Julie Craig, MD
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Latest articles
Drugs and prescribing
"If you violate our rule, we are going to make you pay for it. You could be looking at up to 30-year prison sentences, and believe me, we will be looking to make some examples of bad actors." With these…
“If you violate our rule, we are going to make you pay for it. You could be looking at up to 30-year prison sentences, and believe me, we will be looking to make some examples of bad actors.”
With these words, Florida’s attorney general announced the state’s June 2026 scheduling of 7-hydroxymitragynine (a short-acting psychoactive agent that shares common properties with both opioids and stimulants) and other concentrated derivatives of …
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The 2026 7-OH ban will hit dependent users the hardest
Drugs and prescribing
In March 2020, I was directing a federally qualified health center in rural New Mexico when the first flashover of COVID ripped through the state. In two days, the clinics transitioned from an entirely in-person model to a near-total remote…
In March 2020, I was directing a federally qualified health center in rural New Mexico when the first flashover of COVID ripped through the state. In two days, the clinics transitioned from an entirely in-person model to a near-total remote model. The transformation was raw and unplanned, trialing mediocre communications platforms in real-time and stumbling through the vagaries of electronic prescribing. As we got our feet under us, unexpected upsides …
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Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations
Drugs and prescribing
"Fentanyl Vaccine a Potential 'Game Changer' for Opioid Crisis," declares a Medscape headline. "Fentanyl Vaccine Delivers Promising Results in Trial," reports an industry website. "A Vaccine Against Deadly Fentanyl Might Be Near," promises US News & World Report. Only the…
The promises and limits of a fentanyl vaccine
Drugs and prescribing
In the mid-1980s, with the AIDS epidemic on the horizon, austere conservative Margaret Thatcher sanctioned the first needle exchanges in the U.K. to prevent the budgetary burden that HIV might otherwise have become on the National Health Service. Nearly forty…
In the mid-1980s, with the AIDS epidemic on the horizon, austere conservative Margaret Thatcher sanctioned the first needle exchanges in the U.K. to prevent the budgetary burden that HIV might otherwise have become on the National Health Service. Nearly forty years later, New York City opened its first supervised injection sites in November of 2021, where intravenous drug users inject their substances of choice under the watchful eye …
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We must disrupt harm
Drugs and prescribing
Twenty-six hours into the shakes, sweats, crawling anxiety, and gripping nausea of opioid withdrawal, Faye caves in and takes a couple of fentanyl tabs. She knows that she must tough out a couple of days without fentanyl to start Suboxone…
Twenty-six hours into the shakes, sweats, crawling anxiety, and gripping nausea of opioid withdrawal, Faye caves in and takes a couple of fentanyl tabs. She knows that she must tough out a couple of days without fentanyl to start Suboxone (buprenorphine/naloxone) through a medication-assisted treatment program, but the sickness gets the better of her. Those couple of tablets reset the clock on her withdrawal.
Starting buprenorphine – an evidence-based
…
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Allow patients to continue their opioid of choice while starting microdoses of buprenorphine
Drugs and prescribing
When the "opioid crisis" is mentioned, most people think of heroin, prescription pills like oxycodone, or — more recently — the powerful synthetic opioid fentanyl. Fewer people would think of novel opioids like tianeptine, although an increasing number of Americans…
When the “opioid crisis” is mentioned, most people think of heroin, prescription pills like oxycodone, or — more recently — the powerful synthetic opioid fentanyl. Fewer people would think of novel opioids like tianeptine, although an increasing number of Americans have taken this substance in the form of over-the-counter supplements like ZaZaRed or Tianna – often without knowing that the substance has opioid properties that can cause dependence and overdose. …
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The complications of drug regulation
Drugs and prescribing
In the waning days of the Trump administration, a surprising announcement came down from the Department of Health and Human Services (HHS) that the barrier required to write buprenorphine prescriptions for opioid use disorder would be lifted via reform of…
In the waning days of the Trump administration, a surprising announcement came down from the Department of Health and Human Services (HHS) that the barrier required to write buprenorphine prescriptions for opioid use disorder would be lifted via reform of the so-called “X-waiver.”
The X-waiver is a rare regulation in American medicine that requires an 8-hour training and documented DEA permission before a medical doctor can prescribe Suboxone to
…
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The confusing policy surrounding the buprenorphine X-waiver
Drugs and prescribing
Family lore recalls that my grandfather, succumbing to stomach cancer in the mid-1960s, “died addicted to morphine.” Decades before the AIDS crisis sparked the hospice and palliative care movements, the confluences of pain, dependence, and addiction were confused and regrettably…
Family lore recalls that my grandfather, succumbing to stomach cancer in the mid-1960s, “died addicted to morphine.” Decades before the AIDS crisis sparked the hospice and palliative care movements, the confluences of pain, dependence, and addiction were confused and regrettably moralized. Since then, the science has excelled, but our clinical understanding of how pain and addiction intertwine remains limited by stigma, assumptions, and the separation of the underlying science
…
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Merging the wisdom of pain medicine and addiction medicine to optimize outcomes
Physician voices
"The patient is 15 minutes late. Can you still see her?" "He missed an appointment yesterday because the bus ran late, and he's out of Suboxone. He's getting agitated in the waiting room, and other patients are complaining. Could you…
“The patient is 15 minutes late. Can you still see her?”
“He missed an appointment yesterday because the bus ran late, and he’s out of Suboxone. He’s getting agitated in the waiting room, and other patients are complaining. Could you see him right away?”
“Therapy group has already started. Is the facilitator willing to let one more patient in?”
In the halcyon days before COVID-19, these questions plagued the
…
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Telemedicine reduces the stigma in substance use disorder patients
Drugs and prescribing
Mary first took oxycodone after a minor surgery and found she liked it. Returning to her surgeon a month later with vague ongoing pain, she received another prescription. Her primary care provider took over from there — until one day…
Mary first took oxycodone after a minor surgery and found she liked it. Returning to her surgeon a month later with vague ongoing pain, she received another prescription. Her primary care provider took over from there — until one day that physician checked a urine drug screen and a prescription monitoring program (PMP) report, only to find that she was obtaining various opioids from several providers. The physician cut her …
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Market-based approaches solving the opioid epidemic
Physician voices
The British Medical Journal recently published a paper boasting the astonishing conclusion that medical error is the third leading cause of death in the United States. Headlines aside, the study suffers from questionable statistics that serve up alarmist conclusions about…
The British Medical Journal recently published a paper boasting the astonishing conclusion that medical error is the third leading cause of death in the United States. Headlines aside, the study suffers from questionable statistics that serve up alarmist conclusions about the prevalence of serious medical errors and obscure the road to addressing the tragic phenomenon of death by medical error.
The analysis cites four observational studies on incidents that …
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The alarmist approach to medical errors solves nothing
Physician voices
People lie. Patients lie. Patients tell blank untruths, patients misunderstand truth, patients confabulate with the damage of a thousand fifths of vodka of yesteryear. A core conceit of medicine posits that health care providers expect pure honesty from patients from…
People lie. Patients lie. Patients tell blank untruths, patients misunderstand truth, patients confabulate with the damage of a thousand fifths of vodka of yesteryear.
A core conceit of medicine posits that health care providers expect pure honesty from patients from first handshake on. Violating every social norm around encounters with strangers, we expect that patients with no grounds for trust reveal all.
Providing primary care to patients on the furthest margins of …
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The lies in the doctor-patient relationship
Physician voices
As with any disease, prevalence of this narcotics abuse is region-specific; an hour north of the office where I practice, Rio Arriba County in New Mexico is home to one of the highest opioid overdose rates in America - up…
As with any disease, prevalence of this narcotics abuse is region-specific; an hour north of the office where I practice, Rio Arriba County in New Mexico is home to one of the highest opioid overdose rates in America – up to five times higher than the national average. Our patients routinely lose family to addictions; our clinic has been home to a …
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Stopping prescription drug abuse starts with primary care
Physician voices
Health reform includes measures to link hospital reimbursement to patient satisfaction measures. Through both public and private insurers, this trend is likely to spill over into the outpatient setting in the very near future. Aside from creating redundancy in the…
Health reform includes measures to link hospital reimbursement to patient satisfaction measures. Through both public and private insurers, this trend is likely to spill over into the outpatient setting in the very near future.
Aside from creating redundancy in the market (with some very rural exceptions, patients can act as agents of their own satisfaction by voting with their feet), there are serious limits to physicians as agents of pure …
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