American Doctors Are Moving to Canada to Escape Trump Administration

By Brett Kelman, KFF Health News

Earlier this year, as President Donald Trump was beginning to reshape the American government, Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and got out.

Michael now works in a small-town hospital in Canada. KFF Health News and NPR granted him anonymity because of fears he might face reprisal from the Trump administration if he returns to the U.S. He said he feels some guilt that he did not stay to resist the Trump agenda but is assured in his decision to leave. Too much of America has simply grown too comfortable with violence and cruelty, he said.

“Part of being a physician is being kind to people who are in their weakest place,” Michael said. “And I feel like our country is devolving to really step on people who are weak and vulnerable.”

Michael is among a new wave of doctors who are leaving the United States to escape the Trump administration. In the months since Trump was reelected and returned to the White House, American doctors have shown skyrocketing interest in becoming licensed in Canada, where dozens more than normal have already been cleared to practice, according to Canadian licensing officials and recruiting businesses.

The Medical Council of Canada said in an email statement that the number of American doctors creating accounts on physiciansapply.ca, which is “typically the first step” to being licensed in Canada, has increased more than 750% over the past seven months compared with the same time period last year — from 71 applicants to 615. Separately, medical licensing organizations in Canada’s most populous provinces reported a rise in Americans either applying for or receiving Canadian licenses, with at least some doctors disclosing they were moving specifically because of Trump.

“The doctors that we are talking to are embarrassed to say they’re Americans,” said John Philpott, CEO of CanAm Physician Recruiting, which recruits doctors into Canada. “They state that right out of the gate: ‘I have to leave this country. It is not what it used to be.’”

Canada, which has universal publicly funded health care, has long been an option for U.S.-trained doctors seeking an alternative to the American health care system. While it was once more difficult for American doctors to practice in Canada due to discrepancies in medical education standards, Canadian provinces have relaxed some licensing regulations in recent years, and some are expediting licensing for U.S.-trained physicians.

In mere months, the Trump administration has jeopardized the economy with tariffs, ignored court orders and due process, and threatened the sovereignty of U.S. allies, including Canada. The administration has also taken steps that may unnerve doctors specifically, including appointing Robert F. Kennedy Jr. to lead federal health agencies, shifting money away from pandemic preparedness, discouraging gender-affirming care, demonizing fluoride, and supporting deep cuts to Medicaid.

The Trump administration did not provide any comment for this article. When asked to respond to doctors’ leaving the U.S. for Canada, White House spokesperson Kush Desai asked whether KFF Health News knew the precise number of doctors and their “citizenship status,” then provided no further comment. KFF Health News did not have or provide this information.

Philpott, who founded CanAm Physician Recruiting in the 1990s, said the cross-border movement of American and Canadian doctors has for decades ebbed and flowed in reaction to political and economic fluctuations, but that the pull toward Canada has never been as strong as now.

Philpott said CanAm had seen a 65% increase in American doctors looking for Canadian jobs from January to April, and that the company has been contacted by as many as 15 American doctors a day.

Rohini Patel, a CanAm recruiter and doctor, said some consider pay cuts to move quickly.

“They’re ready to move to Canada tomorrow,” she said. “They are not concerned about what their income is.”

The College of Physicians and Surgeons of Ontario, which handles licensing in Canada’s most populous province, said in a statement that it registered 116 U.S.-trained doctors in the first quarter of 2025 — an increase of at least 50% over the prior two quarters. Ontario also received license applications from about 260 U.S.-trained doctors in the first quarter of this year, the organization said.

British Columbia, another populous province, saw a surge of licensure applications from U.S.-trained doctors after Election Day, according to an email statement from the College of Physicians and Surgeons of British Columbia. The statement also said the organization licensed 28 such doctors in the fiscal year that ended in February — triple the total of the prior year.

Quebec’s College of Physicians said applications from U.S.-trained doctors have increased, along with the number of Canadian doctors returning from America to practice within the province, but it did not provide specifics. In a statement, the organization said some applicants were trying to get permitted to practice in Canada “specifically because of the actual presidential administration.”

Michael, the physician who moved to Canada this year, said he had long been wary of what he described as escalating right-ring political rhetoric and unchecked gun violence in the United States, the latter of which he witnessed firsthand during a decade working in American emergency rooms.

Michael said he began considering the move as Trump was running for reelection in 2020. His breaking point came on Jan. 6, 2021, when a violent mob of Trump supporters besieged the U.S. Capitol in an attempt to stop the certification of the election of Joe Biden as president.

“Civil discourse was falling apart,” he said. “I had a conversation with my family about how Biden was going to be a one-term president and we were still headed in a direction of being increasingly radicalized toward the right and an acceptance of vigilantism.”

It then took about a year for Michael to become licensed in Canada, then longer for him to finalize his job and move, he said. While the licensing process was “not difficult,” he said, it did require him to obtain certified documents from his medical school and residency program.

“The process wasn’t any harder than getting your first license in the United States, which is also very bureaucratic,” Michael said. “The difference is, I think most people practicing in the U.S. have got so much administrative fatigue that they don’t want to go through that process again.”

Michael said he now receives near-daily emails or texts from American doctors who are seeking advice about moving to Canada.

‘You Left Just in Time’

This desire to leave has also been striking to Hippocratic Adventures, a small business that helps American doctors practice medicine in other countries.

The company was co-founded by Ashwini Bapat, a Yale-educated doctor who moved to Portugal in 2020 in part because she was “terrified that Trump would win again.” For years, Hippocratic Adventures catered to physicians with wanderlust, guiding them through the bureaucracy of getting licensed in foreign nations or conducting telemedicine from afar, Bapat said.

But after Trump was reelected, customers were no longer seeking grand travels across the globe, Bapat said. Now they were searching for the nearest emergency exit, she said.

“Previously it had been about adventure,” Bapat said. “But the biggest spike that we saw, for sure, hands down, was when Trump won reelection in November. And then Inauguration Day. And basically every single day since then.”

At least one Canadian province is actively marketing itself to American doctors.

Doctors Manitoba, which represents physicians in the rural province that struggles with one of Canada’s worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S.

The campaign focuses on Florida and North and South Dakota and advertises “zero political interference in physician patient relationship” as a selling point.

Alison Carleton, a family medicine doctor who moved from Iowa to Manitoba in 2017, said she left to escape the daily grind of America’s for-profit health care system and because she was appalled that Trump was elected the first time.

Carleton said she now runs a small-town clinic with low stress, less paperwork, and no fear of burying her patients in medical debt.

She dropped her American citizenship last year.

“People I know have said, ‘You left just in time,’” Carleton said. “I tell people, ‘I know. When are you going to move?’”

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

‘I Can Do It With a Broken Body’: How I Learned to Live with Chronic Pain

By Crystal Lindell

I can still remember the exact day when everything I thought I knew about physical pain was destroyed.

It was 2013, and I had just started to have chronic pain in my ribs a few months prior. Although it would eventually be diagnosed as intercostal neuralgia, and then years later as Ehlers-Danlos Syndrome, at the time nobody seemed to know what was going on. 

The pain was debilitating and I had no idea how to cope with it. Every doctor I saw told me that my imaging and labs were “normal” so there was nothing they could do. They just repeatedly upped my dose of gabapentin and sent me on my way – wash, rinse, repeat as the gabapentin failed to help. 

I had spent another sleepless night tossing and turning in agony as the pain on my right side wrapped around my torso like a spiked metal snake tightening its hold on me. I was stuck in that impossible cycle where the less I slept, the more pain I felt – and the more pain I felt, the less I slept. 

At the time, I didn’t even know the term "chronic pain” yet, and I was struggling to find anyone else who seemed to understand what I was going through. Pain that never goes away was not supposed to happen – especially if there was no underlying injury that could be fixed with surgery. So it had not occurred to me to add "chronic" to my pain.

After being awake most of the night, I got up, dressed and drove myself to immediate care, hoping for a miracle. 

The miracle never came. 

I felt like I was going to die and thought that such a pain level would warrant some sort of response from a doctor – some sort of urgency. But instead, I was dismissed. Actually, worse than that, I was chastised for coming in again when they had already seen me a few weeks prior. 

After waiting over two hours to be seen, the doctor walked into the small exam room, looked up at me, recognized me from previous visits and scolded me, saying, “You still haven’t gotten this figured out?” 

As if I was the one who refused to figure it out. As if the doctors who all refused to help me couldn’t be held responsible because I was the one who was not doing my part. 

The only problem was, I had no idea what my part was even supposed to be. And more than a decade later, I’m still not always sure.

The doctor then quickly told me there was nothing they could do, and that I would need to follow up with my primary care physician. Then she told me to check out at the front desk. 

They did nothing to help me. Nothing at all. And the pain had only gotten more intense during all this. I went to my car feeling hopeless. And then I realized that my day was going to get worse. 

I had been dealing with this pain for multiple months at this point, which means I had already missed weeks worth of work. I suddenly realized that I was going to have to go to the office for the day. 

In pain. 

After spending all morning in immediate care. 

I was going to have to go to work. 

It’s a situation that would have seemed impossible to my healthy body just a few months before.. 

Up until that point, a trip to immediate care would have easily warranted a sick day from work. But even though it was only spring, I had already used up all my sick days for the year and then some. I couldn’t afford to miss a day for a health issue that was now as normal for me as it was horrific. 

After all, normal things require normal days. The pain was normal. So I had to go about my normal day and go to work. 

I sobbed in my car. It was the first time I truly understood that I was going to have to live my regular life in what was now regular pain. Prior to that moment, I would have assumed that the level of pain I was enduring was more than enough to make the world stop – or at least to make my world stop. 

I often think of the lyrics from the Taylor Swift song, “I Can Do It With a Broken Heart.” 

In the song, she laments having to go about her life with a smile after a bad romantic breakup left her feeling depressed, singing:

I was grinnin' like I'm winnin'

I was hittin' my marks

'Cause I can do it with a broken heart

For me, and millions of other people living with chronic pain, the title is slightly different: “I can do it with a broken body.”

Because that’s the thing about chronic pain, it seeps out into every aspect of your life like an oil spill, and you just have to live around it. I still have to work, feed my cats, feed myself, shower, pay bills, and see my family. 

It’s just that most days I have to do all that while also living with horrible pain. 

After more than a decade of living this way, I am relieved to report that I have found some coping strategies. I also moved and found new doctors, who took my pain more seriously, despite the lack of proof on MRI scans and blood work. 

I also meticulously scaled back my life over the years, peeling away things that I now understood were unnecessary. I live a quiet, low-commitment life, so that there is room to breathe while pain takes up all my oxygen. 

Things are not as bad as they were that day back in 2013. My pain is well managed, and my daily life is much more accommodating. 

And yet, the pain persists. It remains chronic. So I still spend most days “doing it with a broken body.”  Or as Taylor Swift put it:

Lights, camera, bitch, smile.

Even when you wanna die

Except for chronic pain patients, there are no lights and no camera. Just a life in pain. 

Are ‘Addicts’ to Blame for Prescription Opioid Crackdowns?

By Crystal Lindell

It’s been nearly a decade since the CDC released its infamous 2016 opioid guideline. In the years since, millions of pain patients have endured immense suffering, as doctors significantly reduced the amount of opioid medication they prescribe.

But who is really responsible for all that pain?

It’s tempting to lay the blame for all the crackdowns on “addicts.” After all, if it wasn’t for them, the rest of us could still get opioids for pain relief, right?

Unfortunately, it’s not so simple. 

The real culprits are the DEA, CDC, and the medical community at large, all of which have worked together to criminalize pain and punish patients.

But blaming ‘addicts” for the crackdown on opioids is exactly what the people with real power are hoping you will do. First and foremost, it has the effect of pitting opioid users against each other, when in reality we’re already on the same team. And as the old saying warns: United we stand, divided we fall. 

Many people who use opioids illegally have chronic pain or other health issues that opioids help address. In a country that does not have guaranteed healthcare, much less guaranteed pain treatment, they are left to fend for themselves. So, it’s no wonder that some of them turn to illegal drugs for relief. 

Using opioids illegally will get you labeled as “an addict,” regardless of the circumstances. In fact, that’s a big part of the reason why I no longer use the word “addict” when talking about illegal users. It’s a murky diagnosis that's often given to deprive patients of a controversial but effective treatment. 

Furthermore, blaming people who use illegal opioids for the fact that many pain patients can’t get an opioid prescription only serves to let the true oppressors off the hook for their crimes. 

We have to remember, it’s not “legal users vs. illegal users.” It’s “all users vs. the DEA, CDC and the medical community.”

I understand where the desire to blame “addicts” comes from. After all, illegal users make a very tempting target. It’s much easier to hate them than to admit that maybe your doctor, who has a lot of power over your life, is actually the one causing you harm. 

It’s also human nature to want to identify yourself as “one of the good ones.” As in: Yes, I use opioids. But I’m different and have a legitimate medical need. 

I mean, obviously, it’s not that simple. But I get why pain patients want to tell themselves that it is. 

The thing is, there are real solutions to the lack of access to opioid pain medication. But we won’t achieve them unless we all work together. 

For example, we could advocate for selling hydrocodone the same way we sell nicotine, alcohol and caffeine: over-the-counter and without a prescription. Eliminating doctors from the equation would help countless pain patients finally get relief, whether they used opioids illegally or legally. And it would be a whole lot safer than the Russian Roulette of drugs on the black market. 

That’s the kind of solution that’s only possible if all opioid users unite in the fight against opioid restrictions. But it won’t happen as long as pain patients insist on telling themselves that there are “addicts” out there that aren’t as worthy as they are.

Because that’s the crux of the issue, isn’t it? Deep down, a lot of pain patients think that people using medications illegally are a separate class of people that need to be banned from accessing opioids “for their own good.” 

Here’s the secret that your doctors won’t tell you though: The medical community has already put you into that group as well. They already think you need to be kept away from opioids “for your own good.” 

In their eyes, both legal and illegal users are one group – so we might as well embrace it. After all, we’re all worthy of pain relief. And all of us should have the right and the ability to treat our own pain as we see fit. 

If we all work together, maybe one day we can make the right to pain treatment a reality. 

How and Where the Trump Administration Will Cut Healthcare Spending

By Elisabeth Rosenthal, KFF Health News

Health care has proved a vulnerable target for the firehose of cuts and policy changes President Donald Trump ordered in the name of reducing waste and improving efficiency. But most of the impact isn’t as tangible as, say, higher egg prices at the grocery store.

One thing experts from a wide range of fields, from basic science to public health, agree on: The damage will be varied and immense.

“It’s exceedingly foolish to cut funding in this way,” said Harold Varmus, a Nobel Prize-winning scientist and former director of both the National Institutes of Health and the National Cancer Institute.

The blaze of cuts have yielded nonsensical and perhaps unintended consequences. Consider instances in which grant funding gets canceled after two years of a three-year project. That means, for example, that $2 million has already been spent but there will be no return on that investment.

Some of the targeted areas are not administration priorities. That includes the abrupt termination of studies on long covid, which afflicts more than 100,000 Americans, and the interruption of work on mRNA vaccines, which hold promise not just in infectious disease but also in treating cancer.

While charitable dollars have flowed in to plug some gaps, “philanthropy cannot replace federal funding,” said Dustin Sposato, communications manager for the Science Philanthropy Alliance, a group that works to boost support from charities for basic science research.

Here are critical ways in which Trump administration cuts — proposed and actual — could affect American health care and, more important, the health of American patients.

Cuts to the National Institutes of Health

The Trump administration has cut $2.3 billion in new grant funding since its term began, as well as terminated existing grants on a wide range of topics — vaccine hesitancy, HIV/AIDS, and covid-19 — that do not align with its priorities. National Institutes of Health grants do have yearly renewal clauses, but it is rare for them to be terminated, experts say. The administration has also cut “training grants” for young scientists to join the NIH.

Why It Matters: The NIH has long been a crucible of basic science research — the kind of work that industry generally does not do. Most pharmaceutical patents have their roots in work done or supported by the NIH, and many scientists at pharmaceutical manufacturers learned their craft at institutions supported by the NIH or at the NIH itself.

The termination of some grants will directly affect patients since they involved ongoing clinical studies on a range of conditions, including pediatric cancer, diabetes, and long covid. And, more broadly, cuts in public funding for research could be costly in the longer term as a paucity of new discoveries will mean fewer new products:

A 25% cut to public research and development spending would reduce the nation’s economic output by an amount comparable to the decline in gross domestic product during the Great Recession, a new study found.

Cuts to Universities

The Trump administration also tried to deal a harrowing blow — currently blocked by the courts — to scientific research at universities by slashing extra money that accompanies research grants for “indirect costs,” like libraries, lab animal care, support staff, and computer systems.

Why It Matters: Wealthier universities may find the funds to make up for draconian indirect cost cuts. But poorer ones — and many state schools, many of them in red states — will simply stop doing research. A good number of crucial discoveries emerge from these labs.

“Medical research is a money-losing proposition,” said one state school dean with former ties to the Ivies. (The dean requested anonymity because his current employer told him he could not speak on the record.) “If you want to shut down research, this will do it, and it will go first at places like the University of Tennessee and the University of Arkansas.”

That also means fewer opportunities for students at state universities to become scientists.

Cuts to Public Health

These hits came in many forms. The administration has cut or threatened to cut long-standing block grants from the Centers for Disease Control and Prevention; covid-related grants; and grants related to diversity, equity, and inclusion activities — which often translated into grants to improve health care for the underserved. Though the covid pandemic has faded, those grants were being used by states to enhance lab capacity to improve detection and surveillance. And they were used to formally train the nation’s public health workforce, many of whom learn on the job.

Why It Matters: Public health officials and researchers were working hard to facilitate a quicker, more thoughtful response to future pandemics, of particular concern as bird flu looms and measles is having a resurgence. Mati Hlatshwayo Davis, the St. Louis health director, had four grants canceled, three in one day.

One grant that fell under the covid rubric included programs to help community members make lifestyle changes to reduce the risk of hypertension and diabetes — the kind of chronic diseases that Health and Human Services Secretary Robert F. Kennedy Jr. has said he will focus on fighting. Others paid the salaries of support staff for a wide variety of public health initiatives.

“What has been disappointing is that decisions have been made without due diligence,” Davis said.

Health-Related Impact of Tariffs

Though Trump has exempted prescription drugs from his sweeping tariffs on most imports thus far, he has not ruled out the possibility of imposing such tariffs. “It’s a moving target,” said Michael Strain, an economist at the American Enterprise Institute, noting that since high drug prices are already a burden, adding any tax to them is problematic.

Why It Matters: That supposed exemption doesn’t fully insulate American patients from higher costs. About two-thirds of prescription drugs are already manufactured in the U.S. But their raw materials are often imported from China — and those enjoy no tariff exemption. Many basic supplies used in hospitals and doctors’ offices — syringes, surgical drapes, and personal protective equipment — are imported, too.

Finally, even if the tariffs somehow don’t themselves magnify the price to purchase ingredients and medical supplies, Americans may suffer: Across-the-board tariffs on such a wide range of products, from steel to clothing, means fewer ships will be crossing the Pacific to make deliveries — and that means delays.

“I think there’s an uncomfortably high probability that something breaks in the supply chain and we end up with shortages,” Strain said.

Changes to Medicaid

Trump has vowed to protect Medicaid, the state-federal health insurance program for Americans with low incomes and disabilities. But House Republicans have eyed the program as a possible source of offsets to help pay for what Trump calls “the big, beautiful bill” — a sweeping piece of budget legislation to extend his 2017 tax cuts.

The amount of money GOP leaders have indicated they could squeeze from Medicaid, which now covers about 20% of Americans, has been in the hundreds of billions of dollars. But deep cuts are politically fraught.

To generate some savings, administration officials have at times indicated they are open to at least some tweaks to Medicaid. One idea on the table — work requirements — would require adults on Medicaid to be working or in some kind of job training. (Nearly two-thirds of Medicaid recipients ages 19-64 already work.)

Why It Matters: In 2024 the uninsured rate was 8.2%, near the all-time low, in large part because of the Medicaid expansion under the 2010 Affordable Care Act. Critics say work requirements are a backhanded way to slim down the Medicaid rolls, since the paperwork requirements of such programs have proved so onerous that eligible people drop out, causing the uninsured rate to rise.

A Congressional Budget Office report estimates that the proposed change would reduce coverage by at least 7.7 million in a decade. This leads to higher rates of uncompensated care, putting vulnerable health care facilities — think rural hospitals — at risk.

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

Banning Kratom is Foolish. Governments Should Avoid Hysteria

By Crystal Lindell

I always say the way you know that kratom is among the rare herbal supplements that actually relieves pain is that everyone is always trying to ban it. 

Unfortunately, two towns in my state - Illinois - have done just that. City councils in Marion and Herrin voted this week to ban the sale and delivery of kratom. 

The reported justifications for the bans are naive at best and outright dishonest at worst. 

According to an article about the bans, the Marion city council acted after hearing from the widow of 41-year old Blake Pieroni, who died two months ago. She blames kratom for his death.

“He initially believed, as many do, that kratom was a safe natural supplement,” said Emily Pieroni. “The first time he tried kratom was when the owner of a gas station here in Marion offered Blake kratom as an energy shot. He told him it was like a 5-Hour Energy, but safer and more natural.”

I was especially interested in this anecdote because it would indeed be quite noteworthy if kratom alone had directly caused someone's death. Such cases are incredibly rare. However, when I looked into it, I quickly found that this was not the case. 

In fact, Emily Pieroni has written publicly that her husband died by suicide. She even includes this information in her Change.org petition asking for kratom to be banned:

“At first, it seemed harmless — just a boost of energy. But it quickly became an addiction. He tried to quit three times in seven months. The withdrawal was unbearable. Eventually, the emotional toll was too much, and kratom addiction led my husband to take his own life.”

Someone committing suicide is not the same thing as someone accidentally overdosing on a substance. If her husband had been trying to avoid coffee when he died, would that be enough to blame caffeine for his death? No. 

While I’m sympathetic to the immense grief Emily Pieroni is no doubt going through, especially as someone who has lost a loved one to suicide myself, her advocacy to have kratom banned is going to cause more harm. 

In fact, it is because she is still dealing with such raw grief that the Marion and Herrin city councils should have acted with clearer heads. 

Instead, they embraced kratom hysteria, with Marion Mayor Mike Absher even calling it “gas station heroin.” 

I want to be very clear here: Kratom is not gas station heroin. It’s an incredibly mild supplement similar to coffee. In fact, kratom comes from the leaves of the Mitragyna speciosa tree, which is literally part of the coffee family.

I could also call coffee “gas station meth” but that doesn’t make it true. And it would actually be more accurate to describe kratom as “herbal coffee.”

Because in reality, kratom helps countless people, including me. I have taken kratom for years for chronic pain. It is the only thing sold over the counter that actually helps me. 

For me, kratom withdrawal symptoms are as mild as withdrawing from coffee. Yes, some people may struggle to stop drinking coffee completely, but we as a society have decided that does not mean coffee should be illegal.

I also want to note that the Herrin city ordinance bans “possession” specifically, which means police can now use it to cite or even arrest people who bought kratom elsewhere, ensnaring them in the legal system and all its ill effects. 

Many kratom users are just people with chronic pain or other health issues looking for relief. We should let them use kratom in peace. Kratom is legal in most states and the vast majority of people use it safely. About 100 deaths have been linked to kratom use, but other drugs and illicit substances were usually involved. 

I hope that other towns and municipalities considering kratom bans will also consider the immense harm those bans will cause. 

Kratom is a very mild alternative to other drugs that treat chronic pain and other health issues. That should be celebrated, not demonized. 

Instead of trying to falsely claim that kratom is the same as heroin, we should be lauding the fact that it’s nowhere near as strong as heroin, and yet it is still quite effective at treating pain.

A Pained Life: Riding the Medical Merry-Go-Round

By Carol Levy

I recently went to an Urgent Care clinic because the left side of my face -- the side with the trigeminal neuralgia and phantom pain -- was swollen.

Had it been the right side of my face, I have no doubt they would have prescribed antibiotics and sent me home. Instead, because it was the left side, it became a major issue of “What is it?”

That earned me another ride on the medical merry-go-round.

Urgent care recommended I see an otolaryngologist; an ear, nose and throat specialist. He did nothing for me, but did pronounce, “Yep, it's swollen.”

My family doctor prescribed steroids, ordered blood tests, and a CAT scan of my facial bones. That was no help.

Next came a dermatologist who said, “No idea. See your neurologist.”

So I did. She ordered an MRI of my facial bones and more blood work. Again, all negative.

My GP suggested another otolaryngologist. The second one said she didn’t know what was causing my face to swell, but prescribed an antibiotic anyway.

At the next appointment, I was floored when she asked, “Has anyone else told you your face is swollen?”

That implied I was making it all up. Even though the swelling was obvious. 

Pain is not obvious.  Articles tell us not to exaggerate our pain or to pretend that we’re not in pain. The lesson seems to be to avoid stigma or judgement by not indicating one way or another if we have pain.

Is it any wonder then that we're asked, “Are you sure it's really that bad?” Or it’s suggested that we’re not really hurting, and could work or get out of bed if we really wanted to.

Being questioned about the reality of our pain is an awful discussion to have. We say we have it. That should be enough. And to some doctors, very few it seems, it is.  We say we have pain and they accept it.

Then, of course, there are the doctors whose philosophy is “seeing is believing.” Because our pain is often invisible to the eye, they refuse to believe us.

Until now, it never occurred to me that also applies when we go to a doctor with a normal everyday complaint. They still didn’t believe me, even when the swelling was plainly visible.

I still have the swelling. No one has figured it out. It’s just one more instance where a chronic pain condition interferes with getting the medical care that we need. And send us for another ride on the merry-go-round.

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

I Hate That I Need Opioid Pain Medication

By Crystal Lindell

I genuinely hate that I need opioid pain medication. 

I hate that I need it to function. I hate how expensive it is. I hate how I have to endure background checks like drug tests and interrogations to get it — like I was a criminal. 

I hate how tired it makes me. 

I hate that I can’t just buy it over-the-counter. I hate that I have to deal with judgmental doctors and pharmacists every single month to get it. I hate how vulnerable it makes me feel. I  hate how much stigma there still is around it. 

I hate that I hate it as much as I do, and yet people still think that I only take it because I’m a lazy loser who loves to get high. 

I hate that when I take it — it actually works — because that just shows how much I need it. 

Chronic pain sucks. But needing daily pain meds for a chronic condition also sucks. 

I have gone to great lengths to try to get off opioids — to try to live without them. 

I’ve done painful nerve block procedures, weekly lidocaine infusions at a hospital over an hour from my house, and gone to every specialist in that hospital. I’ve tried THC, kratom, nicotine gum, wine, and capsaicin cream. I’ve tried yoga, chiropractors, and acupuncture. I’ve tried gluten-free diets, losing weight, daily walking, and prayer.

I’ve also tried to just live with the pain. 

But I can’t. I still need opioid medication. 

I need it to shower. I need it to work. I need it to relieve the pain that makes me suicidal if left untreated.

Without opioid pain meds, I’d either be too disabled to function, or in too much pain to live. 

And I hate that so much. 

I wish that was not the case. I wish I could just exist in this stupid world without needing opioids to be alive, to actually live. 

I wish there was some other way to manage my chronic pain or even better, that I didn’t have chronic pain to begin with.

But alas, that is not the case. I literally need opioid pain medication to survive. 

So I keep taking it. 

I keep submitting to all the stupid hurdles put in place by doctors, pharmacists, and the DEA. I keep coming up with money to pay for my appointments and prescriptions. And I keep enduring the stigma that comes with it.

But I still have hope that one day people who need opioid pain medication won’t have to hate that they need it. That they’ll have access to it, and that they won’t have to submit to dehumanizing treatment to get it. 

I hope that one day needing opioid pain medication won’t be a burden to patients that must be endured on top of whatever ailments they already have. I’d rather they just bring the relief they were intended for.

The healthcare system doesn’t have to be like this. We can change it. Opioid pain medication could be accessible, inexpensive, and stigma-free. We just have to make it so.

Forced Tapering: Only Chronic Pain Patients Are Treated This Way

By Neen Monty

Imagine this: A patient, let’s call her Sue, has severe depression. Her GP prescribes an anti-depressant and refers her to a psychologist. Sue is advised to come back in four weeks. Which she does.

She’s not doing better, so the dose is increased. Sue is reviewed two more times over the next eight weeks, and each time her dose is increased.

Sue starts feeling better. The medication is working. The darkness has lifted, the black dog has been banished. She is grateful to her GP.

The GP is also happy. It has taken many weeks, but the GP raised the dose to find the minimum effective dose that controls Sue’s depression.

Sue comes back in another four weeks. She is happy, back at work, and socialising again. Life is good!

That’s when the GP tells her that it’s time to taper the anti-depressants.

Wait, what?

Or how about this: Sue has high blood pressure. She is at her GP for her yearly physical and the hypertension is discovered. The doctor prescribes a blood pressure medication and advises Sue to return in two weeks. At this review, her blood pressure is still too high, so the dose is increased.

Sue has two more dose increases, and her blood pressure falls into the normal range. She is experiencing no side effects and is very happy with the treatment.

When Sue sees her GP again with perfect blood pressure, he is pleased. Then he tells her it’s time to taper off the medication.

What if Sue had high cholesterol? Or high blood sugar? Or asthma? Epilepsy maybe?

I think you see where I am going with this.

The tapering would never happen, because it’s ludicrous and makes no sense, medically or otherwise. In these situations, people like Sue are often advised that they need to be on a medication for rest of their lives.

Where in medicine do doctors increase the dose of a medication until the symptoms are well managed and the patient is doing better -- and then gets tapered?

Only when the patient has chronic pain and is on opioid therapy. Doctors will prescribe a trial of opioids, which prove to be effective. The patient reports well-controlled pain, no significant side effects, and they are back at work, socialising, and living life again.

And then the doctor starts tapering the opioids. Against the patient’s wishes.

Utter insanity.

That’s not “evidence-based medicine.” There is no evidence to support this practice. I know what the theory is, and what doctors have been taught. But it’s not realistic. Yet many doctors don’t question it.

The theory is that once a patient gets pain relief, they will learn how to manage it without opioids. They’ll start to exercise and meditate, see a psychologist, work on their sleep hygiene, and get proper nutrition.

Except these other modalities will do nothing for severe, disabling pain.

Please point me to one study that shows that improving sleep will reduce the pain of multiple sclerosis, chronic inflammatory demyelinating polyneuropathy, or Parkinson’s disease. Or one study that shows cognitive behavioral therapy or mindfulness will reduce the pain of rheumatoid arthritis and lupus.

Those treatments may be helpful in very small ways. But their effect has been vastly overstated for chronic secondary pain -- pain that is caused by an injury, tissue damage, or disease.

Lifestyle modification can have an impact on a person who has mild to moderate primary pain -- chronic pain that does not have a known pathological cause. That pain is sometimes driven by emotional or psychological causes, so psychological treatments might be effective.

But they are ineffective for chronic secondary pain.

People will feel better on opioids, but its not “euphoria.” It’s because they can start exercising again, restart their hobbies, and return to work. They’ll feel happy again. Those positive things happen because their pain is now being treated.

Take away the pain medication, and the pain will return. The career grinds to a halt, the social life disappears, depression returns. Exercise is impossible while in severe pain. Everything returns to terrible.

There is no magic trick that can replace opioids. There is nothing else that will touch severe pain, be it acute or chronic.

And so, for doctors to provide a trial of opioids for secondary pain with the goal of eventually tapering patients is insanity. The only reason opioids should be tapered is if there are intolerable side effects, if they are not effective for the pain, or the patient wants to taper.

No one should be forcibly tapered. Ever. Forced tapering leads to a pain crisis, suicidal ideation, overdose and death. That’s what the science says.

Opioids are safe and effective when taken long term by a select minority of people – those who live with severe, disabling pain due to an incurable disease or injury.

Think about how cruel it is to provide them with a solution to their pain, to give them their life back, and then take it away.

Its abhorrent.

Its barbaric.

It’s not medicine. It’s not science. It’s not human.

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

Top 3 Ways I Make Money While Living With Chronic Pain

By Crystal Lindell 

Living with chronic pain can make it difficult to navigate traditional employment, due to the physical challenges and the unpredictability of our symptoms   

Unfortunately, we still need money to exist in our society, so I cobble together a living every month with various side jobs that I try to make into a whole job. Below is a look at some of those jobs, and the pros and cons of doing them if you have chronic pain or any sort of chronic illness.  

One large disclaimer is that none of these jobs offer health insurance. For me, for now, that just means that I don’t have insurance and I pay for medical care with cash. But I know a lot of others in a similar situation who either qualify for government insurance or they are able to purchase insurance on the government marketplace. 

Another disclaimer is that having a bunch of side jobs will make doing your taxes much more difficult, so try to put money away for that throughout the year in preparation for it. 

DoorDash

Pros: Flexible schedule, options for same-day pay, low barrier to entry. 

Cons: Success varies greatly based on where you live; the work can be physically exhausting; customers can be unpredictable and difficult; and there’s wear and tear on your car.

I started doing DoorDash in March after my cat Princess D was diagnosed with feline diabetes, and I needed to come up with some extra money for her treatment fast. 

I had a friend who told me she made $400 in four days doing DoorDash, and that was enough incentive to get me to sign up for the Dasher app. 

I live in a rural area where there are few DoorDash customers, so I drive about 20 minutes to a mid-sized city, where there are more customers and I can easily make $100 in about 4-6 hours of work. I’ve noticed that about 10 percent of my earnings go to gas, so I usually do one extra order each night to cover that. 

While there is the possibility of very low-paying orders of just $2, as long as customers tip, each order is usually at least $5 or as much as $15 in my area. 

There’s also an option to do “shop and deliver” orders, where you basically do someone’s grocery shopping. You don’t get offered those jobs at first, but as you get more experience in the app, they will start to give them to you. I had one that paid $60 for a little over an hour of shopping, because I was shopping three grocery orders simultaneously. That’s a great way to increase your earnings. 

I really, really like how flexible DoorDash is and that they offer a couple different ways to get paid the day you work. So if you need some quick cash for something like a utility bill or even just a fun outing, it’s possible to make the money fast and get paid fast. 

In the beginning, I worked mostly dinner hours and focused on Thursday through Sunday, because that’s when the app is the busiest. But after you earn various status levels, they give you more options for working whatever hours you want. Now I’m able to go out during the day, if that works for me. 

Best of all, if I’m having a bad pain day, I don’t do Doordash or can I work a very short shift. That’s flexibility that most traditional jobs don’t offer. 

Plus, if you need to stay below certain income thresholds to qualify for government benefits, it allows you to work exactly as much as you want/need to. 

If you decide to try it, I highly recommend joining some online DoorDash support groups on places like Facebook and Reddit. They are full of tips for drivers and can help you navigate the app and the job as a whole. 

Obviously, doing gig work like DoorDash will put a lot of wear and tear on your car, so you’ll need to keep up with vehicle maintenance. 

But if you’re looking for quick cash that you can make working your own schedule, then DoorDash and other similar gig work like UberEats can be a great way to do that. 

Freelance Writing

Pros: Some flexibility, can pay well, and can often be done at home

Cons: High barrier to entry; basically have to have connections to get work; and the work can be very unsteady.

I have a lot of professional experience as a writer and editor, so after I got laid off from my full-time journalism job in 2022, I had a few people reach out to me with freelance opportunities. 

This has been one of the better paying ways I make money, with some jobs paying as much as $50/hour or more. 

Even if you don’t have experience, that doesn’t mean you can’t freelance. If you have a special skill of any sort, whether it’s painting, photography or house cleaning, you can usually just post on your social media that you’re looking for work and you may be surprised by how many people reach out. 

My main advice would be to charge by the project rather than by the hour, so that you don’t have to track your hours as you go, and you don’t have to worry about any awkwardness between you and the client regarding how fast you’re working. 

If you’re setting your own rates, you have to factor in taxes and healthcare, so you should aim to make about as much per hour as you’d want to make yearly if you multiplied it by 1,000. So if you want to make $60,000 a year, you’ll want to charge a rate that works out to about $60/hour.

The biggest con to freelancing is that the work can be unsteady, which means you can’t really count on the income from month to month. For me, it’s usually based on what the publication or company I’m writing for needs at any given time. If they don’t need me, there’s no work, and thus, no money. 

Also, in the last few years, Generative AI, like ChapGPT, has dried up some of the writing and marketing work that used to be more plentiful for me. I suspect that trend will continue for my industry and others. 

However, I love writing, and freelancing allows me to be choosy about which writing jobs I want to take, so that I can focus on the things l’m passionate about, like writing for Pain News Network. Plus, making any money at all from my writing always feels like a victory to me. 

Selling Used Lego Online 

Pros: Fully done at home, can lead to a decent daily income stream, immediate pay, and it’s fun.

Cons: Relatively high barrier to entry because you have to invest in Legos and set up your own virtual store. It takes many hours of work to get things off the ground.

My fiance and I also run a virtual store where we sell used Lego. We buy bulk Lego from private sellers, wash them, sort them, inventory what we have, and then sell them by the piece. 

I’m not entirely sure I would really recommend this unless it’s something you’re passionate about, as it has been a LOT of work to run the store. And we have to use multiple rooms in our house to store Lego. 

We’ve also had some generous help from relatives, who have helped front the cost of the bulk Lego purchases we get, which helps a lot. 

But we’ve been running the store for a few years now, and it brings in a very steady stream of daily proceeds. And the more we expand the store, the more we tend to make. 

It’s also great to be able to work on the store at home and on our own schedule. 

There are other ways to make money selling used items online, and I know a lot of people make a living selling things on sites like eBay. But again, I really don’t recommend it unless it’s a product you’re really passionate about. 

For example, if you already love thrifting clothes, you may be able to find some cheap but valuable items that you can resell online. But you’ll quickly grow bored and frustrated with how much work is involved if you don’t love the process of sourcing in the first place. 

I will confess that even with all of these jobs, we are often tight on money. But we are very rich in other ways. We choose our own schedules, we are happy, we are able to rest when our bodies need it, and we get to spend a lot of time with our beloved cats. 

Maybe some day I’ll be healthy enough, both mentally and physically, to work full-time again, but for now, I’m just enjoying this chapter in our lives and all the flexibility it gives us. 

How I Learned to Sleep Better and Keep My Mobility

By Madora Pennington

What do you lose when lose your ability to get up, walk, move about, and do things for yourself?

Independence.

Moving your body around requires muscles, stability, balance, good joints, and brain function. If that is lost, you need others to help you do things.

You may not be able to do your own cooking and cleaning. Getting groceries yourself might be too difficult. Even if you get them delivered, you might not be able to put them away. You risk falling and getting injured or not being able to get up. You miss out on social events. You may find yourself isolated and depressed. You’ll need more healthcare services. You might even end up in assisted living.

The number one cause of disability in the United States is loss of mobility, affecting 13% of adults. Many chronic conditions can lead to it: Parkinson's, multiple sclerosis, diabetes, arthritis.

One thing has been shown to slow the loss of mobility for all of them: good sleep.

A 2024 study followed over 70,000 women for eight years. Those that slept enough kept their ability to move and use their bodies. Those that didn’t reported being very sleepy during the day and lost mobility over time.

It seems that no matter what your chronic condition is — or even if you have none – sleeping too little may speed you towards disability.

These results are not surprising. A healthy diet, exercise, and good sleep are accepted as pillars of good health. Improving diet and exercise can be hard, requiring time, effort and education. But solving poor sleep can be a nightmare.

Here are some things I learned from a therapist years ago, when I was having night terrors every night. I would awaken in a state of hyper-arousal, confused about where I was and very afraid. I was diagnosed with PTSD, which is thought to be a disorder of circadian rhythm.

My body, I was told, had lost its sense of when it was time to rest and rejuvenate, and when it was time to be in action and face challenges. The therapist recommended fixing my dysregulated internal clock.

You do that by making sure the bedroom is used for sleep only. That means you avoid hanging out in bed or the bedroom — no eating, no watching TV, no knitting, reading, whatever.

“Can I fold the laundry on the bed?” I asked.

“It would be better to do it elsewhere,” the therapist said. “Stay out of your bedroom during the day as much as possible, so the bedroom itself signals sleepy time.”

Another tip was to avoid bright lights in the hours before bedtime. And to get some red lights to mimic the sun setting.

If you lie in bed feeling anxious and frustrated, you risk training your brain and body that the bed is a stressful place and not for sleep.

If you can’t sleep or go back to sleep, get out of bed and leave the bedroom. Keep the lights low, or even better, make them red. Move around. Unload the dishwasher. Pet the cat. Get right back in bed when drowsiness returns.

Get into bed at the same time every night, before 10 p.m. Set an alarm and get out of bed after eight hours, no matter what. No naps. Don’t confuse the body.

As odd as they seemed at the time, these simple suggestions went a long way in improving my sleep and my whole PTSD phenomena. I still stick to them. I don’t read, relax or watch TV in bed, unless I’m doing it as part of my bedtime routine. If I am sick, I rest elsewhere during the day.

I’ll admit, I do love a weekend nap sometimes. But I only take one if it’s before 2 p.m. Any later than that, and I might not fall asleep easily at night, a habit I do not want to promote.

When I do take a nap, I sleep upright on a bean bag or the couch, with the curtains open and a video playing. That way, my body understands this is a shallow nap – I have not entered a different time zone.

To wake up refreshed and rested is a gift to yourself and those around you. Many issues can prevent regular, deep, restorative sleep. Pain is a sleep interrupter. Antihistamines, benzodiazepines, opioids and alcohol may help put you to sleep, but keep you out of the REM stages of sleep that are needed for repair.

Find knowledgeable practitioners and good advice to help. The right solutions for good sleep are the ones that work for you.

What Not To Say in the Emergency Room

By Carol Levy

Many years ago, I was a clerk in an emergency room ward. Often the people who came in didn't seem to understand how an emergency room works. Unfortunately, those same misunderstandings exist today.

I have seen a number of online posts and comments by chronic pain patients about their experiences in emergency rooms. The posts tend to be very negative about ERs, often angry, and full of frustration over the way they were treated.

My intention when I started this column was to write about the emergency room experience, and what to expect when you make the choice to go there. I did some research to ensure my facts would still be current, such as how ER departments are configured today.

I found several articles on what not to say to your pain management doctor. To my surprise, the answers mimicked what you should not say in the ER, such as “I just need painkillers” or “I know what I need, just prescribe it.”

Saying that gives the impression that you’re just looking for medication, rather than treatment. It’s not advisable to say that to any doctor, regardless of the situation.  

At the ER, you will first see the receptionist or ward clerk. The next step for most hospitals is the triage person, usually a nurse.  When they ask “What is the reason for your visit?” saying, “I have pain” is not sufficient.

They will inquire about when, where and for how long you’ve had pain, to get a better idea of why you are there. That will help them decide what level of an emergency you are.

It’s important not to expect ER staff to know everything about rare disorders, such as CRPS, trigeminal neuralgia or Ehlers-Danlos syndrome. The chances they have seen or even heard of them are slim. Unfortunately, for many rare disorders, we have to be the ones to educate the staff.

Even if you are in extreme pain, shouting “I have pain!” will not help get what you need. Calmly explaining, as best you can, the cause and level of your pain gives them a better understanding of why you are there, and will help get you seen sooner.

Another “don’t” is asking for a specific opioid, as it can make you appear to be a drug seeker. That’s not fair, I know, but that’s just the way it is in the current anti- opioid environment.

Exaggerating your pain can also be seen as the behavior of someone looking to get drugs. Screaming or yelling “I am in horrible pain! Give me something now!” won't get you what you need. Ultimately, the doctor or nurse will decide if you're exaggerating your pain. If they decide that’s the case, you may get nothing at all.

You also shouldn’t question your doctor's expertise. After all, he is the expert (or at least thinks he is). Asking for clarification is fine, but asking for a second opinion may backfire. It’s another way of saying you don't trust or have faith in the doctor. In the ER, you won't be able to get a second opinion. Whichever doctor sees you is the one you’re stuck with.

The wait in the ER may be a long one. The doctors and nurses may seem to be walking around aimlessly, but they may actually be busy, dealing with patients who have suffered a heart attack, stroke, or severe trauma.

If you are a chronic pain patient, your pain may not be seen as an immediate concern. To ER staff, acute pain could be a sign of a life threatening situation that needs immediate attention.

Many ERs now have private rooms, but some still have ward-like areas. It is nice to have privacy, but they may put you in the ward area because that is the only space available.

These unwritten rules apply to everyone on how to act in the ER. But for those of us with chronic pain, we need to to be extra careful about what lines not to cross.

What lessons have you learned in the ER?

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

Misinformation About Fentanyl Threatens To Undermine Overdose Response

By Henry Larweh, KFF Health News

Fentanyl, the deadly synthetic opioid driving the nation’s high drug overdose rates, is also caught up in another increasingly serious problem: misinformation.

False and misleading narratives on social media, in news reports, and even in popular television dramas suggesting people can overdose from touching fentanyl — rather than ingesting it — are now informing policy and spending decisions.

In an episode of the CBS cop drama “Blue Bloods,” for instance, Detective Maria Baez becomes comatose after accidentally touching powdered fentanyl. In another drama, “S.W.A.T.,” Sgt. Daniel “Hondo” Harrelson warns his co-workers: “You touch the pure stuff without wearing gloves, say good night.”

While fentanyl-related deaths have drastically risen over the past decade, no evidence suggests any resulted from incidentally touching or inhaling it, and little to no evidence that any resulted from consuming it in marijuana products. (Recent data indicates that fentanyl-related deaths have begun to drop.)

There is also almost no evidence that law enforcement personnel are at heightened risk of accidental overdoses due to such exposures. Still, there is a steady stream of reports — which generally turn out to be false — of officers allegedly becoming ill after handling fentanyl.

“It’s only in the TV dramas” where that happens, said Brandon del Pozo, a retired Burlington, Vermont, police chief who researches policing and public health policies and practices at Brown University.

In fact, fentanyl overdoses are commonly caused by ingesting the drug illicitly as a pill or powder. And most accidental exposures occur when people who use drugs, even those who do not use opioids, unknowingly consume fentanyl because it is so often used to “cut” street drugs such as heroin and cocaine.

Despite what scientific evidence suggests about fentanyl and its risks, misinformation can persist in public discourse and among first responders on the front lines of the crisis. Daniel Meloy, a senior community engagement specialist at the drug recovery organizations Operation 2 Save Lives and QRT National, said he thinks of misinformation as “more of an unknown than it is an anxiety or a fear.”

“We’re experiencing it often before the information” can be understood and shared by public health and addiction medicine practitioners, Meloy said.

Some state and local governments are investing money from their share of the billions in opioid settlement funds in efforts to protect first responders from purported risks perpetuated through fentanyl misinformation.

In 2022 and 2023, 19 cities, towns, and counties across eight states used settlement funds to purchase drug detection devices for law enforcement agencies, spending just over $1 million altogether. Two mass spectrometers were purchased for at least $136,000 for the Greeley, Colorado, police department, “to protect those who are tasked with handling those substances.”

Del Pozo, the retired police chief, said fentanyl is present in most illicit opioids found at the scene of an arrest. But that “doesn’t mean you need to spend a lot of money on fentanyl detection for officer safety,” he said. If that spending decision is motivated by officer safety concerns, then it’s “misspent money,” del Pozo said.

Fentanyl misinformation is affecting policy in other ways, too.

Florida, for instance, has on the books a law that makes it a second-degree felony to cause an overdose or bodily injury to a first responder through this kind of secondhand fentanyl exposure. Similar legislation has been considered by states such as Tennessee and West Virginia, the latter stipulating a penalty of 15 years to life imprisonment if the exposure results in death.

Public health advocates worry these laws will make people shy away from seeking help for people who are overdosing.

“A lot of people leave overdose scenes because they don’t want to interact with police,” said Erin Russell, a principal with Health Management Associates, a health care industry research and consulting firm. Florida does include a caveat in its statute that any person “acting in good faith” to seek medical assistance for someone they believe to be overdosing “may not” be arrested, charged, or prosecuted.

‘You Can Get It Through Your Fingers’

And even when public policy is crafted to protect first responders as well as regular people, misinformation can undermine a program’s messaging.

Take Mississippi’s One Pill Can Kill initiative. Led by the state attorney general, Lynn Fitch, the initiative aims to provide resources and education to Mississippi residents about fentanyl and its risks.

While it promotes the availability and use of harm reduction tools, such as naloxone and fentanyl test strips, Fitch has also propped up misinformation.

At the 2024 Mississippi Coalition of Bail Sureties conference, Fitch said, “If you figure out that pill’s got fentanyl, you better be ready to dispose of it, because you can get it through your fingers,” based on the repeatedly debunked belief that a person can overdose by simply touching fentanyl.

Officers on the ground, meanwhile, sometimes are warned to proceed with caution in providing lifesaving interventions at overdose scenes because of these alleged accidental exposure risks. This caution is often evidenced in a push to provide first responders with masks and other personal protective equipment.

Fitch told the crowd at the conference: “You can’t just go out and give CPR like you did before.”

However, as with other secondhand exposures, the risk for a fentanyl overdose from applying mouth-to-mouth is negligible, with no clinical evidence to suggest it has occurred.

Her comments underscore growing concerns, often not supported by science, that officers and first responders increasingly face exposure risks during overdose responses. Her office did not respond to questions about these comments.

Health care experts say they are not against providing first responders with protective equipment, but that fentanyl misinformation is clouding policy and risks delaying critical interventions such as CPR and rescue breathing.

“People are afraid to do rescue breathing because they’re like, ‘Well, what if there’s fentanyl in the person’s mouth,’” Russell said. Hesitating for even a moment because of fentanyl misinformation could delay a technique that “is incredibly important in an overdose response.”

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

How Chronic Pain Impacts Romantic Relationships

By Crystal Lindell

The more you love someone with chronic pain, the more likely it is that their pain will cause you emotional distress. 

That’s according to new research published in the Journal of Health Psychology, which looks at the ways middle-aged romantic partnerships are impacted when one person has chronic pain. 

The researchers collected twice-daily surveys over the span of 30 days from 147 couples who were at least 50 years of age and had one partner who suffered from chronic back pain. 

Using the couples' answers to questions about distress and relationship closeness, as well as reports of pain severity from the pain-affected partner, they examined how emotional, behavioral and cognitive closeness affected the quality of couples’ daily interactions.

On the positive side, researchers found that emotional closeness between couples dealing with chronic pain led to more marital satisfaction on days when the couple felt close. 

However, on the other side of things, the closer the couple felt emotionally on any given day, the more likely it was that the non-pain partner experienced more distress. The non-pain partner apparently feels empathy for the pained partner, which results in them feeling stressed. 

As anyone who’s ever been in love knows, empathy is the required price. When your partner is sad, you will also tend to be sad on their behalf. 

This is not inherently a bad thing. Feeling empathy for your partner when they are dealing with pain makes it more likely that you’ll work harder to ease their pain, by doing things like advocating for them in healthcare settings and allowing them to rest while you do the household chores. 

The researchers framed this as something to avoid though, which I guess makes sense if it’s happening excessively.

“Couples have to find a balance that is ideal for them in managing closeness versus independence — this is true for all couples, not just those dealing with the impacts of chronic pain. But for those dealing with chronic pain, we can help them learn how to balance the benefits of closeness with minimizing shared distress stemming from a chronic condition,” lead researcher Lynn Martire, PhD, a professor of human development and family studies at Penn State’s Center for Healthy Aging, said in a press release.: 

The findings suggest that methods could be developed to help couples find the right balance in closeness, which would protect them from causing more pain and distress for each other. Martire and her colleagues plan further studies on the roles of behavioral and cognitive closeness.

“I’m excited to dive deeper into the other research questions we can examine from this data set,” Martire said. “We gathered data using different measures of relationship closeness, how they differ between patients and partners and how relationship closeness changes over time. We are poised to learn a great deal about the impact of pain on couples.”

Prior studies show that closeness is associated with many positive and beneficial relationships, including higher levels of commitment and satisfaction, and a lower risk of the relationship ending. 

However, researchers also say their findings suggest that too much closeness may transfer negative emotions and physical symptoms between partners.

“These findings illustrate a complex interplay between closeness and personal well-being in couples managing chronic illness and suggest the need for interventions that target both the benefits and potential costs of closeness,” they concluded. 

Yes, indeed, there are “benefits and potential costs” in any close relationship. It’s a contradiction that countless poets have spent centuries trying to navigate. 

Love comes at a price, but most of the time, the price is worth it. 

The Pharmacy Shuffle: Navigating the Opioid Shortage Again

By Crystal Lindell

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

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

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

But this time, it was much worse. 

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

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

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

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

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

Finding an Alternative

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

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

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

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

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

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

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

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

Sadly, my guess of $200 was pathetically low.

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

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

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

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

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

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

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

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

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

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

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

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

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

I Got Lucky, Other Patients May Not

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

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

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

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

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

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

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

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

HHS Cuts Signal Seismic Shift in Public Health Policy

By Simon Haeder

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

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

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

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

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

What HHS Does

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

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

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

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

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

Layoffs Affect 25% of HHS Workforce

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

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

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

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

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

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

‘Painful Period’ for HHS

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

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

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

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

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

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

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

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

Fewer Benefits and Services

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

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

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

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

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

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

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

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

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

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

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

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