.

In other words, the fake pills did not work. A conclusion I could have told them before a single participant was even registered for the study.

The frustration doesn’t stop there though. The researchers then tried to salvage these results by claiming that some of the patients did have slight improvements in what they call "secondary outcomes." That includes things like quality of life, pain-related disability, and “Global Impression of Change.” The latter is a fancy way of saying they felt better.

Even though they literally got no pain relief from the placebo pills and no reduction in migraine days, the authors insist that open-label placebos (OLPs) "might have a supportive role in migraine care.”

“Although more research is needed, OLPs… could potentially be a safe and suitable complementary option for patients with migraine, especially those who prefer nonpharmacologic approaches,” said lead author Julian Kleine-Borgmann, MD, a resident in the Department of Neurology at the University Medical Center Essen.

In other words, they want to explore this ineffective line of treatment even further!

This whole study was a waste of time, and the only saving grace would have been if they saw the results and concluded that further research into fake treatments should end – so that real treatment options can be further developed.

But no, the researchers looked at these very clear results and concluded that since some patients felt slightly better, further studies are needed. 

No. Stop it.

We get it, the medical community has had little success treating migraines or developing new pain treatments. But resorting to fake pills that patients know are fake won’t help anyone – except maybe the researchers who build their careers studying it. 

In fact, it only serves to reinforce the stigma that many pain patients are just looking for attention from doctors. 

It’s not difficult to imagine doctors thinking that if fake pills work on patients who know they are fake, then clearly their pain is probably fake too.

The results of this study should prove that is not the case, but I fear that the researchers don’t seem to have fully absorbed that lesson, given the fact that they want to explore placebo treatment further.

Migraines are a very real and debilitating medical condition that can greatly impact people’s lives. Patients who suffer from them deserve very real treatments in response.

Should Doctors Show More Empathy?

By Carol Levy

So many of us have complained, rightly so, about doctors not listening to us. They often ignore our words.

We tell them where the pain is (my back, my foot, my face, etc.) and how it feels (achy, sharp, throbbing, etc.). But when they repeat it back to us or write it into our medical records, the words are no longer ours. Doctors substitute words that are nothing like the ones we spoke.

Then there is the second part of listening -- of truly hearing what we say – and the feelings and emotions behind our words.

Pain makes me feel desperate, soul sick, and depressed. But in the 40 plus years that I’ve had pain from trigeminal neuralgia, not once have I been asked, “How do you feel emotionally? What is the pain doing to your life?”

In a TV commercial, a doctor describes the difficulty some of his older patients have with numbness in their legs or feet --- and how it’s a safety issue for those who have stairs in their homes. He says he never really understood what they were talking about until he started experiencing the same problem.

What is it about empathy? Is it inherent within us? Or is it something we have to learn and cultivate? Does a doctor have to experience the same things we do before he or she can honestly understand what we are going through?

For a doctor to feel empathy for every patient, to understand and feel viscerally what they are describing, might overwhelm them and cloud their judgement.

The opposite of that, a doctor who is detached or standoffish with patients, may think that allows him to be more objective when deciding on a diagnosis or course of treatment. But it can make them seem cold and uncaring.

Research repeatedly shows that patients want their doctors to see them as a person, not as a list of signs and symptoms. They want a doctor who listens on both levels, hearing our words and the “feelings” behind them.

Beth Israel Deaconess Medical Center, a teaching hospital in Boston, has taken steps to incorporate empathy into the doctor-patient experience. The hospital’s patient intake forms have two questions designed to build empathy.

The first is “How would you like to be addressed?” This allows for a patient to be spoken to respectfully, as opposed to the times when a doctor enters the room and immediately calls us by our first name -- whether we want them to or not. I'm not sure that is a form of empathy, but it is at least treating us like a person, not just “Patient X.”

The second question is “What is your main concern for this visit?" This is asked -- on an intake form -- to ensure the doctor will know our priority. But isn't that the point of interviewing us when they come into the exam room? True empathy would require the doctor to ask us face-to-face, “What is your major concern?” 

So here's the conundrum: Is the better doctor the one who is detached, looks at us as symptoms and test results, and computes the proper treatment?

Or is it the doctor who takes the time to listen to us, to understand our aches and pains, who hears why we’re upset about our symptoms and what they might mean?

If we're lucky, maybe the doctor will be a combination of the two.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 40 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.  

Government Shutdown Halts Many Public Health Services

By KFF Health News

Threats of a federal government shutdown have gone from being an October surprise to a recurring theme. This time around, though, the stakes are higher.

Federal funding ran out at midnight on Oct. 1, after Congress failed to pass even a stopgap budget while negotiations continued.

Now the question is how long the deadlock will last, with Democrats pitted against Republicans and a presidential administration that has broken with constitutional norms and regularly used political intimidation and primary threats to achieve its ends. Because Republicans hold only a slim majority in the Senate, any deal will need to attract at least a few Democratic votes.

Ramifications from a shutdown on public health systems and health programs will be felt far beyond Washington, D.C., halting almost all of the federal government’s nonessential functions, including many operations related to public health.

Even on Sept. 30, as the clock ticked toward midnight, President Donald Trump renewed threats about mass firings of federal workers if Democrats didn’t acquiesce to GOP demands. Some people worry that such workforce reductions would further enable the administration to undermine federal government operations and reduce the budget impasse to what’s been described as three-dimensional chess or a game of chicken.

Such threats to fire, rather than temporarily suspend, federal workers are “unprecedented,” said G. William Hoagland of the Bipartisan Policy Center. The lack of negotiations between Capitol Hill Republicans and Democrats in advance of the shutdown is also unprecedented in his experience, said Hoagland, a longtime GOP Senate Budget Committee aide.

The stalemate centers largely on health coverage, with Democrats and Republicans clashing over the Affordable Care Act and Medicaid cuts. For Americans with ACA marketplace plans, government subsidies cap the percentage of household income they must pay toward premiums. Lawmakers expanded the subsidies in 2021 and extended that additional help through the end of 2025, and the looming expiration of those expanded subsidies would increase costs and reduce eligibility for assistance for millions of enrollees.

Democrats want a further extension of the subsidies, but many GOP lawmakers are resistant to extending them as is and say that debate must wait until after a budget deal to keep the federal government afloat. Antagonism has grown, with the parties in a pitched battle to convince voters the other party is to blame for the government’s closure.

Said Senate Minority Leader Chuck Schumer on the Senate floor Sept. 30: “Republicans have chosen the losing side of the health care debate, because they’re trying to take away people’s health care; they’re going to let people’s premiums rise.”

But Senate Majority Leader John Thune accused Democrats of attempting to “take government funding hostage.”

What the Shutdown Will Do

The longer a shutdown lasts, the more impacts could be felt. For example, some community health centers would be at risk of closure as their federal funding dries up.

Long-term projects by the Federal Emergency Management Agency to reduce damage from future natural disasters will stop, for example. Rescue services at national parks that stay open will be limited. And at the National Institutes of Health, many new patients awaiting access to experimental treatments may not be admitted to its clinical center.

Entitlement programs such as Medicaid and Medicare will continue, as will operations at the Indian Health Service. But disease surveillance, support from the Centers for Disease Control and Prevention to local and state health departments, and funding for health programs will all be hampered, based on federal health agencies’ contingency plans.

The Department of Health and Human Services is expected to furlough about 40% of its workforce, which has already been downsized by about 20,000 positions under the Trump administration. Across the federal government, roughly 750,000 employees will be furloughed, according to an estimate released Sept. 30 by the Congressional Budget Office, a nonpartisan agency that calculates the cost of legislation. While furloughed employees won’t be working, eventually they will get back pay, totaling about $400 million daily, the CBO estimated.

At HHS, research is expected to pause on the links between drug prices and the Inflation Reduction Act, the major law enacted under former President Joe Biden to boost the economy. Despite reports that Food and Drug Administration Commissioner Marty Makary said the FDA would basically be untouched, the agency won’t accept new drug applications and food safety efforts will be reduced. Federal oversight of a program that helps hospitals save lives and evacuate individuals in environmental crises is expected to stop.

Fewer federal staff will be available to provide help to Medicaid and Medicare enrollees. CDC responses to inquiries about public health matters will be suspended. And the work of a federal vaccine injury program is also anticipated to stop.

Democrats Want ACA Subsidies Renewed

Congressional Democrats insist the ACA subsidies must be renewed now because enrollment for the Obama-era health program opens on Nov. 1. Without the extended subsidies, health insurers are warning of double-digit premium hikes for millions of enrollees.

House Democratic Leader Hakeem Jeffries has argued that a “Republican-caused health care crisis” is hanging over Americans as a result of Trump’s new tax-and-spending bill, which adds restrictions to Medicaid that are expected to kick millions off the program. Republicans have also advanced mass layoffs and funding cuts at the nation’s health department and caused widespread confusion over access to some vaccines.

“We’re not going to simply go along to get along with a Republican bill that continues to gut the health care of everyday Americans,” Jeffries told reporters Sept. 29. “These people have been trying to repeal and displace people off the Affordable Care Act since 2010.”

Republicans, meanwhile, have blasted Democrats for holding up funding over the subsidies and say any deal will require concessions.

“If there were some extension of the existing policy, I think it would have to come with some reforms,” Thune, the Senate Republican leader, said Sept. 26.

Such a deal may involve changes to a policy that caps what consumers have to pay for ACA marketplace plans at 8.5% of their income, no matter how much they earn. It could also alter their ability to obtain plans with no premiums, an option that became more widely available because of the beefed-up subsidies.

Adding restrictions to the ACA subsidies is likely to decrease enrollment in the program, which saw declines during the first Trump administration and did not reach 20 million for the first time until last year, a milestone reached in large part due to the subsidies.

Several Republicans have expressed interest in extending the subsidies, including a group of GOP representatives who proposed legislation to do so last month.

Democrats may be betting that the timing of the shutdown will put pressure on their Republican colleagues to come to the negotiation table on the ACA subsidies.

Within days of the government’s closure, ACA enrollees are expected to get notices from their health insurers advising them of steeper premiums. Insurers have said the expiring subsidies have forced those large premium hikes because the healthiest and youngest people are more likely to opt out of coverage when prices go up.

The White House, meanwhile, ramped up its pressure campaign on Democrats. White House press secretary Karoline Leavitt insisted Sept. 29 that Trump wants to keep the government open.

“Our most vulnerable in our society and our country will be impacted by a government shutdown,” she said.

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

How Opiophobia Paved the Way for Tylenol Hysteria

By Crystal Lindell

The dirty little secret about alternatives to opioids is that they are all mostly bullshit.

They’re expensive, sometimes outright dangerous, and perhaps worst of all, ineffective.

So when doctors are telling you that you don’t need opioids to treat your pain, what they are really saying is that you don’t need pain treatment at all.

And that’s exactly the message that people are getting from the Trump administration’s recent guidance to avoid taking Tylenol while pregnant.

Specifically, the administration is now advising women not to use acetaminophen — which goes by the brand name Tylenol — for pain and fever during pregnancy due to claims that it raises the risk of their babies developing autism. 

Aside from the fact that science behind this claim is not definitive, the other major problem is that there is no safe alternative to acetaminophen that a woman can take for pain and fever while pregnant. Over-the-counter pain relievers like aspirin and ibuprofen can damage the kidneys of unborn babies.

President Trump admitted as much during the press conference about the new guidance, putting the onus on pregnant women to “tough it out” by not taking Tylenol

“Sadly, first question, what can you take instead? It's actually, there's not an alternative to that,” Trump said. “And as you know, other medicines are absolutely proven bad. I mean, they've been proven bad, the aspirins and the Advils and others, right?

“But if you can't tough it out, if you can't do it, that's what you're going to have to do. You'll take a Tylenol, but it'll be very sparingly.”

That’s a genuinely inhumane response to the pain pregnant women often endure, because what he’s really saying is that you just should not treat pain while pregnant. It’s also on-brand messaging for an opiophobic country that’s been dismissing everyone’s pain for almost a decade now.

As it turns out, when you tell people that their pain doesn’t deserve to be treated by opioids, then it’s a quick path to the idea that pain shouldn’t be treated by other substances, be they cannabis or kratom or Tylenol. 

In the end, it all really comes down to a fundamental question of whether or not pain is worthy of treatment.

And unfortunately, for many healthcare professionals and government officials, the answer is a resounding “no.” They do not believe that pain is worthy of treatment – as long as it’s not their pain. Because, make no mistake, when these types of policies come out, that’s exactly who they apply to: other people.

They know that they themselves will get to use opioids if and when the time comes that they need them for their own pain. And they don’t expect to have a pregnancy themselves, so of course they don’t care if pregnant women can’t have their pain treated.

It's why Trump can so dismissively say "there's no downside in not taking it." He means there is no downside to him if you don’t take Tylenol.

But for pregnant women, there most certainly is a downside. Failing to treat fever and significant pain can pose serious risks to both the mother and baby, resulting in miscarriages, birth defects, depression, infections and high blood pressure.

Enduring untreated pain can wear you down in ways you can’t even predict. It will destroy your sleep, steal your hope, and even make you mean. When it’s your pain, you’ll do anything to make it stop.

Pain is a medical condition on its own, and “toughing it out” is not an effective treatment. Until we as patients and voters demand better, I fear both the government and our healthcare system will continue chipping away at the pain treatments we still have — until there is literally nothing left but silent prayers and fleeting wishes.

I Used to Believe 'Good' Health Insurance Was Actually Good. I Was Wrong

By Crystal Lindell

Chronic pain is not a patient teacher— especially when you combine it with a private health insurance system. 

I first developed debilitating chronic pain in 2013, and I’ve been learning to live with it ever since. Over the last 12 years, I’ve been forced to learn a lot about the realities of what it’s like to live in a country with a mostly private healthcare system.

While I am currently among the lucky few who are able to mostly manage my pain with daily opioid medications, I am also now among the 26 million people in the United States who don’t have any health insurance. As a result, I pay for all of my doctor visits and prescriptions in cash.

It wasn’t always this way though. 

When I first got sick, I had what I would have described as “good health insurance” through my job. I kept that insurance until I was laid off in 2022. But in those nine years, even with that insurance, I still managed to rack up more medical debt that I could ever pay off in my lifetime. 

Until I actually needed my insurance and learned how it works, I really did believe that having it would somehow shield me from drowning in medical debt.

I was wrong.

It turns out that even with good health insurance, you can still rack up thousands or even tens of thousands of dollars in medical bills pretty quickly — even without being hospitalized or undergoing surgery.

Having health insurance means you likely pay a relatively small co-pay for routine appointments — which is good when all you need are the routine appointments.

But the minute you start needing medical tests, specialist care, physical therapy, prescriptions, and ER visits? All bets are off.

It’s partly because many of those things are not covered by co-pay programs. They fall under extremely high deductible programs that can require you to spend thousands of dollars out of your own pocket before insurance kicks in. 

Co-pays can also add up fast when you need to see a different doctor every other week, and all of them prescribe you a different name-brand prescription and a different long-term treatment.

For example, if you have a $50 co-pay for every physical therapy appointment and you need physical therapy three times a week for 12 weeks – that’s suddenly $1,800 right there. 

Or if you need a prescription that doesn’t have a generic available, it can literally be hundreds of dollars each month just for a co-pay.

The first few years I had chronic pain, I was desperate for answers and help, so I saw every specialist I could and got every medical test and treatment that was offered to me. It made sense at the time. After all, wasn’t that the whole point of why I was paying hundreds of dollars a month in premiums for my good health insurance?

But the thing about all those doctor visits and treatments is that nobody ever discusses cost with you beforehand. Instead, you only find out when you get an enormous bill in the mail weeks or even months later. 

Suddenly, the simple X-ray means you somehow owe $3,000. 

I was not making much money at the time, and I make even less money now because I’ve had to scale back my life to accommodate my chronic pain. So a lot of those medical bills just ended up with medical collection agencies, which destroyed my credit. 

The frustrating thing is that most of the money I owe was for doctors who missed my eventual diagnosis of Ehlers-Danlos Syndrome, and for treatments that weren’t nearly as effective as cheap generic hydrocodone. 

But it didn’t matter that I was misdiagnosed or how little help I got from those treatments, because I still ended up with thousands of dollars of medical debt all the same.

I always say, everyone loves their private health insurance, right up until they actually need to use it. Then they find out just how little it actually covers.

We can do better in this country. Even incremental changes to regulations around insurance companies and medical billing practices would make a huge difference. And of course, there’s always the option of universal health care, which could be modeled after similar programs that most developed countries around the world already have. 

We have the most expensive healthcare system in the world, nearly $5 trillion annually or $14,570 per person. Much of its is spent on administration and insurance billing.

Nobody deserves to end up with thousands of dollars of medical debt just because they got sick. We must do better, because only then can patients focus on what really matters: Getting better.

Former Secretary of Veterans Affairs Calls for ‘Opioid-Free VA’

By Crystal Lindell

An alarming new column in The Hill is advocating for an opioid-free Veterans Affairs health system by 2030 – a move that would leave countless veterans and their families without effective pain relief.

Headlined “Whiskey, tobacco, and pain pills: The VA can be an opioid-free health system,” the op/ed was written by David Shulkin, MD, who was Secretary of Veterans Affairs in the first Trump administration, and the VA’s Under Secretary of Health in the Obama administration.

His opening line gets straight to the point he’s trying to make: “There is a time for everything. Now is the time for the Department of Veterans Affairs to go opioid-free.”

His column is promoting a dangerous message, and I fear that Shulkin’s credentials will lead people to take his stance seriously. It’s especially abhorrent because veterans are more likely to have chronic pain and have suicide rates twice as high as civilians, often due to poorly treated pain.

The VA and Department of Defense medical guidelines already discourage opioids from being prescribed for chronic pain, especially for younger patients of military age. The guidelines only allow for short-acting opioids to be prescribed for short-term acute pain.  

Shulkin frames opioids as a sort of magic-spell curse that can ruin lives after just one dose:

“The real opportunity lies in preventing opioid initiation,” Shulkin wrote. “The VA’s comprehensive, integrated system makes it uniquely positioned to lead the nation in eliminating opioid use and become the first opioid-free health system in the country. While it would be inappropriate to abruptly discontinue opioids for current chronic users, the VA could immediately begin limiting opioids for acute pain and adopt new alternatives. 

Shulkin claims that over half of veterans receive opioids for post-operative acute pain, as though that number is too high. But having opioid medication after surgery isn't just common practice, it's the most humane response. And there’s little evidence it leads to opioid addiction.

In fact, I’d go so far as to say that the fact that only half of veterans get opioids post-op is probably too low. Of course, I couldn’t fact check Shulkin’s numbers because the link he uses to validate his claim about how many veterans receive opioids post-op doesn’t even work. It just goes to a “404 error” page not found.  

Shulkin also claims that “roughly 10 percent” of veterans develop opioid addiction after surgery. But the link provided for that misleading claim takes you to a large meta-analysis study of over 4 million chronic pain patients around the world (mostly civilians), which has no relevance to how many U.S. veterans become addicted after surgery.

As noted in the headline to his column, Shulkin also compares opioids to alcohol and tobacco, citing the fact that VA doctors used to recommend both to patients to help make them “more comfortable.”  

“Just as we no longer prescribe alcohol or allow tobacco on VA campuses, the day will come when we look back and wonder why opioids were ever part of routine care,” he writes. 

Of course, there are glaring differences between opioids and those two substances: Opioids require a prescription, while alcohol and tobacco can be bought over the counter. They’re also involved in many more deaths than prescription opioids. 

To be frank, if patients could go out and purchase hydrocodone as easily as they can buy whiskey or a pack of cigarettes, I wouldn’t have a problem with what Shulkin is saying. Patients lacking a prescription from the VA would still have the option to treat their pain how they saw fit — whether or not a doctor approved of the methods would be irrelevant. 

Unfortunately, that’s not the case. And as such, trying to make the VA opioid-free within five years is inhumane. 

‘Additional Advances Are Emerging’

Of course, since Shulkin is advocating for zero opioid prescriptions, one might assume that he would at least offer a list of reasonable non-opioid pain relieving alternatives. But here too, his evidence is lacking. 

His first suggestion is a selective sodium channel blocker called Journavx (suzetrigine), which was recently approved by the FDA, even though it’s no more effective than a low dose of Vicodin. 

According to Yale Medicine, Journavx has very specific limitations. It’s "not a cure-all" and is only meant for moderate-to-severe acute pain, which is short-term pain after trauma or surgery. 

"This means, based on the current evidence, that it would likely be used primarily in the hospital setting and only for a few days," says Robert Chow, MD, a Yale Medicine anesthesiologist and pain management specialist.

Shulkin says "additional advances are emerging” for other non-opioid alternatives, including drugs targeting peptide-receptors that “appear to provide effective pain relief.”

So to recap, Shulkin wants the entire VA system – which provides healthcare to over 8 million military service members, veterans and their families – should go opioid free because we now have one sodium channel blocker and "additional advances are emerging."

Shulkin admits "it would be inappropriate to abruptly discontinue opioids” for long-term patients on opioids. But something tells me that such a warning would be ignored if the VA ever actually did go "opioid free," given the fact that many veterans have already been abruptly tapered off opioids.

I suspect that if Shulkin ever needed opioids for his own pain, he would not hesitate to take them. His is the type of column that is only written about other people’s pain – and other people’s pain is always easy to endure. 

I hope that his proposal is ignored and ridiculed as the nonsense it is. But after witnessing opiophobia for the last decade, I worry that the opposite will happen, and that policymakers will take Shulkin’s ideas seriously. 

Opioids aren’t just helpful – for many veterans they are necessary. And any medical professional advocating for their elimination should not be working in medicine at all. 

If we want to make the world a better place, we need to take pain seriously and treat it as the grave condition it often is. That means giving patients access to opioids when they need them. 

How Trump’s False Claim That 300 Million People Died From Drugs Impacts Pain Patients

By Crystal Lindell

President Donald Trump recently claimed that "300 million people died” from drug-related causes last year.

If that were true, it would mean that nearly the entire population of the United States – 342 million people –  died from a drug overdose in 2024.

Trump’s claim is so absurd, that it’s difficult to know what he was trying to say or what he may have meant.

The comment came during a Q&A with reporters, when he was asked about the U.S. strike on a supposed drug-smuggling boat off the coast of Venezuela, an attack the president of Venezuela called "illegal."

"What's illegal are the drugs that were on the boat and the drugs that are being sent into our country. And the fact that 300 million people died last year from drugs. That's what's illegal," Trump said.

In a community note on X/Twitter, the site’s fact checkers noted that 62 million people worldwide died from all causes in 2024, which “makes it impossible for 300 million people to have died of one single cause.” 

Obviously, the real numbers for drug-related deaths are significantly lower than 300 million. In reality, there were about 80,000 U.S. overdose deaths in 2024. Globally, 600,000 deaths were attributed to drug use in 2019, the most recent data available.

The World Health Organization reported there are 3 million deaths annually due to alcohol and drug use. But a majority of those — 2.6 million — were attributed to alcohol consumption.

So, Trump may have seen the “3 million” and misremembered it as "300 million," while also ignoring the fact that most of those deaths were related to alcohol.

It’s also possible he meant 300-thousand drug deaths. The president has actually used that number in the past, while adding that he doesn’t believe the overdose numbers the government produces. .

“We don’t want drugs killing our people. I believe we lost 300,000. You know, they always say 95, 100,000. I believe they’ve been saying that for 20 years. I believe we lost 300,000 people last year,” Trump said earlier this month. 

Regardless of where the “300 million” statistic came from, it’s troubling that Trump said it at all, and that there was little correction from the media. There also doesn’t seem to have been any correction from the White House, as far as I can tell.

Slips like this aren’t just annoying, they have very real implications – especially for pain patients – who already know what happens when prescription opioid deaths are exaggerated. The supply of opioid pain medication gets cut.

When people hear it from the president or White House, it carries weight. 

The Trump administration is not alone in this. In 2016, during the Obama administration, the CDC and the White House Office of National Drug Control Policy released three different estimates in one week on the number of Americans that died from prescription opioids. The numbers ranged from a low of 12,700 to a high of 17,536 deaths in 2015.

Aside from the fact that it literally impacts government policies, the wildly inflated numbers also affect how people respond to them in their day-to-day lives..

While medical professionals and policy makers might recognize that “300 million” or “300 thousand” deaths is an exaggeration, they also may assume that it can’t be that too far off if the president is saying it. 

Such a toll would be catastrophic and signal that the U.S. overdose crisis is getting worse, when the actual number of drug deaths is declining.

This false information perpetuates the idea that all opioids, both legal and illegal, are an extremely deadly problem and need to be restricted.  

Then, when a doctor who saw the clip of Trump on the news goes to treat a patient, he may think twice before writing a hydrocodone prescription because he vaguely remembers something about millions of people overdosing.

Loved ones of patients in pain can also be negatively swayed by such fake statistics. For example, say a mother is prescribed 5 mg doses of Norco for cancer pain. Their adult child may assume that even such a low dose has the potential to be deadly, because of what the president said, and they may discourage their mom from taking it.

Ideally, the White House Communications Office would issue some sort of correction of Trump’s statement. But seeing how this happened a few days ago, and they have yet to address it, I assume such a correction is unlikely to ever happen. And they’re hoping we’ll all forget about it.

Any single drug-related death is too many, and we absolutely should be looking into policies that address overdoses in ways that are proven to help. But when advocates have to instead spend time combating misinformation, it just takes time and resources away from the real problem.

Opioids do cause deaths, but they also give millions of people their lives back by alleviating their pain and allowing them to actually function. 

When we only focus on one side of the equation — especially when that focus is marred by widely inaccurate information — the result is just more pain and suffering.

It’s Rare for Chronic Pain Patients to Overdose on Opioids

By Neen Monty

The Penington Institute is an Australian non-profit public health and drug policy research organization. Its core mission is to study drug use “in a safe, considerate and practical way. We seek solutions, not scapegoats. We strive for positive outcomes, not negative stereotypes.”

A most worthy cause.

Each year, Penington releases Australia’s Annual Overdose Report, the country’s most comprehensive study of overdose trends and impacts. I am not against the work of the Penington Institute. On the contrary, they serve a very necessary purpose and have a noble goal.

However, for several years running, they have demonized chronic pain patients and twisted the statistics to inflate the harms of prescription opioids. And this is generally what I write about. To correct the record.

Here’s the download page to Penington’s 2025 report. It documents how many overdoses and what substances were involved. The report relates to data from the 2023 calendar year. Paging through it, something jumped out at me immediately.

Naturally, I jumped straight to the ‘Opioids’ section. There is a table, with key facts. One of these key facts is:

“From 2019-2023, there were 163 unintentional drug-induced deaths involving pharmaceutical opioids as the sole drug type.”

That’s an average of nearly 33 people who died accidentally every year when pharmaceutical opioids were the sole drug type. 33 people. In a country with 27.4 million people.

Does that sound like an opioid crisis to you? Does that sound like a reason to deny tens of thousands of patients access to safe and effective pain relief?

Do you know what immediately occurred to me when I realised that less than 50 people per year die from prescription opioid overdose?

I remembered this 2023 report from the Therapeutic Goods Administration (Australia’s version of the U.S. Food and Drug Administration), justifying their changes to paracetamol scheduling. That’s acetaminophen for those of you in the U.S.

Paracetamol pack sizes were reduced to 16 tablets per packet and supermarkets could only sell two packs per person. Larger packs were only available at pharmacies, and some required a pharmacist’s approval.

Do you know why they made paracetamol harder to get?

Because 50 Australians were dying every year from paracetamol overdoses, with rates of intentional overdose highest among adolescents and young adults.

There was an outcry when the changes came into effect. Chronic pain patients were again being harmed by policy because a different patient group was overdosing.

Because 50 people die of paracetamol overdoses per year in Australia.

Do you get what I am saying?

Paracetamol is still available over-the-counter in Australia, albeit in smaller pack sizes. And yet opioids are almost impossible to access.

Fewer Australians die from prescription opioid overdoses than from paracetamol overdoses. This was true long before any changes were made in opioid scheduling in 2020, making opioids much harder to get.

Opioid prescribing was already declining in 2020, so there was no need to change opioid prescribing practices. Certainly no medical need. In fact, this policy change caused a great deal of harm to those who live with constant, severe pain, and has had no benefits. For anyone.

Please think about it. Reflect upon it. Make it make sense. How is this anything other than a witch hunt?

Paracetamol kills more people than prescription opioids, yet it’s still available over the counter. And doctors are torturing people who live with painful, progressive and incurable diseases, by denying us access to safe and effective pain relief.

Because 33 people die of prescription opioid overdoses every year. While 50 people die of paracetamol overdoses.

Does Australia have an opioid crisis? No.

Does Australia have a prescription opioid crisis? Also no!

We never had a prescription opioid crisis. And we were never heading for one. Prescription opioid overdoes have been falling in Australia since 2018. Check the statistics.

Unlearn what you have been told and learn the true statistics.

There was no need to make changes in 2020. Yet those changes caused interminable suffering to people who live with constant, severe pain from illness or injury.

Most chronic pain patients are still suffering. Many have died.

Does this seem fair to you? Does this seem right? Does it seem reasonable?

Does any of this seem like good policy?

To be clear, I am not saying that opioids should be available over-the-counter. Please do not twist my words to imply that.

Opioids for severe, daily pain should be managed as they were before 2020. By general practitioners who know their patients well.

There should be no dose ceilings because there is no evidence that dose ceilings reduce overdoses and death. GPs are more than capable of prescribing an appropriate dose and duration to manage severe chronic pain.

Instead, chronic pain patients in Australia are forced to go to a pain management specialist, who barely knows them and rarely understands their pain.

People who live with severe, daily pain from disease and injury have a right to pain relief. We need help.

And this year’s Penington report shows that we are not the ones who are overdosing.

It is time to restore access to safe and effective pain relief for those who desperately need it. Chronic pain kills far more often than the opioids prescribed for chronic pain do. Patients die from heart attacks, strokes, hypertension, and other stress-induced conditions when their pain is not treated.  

The true cause of most overdose deaths is polypharmacy: multiple drugs, both legal and illegal, that are often mixed with alcohol.

Targeting people who live with painful, progressive and incurable diseases and injuries, denying us access to pain medication, is never going to reduce overdoses by illicit drug users. They are two different patient populations.

It is not chronic pain patients who are overdosing.

Neen Monty is a patient advocate in Australia who lives with rheumatoid arthritis and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), a progressive neurological disease that attacks the nerves.

Neen is dedicated to challenging misinformation and promoting access to safe, effective pain relief. She has created a website for Pain Patient Advocacy Australia to show that prescription opioids can be safe and effective, even when taken long term. You can subscribe to Neen’s newsletter on Substack, “Arthritic Chick on Chronic Pain.”

5 Myths About Opioids That I Believed, Until I Needed Them

By Crystal Lindell

I had been enduring debilitating pain for months by the time I was given my first hydrocodone prescription for chronic pain in 2013.

At the time, I didn’t even know that hydrocodone was an opioid.

I had only heard of Vicodin being an opioid, and that was only because I lived near the Wisconsin border, where there are lots of Packer fans. The news that former Green Bay quarterback Brett Favre had to go to rehab for his Vicodin use was part of the local conversation.

But I had no idea that hydrocodone was the active ingredient in Vicodin.

It’s been over a decade now, and I have come to rely on opioids to manage the chronic pain I have in my right ribs, which is technically called “intercostal neuralgia.”

Before I needed opioids for pain relief, I used to buy into a lot of common cultural myths about them. Below is a look at what I used to believe, and how my views eventually shifted.

Myth #1: Only People Who ‘Misuse’ Opioids Have Physical Withdrawal

When I got my first hydrocodone prescription, I didn’t know it was a controlled substance with strict limits on how often you can get refills. And I definitely didn’t know that I would go through withdrawal if I stopped taking them abruptly.

My doctor prescribed 10mg pills and the label said: “Take 1-2 every 4-6 hours.”

So, that’s exactly what I did: Two pills every four to six hours.

My pain was (and still is) intense, but at the time I was still trying to keep pace with my pre-chronic pain lifestyle, which meant doing everything possible to push the pain away so that I could work and have a somewhat normal life.

But that meant that I ran out of my prescription early – something I was not aware was even a problem. When the doctor’s office said I would need to wait a couple days for a refill, I didn’t think it would be a big deal. Surely, I could easily ride out a couple of days without hydrocodone, no problem. After all, I had been taking them as prescribed.

Yeah. That’s not what happened. Turns out you actually cannot go from 40 to 80 mg of hydrocodone a day to zero.

I naively went to work that day, and still remember the trauma of spending the entire shift in the bathroom with diarrhea, nausea, horrible flu-like aches, and an odd feeling of anxiety.

Turns out, anyone can go through withdrawal from opioids. There is no magic spell that doctors can cast to give you immunity from it, just because you’re taking opioids exactly as prescribed. Your body doesn’t know the difference.

And that physical withdrawal is also not indicative that you have “a problem.”

In fact, it’s one of the reasons I think the entire conversation around addiction is often more nuanced than people want to admit. Taking a dose to combat withdrawal is often labeled as “misuse” – even though anyone can have withdrawal. 

And anyone who’s been through it knows that you’ll do almost anything to make it stop.

Myth #2: The Best Way to Stop Using Opioids Is Quitting Cold Turkey

There’s a common myth that the best way to stop using an addictive substance is to go cold turkey. That’s usually not true for things like nicotine and alcohol, and it’s also not true for opioids.

I used to believe in the common framing for this. That if you stopped using opioids cold turkey, made it through 72 hours of withdrawal, and then took just one dose, it would reset the whole process. You’d have to go through withdrawal all over again.

That’s not true. In fact, taking a dose after going longer than usual without one is often part of the tapering process that works best for getting off opioids. 

Ideally, you taper off slowly by lowering the amount you’re taking each day. So, if you’re on 40mg of hydrocodone a day, the best way to stop using it is to take 35mg daily for a week or so, then 30 mg, and so on until you get down to zero.

That’s the best way to reach success long-term and actually get off the medication, if that is your goal.

If you’re looking for more realistic tips on how to stop taking opioids, see “A Survival Guide for Opioid Withdrawal” that I wrote for PNN with my partner a few years ago. You can trust the advice because we learned it ourselves the hard way.

Myth #3: Opioid Doses Last as Long as Manufacturers Claim

I was eventually prescribed extended-release morphine pills for my chronic pain, and was told that each one should last a full eight hours. I was also told that hydrocodone should last four to six hours.

Unfortunately, neither of those things are true. So-called “extended release” morphine lasts about four hours, while the short-acting hydrocodone can stop working in just two or three hours.

So, it’s not wise to take another dose whenever your pain comes back. If you do that, you’ll end up running out of your prescription early every month.

Instead, you should expect to go through periods throughout the day when your pain starts to come back – and then you have to count down until your next dose.

Myth #4: Even One Dose of an Opioid Creates a High Risk of Addiction

Before I started taking opioids, I honestly believed the myth that just one 10mg dose of Vicodin could result in life-long addiction.

In reality, that’s nearly impossible. In fact, even among patients who take opioids long-term, the rate of addiction is still incredibly low. Estimates vary widely, but according to experts who have studied it, people who take opioids over long periods have addiction rates of 1 to 3 percent.   

Opioids are often framed as being so addictive that anyone can get hooked, so any exposure to them is dangerous and risky. In reality, low-dose opioids are incredibly safe, and most patients taking prescription opioids never develop an addiction to them

Myth #5: If Someone Is ‘Really’ in Pain, Doctors Will Prescribe Opioids

I am a little ashamed to admit this, but I used to think of a Vicodin prescription as an indicator of whether or not someone’s pain was actually severe.

If a doctor prescribed Vicodin to someone, that meant they were in “real” pain.

Boy, was I wrong.

While dealing with pain myself, I quickly learned that doctors will often ignore severe pain in patients because they don’t want to deal with the hassle of prescribing a controlled substance. That reluctance has only gotten worse since 2013. Much worse.

These days, doctors withhold opioid medication from post-op patients, cancer patients, palliative care patients, and even hospice patients. All of them are still in very real pain though.

Whether or not a doctor validates your pain with an opioid prescription has no bearing on how severe your pain actually is.

There’s a lot of misinformation about opioids and these are just some of the common myths perpetuated about them. While it’s understandable to believe them if you’ve actually never needed opioids, I encourage everyone to keep an open mind. After all, if you wait until you or a loved one needs opioids to see the truth, it may be too late.