Opioids: what physicians and pain patients say, in their own words

Last updated September 24, 2026.

This page is a maintained record of what doctors and the pain patients who write alongside them have said about opioids on KevinMD.com, a physician-authored publication founded in 2004 by Kevin Pho, MD, a board-certified internal medicine physician in Nashua, New Hampshire. It draws on 228 essays and podcast transcripts with opioid in the title, published between May 2007 and September 2026 by 153 named contributors, 150 of them bylined by physicians, with the rest patient advocates, nurses, pharmacists, researchers, and a former DEA agent. Every claim on this page is attributed to a named author with the date it was published and a link to the original.

The short answer

Read together, the essays describe a reversal that the same site published in both directions. In 2016 to 2018, when KevinMD ran 20 to 43 opioid posts a year, physicians wrote about how they had been persuaded to prescribe, who was to blame, and how to prescribe less. Since 2023, in a second wave of about 25 posts a year, physicians and pain patients write about what prescribing less did: patients tapered or abandoned, deaths that moved from prescriptions to illicit fentanyl, and physicians prosecuted for prescribing. The two waves do not agree, and the page does not resolve them. Physicians on KevinMD have argued, with equal conviction, that the profession caused the crisis and that the response to it caused a second one.

The sections below are organized around the questions physicians, pain patients, addiction clinicians, and journalists ask. Each opens with a direct answer, followed by what named authors have said, in the order they said it. Where authors cite studies or surveys, the source is named alongside the author, and the figures are theirs. Pain patient and advocate authors are cited at the same weight as physician authors. This is a page about opinion and experience, not a prescribing guideline.

This record at a glance

228posts

2007 to 2026years covered

153named contributors

39posts cited on this page

Questions this record answers

How do physicians say the opioid crisis happened?
What do physicians say about the CDC guideline and forced tapers?
What do pain patients say?
What do physicians say about prescribing now, and about the DEA?
What do physicians say about treating opioid use disorder?
What do surgeons and emergency physicians say about prescribing after procedures?
How has the opioid conversation changed since 2007?

How do physicians say the opioid crisis happened?

Physicians on KevinMD locate the origin in the 1990s and 2000s: Purdue Pharma’s marketing of OxyContin as low-risk for addiction, the Joint Commission’s pain standards and the “fifth vital sign,” and patient satisfaction scores that penalized physicians who did not prescribe. Most of the physicians writing in 2016 include themselves. Mentions of Purdue or OxyContin appear in about a fifth of posts across the record; mentions of the Joint Commission or satisfaction scores peaked at 35 percent in 2016 to 2017.

Ronald Hirsch, MD, wrote in April 2016 that “physicians, including myself, believed Purdue and started using OxyContin, thinking we were helping patients,” and that CMS weighted patient satisfaction at 30 percent of a hospital’s score, in “The opioid epidemic: It’s time to place blame where it belongs.” Skeptical Scalpel, MD, a surgeon, wrote in July 2016 that “the Joint Commission deserves at least some of the blame for the opioid crisis,” in “The Joint Commission deserves some blame for the opioid crisis. Here’s why.” Tanya Feke, MD, wrote in July 2016 that satisfaction scores “do tend to be lower for health care providers who do not prescribe what patients want,” and that the most satisfied patients in one study had 9 percent higher medical expenses and were 12 percent more likely to be admitted, in “What does the opioid crisis have to do with patient satisfaction?”

Steven J. Stack, MD, writing as president of the American Medical Association in May 2016, told physicians that “today’s crisis plainly tells us we must be much more cautious with how we prescribe opioids,” and to register for and use their state prescription drug monitoring program, in “An open letter to America’s physicians on the opioid epidemic.” Andrew Kolodny, MD, wrote in October 2017 that “until opioids are prescribed more cautiously and until effective opioid addiction treatment becomes easier to access,” overdose deaths will likely remain at record levels, in “The opioid epidemic in 6 charts.” Travis N. Rieder, PhD, a bioethicist, wrote in October 2017 that “if medical culture becomes too opioid-phobic, who will prescribe for these patients?” and that moving away from opioids too abruptly risks abandoning patients, in “An ethical dilemma for doctors: When is it OK to prescribe opioids?” Cindy Perlin, LCSW, wrote in June 2016 that “Purdue assured physicians and insurers that they didn’t need to worry” because “the rate of addiction to Oxycontin was miniscule because of its time release properties,” in “The opioid disaster: Stop criminalizing doctors.” Vincent DeGennaro, Jr., MD, MPH, wrote in July 2017 that CDC-attributed opioid deaths “more than doubled from 1999 to 2011, and claimed more than 52,000 lives in 2016 alone,” and that reimbursement tied to satisfaction scores was one reason, in “Here’s why opioid addicts are victims.” Ronald A. Zent, MD, wrote in January 2023 that opioid prescriptions “increased fourfold from 1999-2010, with a concomitant fourfold increase in opioid overdose deaths,” in “How were we duped and what can we do about the opioid overdose crisis?” Rebecca Thaxton, MD, wrote in January 2022 that “The drug industry spent $102 million lobbying Congress between 2014-2016,” that a DEA investigator called fines the cost of doing business, and that the CDC put the cost of the epidemic to society in the United States in 2017 at $1,021 billion, in “Breaking down the real cost of the opioid epidemic.” L. Joseph Parker, MD, wrote in February 2024 that the later narrative “encompassed calling every fentanyl-related death a prescription-related death in the federal databases,” in “The opioid crisis: profits, lawsuits, and pharmaceutical influence.”

On The Podcast by KevinMD: “Why doctors aren’t to blame for the U.S. opioid crisis,” Richard A. Lawhern, May 2023; and “Coal mining culture and the opioid crisis,” Rebecca Thaxton, January 2022.

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What do physicians say about the CDC guideline and forced tapers?

The 2016 CDC guideline is the hinge of the record. Physicians writing in its first years treated it as overdue; physicians and patients writing since 2023 treat its dose thresholds, which were written as suggestions and applied by states, insurers, and pharmacies as limits, as the cause of a second crisis. The CDC revised the guideline in 2022. Posts mentioning the CDC rose from 11 to 15 percent in 2016 to 2019 to 38 percent since 2023, and posts mentioning tapering or cutoffs from 15 to 24 percent.

Kathryn Takayoshi, NP-C, wrote in December 2016 that when she inherited a patient on fentanyl and oxycodone “there were no formal guidelines to help me,” and that she would be much better prepared with them, in “We need to speed up our acceptance of the opioid guidelines.” Angelika Byczkowski, a pain patient, wrote in March 2019 that the guideline’s caveats “are ignored as anti-opioid advocates rush to make the guideline’s suggested opioid dose risk boundaries” at 50 and 90 MME into absolute limits for every patient, in “A patient’s opposition to the anti-opioid movement.” Richard A. Lawhern, PhD, a patient advocate and the most frequent non-physician contributor on the topic, wrote in October 2023 that after “very contentious public challenges by hundreds of U.S. doctors” the CDC announced in December 2019 that it would revise the guideline, in “Rethinking U.S. opioid policy.”

Charles LeBaron, MD, a former CDC medical officer, wrote in April 2025 that veterans discontinued from long-term opioids “had doubled overall mortality and a sixfold increase in deaths from suicide or overdose,” that 95 percent of 3,000 surveyed pain patients called the guideline harmful, and that 72 percent of surveyed pain specialists had been required to reduce doses after it, in “How the CDC’s opioid rules created a crisis for chronic pain patients.” Kayvan Haddadan, MD, a pain physician, wrote in April 2026 that the guidelines “triggered widespread, preventable suffering among legitimate chronic pain patients while leaving illicit fentanyl, the true driver of deaths, largely untouched,” in “How CDC opioid guidelines harmed chronic pain patients.” Simon Feng, MD, wrote in August 2026 that fatal overdoses “would surge over 300 percent over subsequent years, even as prescription rates fell precipitously,” in “Why doctors won’t prescribe opioids, and who profits.”

On The Podcast by KevinMD: “Reassessing the impact of CDC’s opioid guidelines on chronic pain care,” Charles LeBaron, June 2025.

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What do pain patients say?

Pain patients and their advocates write for KevinMD alongside the physicians, and their argument has been consistent since 2017: the crisis discussion left out the patient in pain, dose limits designed for new prescriptions were applied to people stable on opioids for years, and being tapered or dropped is experienced as abandonment. Physicians who treat chronic pain make the same case. Posts mentioning chronic pain patients fell to 11 percent in 2020 to 2022 and rose to 66 percent since 2023, the highest of any period.

Linda Girgis, MD, a family physician, wrote in May 2017 that “the ones that perhaps suffer the most are those patients who truly have pain,” now that “many doctors are now reluctant to prescribe these medications,” in “How should opioids be prescribed?” S. Blake Kelly, MD, wrote in April 2017 that “doctors have been demonized, and patients have been stereotyped,” and asked about “the patient who is in agony despite seeing the right doctors,” in “Where is the patient in the discussion of the opioid epidemic?” Angelika Byczkowski wrote in March 2019 that restricting opioids for patients in pain to stem illicit overdoses “is only a cruel experiment fueled by ignorance and fear,” in “A patient’s opposition to the anti-opioid movement.” Hector R. Perez, MD, wrote in February 2020 that studies show physicians “regard their patients less favorably if opioids are discussed during visits,” and that his team found “language reflecting negative emotions, such as anger and disappointment” in the charts of patients on chronic opioids, in “Talking about opioids can lead to strong emotions.”

Heather Finlay-Morreale, MD, wrote in June 2019 that “Some people use prescribed opioids to treat painful conditions yet still face great stigma,” similar to AIDS patients in the 1980s, in “People who take opioids are the AIDS patients of today.” Giri Venkatraman, MD, MBA, wrote in September 2018 that most patients in treatment require regular urine testing, that a search for how to pass one returns several million results, and that “we rely on clean data to manage this tough population of patients” and prescribe safely, in “Opioid cheating is a billion-dollar industry.” Jeffrey A. Singer, MD, and Josh Bloom, PhD, wrote in June 2026 that opioid pain contracts “demean them, frighten them, and redefine the doctor-patient relationship around suspicion and control, effectively turning physicians into parole officers,” and that some patients are dismissed after testing positive for medications another physician prescribed, in “Opioid pain contracts turn doctors into parole officers.” Layla Parast, PhD, wrote in August 2022 that over-prescribing was real and those responsible were being held accountable, but that expecting a doctor to “take their pain seriously, and do everything possible to help manage pain,” is not the same as expecting an opioid prescription, in “It’s time to address pain despite the opioid crisis.” Cindy Perlin, LCSW, wrote in June 2016 of “doctors, fearful of prosecution for overprescribing, dropping pain patients like hot potatoes,” and of reported suicides by patients “who found life intolerable without their meds,” in “The opioid disaster: Stop criminalizing doctors.” Jennifer Gunter, MD, wrote in February 2013, before the guideline, that the United States consumed 99 percent of the global hydrocodone supply and that “the American problem with opioids and chronic pain will remain unchanged,” in “Why the American problem with opioids and chronic pain is here to stay.”

On The Podcast by KevinMD: “Opioid prescribing, pain management, and patient advocacy,” Richard A. Lawhern, March 2024.

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What do physicians say about prescribing now, and about the DEA?

The physicians writing since 2023 describe a profession that has stopped prescribing out of fear rather than judgment. Posts mentioning the DEA or prosecution rose from about a quarter of posts before 2020 to 51 percent since 2023, and several authors describe indictments built on ordinary practice patterns. Others write that the fear is doing more harm than the drugs, and that the physicians who will still prescribe are also the ones treating addiction.

Dennis Wichern, a former DEA agent, wrote in June 2018 that physicians treating addiction should “follow a national MAT guideline like SAMHSA TIP 40, SAMHSA TIP 63 or ASAM’s 2015 National Practice Guideline,” to fight the crisis and reduce their own DEA risk, in “A DEA agent explains how to fight the opioid crisis and mitigate DEA risk.” L. Joseph Parker, MD, wrote in February 2024 that “patients drove a long way to see them” has been used “in hundreds of indictments against physicians as evidence of criminal conduct,” in “The opioid crisis: profits, lawsuits, and pharmaceutical influence.” Richard A. Lawhern, PhD, wrote in June 2026, quoting a physician whose career “was ended by a manufactured DEA sting operation, a stolen DEA registration number,” after a locum assignment, and argued the agents and judge involved should themselves be investigated, in “Why are doctors prosecuted for prescribing opioids?” Julie Craig, MD, an addiction physician, wrote in March 2023 that DEA rules bar a provider from seeing a telemedicine patient without a DEA license “in the precise state where they are located at the moment of the appointment,” in “Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations.”

Kayvan Haddadan, MD, wrote in April 2026 that modeling shows “aggressive prescription reductions can produce short-term spikes in heroin and fentanyl deaths as patients substitute to deadlier alternatives,” in “How CDC opioid guidelines harmed chronic pain patients.” Simon Feng, MD, wrote in August 2026 that illicitly manufactured fentanyl “now plays the dominant role in opioid-related deaths with prescription opioids playing a minor, ever-diminishing role,” in “Why doctors won’t prescribe opioids, and who profits.” Hans Duvefelt, MD, wrote in May 2016 the other side of the same fear, that “an anonymous caller told Autumn that my patient was injecting her morphine,” in “A family physician duped by a patient on chronic opioids.”

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What do physicians say about treating opioid use disorder?

Addiction physicians on KevinMD have argued since 2015 that treatment, not prescribing policy, is where the deaths are preventable, and that buprenorphine was harder to prescribe than the opioids that caused the addiction, and that stigma keeps people from both treatment and harm reduction services. The X-waiver requirement they wrote against was eliminated in 2023. Mentions of buprenorphine, methadone, or medication treatment have fallen from 42 percent of posts before 2016 to 14 percent since 2023, as the argument moved to pain patients and prosecutions.

Lipi Roy, MD, MPH, an addiction physician for Boston’s homeless community, wrote in September 2015 that overdose was “now the leading cause of death amongst my patients,” in “The tragedy of opioid addiction in the young and homeless.” Christina Kinnevey, MD, wrote in April 2018 that a physician could “graduate my internship and prescribe as much Norco, Vicodin, Percocet, Oxycontin, Morphine, Fentanyl and even methadone that I deem necessary” to treat pain with no additional training, but needed an X-waiver to prescribe buprenorphine for addiction, in “Cutting the red tape with buprenorphine treatment for opioid use disorder.” Kathleen A. Hallinan, MD, wrote in May 2019 that “We are a rural area that is not large enough to support a methadone clinic,” and that Suboxone was the only option that would keep her patients out of withdrawal, in “Why aren’t you treating opioid addiction?”

Martha Bebinger reported for WBUR in April 2017 that 75 percent of Massachusetts residents who died of unintentional overdose the prior year had fentanyl in their system, up from 57 percent in 2015, and that users at one needle exchange “assume there’s fentanyl in every bag they buy,” in “Surviving opioids in the fentanyl era.” Nabila El-Bassel, PhD, wrote in May 2018 that stigma is “a major reason individuals do not seek, receive or complete addiction treatment” or access harm reduction services, in “6 ways to address the opioid epidemic.” Matt McCord, MD, and Brian Klepper, PhD, wrote in January 2024 that a portion of the billions in opioid settlement dollars should go to prevention “not just buying fire extinguishers (Narcan) and fighting fires,” in “Ben Franklin’s timeless wisdom: a key to solving America’s opioid crisis.” Vincent DeGennaro, Jr., MD, MPH, wrote in July 2017 that “Tom is not unlike many of my patients who are victims of the opioid epidemic,” in “Here’s why opioid addicts are victims.” Chris Buresh, MD, MPH, wrote in May 2026 that fewer than one in 54 adolescents receives medication for opioid use disorder after a nonfatal overdose, that only 5 percent with the disorder receive any medication treatment, and that 90 percent of adolescent overdose deaths now involve fentanyl, in “Treating adolescent opioid use disorder with buprenorphine.” An anonymous physician wrote in September 2019 of his own addiction that “The fear of going to prison was surpassed by my desire to live a drug-free life,” in “A physician’s career as an opioid prescriber and addict.”

If you or someone you care for is struggling with opioid use, the SAMHSA National Helpline at 1-800-662-4357 is free, confidential, and available at all hours. Naloxone reverses opioid overdose and is available without a prescription in the United States.

On The Podcast by KevinMD: “We’re failing people with opioid use disorder,” Arthur Robin Williams, March 2022; and “Medication-assisted therapy and opioid use disorder,” Jill Becker, January 2024.

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What do surgeons and emergency physicians say about prescribing after procedures?

A separate line of KevinMD essays, mostly from anesthesiologists and surgeons, argues that the place to reduce exposure is the prescription after surgery or an emergency visit, where most pills went unused and a measurable share of patients went on to opioid use disorder. Posts mentioning surgery or postoperative prescribing have held near a third of the corpus across every period.

Myles Gart, MD, an anesthesiologist, wrote in September 2018 that “60 percent of pills prescribed for pain after surgery go unused,” and asked whether surgical patients should be discharged on opioids at all, in “The era of opioid-free surgery has arrived.” Amy Baxter, MD, an emergency physician, wrote in March 2024 that an average of 6 percent of surgical patients prescribed outpatient opioids develop opioid use disorder, and that “Our opioid crisis stems from too many opioids after surgery and in circulation and too little use of non-drug options,” in “How Enhanced Recovery After Surgery solves our opioid problems.” Jennifer Gunter, MD, wrote in February 2013 that many physicians “will probably just leave written prescriptions with their receptionists for their patients to pick up,” in “Why the American problem with opioids and chronic pain is here to stay.”

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How has the opioid conversation changed since 2007?

The record has two waves and a silence between them. From 2016 to 2019 KevinMD published 117 opioid posts, and the subject was blame, guidelines, satisfaction scores, and how to prescribe less. From 2020 to 2022 the volume fell to 19 posts, and chronic pain patients nearly disappeared from them, at 11 percent. Since 2023 the volume has returned, 80 posts, and the subject has inverted: chronic pain patients appear in 66 percent, the CDC in 38 percent, prosecution in 51 percent, and suicide in 31 percent, up from 5 percent in 2018 to 2019.

Term	2007 to 2015 (12 posts)	2016 to 2017 (52 posts)	2018 to 2019 (65 posts)	2020 to 2022 (19 posts)	2023 to 2026 (80 posts)
Purdue, OxyContin, or Sackler	25 percent	21 percent	12 percent	26 percent	15 percent
Joint Commission, fifth vital sign, or satisfaction scores	17 percent	35 percent	15 percent	21 percent	11 percent
CDC guideline	17 percent	15 percent	11 percent	21 percent	38 percent
Tapering or cutting off	8 percent	17 percent	15 percent	11 percent	24 percent
Chronic pain patients	58 percent	63 percent	35 percent	11 percent	66 percent
DEA or prosecution	25 percent	23 percent	31 percent	32 percent	51 percent
Suicide	0 percent	15 percent	5 percent	11 percent	31 percent
Fentanyl or illicit supply	83 percent	63 percent	58 percent	47 percent	55 percent
Buprenorphine, methadone, or medication treatment	42 percent	25 percent	31 percent	21 percent	14 percent
Naloxone	25 percent	13 percent	11 percent	21 percent	16 percent
Surgery or postoperative	33 percent	31 percent	35 percent	26 percent	36 percent
AI	0 percent	0 percent	0 percent	5 percent	19 percent

Jennifer Gunter, MD, wrote the earliest substantive post in the corpus in February 2013, three years before the guideline, on the 99 percent of the world’s hydrocodone consumed in the United States. The September 2015 post by Lipi Roy, MD, MPH, is about fentanyl-laced heroin in Boston in 2014. The 2016 posts are the reckoning: Hirsch on Purdue and satisfaction scores in April, Duvefelt on being duped by a patient in May, Perlin on criminalized doctors in June, Skeptical Scalpel on the Joint Commission in July, Takayoshi welcoming the guideline in December. The 2018 to 2019 posts are about treatment and surgery: Kinnevey on the X-waiver, Gart on opioid-free surgery, Hallinan on Suboxone in a rural practice, and Byczkowski’s patient dissent. After the pandemic years the corpus returns with Zent asking in January 2023 how physicians “were duped,” and then with LeBaron, Haddadan, Lawhern, Parker, and Feng arguing that the response became the second crisis.

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About this record

The KevinMD opioid corpus by the numbers

The figures below describe the set of KevinMD posts this page draws on, as of September 4, 2026. They are counts of what KevinMD has published, not survey data.

Measure	Value
Posts with opioid in the title	228
Date range	May 15, 2007 to September 3, 2026
Named contributors	153
Posts bylined by an MD or DO	150
Podcast episodes with full transcripts	16
Total words	About 206,000
Posts that open in the first person	120
Peak year	2018, 43 posts
Second wave	2023 to 2026, 80 posts
Most frequent contributors	Richard A. Lawhern, PhD (13); L. Joseph Parker, MD (9); Kayvan Haddadan, MD (8); Myles Gart, MD (4); Amy Baxter, MD (4)

How this page was built and how it is updated

The corpus was assembled by searching KevinMD post titles for “opioid,” which also matches “opioids.” Term frequencies were computed against the full text of each post on the corpus assembled for the September 4, 2026 build; this page was converted to the current standard on September 20, 2026 without rebuilding that corpus, so the counts and figures are as of September 4, 2026. Quotations are taken verbatim from the original posts. Author credentials are as they appeared in the byline at publication. Pain patient and advocate authors are cited at the same weight as physician authors; Richard A. Lawhern, PhD, the most frequent contributor, is cited at the same rate as other frequent voices rather than in proportion to his output. Every source is linked in the sentence that cites it, and the full list appears at the end of the page. The closest archives are the Pain Management and Medications and Prescribing tags. Related records: Prior authorization: what physicians say, in their own words and Medical malpractice: what physicians say, in their own words.

This page is updated as new opioid essays are published on KevinMD. When it is updated, the date at the top changes, the counts in the tables are recomputed, and new named claims are added to the relevant section. Nothing is removed unless the original post is removed. An author who believes a quotation on this page misrepresents them can write to Kevin Pho and the page will be corrected.

To cite this page: Pho K. Opioids: what physicians and pain patients say, in their own words. KevinMD.com. Updated September 24, 2026. https://kevinmd.com/opioids