I write as a health care educator and author with thirty years of research experience and over three hundred papers published as author or co-author, several of them widely cited. In that role, I see thousands of emails and social media postings every month from people whose lives are being destroyed by misdirected and frequently outright fraudulent U.S. public health policy on treatment of pain and addiction. The Centers for Disease Control and Prevention (CDC) itself estimates that 51.6 million of us suffer from chronic pain, and 17.1 million experience “high-impact” pain that compromises quality of life each day.
Despite knowing the magnitude and dimensions of the problem, American health care and particularly chronic pain management are a mess. It can be argued compellingly that this mess is partly a consequence of allowing billions of dollars of dark money “campaign contributions” (aka “bribes”) to influence congressional health care policy. To a health insurance company, chronic patients are “loss leaders”; they don’t get better and their ongoing care is complex and expensive. Corporate financial self-interest is in denying patient care, not in meeting patient needs, and corporations frequently act on that self-interest.
When an issue becomes this large, we must be careful about assigning cause and effect, and even more careful about demanding solutions from our legislators. However, a letter that I recently received from Deanne Goudy-Bartolatta, an Oklahoma law student, bears consideration. Goudy-Bartolatta correctly attributes a large fraction of the current mess in health care to a single public law: the Controlled Substances Act (CSA) of 1970. And she perceives (in my view correctly) that if the current mess in health care is to be remedied, then repeal and replacement of that law is highly in order, among other measures.
Join with me in reading a lightly edited letter to your federal legislators:
Dear [Senator/Representative Last Name]:
No person should have to spend their remaining strength fighting for relief from disabling pain. I am writing to ask you to sponsor legislation to repeal and replace the Controlled Substances Act of 1970 with a framework grounded in medical science, public health, patient dignity, and accountability.
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As a person living with disabling pain, I want you to understand what this issue means beyond prescription statistics. Uncontrolled pain determines whether someone can sleep, bathe, walk to the bathroom, attend a family gathering, or endure another day. For patients whose options are limited, access to appropriate medication can determine how much of their lives they can reclaim.
Federal drug policy must be judged by the lives it protects, including the lives of people who need controlled medications. Present policy fails abysmally on that criterion.
The harms of withdrawing treatment are documented. The Food and Drug Administration (FDA) has reported serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide following sudden discontinuation or rapid reduction of opioid pain medicines in physically dependent patients. CDC guidance warns against rigid prescribing standards and abrupt discontinuation, and its 2022 opioid prescribing recommendations exclude palliative and end-of-life care, cancer-related pain, and sickle cell disease. These warnings demand more than acknowledgment. They demand enforceable patient protections.
All medications carry risks. Those risks require qualified clinical judgment, informed consent, careful monitoring, and accessible treatment for substance use disorders. The risks of untreated pain, disrupted care, and patient abandonment also deserve serious and balanced attention. The patient’s need for relief must never disappear from the government’s definition of safety.
I ask Congress to enact a replacement framework for the CSA:
- Place medical oversight under qualified health leadership: Assign federal oversight of legitimate controlled-medication treatment to a medically led structure within the Department of Health and Human Services (DHHS), with meaningful representation from pain medicine, palliative care, addiction medicine, pharmacy, disability advocates, and patients. Present leadership of DHHS, FDA, Veterans Administration, and U.S. CDC decidedly does not meet these criteria.
- Protect individualized treatment and clinical judgment: Establish clear protections for clinicians providing documented, medically appropriate care. Prescription volume, dosage, or a patient’s complex treatment needs should not, standing alone, be considered as evidence of criminal wrongdoing.
- Prevent abandonment and dangerous interruptions: Require continuity-of-care plans when enforcement actions close a practice or interrupt prescribing. Protect patients from abrupt, nonclinical discontinuation while allowing urgent action when an immediate medical danger exists.
- Preserve accountability for actual harm: Maintain effective laws against trafficking, counterfeit drugs, intentional diversion, fraud, and reckless medical conduct. Design enforcement around evidence and due process, with independent clinical expertise when medical treatment choices are at issue.
- Measure outcomes that matter to people: Require public reporting on treatment access, pain and function, overdose, suicide, medication shortages, and loss of care. Declining prescription totals alone cannot establish that patients are safer.
- Establish that clinicians did not cause and are not sustaining the so-called “opioid crisis”: Contrary to present policy, U.S. CDC must be directed to require county medical examiners and coroners to report whether patients who have died of a drug overdose were under treatment with opioids by a doctor. When this is accomplished, the present 2 percent of reported “prescription only” deaths will likely drop significantly.
- Give affected patients a role in writing the law: Hold public hearings where disabled people, caregivers, clinicians, and people affected by substance use disorders can testify about both the harms of drugs and the harms of denied care.
Full repeal of the Controlled Substances Act requires a responsible transition, including replacement safeguards and attention to related state laws and international obligations. Congress should undertake that work openly and urgently. While comprehensive legislation is developed, immediate protections for patients and continuity of care should move forward.
Senator (Congressman), please imagine needing medication to perform the most basic tasks of your daily life, and discovering that fear of law enforcement has become a barrier between you and medical help. Patients should not have to become policy experts, organize campaigns, or plead publicly, for their suffering to count.
Will you sponsor repeal-and-replacement legislation, request hearings on barriers to medically necessary treatment, and meet with affected patients? Please respond within thirty days with the specific actions your office will take in support of these objectives. Our lives deserve more than expressions of sympathy. They deserve a policy that protects access to competent, compassionate care.
Sincerely,
- Signature: ______________________
- Address: ______________________
- District and state: ______________________
- Phone: ______________________
(End of letter)
Letters to our legislators are a long tradition in American life. In recent years, the apparent convenience of email and online constituent contact gateways operated by Congress seem appealing. But such tools can be a death trap for actually being heard. Forms-based online contact gateways often lock out any writer whose address cannot be traced to the legislator’s district. If emails are read at all, they are frequently trash-canned by junior aides unless they promise campaign contributions.
Physical letters, however, are a different animal. A bulging mail bag delivered to a congressional office is much harder to ignore. When lawmakers receive thousands of letters on a single niche issue (such as the more than 50,000 letters that helped derail the repeal of the Affordable Care Act (ACA) in 2017), it signals to politicians a high “political cost” if they vote against their constituents’ wishes.
The ACA is not the only example of an issue on which constituent letters have forced legislators to change course. The Civil Rights Act of 1964 and the Flint, Michigan, water crisis relief appropriation of 2016 were similarly influenced by people who took time to write and send physical letters. Historically, there are others.
These days, it is easy to learn where to send your signed physical copy of the letter above. Just ask any search engine: “I live in zip code _______. What are the postal addresses of my U.S. senators and representative?”
However, make no mistake. Some analysts feel that trying to bring the U.S. Drug Enforcement Administration (DEA) under effective oversight is practically impossible. If you choose to attempt this project, then you will be tackling an entrenched and wealthy industry that is presently aided and abetted by the people you have sent to Washington, D.C.
The DEA is a $3 billion empire funded by Congress. But the DEA is now effectively immune from real oversight. The last thing they want is real accountability for the damage they have done by persecuting our doctors into prison on false grounds. The same reaction can be anticipated by U.S. CDC and FDA, whose misdirection of policy has directly contributed to the mess by falsely blaming doctors for “over-prescribing.”
There is an old meme that states, “If you aren’t part of the solutions, then you are part of the problem.” Pain care in America is a huge problem. If you are willing to become part of the solutions, then demanding that our legislators take action to repeal and replace the Controlled Substances Act seems appropriate.
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.
