Pain Research and Treatment Missing From 2026 HHS Budget

By Pat Anson

An estimated 60 million Americans suffer from chronic pain, costing the U.S. healthcare system about $77 billion a year.  According to the National Institutes of Health (NIH), chronic pain affects more Americans than diabetes, heart disease, and cancer combined.

You’d never know it though by reading the proposed $94.7 billion budget for the Department of Health and Human Services (HHS) released on Friday by the Trump administration.

There are nearly 21,000 words in the 55-page budget for 2026, and not a single word or dollar is devoted to pain research, treatment, or how to help those 60 million Americans.   

The only reference to pain is a quote attributed to HHS Secretary Robert F. Kennedy, Jr.

“A healthy person has a thousand dreams. A sick person only has one, and right now, there’s 60% of the people in this country who have only one dream – that they can make it through the day without pain, with energy, without having to take medications, and we are going to change that for this country,” Kennedy is quoted as saying.

One can quibble about whether RFK Jr. actually said those exact words or if they were invented for the budget document. In either case, many Americans living with chronic pain already get through the day without taking an effective pain medication, although its not by choice.

Kennedy has previously used the line about “a healthy person has a thousand dreams,” which is paraphrased from Confucius. Kennedy used it without attribution in his Senate confirmation hearing in January and again when he was sworn in as HHS Secretary a month later, but didn’t mention pain in either instance.   

Perhaps it’s only fitting, given how the topic of pain is notably absent from the HHS budget. What we get instead are platitudes about “making Americans the healthiest in the world,” while at the same time reducing the HHS budget by 26 percent, and downsizing or eliminating dozens of federal health programs.

The NIH faces some of the steepest cuts, with its $27.5 billion budget cutback to $18 billion. The Trump administration has already gutted the NIH’s Office of Pain Policy and Planning (OPPP), which focused on pain research. The OPPP’s entire staff was fired in April.

“Even though chronic pain is one of the leading health issues in America, it has never had a true home at NIH with a dedicated institute. Many pain researchers have described the NIH as a place where ‘pain lives everywhere and nowhere,’ and now, with the dismantling of the OPPP, I fear that pain may literally have no home at all,” Dr. Juan Hincapie-Castillo, an assistant professor at UNC Chapel Hill, wrote in The Charlotte Observer. Hincapie-Castillo received funding from OPPP for his studies of trigeminal neuralgia.

‘Embrace Radical Change’

In all, HHS plans to consolidate 28 operating divisions into 15, close five of its regional offices, and end funding for 5,000 contracts – all in the name of saving money.

“This planned realignment will allow the Department to do more at a lower cost to taxpayers by increasing operational efficiency and cutting bureaucratic sprawl,” the budget document states.

“America spends nearly one-third of the federal budget on healthcare, only to rank last in terms of health among developed nations. Americans are seeing declines in life expectancy and facing the highest rates of chronic disease in the world. HHS is committed to making Americans healthy again, making the American health system the best in the world, and putting patients first. To accomplish this, we need to embrace radical change.”

HHS is planning to move several agencies — including the Substance Abuse and Mental Health Services Administration (SAMHSA) and some programs in the Centers for Disease Control and Prevention (CDC) -- into a new agency called the Administration for a Healthy America (AHA), which would be under Kennedy’s direct control. AHA will administer $14 billion in discretionary funding to combat the “chronic disease epidemic.”

“(AHA) will prioritize prevention — a missing piece in the American health system — primary care, maternal and child health, mental health, substance use prevention and treatment, environmental health, HIV/AIDS, workforce development, and policy, research, and oversight,” the HHS says.

Note the absence of pain prevention and treatment in that sentence.

Opioids are mentioned nearly half a dozen times in the budget, but only in the context of addiction treatment, not pain management. Many of the CDC programs that deal with opioid abuse and treatment are being moved to AHA, and $4 billion in block grants for mental health and substance abuse treatment is earmarked for states and rural communities.

“States and local communities best know the way to serve their populations – not the federal government,” HHS said.

When he was running for president, Kennedy had ambitious plans to create a series of “wellness farms” in rural areas, where people addicted to illicit or prescription drugs could get treatment, job training and grow their own organic food.

“I’m going to create these wellness farms where they can go to get off of illegal drugs, off of opiates, but also legal drugs, psychiatric drugs, if they want to, to get off of SSRIs, to get off of benzos, to get off of Adderall, and to spend time, as much time as they need — three or four years if they need it — to learn to get re-parented, to reconnect with communities, to understand how to talk to people,” Kennedy said in 2024.

There is no mention of wellness farms or anything like it in the HHS budget, or in the “Make America Healthy Again (MAHA) Report,” which was also released by the Trump Administration last month.

Like the budget document, pain research and treatment are not discussed in the MAHA report, which has been widely criticized for its sloppy science and fake citations, including some that were apparently generated by artificial intelligence (AI).        

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.

Eli Lilly Bet $1 Billion on Non-Opioids: Will Pain Patients Pay the Price?

By Crystal Lindell

Eli Lilly is investing heavily in new non-opioid pain treatments with its latest acquisition. The pharmaceutical company announced this week that it was acquiring SiteOne Therapeutics in a deal worth as much as $1 billion. 

SiteOne describes itself as “dedicated to the development of safe and effective pain therapeutics without the significant addiction potential and side effects of opioids.” 

The company has been working on a new class of non-opioid medication that targets sodium channels in the peripheral nervous system to treat pain and other nerve conditions. Blocking pain signals in peripheral nerves before they reach the brain means the drug is unlikely to lead to addiction or overdoses.

Its drug STC-004 is in Phase 2 of clinical trials. In a February 2025 press release about the medication, SiteOne said it's an oral medication that would likely be taken once a day “for acute and chronic peripheral pain.” 

Eli Lilly said it has high hopes that STC-004 “may represent a next-generation, non-opioid treatment for patients suffering from chronic pain.” 

It’s noteworthy that Lilly doesn’t even mention acute pain, which suggests the company sees the most potential for STC-004 as a chronic pain treatment.  

While any advancement in pain treatment is obviously welcome, it seems prudent to remain skeptical of any company touting a new medication because its a “non-opioid.”

Vertex Pharmaceuticals recently won FDA approval for Journavx (suzetrigine) a non-opioid that also blocks pain signals in the peripheral nervous system. The FDA approved Journavx for acute pain only, despite lackluster results in clinical trials showing that it works no better than a low dose of hydrocodone.

There’s been a gold rush over the last decade by Vertex, Lilly and other pharmaceutical companies hoping to cash in on the opioid-phobia that resulted from the 2016 CDC opioid guidelines. But it remains unclear if it will just result in fool’s gold for pain patients desperate for relief. 

Mark Mintun, VP of Neuroscience Research and Development for Lilly, admits that thus far “effective non-opioid treatment remains elusive.”

According to one estimate, the global chronic pain market was worth over $72 billion in 2024 and is projected to grow to $115 billion by 2031.

With so much money on the line for any company that even partially succeeds in developing new pain relievers, resources are going to keep pouring into these non-opioid alternatives, regardless of how effective they actually are. 

The sad fact is that there just isn’t as much money in reliable, well-researched generic opioid medications like morphine, which are vastly cheaper than the non-opioids being developed to replace them. 

For chronic pain patients, the $1 billion that Eli Lilly used to acquire SiteOne would be more beneficial if it was spent on lobbying the government and medical professionals to expand access to opioid pain relievers. 

While my hope is that these types of opioid alternatives will deliver on their promises — my fear is that patients will eventually be forced onto them, even if they don't work nearly as well as opioids.

‘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. 

More Australians Are Trying Medical Cannabis for Chronic Pain

By Suzanne Nielsen and Myfanwy Graham  

More Australians than ever are being prescribed medicinal cannabis.

Medicinal cannabis refers to legally prescribed cannabis products. These are either the plant itself, or naturally occurring ingredients extracted from the plant. These ingredients, such as THC (tetrahydrocannabinol) and CBD (cannabidiol), are called cannabinoids. Some cannabinoids are also made in labs to act like the ones in the plant.

Medicinal cannabis comes in different forms, such as oils, capsules, dried flower, sprays and edible forms such as gummies.

Since regulatory changes in 2016 made medicinal cannabis more accessible, Australia’s regulator has issued more than 700,000 approvals. Around half of the approvals have been for chronic pain that isn’t caused by cancer.

In Australia, chronic pain affects around one in five Australians aged 45 and over, with an enormous impact on people’s lives.

So what does the current evidence tell us about the effectiveness of medicinal cannabis for chronic pain?

Limited Benefits

A 2021 review of 32 randomised controlled trials involving nearly 5,200 people with chronic pain, examined the effects of medicinal cannabis or cannabinoids. The study found a small improvements in pain and physical functioning compared with a placebo.

A previous review found that to achieve a 30% reduction in pain for one person, 24 people would need to be treated with medicinal cannabis.

The 2021 review also found small improvements in sleep, and no consistent benefits for other quality of life measures, consistent with previous reviews.

This doesn’t mean medicinal cannabis doesn’t help anyone. But it suggests that, on average, the benefits are limited to a smaller number of people.

Many pain specialists have questioned if the evidence for medicinal cannabis is sufficient to support its use for pain.

The Faculty of Pain Medicine, the professional body dedicated to the training and education of specialist pain physicians, recommends medical cannabis should be limited to clinical trials.

Guidance from Australia’s regulator, the Therapeutic Goods Administration (TGA), on medicinal cannabis for chronic non-cancer pain reflects these uncertainties. The TGA states there is limited evidence medicinal cannabis provides clinically significant pain relief for many pain conditions. Therefore, the potential benefits versus harms should be considered patient-by-patient.

The TGA says medicinal cannabis should only be trialled when other standard therapies have been tried and did not provide enough pain relief.

In terms of which type of medical cannabis product to use, due to concerns about the safety of inhaled cannabis, the TGA considers pharmaceutical-grade products (such as nabiximols or extracts containing THC and/or CBD) to be safer.

This evidence may feel at odds with the experiences of people who report relief from medicinal cannabis.

In clinical practice, it’s common for individuals to respond differently based on their health conditions, beliefs and many other factors. What works well for one person may not work for another.

Research helps us understand what outcomes are typical or expected for most people, but there is variation. Some people may find medicinal cannabis improves their pain, sleep or general well-being – especially if other treatments haven’t helped.

Side Effects and Risks

Like any medicine, medicinal cannabis has potential side effects. These are usually mild to moderate, including drowsiness or sedation, dizziness, impaired concentration, a dry mouth, nausea and cognitive slowing.

These side effects are often greater with higher-potency THC products. These are becoming more common on the Australian market. High-potency THC products represent more than half of approvals in 2025. In research studies, generally more people experience side effects than report benefits from medical cannabis.

Medical cannabis can also interact with other medications, especially those that cause drowsiness (such as opioids), medicines for mental illness, anti-epileptics, blood thinners and immunosuppressants. Even cannabidiol (CBD), which isn’t considered intoxicating like THC, has been linked to serious drug interactions.

These risks are greater when cannabis is prescribed by a doctor who doesn’t regularly manage the patient’s chronic pain or isn’t in contact with their other health-care providers. Since medicinal cannabis is often prescribed through separate telehealth clinics, this fragmented care may increase the risk of harmful interactions.

Another concern is developing cannabis use disorder (commonly understood as “addiction”). A 2024 study found one in four people using medical cannabis develop a cannabis use disorder. Withdrawal symptoms – such as irritability, sleep problems, or cravings – can occur with frequent and heavy use.

For some people, tolerance can also develop with long-term use, meaning you need to take higher doses to get the same effect. This can increase the risk of developing a cannabis use disorder.

Like many medicines for chronic pain, the effectiveness of medicinal cannabis is modest, and is not recommended as a sole treatment.

There’s good evidence that, for conditions like back pain, interventions such as exercise, cognitive behavioural therapy and pain self-management education can help and may have fewer risks than many medicines. But there are challenges with how accessible and affordable these treatments are for many Australians, especially outside major cities.

The growing use of medicinal cannabis for chronic pain reflects both a high burden of pain in the community and gaps in access to effective care. While some patients report benefits, the current evidence suggests these are likely to be small for most people, and must be weighed against the risks.

If you are considering medicinal cannabis, it’s important to talk to your usual health-care provider, ideally one familiar with your full medical history, to help you decide the best approaches to help manage your pain.

Suzanne Nielsen, PhD, is a Professor and Deputy Director of the Monash Addiction Research Centre at Monash University in Melbourne, Australia.  Suzanne has been a registered pharmacist for over 20 years. Her clinical experience in the treatment of substance use disorders includes working in specialist drug treatment and community-based alcohol and drug treatment settings in Australia and the United Kingdom.

Myfanwy Graham is a Postgraduate Scholar and Researcher at the Monash Addiction Research Centre. She has been a registered pharmacist for over 17 years and was a consultant to the United Nations Office on Drugs and Crime, the World Health Organization, and the National Academy of Sciences, Engineering and Medicine.

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

Flexible Implant Could Be Alternative to Spinal Cord Stimulators

By Pat Anson

Spinal cord stimulators have long been fraught with problems. First developed in the 1960’s, the devices are surgically implanted near the spine to deliver mild electric impulses that block pain signals from traveling to the brain.

Although their design and technology have improved over the years, making them smaller, rechargeable and programmable, spinal cord stimulators (SCSs) still have high failure rates and poor safety records. Recent studies have also questioned their effectiveness in treating back pain.

Researchers at the University of Southern California have developed an alternative: a small, flexible, wireless, and battery-free implant that could overcome some of the limitations of SCSs.

NATURE ELECTRONICS

The experimental device, recently introduced in a paper published in Nature Electronics, is powered by a wearable ultrasound transmitter and uses machine learning algorithms to customize treatment for each patient. The implant is designed to bend and twist, unlike traditional stimulators that tend to be bulky and are hard-wired to batteries.

“Implantable percutaneous electrical stimulators… are expensive, can cause damage during surgery and often rely on a battery power supply that must be periodically replaced. Here we report an integrated, flexible ultrasound-induced wireless implantable stimulator combined with a pain detection and management system for personalized chronic pain management," wrote a team of researchers at USC’s Alfred E. Mann Department of Biomedical Engineering.

The researchers tested the wireless stimulator in laboratory rodents experiencing different levels of pain. They found the device accurately predicted the levels of stress experienced by the animals and adapted the electrical stimulation it delivered, easing most of their pain.

“We classify pain stimuli from brain recordings by developing a machine learning model and program the acoustic energy from the ultrasound transmitter and, therefore, the intensity of electrical stimulation," researchers said. "The implant can generate targeted, self-adaptive and quantitative electrical stimulations to the spinal cord according to the classified pain levels for chronic pain management in free-moving animal models."

The research team is planning further tests on other lab animals, with the goal of eventually testing the device in clinical trials on humans.

About 50,000 traditional spinal cord stimulators are implanted every year in the U.S., where they are promoted as alternatives to opioids and other pain treatments. However, a 2022 study found that SCSs do not reduce patient use of opioids, epidurals, steroid injections or radiofrequency ablation. About a fifth of patients experienced complications so severe the devices had to be removed or revised.

Gender Bias: Why Gynecological Pain Is Often Dismissed

By Elizabeth Hintz and Marlene Berke

For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people – most of whom identify as women – sexual intercourse and routine pelvic exams are unbearable.

Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women.

Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain.

We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions.

We’ve consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training.

‘It’s All In Your Head’

A 2024 study of patients who went to a clinic for vulvovaginal pain – pain experienced in the external female genitals and vagina – found that 45% of these patients had been told that they “just needed to relax more” and 39% were made to feel that they were “crazy”. A staggering 55% had considered giving up on seeking care.

These results echo what one of us – Elizabeth Hintz – found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this “It’s all in your head” response from doctors.

Another study followed patients in two different major U.S. cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information.

These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care?

“Let me describe the pain that would drive me to try so many different doctors, tests and treatments,” a patient with vulvovaginal pain said to her doctor. For her, sex “is like taking your most sensitive area and trying to rip it apart.”

“I can now wear any pants or underwear that I want with no pain,” said another patient after successful treatment. “I never realized how much of a toll the pain took on my body every day until it was gone.”

Medical Gaslighting

Many patients worldwide experience medical gaslighting – a social phenomenon where a patient’s health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright.

Medical gaslighting is rooted in centuries of gender bias in medicine.

Women’s reproductive health issues have long been dismissed as psychological or “hysterical.” Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy.

These historical views help shed light on why these symptoms are still not taken seriously today.

In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity.

This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed.

Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist.

Disparities in Funding and Care

Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January 2025 report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men.

This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women’s health has actually declined over the past decade. Despite these known disparities, in April 2025 the Trump administration threatened to end funding for the Women’s Health Initiative, a long-running women’s health research program, further worsening the problem.

Without sustained federal funding for women’s health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded.

As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race.

One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients’ pain and offered them less accurate treatment recommendations.

Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men.

Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine.

These lingering erroneous beliefs about gender and race are key reasons patients’ pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death.

Learning and Listening

Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients’ lived experiences and admit when an answer isn’t known.

In the meantime, people navigating the health care system can take practical steps when encountering dismissive care.

They can educate themselves about chronic gynecological pain conditions by reading books like “When Sex Hurts: Understanding and Healing Pelvic Pain” or educational information from trusted sources like the International Society for the Study of Women’s Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease.

Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting.

If someone you know has experienced medical gaslighting and would like support, there are resources available.

Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information – like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.

Elizabeth Hintz, PhD, is an Assistant Professor in the Department of Communication at the University of Connecticut.

Marlene Berke recently completed her PhD in Philosophy at the Computational Social Cognition Lab at Yale University.

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

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. 

‘Zombie’ Nerve Cells Make Chronic Pain Worse

By Pat Anson

The zombies are at it again.

Weeks after researchers announced a new way to treat low back pain by targeting so-called zombie cells – a new study suggests that peripheral nerve pain could also be treated with drugs that target aging cells.

Senescent neurons are cells that stop dividing, but refuse to die and linger in the central nervous system. As people age, more and more of these “zombie cells” build up, secreting inflammatory agents that increase pain sensitivity and raise the risk of age-related diseases like arthritis, Alzheimer’s and Parkinson’s.

“Very little is known about underlying causes of pain experienced during aging. The prevalence of chronic pain in aging populations and the lack of effective and non-addictive treatments motivated this exploration into neuronal senescence as a potential mechanism,” Lauren Donovan, PhD, a research scientist at Stanford University, told PsyPost.

In studies on laboratory animals, Donovan and her colleagues at Stanford found that pain was amplified in older mice by senescent cells, which released inflammatory signals when the mice were injured. The same inflammatory reaction was found in younger mice, but was more pronounced in the older ones.

When the injured mice were treated with a drug called ABT263 – a compound that destroys senescent cells – the older mice showed less pain sensitivity and significant improvement in their weight-bearing behavior.

The younger mice treated with ABT263 showed only modest improvements in their pain-related behavior, which suggests that senescent cells play a significant role in causing chronic pain.

“The key takeaway for the average person is that as we age, some of our sensory neurons undergo a process called senescence, which may contribute to chronic pain,” said Donovan, who reported the findings in the journal Nature Neuroscience.

“In addition, we found that injury can exacerbate senescence in neurons, leading to an additive effect of aging and injury that may enhance pain. This research identifies a new potential target for treating chronic pain, especially in older individuals. It suggests that addressing cellular senescence in the nervous system can lead to new ways of managing pain and sensory dysfunction.”

Researchers at McGill University reported similar findings last month in studies on laboratory mice with damaged discs. When the mice were given drugs that targeted senescent cells in their spines, they experienced less pain and their bone quality improved.

Previous animal studies have shown that senolytic drugs can reverse osteoarthritis by eliminating senescent cells, giving the body a chance to repair and rejuvenate damaged cartilage.

The findings need to be replicated in humans, but they suggest that senolytic drugs that target zombie cells have the potential to prevent or even cure some age-related diseases.

Doctors Finally Told to Take IUD Pain More Seriously

By Crystal Lindell

The American College of Obstetricians and Gynecologists (ACOG) is finally acknowledging just how painful some uterine and cervical procedures can be for women. 

They are now recommending pain treatment for in-office procedures that patients have long complained were under-addressed. 

The ACOG’s new guidelines address pain from intrauterine device (IUD) insertion, endometrial biopsy, hysteroscopy, intrauterine imaging, cervical biopsy, and other similar procedures. 

“There is an urgent need for health care professionals to have a better understanding of pain-management options and to not underestimate the pain experienced by patients and for patients to have more autonomy over pain-control options during in-office procedures,’ the ACOG said. 

While the recommendations vary by procedure, most of them involve some version of lidocaine, and a few recommend NSAIDs and naproxen. For more intense procedures and conditions like hysteroscopy, ablation, and polypectomy, they recommend local anesthesia. 

For IUD insertion, a procedure that patients have long complained was extremely painful, the ACOG recommends local anesthetic agents. More specifically, they recommend applying lidocaine cream, lidocaine spray, or a paracervical lidocaine block injection. 

The ACOG says pain management options “should be discussed with and offered to all patients seeking in-office gynecologic procedures."

However, there is a telling couple of sentences in the new guidelines that reveal how doctor-centered the thought processes around pain management still are. 

The ACOG acknowledges that some healthcare professionals tend to underestimate the pain that patients experience and that pain management “may not be discussed with or offered to patients.” Basically, some doctors don’t believe that patients experience pain, so they don’t even bother to offer pain treatment options. 

There may also be a false belief that a pain treatment that works for one patient must work for everyone.

“Several pain-management interventions being used have limited or conflicting evidence supporting their effectiveness at providing adequate pain control during in-office gynecologic procedures,” the ACOG said.

“Health care professionals therefore must be cautious when extrapolating data on what works for one procedure to another. Shared decision making with the patient should be practiced when discussing pain-management options because options that work for one patient may not work for another.”

It’s good they are acknowledging the issue. I always say that other people’s pain is always easier to endure. Of course doctors think pain management is unnecessary – they aren’t the ones in pain!

The ACOG adds that “despite patients reporting a higher level of pain than clinicians expect, patients still report a high level of satisfaction with office procedures.”

It’s so telling that they think that patient satisfaction scores should even be mentioned when deciding pain treatment guidance. As usual, there tends to be a focus on how patient pain impacts the doctor and their practice. And it’s even more telling that they think they don’t need to treat pain as long as patients don’t complain. 

In reality, doctors should be treating pain because pain sucks, and it’s the right thing to do!

I am glad to finally see more official guidance for doctors to treat pain that patients have long reported. But if doctors would just believe their patients when they report pain, they wouldn’t need the ACOG to tell them to treat it. 

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.  

The Two Most Common Causes of Adhesive Arachnoiditis

By Dr. Forest Tennant

Adhesive arachnoiditis (AA) doesn’t just happen out-of-the-blue or overnight. It is the tragic end result of sequential pathologic damage, over time, to multiple spinal tissues.

AA may develop from a direct spinal injury or from an inflammatory, autoimmune disease that originates outside the spine.  The discovery that inflammatory-autoimmune diseases can originate outside the spine and spread into spinal tissue is a new medical concept.

Here are the two common pathologies that can cause AA, and the early symptoms that precede AA itself:

Pathology #1: Spinal Trauma

The first pathologic journey is accidental spine trauma or a medical procedure such as an epidural injection that damages the spinal canal cover, which consists of an outer layer (dura) and an inner layer (arachnoid).

Direct spinal injuries may occur to persons in good health.  Examples are auto accidents or electrocution in an industrial accident. The arachnoid layer becomes inflamed after trauma, just like a finger that has been hit with a hammer. The inflammation may progress and then spread.

Eventually, the inflammation will contact cauda equina nerve roots and spread into them. After a time ranging from weeks to months, the inflammatory adhesions “glue” cauda equina nerve roots to the arachnoid, forming the disease called adhesive arachnoiditis.

Pathology #2: Degenerative Discs

Spinal discs degenerate when they become inflamed, due to a pathologic generator such as an infection, autoimmunity or trauma.

Persons who have a genetic connective tissue disease like Ehlers-Danlos, a spine anatomic abnormality, or an autoimmune disease are at high risk to develop degenerative disc disease. Once inflammation sets in, the disc softens, shrinks and slips out of its space, pressing against the spinal canal cover (dura and arachnoid layers).

The inflammation in the disc may spread to the arachnoid membrane and cauda equina nerve roots. As stated in Pathology #1, when inflammation produces sticky adhesions in the cauda equina nerve roots and arachnoid, they may glue together forming AA.

Early Symptoms

If the arachnoid becomes inflamed after trauma, epidural injection, spinal puncture or surgical procedure, there will be headaches, localized back pain, feverishness and dysphoria (a state of unease, depression and fatigue). This usually starts 7 to 10 days after the procedure or trauma.

When the cauda equina also becomes inflamed, the first early symptoms are shooting pains into the buttocks and legs, burning feet, and the tingling sensation of water or insects on the buttocks or legs.

Prevention of AA may be possible in these circumstances by use of one or more anti-inflammatory drugs that are effective inside the spinal canal. You can learn more about the symptoms and treatments for AA on our website.

Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain. Readers interested in learning more about his research should visit the Tennant Foundation’s website, Arachnoiditis Hope. You can subscribe to its research bulletins here.

The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section.  

Are 1 in 10 Americans Really Using Illicit Opioids?

By Crystal Lindell

A new study claims to have found that nearly 11% of Americans reported using illicit opioids in 2024, with 7.5% of them using illicit fentanyl.

It's a startling claim, in large part because those numbers are significantly higher than what's been reported in previous research. When the National Survey on Drug Use and Health asked about illicit fentanyl use in 2022, they found that just 0.3% of American adults used it in the past year

The study by researchers at the RAND corporation and USC led to a number of splashy headlines, including one in U.S. News and World Report reading: "U.S. Illicit Opioid Use Could Be 20 Times Higher Than Previously Estimated"

That is indeed a pretty striking claim – which is a large reason I am so skeptical of the research.

How did the study authors arrive at those figures? They developed and fielded a survey with Respondi, an online platform often used in academic research. So essentially, they did an online survey of 1,515 adults.

Participants were asked about their use of nonprescription opioids within the past 12 months, with heroin and illicitly manufactured fentanyl given as examples.

Among the respondents, they found that 166 (10.96%) reported illicit opioid use and 114 (7.5%) said they used illicit fentanyl. 

While I understand that population data is often collected with a relatively small sample size, it feels rushed to claim that 7.5% of adults used illicit fentanyl based on responses from 114 people in an online survey.

It feels equally rushed to claim that because 166 people reported illicit opioid use, that must mean that 11% of the population did so. 

There are about 262 million adults in the United States. If those survey numbers are accurate, that would mean 19.7 million Americans are using illicit fentanyl. And 28.8 million are using illicit opioids. That’s a lot of people. 

Overdose Deaths Declining

Keep in mind that the CDC just reported that U.S. overdose deaths fell by nearly 27% in 2024, the largest annual decline since they started tracking overdoses 45 years ago. 

Of the 80,391 drug deaths reported in 2024, the CDC estimates that 48,422 of those deaths involved synthetic opioids, primarily fentanyl. That’s nearly 28,000 fewer fentanyl deaths than the year before.

How can fentanyl deaths be declining when so many Americans claim they used the potent and often deadly street drug?     

The numbers just don’t add up. They suggest that illicit fentanyl isn’t nearly as dangerous as we’ve been led to believe, although I doubt that that’s the point the study authors were hoping to make. 

The RAND and USC researchers say their findings add to evidence that the CDC may significantly underestimate illicit drug use and that new methods are necessary to keep better track of them.  

“Estimates of illicit opioid use are rare and typically are available only years after the information is collected, limiting our ability to monitor trends on a near-term basis,” says lead author David Powell, PhD, a senior economist and Professor of Policy Analysis at RAND. “Our study offers a method to quickly and repeatedly monitor illicit opioid prevalence at low cost.”

All of this matters because studies like this are often used to punish people who use any opioids – both legal and illegal. 

For example, if 11% of the population truly is using illicit opioids, then the medical community may use that statistic to claim that opioid prescribing is still too high and that too many prescription opioids are finding their way onto the black market. 

They might also claim more public funding is needed for the addiction treatment industry. Or that the overdose reversal drug naloxone should be required for anyone getting an opioid prescription. 

There’s also the prevailing myth that prescription opioids are what lead people to use fentanyl and other street drugs, a claim that the RAND/USC researchers believe is true.

“As the opioid crisis has evolved, attention to the role of prescription opioids has waned, even though overdose deaths from prescription opioids remain high and prescription opioids may operate as critical pathways to illicit opioid use,” they reported.  

That’s why it is so important for researchers to be more cautious in how they frame their results, and it’s also important for the media to be skeptical of research that shows extreme outlier data. 

Maybe 11% of people are using illicit opioids, and 7.5% are using illicit fentanyl. Both of those things could very well be true. But I think additional research replicating those results is needed before regulators and opioid prohibitionists act on them – especially if that means further restricting access to pain medication. 

Pain Clinic CEO Faced 20 Years for Fraud. He Got 18 Months.

By Brett Kelman, KFF Health News

Federal prosecutors sought a maximum prison sentence of nearly 20 years for the CEO of Pain MD, a company found to have given hundreds of thousands of questionable injections to patients, many reliant on opioids. It would have been among the longest sentences for a health care executive convicted of fraud in recent years.

Instead, he got 18 months.

Michael Kestner, 73, who was convicted of 13 fraud felonies last year, faced at least a decade behind bars based on federal sentencing guidelines.

He was granted the substantially lightened sentence due to his age and health Wednesday during a federal court hearing in Nashville.

U.S. District Judge Aleta Trauger described Kestner as a “ruthless businessman” who funded a “lavish lifestyle” by turning medical professionals into “puppets” who pressured patients into injections that did not help their pain and sometimes made it worse.

“In the court’s eyes, he knew it was wrong, and he didn’t really care if it was doing anyone any good,” Trauger said.

MICHAEL KESTNER

But Trauger also said she was swayed by defense arguments that Kestner would struggle in federal prison due to his age and medical conditions, including the blood disorder hemochromatosis. Trauger said she had concerns about prison health care after considering about 200 requests for compassionate release in other court cases.

“The medical care at these facilities,” defense attorney Peter Strianse said, “has always been dodgy and suspect.”

Kestner did not speak at the court hearing, other than to detail his medical conditions. He did not respond to questions as he left the courthouse.

‘Human Pin Cushions’

Pain MD ran as many as 20 clinics in Tennessee, Virginia, and North Carolina throughout much of the 2010s. While many doctors were scaling back their use of prescription painkillers due to the opioid crisis, Pain MD paired opioids with monthly injections into patients’ backs, claiming the shots could ease pain and potentially lessen reliance on pills, according to federal court documents.

During Kestner’s October trial, the Department of Justice proved that the injections were part of a decade-long scheme that defrauded Medicare and other insurance programs of millions of dollars by capitalizing on patients’ dependence on opioids.

The DOJ successfully argued at trial that Pain MD’s “unnecessary and expensive injections” were largely ineffective because they targeted the wrong body part, contained short-lived numbing medications but no steroids, and appeared to be based on test shots given to cadavers — people who felt neither pain nor relief because they were dead. During closing arguments, the DOJ argued Pain MD had turned some patients into “human pin cushions.”

“They were leaned over a table and repeatedly injected in their spine,” federal prosecutor Katherine Payerle said during the May 14 sentencing hearing. “Over and over, month after month, at the direction of Mr. Kestner.”

At last year’s trial, witnesses testified that Kestner was the driving force behind the injections, which amounted to roughly 700,000 shots over about eight years, with some patients receiving up to 24 at once.

Four former patients testified that they tolerated the shots out of fear that Pain MD otherwise would have cut off their painkiller prescriptions, without which they might have spiraled into withdrawal.

One of those patients, Michelle Shaw, told KFF Health News that the injections sometimes left her in so much pain she had to use a wheelchair. She was outraged by Kestner’s sentence.

“I’m disgusted that all they got was a slap on the wrist as far as I’m concerned,” Shaw said May 14. “I hope karma comes back to him. That he suffers to his last breath.”

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.