To be honest, I never imagined myself treating A-list celebrities and professional athletes in Manhattan. As a young physician in Juárez, Mexico, I spent my earliest years working in community clinics and even pharmacies on the city’s impoverished peripheries. Back then, the idea of practicing at one of the most prestigious hospitals in the United States (let alone as a pain management specialist) was unthinkable. And yet, only a few years later, I found myself in the gilded hallways of a prestigious specialty hospital, rubbing shoulders with wealth, status, and the illusion of elite medicine. But behind the boutique façade and prestigious Academic associations, the truth was far less glamorous: a dumping ground of patients who have an addiction, hopelessly drug-seeking, and a system built on keeping them happy at all costs, even if it meant fueling the very addictions we claim to fight.

The hidden damage

When Americans talk about the opioid crisis, the numbers usually focus on overdoses, hospitalizations, or deaths. Those statistics are tragic, but they only tell part of the story. What rarely gets counted is the slow erosion of lives through relapses, people who might have been managing their addiction, only to be thrust back into dependency because a physician, often under pressure, wrote the wrong prescription at the wrong time. Those cases do not make headlines. They do not show up in federal dashboards. But they destroy families all the same.

The literature bears this out. Relapse following opioid exposure in medical settings is common but vastly under-measured; studies in JAMA Psychiatry and Drug and Alcohol Dependence show that up to ninety percent of individuals with opioid use disorder relapse within one year, often triggered by renewed prescribing after hospitalization. Yet relapse is invisible in most national opioid metrics, which focus narrowly on overdose mortality.

Medicine for the wealthy: a different kind of danger

Much of the public conversation about opioids frames addiction as a crisis of poverty: Rust Belt towns hollowed out by pills, or low-income patients manipulated by Purdue Pharma. That narrative is true, but incomplete. Addiction thrives just as easily in wealthy zip codes, shielded by concierge medicine and private discretion.

Many of the VIP patients who arrived at the specialty hospital were already dependent. They came armed with prescriptions from unethical concierge doctors who would hand over whatever the patient wanted: opioids, benzodiazepines, Adderall, the “holy trinity” of uppers and downers. These kinds of prescribing patterns are well documented: a 2017 Annals of Internal Medicine review found that benzodiazepines and opioids were co-prescribed in up to one-third of chronic pain patients, despite strong evidence of overdose risk.

Celebrity deaths have repeatedly exposed the risks of VIP medicine. Prince died in 2016 of a fentanyl overdose after reportedly obtaining prescriptions from multiple doctors. Michael Jackson’s death in 2009 was ruled a homicide, caused by propofol administered by a private physician who treated him as a client more than a patient. Matthew Perry, star of Friends, was found in 2023 with lethal ketamine levels, raising questions about access to experimental treatments without safeguards. Even Joan Rivers, though her death was due to procedural errors rather than opioids, exemplifies how special treatment for celebrity patients can bend standards in dangerous ways.

The moral injury of “golden wrapping”

Our inpatient pain management service was treated as the hospital’s basement unit, necessary but undesirable, a place where “real doctors” sent the patients they did not want to deal with. Outpatient pain specialists considered themselves above inpatient care. Surgeons, often poorly educated in addiction medicine but well connected socially and financially, expected us to do their bidding: endless opioid prescriptions, regardless of medical judgment.

Every day, I faced the same moral injury. Do I give in to the pressure and write for more opioids than any patient could reasonably need? Or do I risk retaliation by saying no? Management, patient advocates, even colleagues, all reinforced the same message: prescriptions keep the ratings high, and high ratings keep the donors and celebrities coming back.

This is not just my perception. Research has shown that hospital patient satisfaction scores correlate strongly with opioid prescribing. A 2012 study in the Journal of Pain found that patients who received opioids during hospitalization were more likely to give high satisfaction ratings, regardless of medical appropriateness. As long as satisfaction is tied to reimbursement and reputation, the pressure to overprescribe remains.

Addiction in velvet gloves

Concierge and VIP medicine sells itself as a safer, more attentive alternative to the overburdened public system. The reality is darker: when patient wealth and satisfaction become the highest priority, medical standards collapse. Addiction is normalized for the privileged, wrapped in privacy and prestige. Meanwhile, frontline doctors are silenced or punished for resisting.

The opioid epidemic did not emerge in a vacuum. It flourished because the health care system, whether in an underfunded rural clinic or a world-renowned Manhattan hospital, was willing to compromise medical integrity in exchange for patient satisfaction and profit.

A call for change

If we want to address addiction honestly, we need to look beyond overdose numbers and toward the hidden damage inflicted by our own health care structures. That means:

• Reforming patient satisfaction metrics that equate “more drugs” with “better care.”
• Holding concierge and boutique practices accountable for unethical prescribing.
• Protecting physicians from retaliation when they refuse to participate in addiction by prescription.

Opioid addiction is not just a crisis of the poor. It is a crisis of prestige as well. Behind the golden wrapping of VIP medicine lies a simple truth: wealth and influence can be, occasionally, just as dangerous to public health as poverty and neglect.

Closing note

I left my job at the specialty hospital because the moral injury was irreconcilable. I miss my colleagues, the pay, the prestige, even the illusion of working at a world-class institution. But what I could not live with was the knowledge that I was being asked to harm patients in the service of the institution’s reputation and financial well being. Addiction is indifferent to wealth, fame, or influence. And until our health care system recognizes that, VIP medicine will continue to ruin lives, quietly, elegantly, and with devastating effect.

Carlos N. Hernandez-Torres is a family medicine and addiction medicine physician.