Contained in the battle for the way forward for habit medication : Pictures

[ad_1] <img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4624x3472+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Ffe%2F2d%2Fbdd67e3b41ca9927e3fe6e94cdcf%2Felyse-and-ronald-major.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4624x3472+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Ffe%2F2d%2Fbdd67e3b41ca9927e3fe6e94cdcf%2Felyse-and-ronald-major.jpg" class="img" alt="Dr. Elyse Stevens wears glasses, a yellow t-shirt and a sweater. Ronald Major wears a stylish white track suit." fetchpriority="high"/> Dr. Elyse Stevens, left, attends a group breakfast at a New Orleans nonprofit, along with her former affected person Ronald Main who says Stevens handled him like household. Aneri Pattani/KFF Well being Information disguise caption

toggle caption

Aneri Pattani/KFF Well being Information NEW ORLEANS — Dr. Elyse Stevens had a status for taking up complicated medical instances, together with individuals who'd been battling habit for many years. Some had been chronic-pain sufferers on excessive doses of opioids; others had been intercourse staff and other people residing on the road.

"Lots of my sufferers are messy, those that do not know in the event that they wish to cease utilizing medication or not," mentioned Stevens, a major care and habit medication physician.

Whereas different docs prevented these sufferers, Stevens — who was conversant in New Orleans from her time in medical college at Tulane College — sought them out. She usually attended 6 a.m. breakfasts for homeless folks, volunteered at a homeless shelter clinic on Saturdays, and, on Monday evenings, visited an deserted Household Greenback retailer the place advocates distributed provides to individuals who use medication.

Award-winning care One such night about 4 years in the past, Charmyra Harrell arrived there limping, her proper leg swollen and coated in sores. Emergency room docs had repeatedly dismissed her, so Harrell mentioned she eased the ache with road medication.

Stevens cleaned her sores on Mondays for months till lastly persuading Harrell to go to the clinic at College Medical Heart New Orleans. There, Stevens found Harrell had diabetes and most cancers.

She agreed to prescribe Harrell ache treatment — an possibility many docs would routinely dismiss for concern {that a} affected person with a historical past of habit would misuse it.

However Stevens was assured Harrell might maintain up her finish of the deal.

"She informed me, 'You can not do medication and do your ache meds,'" Harrell recounted on a Monday night in October. So, "I am not on cocaine."

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4624x3472+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Fdf%2Fdf%2F41f046664801ad2272cb789a331f%2Fcharmyra-harrell-2.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4624x3472+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Fdf%2Fdf%2F41f046664801ad2272cb789a331f%2Fcharmyra-harrell-2.jpg" class="img" alt="Charmyra Harrell is wearing a pink t-shirt and standing near a rack of clothing. " loading="lazy"/> Charmyra Harrell credit Dr. Elyse Stevens with diagnosing her diabetes and most cancers and serving to her cease utilizing cocaine. Aneri Pattani/KFF Well being Information disguise caption

toggle caption

Aneri Pattani/KFF Well being Information Stevens' method to affected person care has received her awards and nominations in medication, group service, and humanism. As an alternative of seeing sufferers in binaries — addicted or sober, with a optimistic or unfavourable drug take a look at — she measures progress on a spectrum. Are they showering every day, cooking with their households, utilizing much less fentanyl than the day earlier than?

However not everybody agrees with this versatile method that prioritizes working with sufferers on their objectives, even when abstinence is not certainly one of them. And it got here to a head in the summertime of 2024.

"The identical issues I used to be high-fived for 1000's of occasions — all of a sudden that was unhealthy," Stevens mentioned.

Versatile care or slippery slope? Greater than 80% of Individuals who want substance use remedy do not obtain it, nationwide knowledge from the Substance Abuse and Psychological Well being Companies Administration reveals. Boundaries abound: excessive prices, lack of transportation, clinic hours which might be incompatible with jobs, concern of being mistreated.

Some docs had been attempting to ease the method for years. The pandemic accelerated that development. Telehealth appointments, fewer urine drug checks, and drugs refills that last more grew to become the norm.

The outcome?

"Sufferers did OK and we truly reached extra folks," mentioned Brian Hurley, the previous president of the American Society of Dependancy Medication. The group helps persevering with versatile practices, comparable to serving to sufferers keep away from withdrawal signs by prescribing higher-than-traditional doses of habit treatment and specializing in restoration objectives aside from abstinence.

However some docs choose conventional approaches that vary from zero tolerance for sufferers utilizing unlawful medication to setting stiff penalties for individuals who do not meet their docs' expectations. For instance, a affected person who checks optimistic for road medication whereas getting outpatient care can be discharged and informed to go to residential rehab. Proponents of this methodology concern loosening restrictions may very well be a slippery slope that in the end harms sufferers. They are saying persevering with to prescribe painkillers, for instance, to folks utilizing illicit substances long-term might normalize drug use and hamper the aim of getting folks off unlawful medication.

Progress ought to be greater than protecting sufferers in care, mentioned Keith Humphreys, a Stanford psychologist, who has handled and researched habit for many years and helps involuntary remedy.

"In the event you give addicted folks numerous medication, they prefer it, and so they might come again," he mentioned. "However that does not imply that that's selling their well being over time."

Versatile practices additionally are inclined to align with hurt discount, a divisive method that proponents say retains individuals who use medication protected and that critics — together with the Trump administration — say allows unlawful drug use.

The talk is not only philosophical. For Stevens and her sufferers, it got here to bear on the streets of New Orleans.

"Unconventional" prescribing In the summertime of 2024, Stevens' supervisors began questioning her method.

In emails reviewed by KFF Well being Information, they expressed considerations about her prescribing too many ache drugs, a mixture of opioids and different managed substances to the identical sufferers, and excessive doses of buprenorphine, a medicine thought of the gold customary to deal with opioid habit.

Stevens' supervisors fearful she wasn't doing sufficient urine drug checks and stored treating sufferers who used illicit medication as a substitute of referring them to increased ranges of care, comparable to inpatient rehab.

"Her prescribing sample seems unconventional in comparison with the native customary of care," the hospital's chief medical officer on the time wrote to Stevens' supervisor, Dr. Benjamin Springgate. "Be aware that that is the one customary of care which might doubtless be thought of ought to a authorized concern come up."

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4624x3472+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Ffa%2F70%2F76bfe3d740a9bb4926609b97c0e3%2Felyse-and-bey-2.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4624x3472+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Ffa%2F70%2F76bfe3d740a9bb4926609b97c0e3%2Felyse-and-bey-2.jpg" class="img" alt="Dr. Elyse Stevens and her husband, Aquil Bey sit across a table from each other. Bey is looking at a tablet computer. They are wearing matching yellow t-shirts." loading="lazy"/> Dr. Elyse Stevens and her husband, Aquil Bey, a paramedic, talk about affected person instances at a breakfast for homeless folks in New Orleans. Bey based Freestanding Communities, a corporation to assist weak folks. Aneri Pattani/KFF Well being Information disguise caption

toggle caption

Aneri Pattani/KFF Well being Information Springgate forwarded that e mail to Stevens and inspired her to refer extra sufferers to methadone clinics, intensive outpatient care, and inpatient rehab.

Stevens understood the final apply however could not reconcile it with the fact her sufferers confronted. She questioned how somebody residing in a tent, frightened of dropping their possessions, would trek to a methadone clinic every day.

Stevens despatched her supervisors dozens of analysis research and nationwide remedy tips backing her versatile method. She defined that if she stopped prescribing the medicines of concern, sufferers would possibly go away the well being system, however they might nonetheless be sick.

"They simply would not be getting care and maybe they'd be lifeless," she mentioned in an interview with KFF Well being Information.

Each College Medical Heart and LSU Well being New Orleans, which employs Stevens and different physicians at UMC, declined repeated requests for interviews. They didn't reply to detailed questions on habit remedy or Stevens' practices.

As an alternative, they offered a joint assertion from Dr. Richard DiCarlo, dean of the LSU Well being New Orleans College of Medication, and Dr. Jeffrey Elder, chief medical officer of College Medical Heart New Orleans.

"We aren't at liberty to remark publicly on inner personnel points," they wrote.

"We acknowledge that habit is a severe public well being downside, and that habit remedy is a problem for the well being care business," they mentioned. "We stay devoted to increasing entry to remedy, whereas upholding the best customary of care and security for all sufferers."

Not black-and-white KFF Well being Information shared the complaints towards Stevens and the responses she'd written for supervisors with two habit medication docs outdoors of Louisiana, who had no affiliation with Stevens or her employers. Each discovered her practices to be inside the bounds of regular habit care, particularly for complicated sufferers.

Dr. Stephen Loyd, an habit medication specialist and the president of Tennessee's medical licensing board, mentioned docs working capsule mills usually have sparse affected person notes that record a chief criticism of ache. However Stevens' notes detailed sufferers' life circumstances and the intricate choices she was making with them.

"To me, that is the large distinction," Loyd mentioned.

Some folks assume the "solely good reply is not any opioids," comparable to oxycodone or hydrocodone, for any sufferers, mentioned Dr. Cara Poland, an habit medication specialist and affiliate professor at Michigan State College.

However sufferers may have them — generally for issues like most cancers ache — or require months to decrease their doses safely, she mentioned. "It is not as black-and-white as folks outdoors our discipline need it to be."

Humphreys, the Stanford psychologist, had a distinct take. He didn't evaluate Stevens' case however mentioned, as a basic apply, there are dangers to prescribing painkillers long-term, particularly for sufferers utilizing immediately's deadly road medication too.

Overprescribing fueled the opioid disaster, he mentioned. "It is not going to go away if we do this once more."

"The factor that kills folks" After months of pressure, Stevens' supervisors informed her on March 10 to cease coming to work. The hospital was conducting a evaluate of her practices, they mentioned in an e mail considered by KFF Well being Information.In a single day, a whole bunch of her sufferers had been moved to different suppliers.

Luka Bair had been seeing Stevens for 3 years and was steady on every day buprenorphine.

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/3472x4624+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Ffb%2F0e%2F43aa573c4eeb96fbf67fae9589de%2Fluka-bair-2.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/3472x4624+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Ffb%2F0e%2F43aa573c4eeb96fbf67fae9589de%2Fluka-bair-2.jpg" class="img" alt="Luka Bair is a young person with close cropped hair, carrying a bottle of Coca-Cola. " loading="lazy"/> Luka Bair holds a movie of buprenorphine, a every day treatment thought of the gold customary to deal with opioid habit. Aneri Pattani/KFF Well being Information disguise caption

toggle caption

Aneri Pattani/KFF Well being Information After Stevens' departure, Bair was left with out treatment for 3 days. The withdrawal signs had been extreme — headache, nausea, muscle cramps.

"I used to be simply in bodily hell," mentioned Bair, who works for the Nationwide Hurt Discount Coalition and makes use of they/them pronouns.

Though Bair finally acquired a refill, Springgate, Stevens' supervisor, did not wish to proceed the routine long-term. As an alternative, Springgate referred Bair to extra intensive and residential packages, citing Bair's intermittent use of different medication, together with benzodiazepines and cocaine, as markers of excessive danger. Bair "requires a better degree of care than our clinic fairly can supply," Springgate wrote in affected person portal notes shared by Bair and reviewed by KFF Well being Information.

However Bair mentioned every day attendance at these packages was incompatible with their full-time job. They left the clinic, with 30 days to discover a new physician or run out of treatment once more.

"That is the factor that kills folks," mentioned Bair, who finally discovered one other physician prepared to prescribe their buprenorphine.

Springgate didn't reply to repeated calls and emails requesting remark.

College Medical Heart and LSU Well being New Orleans didn't reply questions on transferring and discharging Stevens' sufferers.

"Reckless conduct" A couple of month after Stevens was informed to remain dwelling, Haley Beavers Khoury, a medical scholar who labored along with her, had collected almost 100 letters from different college students, docs, sufferers, and homelessness service suppliers calling for Stevens' return.

One scholar wrote, "Make no mistake — a few of her sufferers will die with out her." A nun from the Daughters of Charity, which ran the hospital's earlier incarnation, referred to as Stevens a "lifeline" for weak sufferers.

Beavers Khoury mentioned she despatched the letters to about 10 folks in hospital and medical college management. Most didn't reply.

In Might, the hospital's evaluate committee decided Stevens' practices fell "outdoors of the suitable group requirements" and constituted "reckless conduct," based on a letter despatched to Stevens.

The hospital didn't reply KFF Well being Information' questions on the way it reached this conclusion or if it recognized any affected person hurt.

In the meantime, Stevens had secured a job at one other New Orleans hospital. However as a result of her resignation got here amid the continued investigation, College Medical Heart mentioned it was required to tell the state's medical licensing board.

The medical board started its personal investigation — a growth that finally price Stevens the opposite job supply.

In presenting her aspect to the medical board, Stevens repeated many arguments she'd made earlier than. Sure, she was prescribing highly effective medicines. No, she wasn't making scientific choices based mostly on urine drug checks. However nationwide habit organizations supported such practices and promoted tailoring care to sufferers' circumstances, she mentioned. Her response included a 10-page bibliography with 98 citations.

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4624x3472+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F57%2Fcf%2Fa15289704264a467913efad59b2a%2Felyse-fire-pit-3.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4624x3472+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F57%2Fcf%2Fa15289704264a467913efad59b2a%2Felyse-fire-pit-3.jpg" class="img" alt="Dr. Elyse Stevens and a family member are standing near a backyard fire pit. She is putting prescription paper into the smoky fire." loading="lazy"/> In October 2025, Dr. Elyse Stevens determined to go away New Orleans. Earlier than she left, she and her household burned her previous prescription pads as "a ceremonial dying of an previous life and delivery of a brand new starting," she says. Aneri Pattani/KFF Well being Information disguise caption

toggle caption

Aneri Pattani/KFF Well being Information Legal responsibility The Louisiana state board's investigation into Stevens is ongoing. Its web site reveals no motion taken towards her license as of late December.The board declined to touch upon each Stevens' case and its definition of applicable habit remedy.

In October, Stevens moved to the Virgin Islands to work in inner medication at a neighborhood hospital. She mentioned she's grateful for the welcoming locals and the monetary stability to assist herself and her dad and mom.

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/3468x4624+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F19%2F56%2Fff8b4f93493c91194be3f2b031d2%2Felyse-and-mom-2.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/3468x4624+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F19%2F56%2Fff8b4f93493c91194be3f2b031d2%2Felyse-and-mom-2.jpg" class="img" alt="Dr. Elyse Stevens, who is wearing shorts and a tank top, gets a kiss from her mom, Mary Chaput. They are standing near a parked car on a street in New Orleans." loading="lazy"/> Dr. Elyse Stevens says goodbye to her mother, Mary Chaput, as they half methods on certainly one of Stevens' closing days in New Orleans. Aneri Pattani/KFF Well being Information disguise caption

toggle caption

Aneri Pattani/KFF Well being Information However it hurts to consider her former sufferers in New Orleans.

Earlier than leaving, Stevens packed away handwritten letters from a number of of them — one was 15 pages lengthy, written in alternating inexperienced and purple marker — through which they shared childhood traumas and small successes that they had whereas in remedy along with her.

Stevens does not know what occurred to these sufferers after she left.

She believes the scrutiny of her practices facilities on considerations over legal responsibility greater than affected person security.

However, she mentioned, "legal responsibility is in abandoning folks, too."

KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF.