KevinMD recently published a paper describing the horrible impacts of health care lobbying in the U.S. This article assesses how effective the lobbyists have been in misdirecting four key legislators on health care-related committees of the U.S. House of Representatives and Senate.

As we will shortly discover, these highly influential lawmakers have parts of their story right. They also have parts desperately wrong, in ways that are destroying American medicine and the lives of people in pain. Major course corrections are needed.

The following text is quoted from an artificial intelligence (AI) search engine. Perplexity.ai returned this text with extensive curated source listings (checked by the author of this paper), in response to a question posed four times: “What public statements have been made by [name and position] concerning the role of doctors prescribing to their pain patients, with respect to the so-called U.S. opioid crisis?”

Senator Bill Cassidy has publicly argued that some opioid crisis policies were being misapplied in ways that harmed legitimate pain patients, and he specifically warned that physicians were misinterpreting the Centers for Disease Control and Prevention (CDC) opioid guidelines and cutting off or tapering stable patients inappropriately. In a 2019 letter to the Drug Enforcement Administration (DEA), Cassidy wrote that the 2016 CDC opioid prescribing guidelines “have been misinterpreted or misapplied,” creating problems for patients with chronic pain and the doctors who treat them. He said some stable pain patients were being “forced tapered or abandoned” and, in some cases, turned to illegal opioids afterward.

Senator Bernie Sanders has publicly criticized patterns of prescribing by doctors in the context of the U.S. opioid crisis, but he has framed them as part of a broader system failure rather than blaming individual clinicians. His main emphasis has been on how pharmaceutical marketing, regulatory weaknesses, and limited access to non-opioid pain care have contributed to overprescribing, rather than on punitive measures against physicians. Sanders has repeatedly stressed that many clinicians were encouraged to prescribe opioids heavily because drug companies misrepresented the addiction risk and aggressively marketed these drugs as safe and non-addictive. He has argued that doctors became “over prescribers” partly because alternatives like physical therapy, long-term mental health care, and non-opioid pain management options were under-covered or unavailable, especially in poor and rural communities. In speeches and legislation such as the Opioid Crisis Accountability Act, Sanders targets drug company executives and marketing practices, not individual prescribers, proposing criminal and financial penalties for companies that mislead doctors and patients about addiction risk. He has also supported expanding community health center funding, addiction treatment programs, and prescription drug monitoring programs, which aim to guide safer prescribing while improving access to treatment for those already addicted.

Representative Ron Wyden has publicly framed doctors’ prescribing practices as central to the U.S. opioid crisis, but he has emphasized guidance, system-level changes, and support for clinicians rather than simple blame. His statements usually stress that safer prescribing must be backed by better information, fewer industry conflicts, and stronger safeguards in the health care system. Wyden has explicitly supported the CDC’s opioid prescribing guidelines, calling them a “turning point” toward smarter pain management and stressing that doctors and families need up-to-date, non-biased guidance on how to prevent misuse and overdose. He has argued that how these drugs are prescribed “in the first place” is one of the main levers for halting the epidemic, while insisting that pharmaceutical company influence not distort the evidence. In a 2016 letter and public statements, Wyden highlighted reports that pain research and advisory panels with ties to opioid manufacturers tried to weaken or dilute the CDC’s draft prescribing guidance. He warned that such conflicts could indirectly shape how doctors understand risk and dosing, and he urged the Department of Health and Human Services (HHS) to require full disclosure of conflicts of interest so that clinicians receive untainted guidance.

Senator Mike Crapo has publicly acknowledged that doctors’ prescribing practices helped drive the U.S. opioid crisis, but he has generally framed the issue around systemic incentives, oversight, and access to treatment reforms rather than singling out individual clinicians. His statements consistently emphasize that federal, state, and local policies must align to support safer prescribing while expanding alternatives and treatment. In hearings and public remarks, Crapo has noted that legislated federal programs have helped reduce the “use and supply of prescription opioids,” implicitly endorsing tighter prescribing norms for clinicians. He has pointed to the fact that as prescription opioids became harder to obtain, deaths have shifted toward illicit drugs like fentanyl, underscoring that earlier prescribing patterns were a major contributor to the epidemic.

What legislators got mostly right

All four of these legislators are correct in observing that many doctors have overreacted to U.S. CDC and Veterans Administration (VA) guidelines on prescription of opioid analgesics, by force tapering their patients to dose levels too low to be effective. Though the legislators have not said so publicly, clinicians are also well aware that forced tapering and denial of effective pain care are both unnecessary and fatal for many patients.

The legislators are also correct in observing that problems in health care are system-wide, and that health care insurance and pharmaceutical companies have historically had disproportionate influence on regulatory policy. However, unmentioned in the curated answers to the question is that health care insurance and pharmaceutical companies are highly financially self-interested, and each group is lobbying and working against the other.

To a pharmaceutical company, even when their products are proven safe and effective (which almost all drugs used in pain management are), “more drugs sold” equals higher profits. But to a health care insurance company, chronic pain patients are loss leaders. They do not get better and their care is often very complex. These realities create highly perverse incentives in corporate advocacy for public health policy that is clearly killing patients by thousands every year.

Where legislators are desperately wrong

Even when they do not advocate punishing clinicians, all four of these key legislators blame overprescribing as a serious contributor to the U.S. opioid crisis. Doctors and many among the 50 million Americans who suffer with often-intractable pain every day are well aware that this assertion is false.

As recently presented before a session on drug user health at America’s largest-ever harms reduction conference (SYNC-2026, March 19, 2026, Arlington, Virginia), we now know several facts beyond any rational contradiction:

• The 2023 U.S. CDC and VA guidelines on prescription of opioids were based on political agendas, not science. Gross errors of methodology and science were known to the authors and reviewers of these guidelines well before publication.
• Drug dependence and tolerance are purely physiological outcomes caused by pain treatment, and these outcomes are not the same as addiction. There is no evidence that dependence or tolerance predisposes patients toward addiction. Likewise, recent corrections to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) have removed these factors from criteria for diagnosing moderate to severe substance use disorder.
• Incidence of treatment-related substance abuse or overdose in patients managed by a clinician is on the order of one to three patients per 1,000 treated for pain. Assertions of immediate addiction as a consequence of clinical treatment are grossly and incorrectly over-hyped.
• In rare cases where overdose or suicide events occur in clinical patients treated with opioid analgesics by a doctor, factors in mental health history are six to 24 times more important than prescription of opioids in estimating short-term risk of patient hospitalization, suicide attempts, or successful suicide.
• Forty-five years of CDC data prove that the U.S. opioid crisis was not caused by overprescribing and is not now sustained thereby.
• Despite its extensive use as a safety threshold criterion by the U.S. CDC, morphine milligram equivalent (MME) dose is a mythology, not a method.
• Finally, due to major errors in protocols design, much of the existing trials literature on safety and effectiveness of thousands of drugs that are metabolized in the human liver must be burned to the ground and done over at a potential cost of tens of billions of dollars.

In November 2023, the author posed a question to doctors who diagnose addiction: “Are the blind leading the blind?” We now know that the answer to this question is a resounding “yes” for both doctors and legislators who regulate clinical practice. This outcome is a deliberate result of lobbying.

This is institutionalized madness. It is time that citizens demand from our legislators that this madness be stopped.

Richard A. Lawhern is a nationally recognized health care educator and patient advocate who has spent nearly three decades researching pain management and addiction policy. His extensive body of work, including over 300 published papers and interviews, reflects a deep critique of U.S. health care agencies and their approaches to chronic pain treatment. Now retired from formal academic and hospital affiliations, Richard continues to engage with professional and public audiences through platforms such as LinkedIn, Facebook, and his contributions to KevinMD. His advocacy extends to online communities like Protect People in Pain, where he works to elevate the voices of patients navigating restrictive opioid policies. Among his many publications is a guideline on opioid use for chronic non-cancer pain, reflecting his commitment to evidence-based reform in pain medicine.