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Regulators And Insurers Responsible For Opioid Crisis

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Last Post by 10x25mm 1 month ago

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10x25mm

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Topic starter November 28, 2025 5:37 pm

With the benefit of hindsight, it is becoming clear that the simplistic storyline about the “opioid epidemic” was entirely false. The claim that doctors prescribed too many opioid pills and that OxyContin “drove” people to heroin was a fiction - profitable for lawyers and government, but a fiction nonetheless. A very capable policy analyst, Amy Bianco, now shows us how the insurance industry quietly dismantled expensive, comprehensive pain programs and pushed opioid pills as the only reimbursable pain management program.

A Tale of Two Graphs (and More); An Investigative History of America's Overdose Crisis by Amy Bianco got little notice when it was published back in May, probably due to its length. We now have a Cliffs Notes edition by Lynn Webster at The American Council of Science and Health which should provoke some serious thought:

https://www.acsh.org/news/2025/11/21/tale-two-graphs-why-four-phase-opioid-story-falls-apart-49835

https://paingame.substack.com/p/a-tale-of-two-graphs-and-more

A Tale of Two Graphs – Why the Four-Phase Opioid Story Falls Apart
By Lynn Webster, MD — November 21, 2025

America’s overdose crisis isn’t the simple story we’ve been told for years. A new investigation reveals how two key graphs — one famous, one ignored — shift entirely the way we understand what happened, why deaths keep rising, and why current policies continue to fail. This op-ed explains why the familiar “four-phase opioid epidemic” narrative collapses under scrutiny.

For years, we’ve been told a simple story about the “opioid epidemic”: first, doctors prescribed too many pills, then reformulated OxyContin “drove” people to heroin, then fentanyl arrived, and now a wave of ultra-potent synthetics is killing “naïve” users in record numbers. Four neat phases, one neat villain: prescription opioids.

It’s a compelling narrative. It’s also deeply misleading.

A new multi-part investigation by journalist Amy Bianco at The PAIN GAME—“A Tale of Two Graphs (and More)” is, in my view, the clearest and most honest dismantling of that four-phase storyline that anyone has published to date.

Instead of starting with slogans or cherry-picked timelines, the author goes back to the graphs that shaped public policy: the classic CDC figure showing prescription opioid sales rising in lockstep with “prescription opioid deaths,” and the less famous but far more important Jalal/Burke graph showing that overall overdose deaths have risen on a smooth exponential curve since the late 1970s, across all drugs, long before OxyContin ever appeared.

Once you put those two graphs side by side, the four-phase myth starts to unravel.

What this series does differently

Most commentary treats “Phase One” as a morality play: greedy companies, gullible doctors, and passive patients whose prescriptions inevitably turned into addiction and death. This series refuses that caricature.

It shows how the modern pain movement began in oncology and AIDS care. This was a good-faith effort by clinicians who had seen opioids transform the lives of people in terrible pain, and who reasonably believed that carefully monitored use could help a wider group of patients. It traces how that model depended on time, expertise, and multidisciplinary care—psychology, physical therapy, and careful follow-up—not just a prescription pad.

Then it documents how the insurance industry quietly dismantled those comprehensive pain programs, reimbursing the cheapest elements and starving the rest. By 2015, the number of collaborative pain clinics in the U.S. had collapsed from roughly 1,000 to under 100 outside the VA. What survived in most communities was a 15-minute visit and a bottle of pills—not because physicians were lazy or corrupt, but because the system made everything else nearly impossible.

The piece also exposes something almost no one outside this world has seen: how overdose is coded and counted. “Prescription opioid deaths” on a CDC graph are usually multi-drug deaths where an opioid was present, not the proven cause. When a doctor is under investigation, the pressure on medical examiners to label a death as a “prescription overdose” can be intense—even when the patient had advanced heart disease, cancer, infection or, in one jaw-dropping example, died in a car crash.

Once you understand how messy the “opioid deaths” line really is, the simple Phase One story—“doctor prescribes → patient becomes addicted → patient overdoses”—looks much less like science and much more like a convenient political script.

Beyond four phases: waves, scams, and a rigged ecosystem

One of the most powerful sections comes from a methadone nurse in Maine who describes three overlapping waves of patients she saw between the late 1990s and early 2000s:

• long-time heroin users trying to stabilize
• abandoned chronic pain patients whose doctors cut them off
• young people getting hooked on diverted pills from medicine cabinets and the street

Those three waves alone blow up the idea that Phase One was mostly about “innocent patients turned into addicts by their prescriptions.” The reality was a tangled ecosystem where licit and illicit markets bled into each other, where diversion happened in countless small ways, and where the same pill could mean stability for one person and chaos for another.

The series goes further, tracing what it calls a “hierarchy of scams”: scammers who lied to doctors to get pills; law-enforcement strategies that turned those scammers into witnesses against high-volume prescribers; prosecutors who built careers by portraying pain specialists as kingpins; and insurers and government programs quietly saving money when those practices were shut down and complex patients scattered. All of this was then wrapped in the rhetoric of a new front in the War on Drugs: the “War on Prescription Drug Abuse.”

Meanwhile, as opioid prescriptions have fallen sharply since 2012, deaths from illicit fentanyl and its analogues have exploded. The second CDC graph of the article makes this brutally clear: prescribing plummets while the line of synthetic opioid deaths rockets upward. If pills were truly the singular engine of the crisis, those trends should move together. They don’t.

Why this matters now

If you live with pain, treat people in pain, or care about overdose policy, you already know something is off in the dominant story. Pain patients are being forcibly tapered or abruptly cut off. Clinicians are leaving the field in fear. Yet overdose deaths keep rising, driven by a volatile illicit market that our policies helped create.

Bianco’s series gives you the missing context and language to explain why.

It challenges the “magic molecule” theory which is the idea that a brief encounter with an opioid dooms a large share of people to lifelong addiction. If that were true, routine post-surgical prescribing over the last 50 years would have produced apocalyptic levels of opioid use disorder. It didn’t. The reality is far more nuanced, and far more tied to social conditions, trauma, and long-running failures of the War on Drugs than to any single product or prescription.

Most importantly, Bianco’s pieces insist on telling the story in all its messy, human detail: the patients who did everything “right” and were still treated as suspects; the young people who started using pills as teenagers because they were everywhere and life was hard; and the clinicians and law-enforcement officers who tried to do the right thing inside systems that rewarded spectacle over truth.

An invitation

If you’re tired of being told that the crisis can be explained in four tidy phases and one villain, I’d encourage you to read “A Tale of Two Graphs (and More)” and share it widely.

It doesn’t deny the harms of opioids or the responsibility of industry. It does something braver; it shows how partial truths, weaponized graphs, and a half-century of bad drug policy have combined to produce the catastrophe we’re in, and it explains why doubling down on the same narrative will only make things worse.

If we want policies that save lives and protect people in pain, we have to start by telling the story honestly. This series is a major step in that direction.

Lynn R. Webster, MD, is a pain and addiction medicine specialist and serves as Executive Vice President of Scientific Affairs at Dr. Vince Clinical Research, where he consults with pharmaceutical companies. He is also Senior Fellow, Center for U.S. Policy

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

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10x25mm

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Topic starter December 8, 2025 5:26 pm

Hung jury in Florida hospitals' opioid case against CVS, Walgreens, and Wal-Mart:

https://www.reuters.com/legal/litigation/florida-hospitals-opioid-case-against-walmart-cvs-walgreens-results-mistrial-2025-12-08/

Florida hospitals' opioid case against Walmart, CVS, Walgreens results in mistrial
By Dietrich Knauth - December 8, 2025

Dec 8 (Reuters) - A Florida judge on Monday declared a mistrial in a lawsuit that accused Walmart, CVS and Walgreens of flooding the state with opioids and raising costs for local hospitals.

The trial began in Broward County Circuit Court in September, and jurors deliberated for 14 days before telling the judge they could not reach a unanimous verdict.

Get a quick look at the days breaking legal news and analysis from The Afternoon Docket newsletter. Sign up here.
During the lengthy deliberations, one juror was dismissed from the case after a dispute with another juror. Broward County Chief Judge Carol-Lisa Philips had denied several of the pharmacy chains' motions for a mistrial on Monday morning before the remaining eight jurors told her for a second time that they could not reach agreement later that day.

SURGE IN OPIOID USE

Sixteen Florida hospitals, including Broward Health, Tampa General Hospital and Good Samaritan Medical Center, sued in 2019, accusing the pharmacy chains of violating Florida's anti-racketeering law by working with drugmakers and distributors to drive up opioid sales. The hospitals say the surge in opioid use led to injuries they had to treat, often without being reimbursed.

Opioid addiction is an epidemic in the United States, and the health crisis has sparked thousands of lawsuits accusing drug companies of contributing to the problem by deceptively marketing opioid painkillers like Oxycontin as less addictive alternatives for pain treatment.

More than 800,000 people died from opioid overdoses between 1999 and 2023, according to statistics from the Centers for Disease Control. That number includes both prescription medicine and illegal drugs, like fentanyl, which have accounted for an increasing proportion of overdoses and injuries in recent years.

The hospitals claimed the companies conspired to profit from soaring opioid prescriptions despite being keenly aware of the addiction risks. Between 2006 and 2018, the pharmacies dispensed more than 21 billion opioid pills in 15 Florida counties served by the hospitals — nearly 200 pills a year for every resident, according to the complaint. The hospitals say they racked up $528.3 million in unpaid bills for treating opioid-related injuries, and another $1.5 billion when patients with opioid-related conditions sought care for other issues.

Plaintiffs' attorney Warren Burns said in closing arguments that Reuters viewed on Courtroom View Network that patients' opioid use complicated treatment and drove up costs even for patients admitted to the hospital for other reasons.

"Opioids have an impact on practically every system in your body," Burns said. "Even when you're coming in with a car accident, opioids can potentially complicate that care as well, because they can't treat your pain."

The pharmacy chains argued they sold legal medications prescribed by doctors and denied conspiring with drugmakers.

In his closing argument, Walmart attorney David Markus called the lawsuit “a money grab,” saying the hospitals’ damages calculations included cases where bills were fully paid and even instances where the hospitals’ own physicians prescribed opioids.

“There was no conspiracy,” Markus told jurors.

The hospitals initially sued a wide range of opioid manufacturers, distributors and pharmacies, but most other defendants reached nationwide settlements that resolved the hospitals' opioid claims. Companies that made or sold opioid medications have committed over $50 billion to settlements, including both the nationwide deals and separate agreements negotiated by individual states.

The case is Florida Health Sciences Center, North Broward Hospital District, et al. v. CVS, Walmart, and Walgreens; Seventeenth Judicial Circuit of Florida, No. 19-018882

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Abigail Nobel

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February 8, 2026 1:01 am

If you live with pain, treat people in pain, or care about overdose policy, you already know something is off in the dominant story. Pain patients are being forcibly tapered or abruptly cut off.

A Patreon post details forced tapering that makes me sick to read. Has healthcare really come to such sadism?

The authors' hot links and reader comments deserve a good look at the site.

https://www.patreon.com/posts/140979067

💊 Benzos, Bureaucracy, and the “Over-65” Cut-Off Club

The Doctor Patient Forum with Claudia A. Merandi and Bev C. Schechtman | Oct 11, 2025

ASAM has decided to give its benzodiazepine tapering guideline another big rollout, now with a shiny new resource page packed with webinars, clinician toolkits, and patient handouts.

👉 ASAM Benzodiazepine Tapering Guideline Resources

It includes:

“How-To” videos for prescribers on managing long-term benzodiazepine use

A full slide deck and continuing-education webinar on tapering practices

Links to sample patient education materials

A summary of “special populations," which, of course, includes adults 65 and older

And that’s where it gets fun (by “fun,” we mean horrifying).
ASAM recommends that clinicians taper most adults aged 65 and up, unless there’s a “compelling reason” not to.

Translation: If Grandma’s still breathing, start the taper.

This explains why we keep hearing from seniors who’ve been cut off both benzos and opioids, even when they’ve been stable for decades. The document reads like it’s protecting patients, but in practice, it’s giving cover for age-based de-prescribing that feels an awful lot like forced tapering.

They also remind doctors to “avoid abrupt discontinuation,” but if you’ve been around long enough, you know that’s the part nobody seems to pay attention to.

So now that ASAM has repackaged this as “new educational content,” we’re curious, How many of you here have been pressured or forced off benzodiazepines?

Share your experience in the comments, it helps us show how these policies play out in real life.

The patient stories in the comments will horrify you.

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10x25mm

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Topic starter February 13, 2026 10:29 am

Some states are now forcing insurers - and their Medicaid programs - to pay for opioid alternatives:

https://michiganadvance.com/2026/02/13/repub/more-states-are-requiring-insurers-to-cover-non-opioid-pain-meds/

More states are requiring insurers to cover non-opioid pain meds
By Nada Hassanein - February 13, 2026

More states are requiring their Medicaid programs and health insurance companies to cover non-opioid pain medications as an alternative to opioids, which can be cheaper for insurers but also more addictive for patients.

Advocates, providers, medical associations and state lawmakers are pushing for parity in coverage. That means prohibiting insurers from charging higher copayments for non-opioids than they do for opioids, and barring them from requiring prior authorization or step therapy — mandating that patients try other medications first — before they will cover non-opioid drugs.

At least eight states have enacted such laws: Arkansas, Illinois, Louisiana, Maine, Massachusetts, Oklahoma, Oregon and Tennessee. In states that are still considering legislation, the efforts have been bipartisan, pushed by lawmakers in Democratic-controlled states such as Colorado and New York and Republican-leaning states including Kentucky and Missouri.

The issue has gained momentum in recent years, as leading medical associations such as the American Society of Regional Anesthesia and Pain Medicine have urged providers not to prescribe opioids as the first-line treatment for pain. Meanwhile, bipartisan legislation introduced in Congress last year aims to increase Medicaid Part D enrollees’ access to non-opioid pain medications. It’s been referred to a committee.

Dr. Patrick Giam, president of the American Society of Anesthesiologists, said the organization “believes it is important that insurance plans make non-opioid therapies as accessible to patients as opioid-based therapies.”

Suzetrigine

The U.S. Food and Drug Administration last year approved a new drug called suzetrigine, under the brand name Journavx, the first non-opioid pain relief medication in a new class of analgesic drugs.

Non-opioid pain medications include prescription-strength anti-inflammatory NSAIDs such as naproxen and ibuprofen, nerve-blocking injections, certain antidepressants, anticonvulsant medications, acetaminophen and other medications. Opioids include oxycodone, codeine, morphine and fentanyl. The U.S. Food and Drug Administration has long encouraged non-opioid pain relief alternatives.

Last year, the agency approved a new drug called suzetrigine, under the brand name Journavx, the first non-opioid pain relief medication in a new class of analgesic drugs. The drug, which is available in tablets, can be prescribed for acute pain after surgery or injury. Vertex Pharmaceuticals, the manufacturer, is one of the funders of Voices for Non-Opioid Choices, which has been lobbying for the bills.

In Missouri, where GOP-sponsored legislation would prohibit insurance companies from denying coverage of a prescribed non-opioid or requiring a higher copayment for a non-opioid, the Missouri Insurance Coalition has argued that the measure would increase health care costs and effectively create “a monopoly” for Journavx. Each tablet can cost around $15 per tablet out-of-pocket. But lawmakers pointed to non-opioid alternatives.

Why non-opioids often cost more

Newer non-opioid drugs entering the market are more expensive than opioids because there isn’t yet a generic alternative, explained Sterling Elliott, an Illinois clinical pharmacist and lecturer at Northwestern University’s Feinberg School of Medicine and a board member of Voices for Non-Opioid Choices.

“The price is so high for a lot of things because the price for generic opioids is so low. Generic opioids are amongst the cheapest medications that you’ll find flowing through the American pharmaceutical supply,” Elliott said. “When you get a new entrant into the pain market, the marketplace factors are set up to drive the price up.”

Elliott added that some insurance plans don’t cover prescription-strength NSAIDs such as ibuprofen because they’d rather people pay out-of-pocket for lower strength, over-the-counter versions of those drugs.

In New York, Democratic Assemblymember Phil Steck, the cosponsor of a bipartisan bill that hasn’t received a hearing, said challenging the insurance companies isn’t easy.

“You’re trying to tell insurers what to do,” Steck said. “Those are usually difficult undertakings. … Our experience is that the [legislature’s] insurance committee is very difficult to deal with, and so it hasn’t been pursued as much as we would like.”

Coverage of non-opioids can vary widely across insurance plans, explained clinical pharmacist Emma Murter, who co-chairs the advocacy committee of the Society of Pain and Palliative Care Pharmacists.

“There are so many [non-opioid] medications that can be used for chronic pain,” Murter said. “It isn’t gut-instinct obvious, what is and isn’t covered. It’s very Wild West, chaotic.”

When it comes to filling prescriptions, Murter said, she often has to “fight and appeal for some of these non-opioid therapies” with insurance companies.

Dima Qato, associate professor of clinical pharmacy at the University of Southern California, said non-opioid pain prescription meds are less common on insurance companies’ “preferred” drug lists. Because insurers may favor the less expensive opioids, that can result in higher copayments or consumers paying more out-of-pocket.

That was the case for Chris Fox, the Washington lobbyist who serves as executive director of Voices for Non-Opioid Choices. Fox has traveled to state capitals around the country to lobby for the bills. Recently, he had a personal experience with pain medications following oral surgery.

“For everything but the non-opioid, my out-of-pocket expectation was $0,” he said. He was charged $30 out-of-pocket for the non-opioid.

His oral surgeon wasn’t familiar with the availability of the new first-in-class non-opioid suzetrigine, Fox added. When he asked the doctor for a prescription for it, the surgeon wrote it but also prescribed an opioid along with an antibiotic.

“He prescribed me hydrocodone to go along with it, just in case, because he wasn’t as familiar with [suzetrigine],” Fox said.

Preventing addiction

As he spoke with Stateline by phone, Fox was driving to the local sheriff’s office to drop off the hydrocodone, which he didn’t take following his surgery.

“We’ve neglected the opportunity, I would say, to prevent opioid addiction where we can, which is in those patients that will develop a newly persistent opioid use pattern following exposure to an opioid that they get for medical reason,” Fox said.

Although opioid overdose deaths have declined, the drugs still kill about 200 Americans a day.

Health care professionals at hospitals also run into issues with lower reimbursement rates for some non-opioids.

Dr. Joseph Smith, an anesthesiologist at a Virginia surgical center who has practiced for three decades, pointed to a nerve-block pain pump as an example. Administering a brand-name version of the drug could cost up to $400 for all the equipment, he said. Smith, like Elliott, sits on the board of Voices for Non-Opioid Choices.

“So the hospital is like, ‘Well, I can spend $400 or I can spend 25 cents on a narcotic pill,’” Smith said.

Smith treats many young teen athletes with sports injuries. Research has shown post-surgery narcotic use can increase risk of addiction.

“My goal when I get a 14-year-old or 15-year-old in here is to never have them try a narcotic, never have them exposed to narcotics,” he said.

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