Pain Management

California’s opioid policy hypocrisy

Conditions
December 4, 2025

California’s opioid policies reveal a stark hypocrisy, imposing draconian restrictions on prescriptions for chronic pain patients (leaving wildfire survivors and others in unrelenting agony) while allocating over $100 million annually through initiatives like the California Harm Reduction Initiative (CHRI) and Proposition 36 to provide free needles, pipes, and fentanyl test strips to addicts with minimal oversight. This disparity is compounded by the Medical Board of California’s (MBC) overreach, where physicians …

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Modified DSM-5 opioid use disorder criteria for pain patients

Conditions
December 1, 2025

Two years ago, I asked, “Doctors diagnosing addiction: Are the blind leading the blind?”

The estimated rates of substance use disorder among clinical patients treated for pain vary greatly, depending on whom one believes. Studies also suffer from a widespread failure to address genetically mediated variability in minimum effective opioid dose between individuals. Thus, I have many times respectfully suggested that the entire body of literature on opioid …

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Rethinking opioid prescribing policies

Physician
December 1, 2025

As a pain management specialist, my intent is not to promote unchecked opioid prescribing or overlook the serious risks these medications pose. Instead, I advocate for viewing the full picture in patient care. Physicians, trained in medicine and its side effects, must be empowered to use their knowledge and direct observations, including subtle cues like body language and patient interactions during brief visits, to make tailored decisions. Documentation in charts …

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Physician legal rights: What to do when agents knock

Physician
November 19, 2025

An excerpt from Doctor Not Guilty.

The Fifth Amendment of the United States Constitution exists for a reason. It protects you from self-incrimination. If you remember one rule from this book, hold on to this: Never talk to the police.

By “police,” I mean every investigative agent: FBI, DEA, OIG, HHS, state boards of medicine, and investigators from the attorney general’s office. Not with a lawyer. Not without one. Not ever.

Silence …

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The opioid crisis’s other victims

Conditions
November 9, 2025

Introduction: a crisis of pain

The opioid crisis is one of the most significant public health emergencies of our time, defined by staggering rates of addiction and overdose. Yet, behind the headlines is a story of profound and often overlooked human suffering. In an effort to save lives, public health policies were enacted to aggressively reduce opioid prescriptions. While well-intentioned, these policies have inadvertently precipitated a parallel crisis of iatrogenic harm, …

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Opioid prescribing guidelines ignore metabolism

Conditions
November 7, 2025

My primary focus is on U.S. and international public health policy for treatment of severe chronic pain. I have been active for over 28 years as a health care writer and educator, with over 300 papers authored or co-authored in a mix of peer-reviewed journals and mass media.

I am a particular critic of what I believe to be the proven misdirection (a.k.a. “fraud“) committed by Federal and State …

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The frustrating bureaucracy of getting a vaccine

Conditions
October 26, 2025

At age 81, I speak and write voluminously as a health care educator specializing in public health policy and practice for the treatment of pain and addiction. My wife and I are also careful about getting our periodic vaccinations for flu and COVID-19. A few days ago we responded to an invitation from our pharmacy to drop in for our shots on a walk-in basis. The process turned out to …

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Treating chronic pain in older adults

Conditions
October 23, 2025

For decades, I treated patients with chronic pain. One truth became evident early: most older adults prescribed narcotics use them responsibly. My clinical acumen, shaped over more than forty years, intuitively knew this to be true. Still, I understood that intuition and opinion alone are insufficient. Compassion in medicine must be paired with objectivity.

Now the data confirms what practice long suggested. A national survey of adults aged 50 and older …

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Are doctors’ emotions fueling the opioid crisis?

Conditions
October 10, 2025

It should be obvious by now, but somehow it is not: Physicians are not immune to the same emotions that govern human behavior everywhere else. We like to imagine that our white coats and years of training somehow grant us a protective immunity to fear, to shame, to the raw surge of emotion that can stop us in our tracks. The truth is, physicians and other medical professionals are just …

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The unfair war on buprenorphine

Meds
September 23, 2025

In my years as a physician on the front lines of addiction and pain medicine, I have never encountered a medication as transformative as buprenorphine (Suboxone). I have seen patients, broken by years of opioid addiction, have their lives change within an hour of their first dose, ready to reclaim a life they thought was lost. For these patients, buprenorphine is as essential as insulin is for a person with …

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How nature is inspiring the future of pain medicine

Conditions
September 18, 2025

Across the world’s earliest civilizations, healers turned to nature as their pharmacy. Ancient systems like Ayurveda in India, Unani (Hikmat) medicine in the Middle East, and early European herbalism developed sophisticated therapeutic practices rooted in plants and natural compounds, many of which are still clinically relevant today.

Take turmeric, for example. Traditionally simmered in milk or prepared as a paste, it was used for its healing and anti-inflammatory properties. Today, biomedical …

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How restrictive opioid policies worsen the crisis

Physician
September 3, 2025

The ongoing opioid crisis, claiming over 70,000 lives annually in the U.S. according to the CDC’s 2023 data, presents a perplexing scenario where regulatory bodies, in their attempt to curb misuse, have inadvertently intensified challenges for health care providers and patients. The Centers for Disease Control and Prevention (CDC) issued its 2016 guideline for prescribing opioids for chronic pain, with revisions in 2022 to address misapplications, yet these efforts have …

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Why reforming medical boards is critical to saving patient care

Physician
August 27, 2025

Imagine a dedicated physician, after years of rigorous training and countless lives saved, facing a medical board complaint over a minor issue—perhaps a clerical error in documentation or a subjective interpretation of a clinical decision. What should be a straightforward matter escalates into a career-threatening ordeal. State medical boards, endowed with significant authority, often wield it with little accountability. Armed with prosecutors who prioritize winning over truth, boards can distort …

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How pain clinics contribute to societal safety

Physician
August 25, 2025

In today’s interconnected society, individual health shapes the well-being of communities. This is evident in the role of pain clinics, which have evolved beyond their traditional mandate of managing chronic pain. A recent peer-reviewed research publication in the SVOA Medical Research journal highlights how pain clinics are contributing to societal safety by addressing risks that extend beyond the clinical setting; promoting safer roads, stronger families, and healthier workplaces.

The clinical …

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Why chronic pain patients and doctors are both under attack

Conditions
August 21, 2025

At age 81, I am one of “the old guys” who writes in online chronic pain support groups. I get a lot of emails from people in pain. One recent inquiry was from a lady named Marisa, who asked questions that are combined in the title of this article. The following is my response to Marisa and others.

My wife is a chronic pain patient who has multiple medical issues. I …

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Why pain doctors face unfair scrutiny and harsh penalties in California

Physician
August 20, 2025

Pain management physicians, who often prescribe controlled substances like opioids, face intense scrutiny. Critics argue that investigations are overly aggressive, resembling fishing expeditions where investigators search broadly for any evidence of wrongdoing, often beyond the original complaint. A 2023 Los Angeles Times report noted that nearly 10,000 investigations were conducted in 2021–2022, with pain physicians disproportionately targeted due to outdated guidelines predating modern evidence-based practices. For example, the reliance on …

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How the quietly efficient physician can turn perception into power

Physician
August 14, 2025

In the bustling environment of modern health care, the loudest voices frequently attract the most attention. Yet, a special category of physicians who are less visible but no less significant exists: the efficient, quiet clinicians who are usually underestimated. This physician type blends high productivity with a calm demeanor, allowing skill and results to speak louder than words.

Underestimation can undermine leadership opportunities for quiet physicians because visibility may play a …

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Physician hiring bias in one of America’s most progressive cities

Physician
August 5, 2025

I have been fortunate to practice in several areas of medicine in my career. This has led me to triple board certification in family medicine, palliative medicine, and addiction medicine. I speak Spanish fluently, have a spotless record, and have dedicated my career to caring for underserved patients.

Despite this, after years of applying to prestigious health systems in a major city, I’ve never once been contacted for an interview in …

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From errors to resilience: a smarter approach to patient safety

Physician
August 1, 2025

Historically, health care has approached safety with a Safety-I lens, emphasizing the prevention of errors and investigating failures. While this method remains significant, contemporary health care’s complex, dynamic, and interdependent nature necessitates proactive and adaptive safety strategies. The emerging Safety-II and Safety-III frameworks provide novel perspectives on safety by prioritizing resilience, real-time adaptation, and learning from success, rather than from failure.

Safety-II shifts the focus from what goes wrong …

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Why medical boards are facing growing backlash for abusing power

Physician
August 1, 2025

In principle, the judicial system is founded on fairness, requiring that guilt or innocence be established based on evidence.

All parties including judges, defendants, and plaintiffs should be engaged in a rigorous process of fact presentation and scrutiny.

However, in stark contrast, political systems often prioritize rule manipulation and fact distortion, seeking validation over truth. This critical distinction between politics and jurisprudence becomes dangerously blurred when examining the conduct of medical boards …

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