Treating Pain Cost an Addiction Medicine Doctor Her Job

By Aneri Pattani, KFF Health News

Elyse Stevens had a reputation for taking on complex medical cases. People who’d been battling addiction for decades. Chronic-pain patients on high doses of opioids. Sex workers and people living on the street.

“Many of my patients are messy, the ones that don’t know if they want to stop using drugs or not,” said Stevens, a primary care and addiction medicine doctor.

While other doctors avoided these patients, Stevens — who was familiar with the city from her time in medical school at Tulane University — sought them out.

She regularly attended 6 a.m. breakfasts for homeless people, volunteered at a homeless shelter clinic on Saturdays, and on Monday evenings, visited an abandoned Family Dollar store where advocates distributed supplies to people who use drugs.

One such evening about four years ago, Charmyra Harrell arrived there limping, her right leg swollen and covered in sores. Emergency room doctors had repeatedly dismissed her, so she eased the pain with street drugs, Harrell said.

Stevens cleaned her sores on Mondays for months until finally persuading Harrell to visit the clinic at University Medical Center New Orleans. There, Stevens discovered Harrell had diabetes and cancer.

She agreed to prescribe Harrell pain medication — an option many doctors would automatically dismiss for fear that a patient with a history of addiction would misuse it.

ELYSE STEVENS

But Stevens was confident Harrell could hold up her end of the deal.

“She told me, ‘You cannot do drugs and do your pain meds,’” Harrell recounted on a Monday evening in October. So, “I’m no longer on cocaine.”

Stevens’ approach to patient care has won her awards and nominations in medicine, community service, and humanism. Instead of seeing patients in binaries — addicted or sober, with a positive or negative drug test — she measures progress on a spectrum. Are they showering daily, cooking with their families, using less fentanyl than the day before?

But not everyone agrees with this flexible approach that prioritizes working with patients on their goals, even if abstinence isn’t one of them. And it came to a head in the summer of 2024.

“The same things I was high-fived for thousands of times — suddenly that was bad,” Stevens said.

Flexible Care or Zero Tolerance?

More than 80% of Americans who need substance use treatment don’t receive it, national data shows. Barriers abound: high costs, lack of transportation, clinic hours that are incompatible with jobs, fear of being mistreated.

Some doctors had been trying to ease the process for years. Covid-19 accelerated that trend. Telehealth appointments, fewer urine drug tests, and medication refills that last longer became the norm.

The result?

“Patients did OK and we actually reached more people,” said Brian Hurley, immediate past president of the American Society of Addiction Medicine. The organization supports continuing flexible practices, such as helping patients avoid withdrawal symptoms by prescribing higher-than-traditional doses of addiction medication and focusing on recovery goals other than abstinence.

But some doctors prefer traditional approaches that range from zero tolerance for patients using illegal drugs to setting stiff consequences for those who don’t meet their doctors’ expectations. For example, a patient who tests positive for street drugs while getting outpatient care would be discharged and told to go to residential rehab.

Proponents of this method fear loosening restrictions could be a slippery slope that ultimately harms patients. They say continuing to prescribe painkillers, for example, to people using illicit substances long-term could normalize drug use and hamper the goal of getting people off illegal drugs.

Progress should be more than keeping patients in care, said Keith Humphreys, a Stanford psychologist, who has treated and researched addiction for decades and supports involuntary treatment.

“If you give addicted people lots of drugs, they like it, and they may come back,” he said. “But that doesn’t mean that that is promoting their health over time.”

Flexible practices also tend to align with harm reduction, a divisive approach that proponents say keeps people who use drugs safe and that critics — including the Trump administration — say enables illegal drug use.

The debate is not just philosophical. For Stevens and her patients, it came to bear on the streets of New Orleans.

‘Unconventional’ Prescribing

In the summer of 2024, supervisors started questioning Stevens’ approach.

In emails reviewed by KFF Health News, they expressed concerns about her prescribing too many pain pills, a mix of opioids and other controlled substances to the same patients, and high doses of buprenorphine, a medication considered the gold standard to treat opioid addiction.

Supervisors worried Stevens wasn’t doing enough urine drug tests and kept treating patients who used illicit drugs instead of referring them to higher levels of care.

“Her prescribing pattern appears unconventional compared to the local standard of care,” the hospital’s chief medical officer at the time wrote to Stevens’ supervisor, Benjamin Springgate. “Note that this is the only standard of care which would likely be considered should a legal concern arise.”

Springgate forwarded that email to Stevens and encouraged her to refer more patients to methadone clinics, intensive outpatient care, and inpatient rehab.

Stevens understood the general practice but couldn’t reconcile it with the reality her patients faced. How would someone living in a tent, fearful of losing their possessions, trek to a methadone clinic daily?

Stevens sent her supervisors dozens of research studies and national treatment guidelines backing her flexible approach. She explained that if she stopped prescribing the medications of concern, patients might leave the health system, but they wouldn’t disappear.

“They just wouldn’t be getting care and perhaps they’d be dead,” she said in an interview with KFF Health News.

Both University Medical Center and LSU Health New Orleans, which employs physicians at the hospital, declined repeated requests for interviews. They did not respond to detailed questions about addiction treatment or Stevens’ practices.

Instead, they provided a joint statement from Richard DiCarlo, dean of the LSU Health New Orleans School of Medicine, and Jeffrey Elder, chief medical officer of University Medical Center New Orleans.

“We are not at liberty to comment publicly on internal personnel issues,” they wrote.

“We recognize that addiction is a serious public health problem, and that addiction treatment is a challenge for the healthcare industry,” they said. “We remain dedicated to expanding access to treatment, while upholding the highest standard of care and safety for all patients.”

Not Black-and-White

KFF Health News shared the complaints against Stevens and the responses she’d written for supervisors with two addiction medicine doctors outside of Louisiana, who had no affiliation with Stevens. Both found her practices to be within the bounds of normal addiction care, especially for complex patients.

Stephen Loyd, an addiction medicine doctor and the president of Tennessee’s medical licensing board, said doctors running pill mills typically have sparse patient notes that list a chief complaint of pain. But Stevens’ notes detailed patients’ life circumstances and the intricate decisions she was making with them.

“To me, that’s the big difference,” Loyd said.

Some people think the “only good answer is no opioids,” such as oxycodone or hydrocodone, for any patients, said Cara Poland, an addiction medicine doctor and associate professor at Michigan State University. But patients may need them — sometimes for things like cancer pain — or require months to lower their doses safely, she said. “It’s not as black-and-white as people outside our field want it to be.”

Humphreys, the Stanford psychologist, had a different take. He did not review Stevens’ case but said, as a general practice, there are risks to prescribing painkillers long-term, especially for patients using today’s lethal street drugs too.

Overprescribing fueled the opioid crisis, he said. “It’s not going to go away if we do that again.”

‘The Thing That Kills People’

After months of tension, Stevens’ supervisors told her on March 10 to stop coming to work. The hospital was conducting a review of her practices, they said in an email viewed by KFF Health News.

Overnight, hundreds of her patients were moved to other providers.

Luka Bair had been seeing Stevens for three years and was stable on daily buprenorphine.

After Stevens’ departure, Bair was left without medication for three days. The withdrawal symptoms were severe — headache, nausea, muscle cramps.

“I was just in physical hell,” said Bair, who works for the National Harm Reduction Coalition and uses they/them pronouns.

Although Bair eventually got a refill, Springgate, Stevens’ supervisor, didn’t want to continue the regimen long-term. Instead, Springgate referred Bair to more intensive and residential programs, citing Bair’s intermittent use of other drugs, including benzodiazepines and cocaine, as markers of high risk. Bair “requires a higher level of care than our clinic reasonably can offer,” Springgate wrote in patient portal notes reviewed by KFF Health News.

But Bair said daily attendance at those programs was incompatible with their full-time job. They left the clinic, with 30 days to find a new doctor or run out of medication again.

“This is the thing that kills people,” said Bair, who eventually found another doctor willing to prescribe.

Springgate did not respond to repeated calls and emails requesting comment.

University Medical Center and LSU Health New Orleans did not answer questions about discharging Stevens’ patients.

‘Patients Will Die Without Her’

About a month after Stevens was told to stay home, Haley Beavers Khoury, a medical student who worked with her, had collected nearly 100 letters from other students, doctors, patients, and homelessness service providers calling for Stevens’ return.

One student wrote, “Make no mistake — some of her patients will die without her.” A nun from the Daughters of Charity, which ran the hospital’s previous incarnation, called Stevens a “lifeline” for vulnerable patients.

Beavers Khoury said she sent the letters to about 10 people in hospital and medical school leadership. Most did not respond.

In May, the hospital’s review committee determined Stevens’ practices fell “outside of the acceptable community standards” and constituted “reckless behavior,” according to a letter sent to Stevens.

The hospital did not answer KFF Health News’ questions about how it reached this conclusion or if it identified any patient harm.

Meanwhile, Stevens had secured a job at another New Orleans hospital. But because her resignation came amid the ongoing investigation, University Medical Center said it was required to inform the state’s medical licensing board.

The medical board began its own investigation — a development that eventually cost Stevens the other job offer.

In presenting her side to the medical board, Stevens repeated many arguments she’d made before. Yes, she was prescribing powerful medications. No, she wasn’t making clinical decisions based on urine drug tests. But national addiction organizations supported such practices and promoted tailoring care to patients’ circumstances, she said. Her response included a 10-page bibliography with 98 citations.

Abandoning People

The board’s investigation into Stevens is ongoing. Its website shows no action taken against her license as of late December.

The board declined to comment on both Stevens’ case and its definition of appropriate addiction treatment.

In October, Stevens moved to the Virgin Islands to work in internal medicine at a local hospital. She said she’s grateful for the welcoming locals and the financial stability to support herself and her parents.

But it hurts to think of her former patients in New Orleans.

Before leaving, Stevens packed away handwritten letters from several of them — one was 15 pages long, written in alternating green and purple marker — in which they shared childhood traumas and small successes they had while in treatment with her.

Stevens doesn’t know what happened to those patients after she left.

She believes the scrutiny of her practice centers on liability more than patient safety.

But, she said, “liability is in abandoning people too.”

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

Medical Cannabis Helps Relieve Fibromyalgia Symptoms

By Pat Anson

Medical cannabis products help relieve pain and anxiety caused by fibromyalgia, and improve sleep and quality of life, according to a new study of patients enrolled in the UK’s Medical Cannabis Registry.

Fibromyalgia is a poorly understood and difficult-to-treat condition that causes widespread body pain, fatigue, insomnia, mood disorders and brain fog. 

The UK study of nearly 500 fibromyalgia patients found the greatest improvement in symptoms when participants took higher doses of cannabidiol (CBD) daily over an 18-month period. Higher CBD doses were associated with better outcomes compared to lower doses, and current cannabis users saw better results than those who had never tried it before. 

Participants were initially prescribed a cannabis oil, but as the study progressed, most began to use a mixture of oils taken orally and dried flowers inhaled through a vaporizer. The median CBD dosage increased during the study, from 20mg a day at the start to 25mg at the end, which is considered a moderate to strong dose. 

Tetrahydrocannabinol (THC) content also increased, from a median of 2mg a day at the start of the study to 112.5mg at the end – a high dose likely to cause a strong buzz. But high THC doses were not associated with an improvement in symptoms.

The UK study contradicts a recent U.S. study that found THC more effective in relieving pain than CBD. However, that study primarily involved synthetic FDA approved cannabis-based medicines, such as dronabinol and nabilone, which are approved to reduce nausea and increase appetite – not for pain relief. The UK study involved products that cannabis consumers are much more likely to use.

In the UK, fibromyalgia patients are only eligible to be prescribed “unlicensed” medical cannabis if they have failed to gain improvement in symptoms from licensed pharmaceutical medicines. 

Nearly half of the participants reported mild to moderate side effects, with fatigue and dry mouth being the most common. Researchers believe the high rate of adverse events (AEs) stem from fibromyalgia’s central sensitization effects, which increase the nervous system’s sensitivity to new stimuli. 

“This study found treatment with CBMPs (cannabis-based medicinal products) in fibromyalgia was associated with short to medium-term improvements in pain, anxiety, sleep, and general quality of life. There was a high incidence of AEs, perhaps due to its central sensitisation mechanism, associated with an increased susceptibility to AEs,” the authors reported in the journal Clinical Rheumatology.

Researchers say the improvement in fibromyalgia symptoms had a waning effect as the study progressed, with peak improvement at 1 month and the lowest after 18 months.

Previous studies in Israel and Brazil have also found that cannabis products improve fibromyalgia symptoms.

The amount of THC – the psychoactive ingredient in cannabis – consumed in the UK study was unusually high. After 18 months, the median dose was 112mg of THC a day, with some participants taking nearly 217mg daily.

Another team of UK researchers recently recommended that adults not consume more than 40mg of THC a week – or about 5.7mg a day. Higher THC doses are associated with increased rates of cannabis use disorder.

In More Pain? Blame the Weather – and Climate Change

By Crystal Lindell

On Wednesday, three people I know all had a migraine. My mom also told me that her hip joint was suddenly much more painful than normal. And the intercostal neuralgia in my ribs hurt so bad that I spent most of the day in bed.

The next day, the temperature here in northern Illinois suddenly spiked to 53 degrees Fahrenheit – an unusual occurrence for Januar. Then the rain started and never really stopped.

The random spike to 50 degree weather – when most people here still have their Christmas lights up – felt almost ominous. And it seems our bodies agreed.   

If we lived in the 1800s, all of us could have served as our town’s meteorologist, accurately predicting both temperature changes and precipitation.

But here in 2026, many people still don’t even connect their pain flares to weather changes. And I still hear doctors dismiss the idea that weather can impact pain.

As someone who lives with chronic pain, I think the connection is obvious. I can tell you almost down to the hour when it’s going to snow. I have learned to plan my rest days around rapid temperature changes in the forecast. And when it’s sunny and clear, I sometimes find myself wondering if I have somehow been cured – because I feel so little pain!

The thing is, the reason we had a 53 degree temperature spike in the middle of winter in northern Illinois is likely due to climate change. While the warm front may have come in regardless, just how warm it got was likely amplified by global warming.

In fact, the shifting global climate means we are all experiencing weather fluctuations and temperatures that had previously been considered rare.

And our bodies have noticed.

A recent story by Inside Climate News discusses the link.

"Global warming is bringing more heatwaves and an atmosphere that sucks up more moisture to feed storms. Those thermodynamic effects of climate change often have more clear ties to pain," wrote Chad Small, a PhD student in Atmospheric and Climate Science at the University of Washington. 

“For example, gout sufferers living in Arizona—which will continue to get hotter and dryer as global temperatures increase—will likely experience worse pain due to more frequent and severe instances of dehydration driven by the increasing temperatures and aridity. That’s on top of the exacerbation of the pain by the heat itself.” 

In 2023, The University of Pennsylvania published an article titled, "Why climate change might be affecting your headaches" in Penn Medicine News.

“Rising global average temperature and extreme weather events are likely to become more frequent or more intense,” they wrote. “Experts suggest that the stress of these events can trigger headaches.”

Society at large seems to still be in denial about all of this though, at least in my experience.

For example, when the weather changes, people who get migraines don’t get more sick days or easier access to government assistance.

And while weather changes are causing more pain flares, government regulators and health officials still limit access to opioid pain medication.

Not to mention the lack of social accommodation. Friends and family aren’t more understanding about the increase in pain because of climate change. In fact, most people aren’t even more forgiving of their own bodies in that situation.

The ableism at the root of our culture in the United States still expects people to push through the pain and show up anyway – and that social pressure only increases when someone’s pain flares get more frequent.

In other words, the more climate change increases pain, the less accepting people are of it. Perhaps that’s because many are still in denial that climate change even exists.

Unfortunately, all indications are that climate change is only going to continue getting worse, which means the pain it causes will do the same.

If we are going to endure it, we are going to have to offer grace to others and ourselves when that pain shows up in our bodies.

We can’t control the weather, but we can control how we endure it.  

Chronic Pain and Complications Common After Outpatient Surgery

By Pat Anson

Outpatient surgeries are often touted for their convenience and cost savings. The surgeries are often minimally invasive, less painful, reduce trauma and recovery time, and save patients (and insurers) thousands of dollars because they don’t have to spend a night or two in the hospital in post-op care. 

But two new studies in the UK – where outpatient procedures are called “day-case” surgeries – show the benefits of outpatient surgery are not universal and often make pre-existing pain conditions worse.

The studies, published here and here in the journal Anaesthesia, involved nearly 17,500 patients, and were conducted by a team of researchers at the NHS Foundation Trust and University Hospitals Plymouth. 

In the first study, researchers found that 1 in 8 patients (11.8%) who had day-case surgery did not go home the same day and were admitted to hospital for various complications. For some patients who had prostate procedures (including those for cancer and benign prostate growth), the hospital admission rate was higher than 50%.

In the second study, one in 14 patients (7.2%) developed chronic pain or had their pain worsen at the surgery site. Some procedures had higher rates of chronic pain after 3 months, including orthopaedic (13.4%) and breast (10%) surgeries. Patients with chronic post-surgical pain also had lower quality of life scores than they did before the surgeries.

To be fair, many of the patients in the studies had chronic pain before their surgeries. Pain was already present at the surgery site in 39% of patients and was moderately severe. Chronic pain elsewhere in the body was also common. About one in four patients had opioid prescriptions prior to their surgeries, and a little over one in 10 used opioids daily. 

These were the first studies of their kind in the UK, and fill an important gap in information about the outcomes of outpatient surgery. Because the UK’s National Health Service seeks to have 85% of eligible elective operations be done as day-case surgeries, researchers expect the outpatient workload to increase and the numbers of patients with chronic post-surgical pain to also grow..

“In summary, this large multicentre UK observational study on day-case surgery provides valuable new insights into a key patient group. We have shown that chronic pain is prevalent within this cohort, with a significantly higher burden than the general population,” the authors found.

“While most patients undergoing day-case surgery were discharged on the same day, the rate of unplanned inpatient admissions was unacceptably high, at twice the national target. This finding underscores a critical area for improvement, as reducing unplanned admissions would enhance the efficiency of day-case surgery and improve outcomes for patients. We highlight the complexity of day-case surgery, where even procedures that are generally seen as straightforward can still carry potential risks, especially for certain patient groups.”

Previous studies have found that female patients had higher rates of chronic post-surgical pain. The new studies found no difference in outcomes between males and females overall, but did show that gynaecological and breast surgeries (almost all female patients) had higher rates of chronic post-surgical pain. This suggests that medical specialties –  rather than being female –- were behind the increased risk.

The studies also found that wealthier patients were less likely to have chronic post-surgical pain compared to the poorest ones. Patients of Asian, Black and mixed ethnicity were also more likely to report chronic post-surgical pain, which may be due to healthcare inequities and cultural difference in pain perception.

Utah Launches AI-Powered Prescription Refills

By Crystal Lindell

Utah is testing a new AI-powered prescription drug service that allows people to skip seeing the doctor if they need a medication refilled for some chronic conditions.

The program is powered by Doctronic, a telehealth service that uses artificial intelligence to act in the role of a doctor, asking patients questions that are typically asked during a refill appointment.

The renewal process will take less than five minutes and Doctronic will charge just $4 for the service.

“If you’re in the state of Utah and you need let’s say a statin renewed because you have high cholesterol and you don’t have any more renewals left on your prescription, but you’ve already been taking that statin, you can talk to our AI,” Matt Pavelle, Co-CEO of Doctronic, told ABC4 in Salt Lake City. 

“It’s going to lead you through the process as a human doctor would, ask all of the right questions, look up all the right interactions, make sure that it’s safe for you…to receive that renewal. It will approve that and send it to a pharmacy in Utah for you.”

The list of medications that Doctronic will refill is limited. The strongest pain relievers you can get are prescription strength acetaminophen and NSAIDs. Other medications used by people with chronic conditions like diabetes are also unavailable.

“The program does not fill prescriptions for controlled substances, such as opioids or ADHD medications, nor are injectables eligible, such as insulin or semaglutide/weight-loss drugs,” a spokesperson for the Utah Department of Commerce told PNN.

Maybe Utah’s program will work as they claim and using it will be even better than talking or seeing a human doctor. But I’m skeptical.

A program like this has the potential to help patients, but it comes with a lot of questions about how it will work in practice – especially given how horrible customer service AI bots have been in general. From personal experience, I can tell you that they are often impossible to communicate with.

I also worry about how accurate Doctronic is, given that other AI bots like ChatGPT can have an error rate of 52%. When it comes to medical decisions, that kind of error rate can be deadly. 

In case of a problem or error with a prescription, Doctronic could be held liable. According to ABC4, Doctronic is covered by a malpractice insurance policy

AI prescription refills could save patients from the cost and hassle of a doctor’s appointment, but if a program like this really takes off, I am certain that the companies running them will then increase the price of each AI appointment. 

In the end, if it was safe to continue prescribing a medication without checking in with a human doctor, the human doctor could easily allow for multiple refills..

And if a human doctor is not needed as part of the equation, why is an AI doctor even needed?

Theoretically, if human doctors are not needed, commonly renewed medications could just have a check-in questionnaire that patients fill out when they need more refills. A doctor would only get involved if any of the responses warranted it.

I would wager such a program would be significantly more accurate, but also significantly more difficult to launch. The lack of a buzzy AI angle would probably be a turn off for both lawmakers and medical professionals.  

There’s also the issue of losing the patient-to-doctor interaction, where other health issues are often flagged and treated. This program all but eliminates that possibility. 

It will be interesting to see how patients and doctors respond to the Doctronic program, and whether they like actually using it. I fully support making healthcare and prescriptions more affordable and accessible. I am just not convinced that an AI chatbot is the best way to achieve either of those goals. 

Excess Weight Raises Risk of Lower Back Pain

By Pat Anson

If you suffer from lower back pain, chances are you’ve had a doctor or someone in your life suggest that you lose some weight. Back pain is commonly associated with a sedentary lifestyle, lack of exercise, and a high body mass index (BMI).

But how much weight is too much? How many pounds do you have to lose to reduce the risk of back pain?

A large new study at Boston University provides some surprising answers. Researchers there reviewed the medical records of over 110,000 adults, aged 18 or older, who visited an urban teaching hospital for outpatient care. Their weight, height, age and sex were then used to calculate their body mass index.  

Not surprisingly, the higher the BMI, the higher the risk was of having lower back pain (LBP). For people with a BMI in the range of 18-35, researchers found that every increased unit of BMI (about 10 pounds), raises the risk of lower back pain by 7%. 

What’s surprising about that finding is that it includes people with a BMI of 18 to 24.9, which is considered a healthy weight, as well as people who are overweight (25 to 29.9 BMI) or obese (30-34.9 BMI).

People with a BMI above 35, which is considered severe obesity, and those with a BMI above 40 (morbid or extreme obesity), must have an even higher risk of lower back pain, right?

Wrong.

Researchers found that for those with a BMI above 35, the prevalence of low back pain did not increase but stayed the same.

Of course, that doesn’t mean you should pack on extra pounds and become morbidly obese to lower your risk of back pain. But it suggests that at a certain point, excess weight stops being a driving factor in LBP and that BMI is an imperfect tool to measure risk. 

Not everyone with a high BMI will experience LBP and being at a healthy weight will not protect you from back pain. About 80 percent of adults experience low back pain at some point in their lives, making it a nearly universal experience, regardless of weight. LBP is the most common cause of job-related disability and a leading contributor to missed work days. 

A number of other factors contribute to LBP, such as smoking, alcohol use, poor sleep and psychological stress. Regular exercise and a healthy lifestyle can help lower your risk of LBP, but they won’t prevent it. 

“Our study strongly suggests that maintaining a healthy weight or BMI is likely helpful at avoiding low back pain,” says lead author Michael Perloff, MD, an Assistant Professor of Neurology at Boston University and Director of Pain Medicine at Boston Medical Center.

“Low back pain is one of the most common complaints patients have for their medical providers. While medications, formal physical therapy and other treatments can help, correcting risk factors, such as smoking or deconditioning, also help LBP.”

The findings appear online in the journal Pain Medicine.

Other studies have found that having a few extra pounds is not harmful to overall health. Some older adults with the lowest risk of early death had BMIs of 27 to 28, which falls into the “overweight” range; while many older adults with the highest mortality risk have BMIs under 22 — which would be considered a healthy weight.

While losing weight won’t prevent low back pain, it could help lower your pain levels. A 2018 study found that people who lose 10% of their body weight had less overall body pain. They also had better mental health, improved cognition and more energy. Men in particular showed improvements in their energy levels when they lost weight.

DEA Cuts Oxycodone Supply, But Raises Production of Morphine in Surprise Move

By Pat Anson

The Drug Enforcement Administration is moving ahead with its plan to reduce the supply of oxycodone by over 6% in 2026, while at the same time significantly raising its production quota for morphine. There will be small reductions in the supply of hydrocodone, codeine and other Schedule II opioids this year.

The move to increase the supply of morphine by 10.5% is surprising, as the agency proposed cutting morphine production by over half a percent a little over a month ago. 

The DEA officially announced its plans January 5 in the Federal Register, 35 days after a December 1 deadline set for the agency in the Controlled Substances Act (CSA). Under the CSA, the DEA has broad legal authority to set annual aggregate production quotas (APQs) for opioids and other controlled substances. 

The December 1 deadline is important because it gives the pharmaceutical industry time to prepare for the coming year by adjusting drug manufacturing and distribution schedules. The DEA’s chronic failure to meet that deadline in previous years has contributed to shortages, according to drug makers.

Over 5,000 public comments were received by the DEA in response to the agency’s initial APQs for 2026. Most comments pleaded with the agency not to make any further cuts in the supply of opioids, many of which are already in short supply at pharmacies and hospitals. 

“I oppose cutting production for controlled medications at this time as there is already a shortage for many of these medications and patients are often not able to obtain their prescriptions. Cutting production during a shortage will only exacerbate the problem and increase patient suffering,” Hannah Khalil wrote in a public comment echoed by many others. 

The DEA, however, was dismissive of claims about opioid shortages, saying it was not responsible for them.

“Drug shortages may occur due to factors outside of DEA's control such as manufacturing and quality problems, processing delays, supply chain disruptions, or discontinuations,” the DEA said. “Currently, FDA has not listed on its Drug Shortage website any nationwide shortages of oxycodone and hydrocodone products.”

While it is true the FDA does not currently have oxycodone or hydrocodone on its shortage list, the American Society of Health-System Pharmacists (ASHP) has listed both opioids on its shortage list since 2023. Limited supplies of oxycodone and hydrocodone are available from some manufacturers, according to the ASHP, while others have the medications on back order.

The difference between the FDA and ASHP shortage lists is that the FDA relies on drug manufacturers to report shortages, while the ASHP proactively surveys both pharmacies and drug makers about their inventories. That arguably makes it superior to the FDA’s methodology.

Ironically, the DEA itself has challenged the reliability of the FDA’s drug shortage list.

“DEA has made it clear it does not trust FDA’s information, as it does not consider many of the shortages that FDA verifies to be legitimate,” the General Accountability Office (GAO) said in a 2015 audit report. “They do not believe FDA appropriately validates or investigates the shortages.”

Increased Morphine Production

The DEA offered no explanation for the increase in morphine production. The production quota for morphine is 10.55% higher than last year's quota and the highest amount since 2021.

One likely reason for the DEA’s decision is that the FDA recently added morphine tablets and injectable morphine solutions to its shortage list, due to discontinuations and short supplies. The ASHP has listed morphine in shortage for several months. 

Morphine solutions and other injectable opioids are an important resource in hospitals, emergency rooms and surgery centers, where they are used in post-op care, sedation and anesthesia.

Morphine tablets are most often used to treat severe chronic pain.

“I fear there will be continued shortages resulting in many patients suffering from the DEA’s quota decisions.”

— Dr. Lynn Webster, pain management expert

“In 2025, there were major shortages of morphine immediate release (15-mg, 30-mg tablets) and morphine extended release (mostly 30-mg tablets) that lasted 3-4 months and were disruptive to care. I mentioned morphine in my personal, submitted comments (to the Federal Register),” said Chad Kollas, MD, a palliative care physician in Florida.

“I suspect that others also complained about last year’s morphine shortages, which may have led to the increase in production of morphine in 2026. It is also the cheapest of the traditional opioids, which may have played a role in the decision. I’m disappointed that they held the line on the oxycodone reduction.”

“I don't know why the DEA would reduce oxycodone while increasing the morphine quota. It seems illogical since there are reports that both are in shortage at the clinical level,” says Lynn Webster, MD, a pain management expert and former president of the American Academy of Pain Medicine. “I fear there will be continued shortages resulting in many patients suffering from the DEAs quota decisions.  

“They know patients are struggling to get access to both medications but they may think oxycodone is more likely to be abused than morphine. It appears they are trying to tell providers what they should prescribe. Yet they are not supposed to be involved in determining how medicine is practiced. Whether intentional or not, that is exactly what they are doing.”

Even with this year’s increase in morphine production, DEA has reduced the supply of morphine by over 63% since 2015. Steep declines have also been made in quotas for hydrocodone (-73%), oxycodone (-71%), and codeine (-70%) over the past decade.  

The DEA began cutting the opioid supply in response to pressure from Congress and anti-opioid activists, who claimed that prescription opioids were responsible for soaring overdose rates. While that claim has been largely debunked, opioid prescribing has continued to fall, as doctors became fearful of being accused of “overprescribing.”

The DEA says the “medical usage” of opioids fell by 10.5% in 2024 alone. The agency expects  that trend to continue, while dismissing claims that its shrinking opioid production quotas have interfered with the practice of medicine. 

“DEA's regulations do not impose restrictions on the amount and the type of medication that licensed practitioners can prescribe. DEA has consistently emphasized and supported the authority of individual practitioners under the CSA to administer, dispense, and prescribe controlled substances for the legitimate treatment of pain within acceptable medical standards,” DEA said. 

3 New Year’s Resolutions on Behalf of Pain Patients

By Crystal Lindell

It’s now 2026, which means I’ve spent too many decades making mostly failed New Year’s resolutions for myself. So this year, I’m not going to bother.

Instead, I have some New Year’s resolutions for other people. Specifically, they’re for people with power, like doctors and healthcare policy makers.

After all, it really seems like they need to make some policy changes, given the current state of things for people in pain. Perhaps they are just waiting for someone to tell them what those changes should be. 

Below is a look at three of my 2026 New Year’s resolutions on behalf of pain patients..

Resolution # 1: Fully Legalize 7-OH and Develop New Edibles

There’s so many conflicting local regulations when it comes to kratom and 7-OH, despite the fact that neither one is as harmful as health officials and lawmakers often claim.

For those unfamiliar, 7-OH is short for 7-hydroxymitragynine, an alkaloid that occurs naturally in kratom in trace amounts. Some kratom vendors now sell concentrated versions of 7-OH to boost its potency as a pain reliever and mood enhancer.

A lot of pain patients find both 7-OH and kratom to be effective at treating chronic pain. And while I am glad that both are still legal in most places in the United States, I would really like to see them fully legalized across the country, as municipalities and states realize just how beneficial these products can be.

I also would really like to see 7-OH vendors come out with some new edible formats, like chocolates, gummies and even seltzer.

I think 7-OH in particular has the potential to help a lot of people who have been denied adequate pain treatment. However, many of them may not be comfortable figuring out where to buy and correctly dose a 7-OH chewable tablet, especially if they are among one of the largest demographic of pain patients: the elderly.  

I think of my grandma trying to get 7-OH tablets at a local smoke shop, or having to figure out how to order them online. Both options are bad. 

Ideally, regular grocery stores and local pharmacies would have a display of low-dose 7-OH chocolates available over-the-counter for pain patients like her.

Resolution # 2: Stop Prescribing Gabapentin and Tramadol for Pain

This would be such a relatively easy change for doctors to make, and there’s so much science to back it up.

In October of 2025, PNN covered a study showing that tramadol is often not effective for chronic pain. And PNN has long been covering how ineffective gabapentin is for most pain conditions.  

However, despite the evidence, doctors still regularly prescribe gabapentin and tramadol for chronic pain. 

It doesn’t have to be that way. Doctors have alternatives that actually work, most notably low-dose hydrocodone. Yes, there are more regulations around that medication, making it more difficult to prescribe. But actually giving pain patients real options shouldn’t be so difficult.  

So, I would like doctors and other healthcare professionals to make it their goal to stop prescribing ineffective medications. Instead, offer pain treatments that actually work. Your patients will thank you.

Resolution # 3: Implement Medicare for All

Yes, I know this one is kind of unrealistic. But that’s what New Year’s magic is all about —  putting whimsical ideas out into the universe with the hope of seeing them come to fruition. 

After all, it can’t happen if we never ask for it.

Unfortunately, as the year starts off, we are actually heading in the opposite direction, with many Americans seeing their health insurance premiums soar or even deciding not to buy coverage. 

But I’m hoping that may be the catalyst we need for the public to start demanding real change. Right now, millions of people are losing their health insurance because the Trump administration ended federal subsidies for coverage under the Affordable Care Act. 

It’s an awful and unnecessary situation that our policy leaders have the power to fix, if only they worked together on the issue.

Every human should have the right to healthcare, and Medicare for All would go a long way to making that happen.

I know a lot of these resolutions probably won’t come to fruition in 2026, but I do think they could realistically happen before we start the next decade. And all of them have the potential to vastly improve the lives of millions of people living with chronic pain.

Happy New Year everyone. May your 2026 be filled with low-pain days, too much joy, and lots of love.

Hip Pain Has Many Causes and Most Don’t Require Surgery

By Charlotte Ganderton and Joshua Heerey

You can feel hip pain at any stage of life, including childhood, young adulthood and the middle years.

This can come as a surprise; since many people associate hip pain with old age. It can strike fear into the hearts of those in their 40s or 50s, who may suddenly wonder if old age – or even a hip replacement – may be on the horizon much sooner than expected.

The good news is only a minority of people with hip pain will have something medically concerning or actually need surgery. Surgery should only be considered after doing a comprehensive rehabilitation exercise program.

There are lots of complex underlying reasons for hip pain, and there may be plenty you can do before you start jumping to conclusions about needing surgery.

Causes of Hip Pain

In young boys and men, a condition known as femoroacetabular impingement syndrome is a common cause of hip pain. This is particularly true for those who play sports (such as soccer) where you need to change direction quickly and often.

This condition is caused by a bigger hip ball (also known as the femoral head) or the hip socket (the acetabulum). This may cause pain at the front or side of the hip. The pain may get worse during movements that involve the knee coming towards the chest (such as a squat) or trending across the middle of the body (such as sitting cross-legged).

In young girls and women, hip dysplasia is particularly common. This happens when the hip socket does not fully cover the ball of the joint. The hip can move too much, and may cause pain at the front, side or back of the hip.

However, excessive hip movement can also be caused when the connective tissue (such as the ligaments and hip capsule) get too elastic or stretchy.

Some people – such as performing artists, yogis and swimmers – may thrive on having more mobility for their artistry and sporting pursuits, but they need to be strong enough to control their excessive motion. Because people with increased mobility are at risk of injury, it is important to maintain hip muscle strength to support the hip joint.

In middle-aged adults and older people, the most common causes of hip pain are osteoarthritis and gluteal tendinopathy.

People with osteoarthritis often experience hip pain and stiffness, and may find it hard to reach down and put on shoes and socks.

People with gluteal tendinopathy might experience pain on the outside of their hip and have problems with lying on their side, climbing stairs or standing on one leg.

My Hip Hurts. How Worried Should I Be?

Well, it’s fundamentally about quality of life.

Does your hip pain make it hard to do social or community activities, perform daily tasks, or stay active? If so, then yes – you’re right to be concerned about your hip pain.

However, most hip conditions can be well managed with non-surgical treatments, such as exercises or stretches prescribed by a physiotherapist, doctor or other health-care professional. You may find you’re soon back to taking those long strolls in the park.

Whether your hip is too stiff or too mobile, start by seeking a thorough clinical examination from a trained and registered doctor or healthcare professional (such as a physiotherapist).

They may ask you to get some scans to help diagnose the cause of your hip pain. In most cases, an X-ray is used to understand the shape of the bones that form the hip joint and check for osteoarthritis.

In some people, an MRI is ordered to get a more detailed understanding of the different components of the hip joint. However, it is important to remember something might show up on an MRI even in people without pain.

Treatment for Hip Pain

Hip pain can often be managed with or without surgery.

If you do end up needing surgery, it’s worth knowing there are lots of different types of surgical treatments. The most common are hip arthroscopy (keyhole surgery) and hip replacement. For many people, though, non-surgical treatments are effective.

These might include adjusting how you exercise or do sport; learning about how to manage symptoms; and muscle strengthening exercises.

In most cases, it’s recommended to try non-surgical treatments for at least three months to see if they help reduce pain and improve hip function before considering surgery.

Whatever you do, stay active. And remember strong bum muscles are important to maintaining healthy hips, so try to find ways to keep your glutes strong.

Charlotte Ganderton, PhD, is a Senior Lecturer in Physiotherapy at RMIT University in Australia. She has received numerous awards for her research and has published papers and presented at national conferences in the musculoskeletal management of the hip and shoulder. 

Joshua Heerey, PhD, is a Physiotherapist and Research Fellow at La Trobe University in Australia. He has published numerous articles examining the diagnosis and treatment of intra-articular hip conditions and is a current member of the International Hip-Related Pain Research Network and Young Athlete’s Hip Research Collaboration.

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

The 5 Most Popular PNN Stories of 2025

By Crystal Lindell

Looking back at 2025, there was a lot of news to cover when it came to chronic pain and illness. Access to opioids was again a major concern for our readers, but there was also a lot of interest in the potentially harmful effects of gabapentin.

Below is a look at the top 5 most widely read articles that PNN published in 2025.

We truly appreciate every time you read, comment and share our articles. And we can’t wait to bring you more great coverage in 2026! 

1) Over 15 Million Americans Prescribed Gabapentin Despite Warnings

In September, we covered an analysis by CDC researchers that showed that the use of gabapentin (Neurontin) continued to soar in the United States — usually for chronic pain and other health conditions the drug is not approved to treat. 

Gabapentin is the fifth most prescribed drug in the United States, with prescriptions nearly tripling since 2010, according to findings published in the Annals of Internal Medicine. The number of patients prescribed gabapentin reached 15.5 million in 2024, up from 5.8 million in 2010.

Read the full article here.  

2) Cannabis Use by Older Adults Linked to ‘Younger Brains’ and Improved Cognition

In August, we covered a study that showed that cannabis use by older adults slowed the aging of their brains and may even improve cognitive function.  

An international research team analyzed health data on more than 25,000 adults in the UK, looking at the relationship between cannabis use, aging, and cognitive function. They found that cannabis users had brain characteristics “typically associated with younger brains” and “enhanced cognitive abilities.” 

Read the full article here. 

3) 6 Things to Try If Your Doctor Won’t Prescribe Opioid Pain Medication

A lot of pain patients find that their doctors are reluctant to prescribe opioids. So in February, I shared six things to try if your physician tells you to go home and take ibuprofen.

The first tip is not to give up. Tell your doctor what poorly treated pain is doing to your life – that you’re unable to work or that you may have to go to the emergency room. Tell the truth and don’t exaggerate, and you just might get them to change their mind.

Another option is to try kratom and/or cannabis. They don’t work for everyone, but many patients say they provide some level of pain relief.  

Read the full article here. 

4) DEA Plans Further Cuts in Oxycodone Supply

In November, we covered the DEA’s plan to cut the supply of oxycodone by more than 6% in 2026, along with marginal reductions in the supply of hydrocodone, morphine and other Schedule II opioids. 

From year-to-year, the cuts may not appear significant. But over the past decade, there has been an historic decline in the nation’s opioid supply. If its current plan is adopted, DEA will have cut the supply of hydrocodone and oxycodone by over 70% since 2014.

The DEA says the “medical usage” of prescription opioids is declining, when in fact the “medical need” for them is actually increasing.

Read the full article here. 

5) Study Links Gabapentin to Increased Dementia Risk 

In July, we covered how gabapentin (Neurontin) may significantly increase the risk of dementia and cognitive impairment, even for middle-aged patients who only took the nerve medication for six months.

That was according to research published in the Regional Anesthesia & Pain Medicine journal, which looked at health records for more than 26,000 U.S. patients with chronic low back pain.

Researchers found that patients with six months or more of gabapentin use had a 29% higher risk of developing dementia and an 85% higher risk of developing mild cognitive impairment 

Read the full article here.

We hope you enjoyed reading PNN in 2025 and that you found our stories informative and helpful. We look forward to continuing our coverage of chronic pain and other health issues in 2026. 

Unlike many other online news outlets, we don’t hide behind a paywall or charge for subscriptions. PNN depends on reader donations to continue publishing, so please consider making a donation today.

Happy New Year everyone!

The Basic Protocol for Treating Adhesive Arachnoiditis

By Dr. Forest Tennant

When Arachnoiditis Hope was formed eight years ago, we had enough experience under our belt to know that treatment of adhesive arachnoiditis (AA) required 3 medical components: 

1. Suppression of inflammation

2. Regeneration of the cauda equina and arachnoid membrane

3. Relief of pain 

Our recommended basic protocol has evolved over the past eight years, based on our review of about 2,000 AA cases. This treatment protocol has been consistently successful in treating most AA cases.  

The basic protocol represents our best approach to stop deterioration. Once established, we recommend additional measures in an attempt to permanently reduce pain and neurologic impairments.

The starting treatment protocol:   

Relief of Pain

Choose a short-acting opioid for pain flares and exacerbations.

Options include less potent opioids, such as tramadol, codeine, buprenorphine, and hydrocodone or oxycodone with acetaminophen 

More potent opioids include oxycodone (plain), morphine, fentanyl and hydromorphone

Suppression of Inflammation and Autoimmunity

• Methylprednisolone 4 mg or dexamethasone 0.5 or 0.75 mg two or three days a week

• Ketorolac 10 mg with meals 2 days a week or a 15 to 60 mg injection one day a week

There are alternatives to corticosteroids and ketorolac, but they do not appear as consistent or effective.

Regeneration of Cauda Equina and Arachnoid Membrane

Dehydroepiandrosterone (DHEA) 200 mg in AM and PM

Additional Measures

Supportive Diet, Vitamins and Minerals: The basic protocol is supported by a daily protein, low carbohydrate, sugar-restrictive, anti-inflammatory diet (daily fruits and vegetables), plus vitamins C, B-12, D and the minerals, magnesium and selenium.

Spinal Fluid Flow Exercises: Rocking in a chair or gentle bouncing on an indoor trampoline are recommended.

Advanced Treatment: After a person is stabilized on the basic protocol, some additional measures that are designed to permanently reduce pain and symptoms can be added. These include peptide/hormone administration, Epstein-Barr virus eradication, adhesion dissolution, electromagnetic therapy, and central pain therapy.

As we approach the end of 2025 we hope you have received some benefit from our efforts to help those suffering with adhesive arachnoiditis and related conditions.  We will likely start a new bulletin series in 2026.  You may wish to print or download and save some of our bulletins from 2025.

Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis. 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. 

A Pained Life: What's in a Name?

By Carol Levy

First, we were called “handicapped." It was a wholesale term to paint all those with physical, emotional or intellectual limitations. One inability meant total inability. Often, it was used as an exclusionary term, to mean someone was “less than.”

Eventually, it was realized that handicapped was a demeaning term. So, they changed it to “disabled.” That too was belittling — a word that tended to make us seem less than whole.

Then came physically (or emotionally or intellectually) “challenged.” That sounds better. After all, being challenged just means you have to try harder to meet goals and objectives.

But even that term carries a subtle meaning: we can overcome challenges if we just “try harder” or “do better.” It suggests we are too lazy, too much of a malingerer, and don't want to even try.

There has to be something better. In thinking about this, I had an “Aha!” moment: I am not disabled, I am “unable.”

That seems more appropriate. After all, being unable in one sense does not mean unable in all. "I am unable to answer the phone right now. Please call back later.".

Because of my trigeminal neuralgia, I can't use my eyes for more than 15 -20 minutes without severe pain. I can't tolerate wind or even a slight breeze against the affected side of my face.

But the rest of me is able and willing. It only makes me unable to do things that require the use of my eyes. I am still able to do things that are physically demanding. I can walk, talk, think, exercise, and thankfully take care of myself. That is far from being disabled. 

Others among us may be unable to lift things, clean a room, or even walk. But we can still think, talk, read, and interact with others, even if only on the phone or online.  We are “unable” in part, but able in many other ways.

But, at the end of the day, does the term used to describe those with inabilities really matter? Most healthy people don’t even consider the label, it’s just a way of quickly describing someone.

Quick descriptions, though, lead to stereotypes and misunderstandings. Take, for example, someone parking in a “handicapped” parking spot.

They may have the placard or license plate that gives them permission to park in these spaces, but when they exit their car and start to walk away, another person may object. They’ll start yelling, “You're not handicapped! How dare you park there and take the space away from someone who actually needs it!”

I have had this happen to me. But it’s too hard to explain what trigeminal neuralgia is, and how the wind or even a breeze could set off a pain flare.

Instead, I say, “I do not need to have a cane or wheelchair to be disabled. I may have a heart condition or emphysema or any number of other disorders that make it difficult for me to park farther away from the entrance.”

Looking abashed, if you're lucky, the person walks away.

It would be nice and so much easier, if I could respond by saying “You're right. I am not handicapped in the way you expect me to be. I am unable physically in a way that may be invisible to you, but necessitates my using this spot.”

I keep my fingers crossed, hoping it’s a teachable moment, that this person will understand that “unable” in one sense does not mean unable in all. Maybe, if we're all really lucky, she’ll be able to pass it on.

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

On a Scale of 1 to 10…

By Julie Titone

Pain is the most common reason that people see a primary care doctor. If you have chronic pain – the kind that’s stuck around for three months or more – chances are you’ve seen lots of specialists, too. 

You may dread their standard question as much as I do: “On a scale of 1 to 10, how much pain do you feel, with 10 being the worst pain possible?”

I hesitate to answer. If I say 6, will I feel like a whiner? If I say 5, will my pain be taken seriously? 

How would I know if I felt the worst possible pain? 

Are you asking me how much it hurts when I stand or when I sit?

There is value in trying to quantify pain, and many have tried to improve upon the 10-point scale. But pain can never be captured by numeric language or, for that matter, by the English language. Good doctors are less interested in numbers than in how the pain is affecting someone’s life.

This subject is on my mind because of the responses to my column, “Arachnoiditis: My Not-So-Rare Disease.” 

Readers who share my diagnosis of adhesive arachnoiditis told me they appreciated my effort to spread the word about this chronic inflammatory disease. But a few chided me for downplaying how painful arachnoiditis can become. 

Here is what I wrote: “Patients experience lower body numbness and stinging pain that, at its worst, is likened to hot water dripping down the legs. The disease can lead to paralysis and bladder dysfunction.”

I debated which words to use in that paragraph. A litany of misery might cause folks to stop reading, so I kept the descriptive list short. 

Now, in recognition of those who suffer, I will expand upon the kinds of pain reported by arachnoiditis patients:

• Burning, stabbing, shocking, zapping

• Buzzing, icy hot, insects crawling under the skin. 

• Deep aching/boring in the spine. 

• Pain radiating down the back of the legs. 

• Vice-like pressure. Cramping. 

• Pain that increases upon standing or sitting. 

• Sudden flares triggered by movement. 

• Widespread burning in the lower body. 

• Pelvic, abdominal and bladder-related pain. 

• Unrelenting, throbbing, exhausting pain.

As one woman wrote in an online discussion: “How much can a body take?” 

Some patients would answer that question with suicide.

What makes this all doubly sad is that arachnoiditis often begins when people seek relief, via injections or surgery, from another source of pain.

So far, my own arachnoiditis is not debilitating. I get modest relief from medicines, movement and massage. Distraction helps. If you need advice on the best ice packs and seat cushions, I’m your gal.

Chronic pain plagues an estimated 20 to 30 percent of people in the world at any given time. The cliché goes that misery loves company. I don’t love it, but that massive company could work in my favor someday.

Researchers have 2 billion reasons to investigate pain treatment and prevention. As the secrets of neural pathways are unlocked, the knowledge is bound to benefit those of us with arachnoiditis.

Julie Titone is a former newspaper journalist who also worked in academic and library communications. She is retired and lives in Everett, Washington. Julie’s website is julietitone.weebly.com.

This column first appeared in Julie’s Substack blog and is republished with permission. 

Congress Went Home for Holidays, Leaving Millions to Face Rising Healthcare Costs

By Robert Applebaum

Dec. 15, 2025 – the deadline for enrolling in a marketplace plan through the Affordable Care Act for 2026 – came and went without an agreement on the federal subsidies that kept ACA plans more affordable for many Americans. 

Despite a last-ditch attempt in the House to extend ACA subsidies, with Congress adjourning for the year on Dec. 19, it’s looking almost certain that Americans relying on ACA subsidies will face a steep increase in health care costs in 2026.

As a gerontologist who studies the U.S. health care system, I’m aware that disagreements about health care in America have a long history. The main bone of contention is whether providing health care is the responsibility of the government, or of individuals or their employers.

The ACA, passed in 2010 as the country’s first major piece of health legislation since the passage of Medicare and Medicaid in 1965, represents one more chapter in that long-standing debate. That debate explains why the health law has fueled so much political divisiveness – including a standoff that spurred a record-breaking 43-day-long government shutdown, which began on Oct. 1, 2025.

In my view, regardless of how Congress resolves, or doesn’t resolve, the current dispute over ACA subsidies, a durable U.S. health care policy will remain out of reach until lawmakers address the core question of who should shoulder the cost of health care.

The ACA’s Roots

In the years before the ACA’s passage, some 49 million Americans – 15% of the population – lacked health insurance. This number had been rising in the wake of the 2008 recession. That’s because the majority of Americans ages 18 to 64 with health insurance receive their health benefits through their employer. In the 2008 downturn, people who lost their jobs basically lost their health care coverage.

For those who believed government had a primary role in providing health insurance for its citizens, the growing number of people lacking coverage hit a crisis point that required an intervention. Those who place responsibility on individuals and employers saw the ACA as perversion of the government’s purpose. The political parties could find no common ground – and this challenge continues.

The major goal of the ACA was to reduce the number of uninsured Americans by about 30 million people, or to about 3% of the U.S. population. It got about halfway there: Today, about 26 million Americans, or 8%, are uninsured, though this number fluctuates based on changes in the economy and federal and state policy.

Health Insurance for All?

The ACA implemented an array of strategies to accomplish this goal. Some were popular, such as allowing parents to keep their kids on their family insurance until age 26. Some were unpopular, such as the mandate that everyone must have insurance.

But two strategies in particular had the biggest impact on the number of uninsured. One was expanding the Medicaid program to include workers whose income was below 138% of the poverty line. The other was providing subsidies to people with low and moderate incomes that could help them buy health insurance through the ACA marketplace, a state or federal health exchange through which consumers could choose health insurance plans.

Medicaid expansion was controversial from the start. Originally, the ACA mandated it for all states, but the Supreme Court eventually ruled that it was up to each state, not the federal government, to decide whether to do so. As of December 2025, 40 states and the District of Columbia have implemented Medicaid expansion, insuring about 20 million Americans.

Meanwhile, the marketplace subsidies, which were designed to help people who were working but could not access an employer-based health plan, were not especially contentious early on. Everyone receiving a subsidy was required to contribute to their insurance plan’s monthly premium. People earning US$18,000 or less annually, which in 2010 was 115% of the income threshold set by the federal government as poverty level, contributed 2.1% of their plan’s cost, and those earning $60,240, which was 400% of the federal poverty level, contributed 10%. People making more than that were not eligible for subsidies at all.

In 2021, legislation passed by the Biden administration to stave off the economic impact of the COVID-19 pandemic increased the subsidy that people could receive. The law eliminated premiums entirely for the lowest income people and reduced the cost for those earning more. And, unlike before, people making more than 400% of the federal poverty level – about 10% of marketplace enrollees – could also get a subsidy.

These pandemic-era subsidies are set to expire at the end of 2025.

Cost vs Coverage

If the COVID-19-era subsidies expire, health care costs would increase substantially for most consumers, as ACA subsidies return to their original levels. So someone making $45,000 annually will now need to pay $360 a month for health insurance, increasing their payment by 74%, or $153 monthly. What’s more, these changes come on top of price hikes to insurance plans themselves, which are estimated to increase by about 18% in 2026.

With these two factors combined, many ACA marketplace users could see their health insurance cost rise more than 100%. Some proponents of extending COVID-19-era subsidies contend that the rollback will result in an estimated 6 million to 7 million people leaving the ACA marketplace and that some 5 million of these Americans could become uninsured in 2026.

Policies in the tax and spending package signed into law by President Donald Trump in July 2025 are amplifying the challenge of keeping Americans insured. The Congressional Budget Office projects that the Medicaid cuts alone, stipulated in the package, may result in more than 7 million people becoming uninsured. Combined with other policy changes outlined in the law and the rollback of the ACA subsidies, that number could hit 16 million by 2034 – essentially wiping out the majority of gains in health insurance coverage that the ACA achieved since 2010.

Subsidy Downsides

These enhanced ACA subsidies are so divisive now in part because they have dramatically driven up the federal government’s health care bill. Between 2021 and 2024, the number of people receiving subsidies doubled – resulting in many more people having health insurance, but also increasing federal ACA expenditures.

In 2025, almost 22 million Americans who purchased a marketplace plan received a federal subsidy to help with the costs, up from 9.2 million in 2020 – a 137% increase.

Those who oppose the extension counter that the subsidies cost the government too much and fund high earners who don’t need government support – and that temporary emergencies, even ones as serious as a pandemic, should not result in permanent changes.

Another critique is that employers are using the ACA to reduce their responsibility for employee coverage. Under the ACA, employers with more than 50 employees must provide health insurance, but for companies with fewer employers, that requirement is optional.

In 2010, 92% of employers with 25 to 49 workers offered health insurance, but by 2025, that proportion had dropped to 64%, suggesting that companies of this size are allowing the ACA to cover their employees.

Dueling Solutions

The U.S. has the most expensive health care system in the world by far. The projected increase in the number of uninsured people over the next 10 years could result in even higher costs, as fewer people get preventive care and delayed health care interventions, ultimately leading to more complex medical care

Federal policy clearly shapes health insurance coverage, but state-level policies play a role too. Nationally, about 8% of people under age 65 were uninsured in 2023, yet that rate varied widely – from 3% in Massachusetts to 18.6% in Texas. States under Republican leadership on average have a higher percentage of uninsured people than do those under Democratic leadership, mirroring the political differences driving the national debate over who is responsible for shouldering the costs of health care.

With dueling ideologies come dueling solutions. For those who believe that the government is responsible for the health of its citizens, expanding health insurance coverage and financing this expansion through taxes presents a clear approach. For those who say the burden should fall on individuals, reliance on the free market drives the fix – on the premise that competition between health insurers and providers offers a more effective way to solve the cost challenges than a government intervention.

Without finding resolution on this core issue, the U.S. will likely still be embroiled in this same debate for years, if not decades, to come.

Robert Applebaum, PhD,  is a Senior Research Scholar in the Department of Sociology and Gerontology at Miami University. He is also Director of the Ohio Long-Term Care Research Project and Senior Research Scholar at the Scripps Gerontology Center.

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

My Christmas Wishes for Pain Patients

By Crystal Lindell

With Christmas spirit in the air, and the hope of the New Year close behind, it seems only appropriate to make some holiday wishes for all my fellow pain patients.

Here are my wishes for people in pain:

More low-pain days than not. Easy opioid prescription refills. Clothes that don’t hurt to wear. Supportive family that always believes you and never judges you.

The ability to use a cane, the possibility of not needing it, and the wisdom to know the difference.

I wish for you a sweet pet to cuddle up in your lap whenever you can’t get off the couch. Money that comes in more than it goes out. And steady weather, so that the barometric pressure doesn’t increase your pain.

I wish that every book you read to get through a pain flare takes you to a new world where your pain isn’t as bad.

I wish for you a doctor who takes you seriously and prescribes you medications that actually work. Health insurance that actually covers all of your medical expenses. And a pharmacist who actually believes you.

I wish you more strength that you need to keep going when the pain is really trying to make you stop. And the ability to keep hope alive even when you’d rather be dead.

If you’re seeking answers and a diagnosis, I hope you find both. 

If you’re seeking a romantic partner, I hope they find you. 

If you’re just seeking a good TV show to watch on bad pain days, I hope you find one with lots of seasons. Hopefully, it’s on one of the streaming services you already subscribe to!

May your naps always rejuvenate you, your medications always kick in quickly, and your shoes always be comfortable.

But most of all, my wish for you is that your pain goes away. I really do.

Sadly, like my body, my wishes don’t always work so well. They only rarely come true. 

So, if your pain refuses to leave, I wish only that you know that this world needs you in it, and that it’s vitally important that you keep going. There are still so many things left for you to see and do and accomplish. 

Merry Christmas dear pain patient, and hopefully a very happy New Year – or at least a survivable year ahead.