Dr. Elyse Stevens, left, attends a group breakfast at a New Orleans nonprofit, together with her former affected person Ronald Main who says Stevens handled him like household.
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NEW ORLEANS — Dr. Elyse Stevens had a status for taking up advanced medical circumstances, together with individuals who’d been battling habit for many years. Some had been chronic-pain sufferers on excessive doses of opioids; others had been intercourse employees and other people residing on the road.
“Lots of my sufferers are messy, those that do not know in the event that they need to cease utilizing medication or not,” mentioned Stevens, a major care and habit medication physician.
Whereas different docs prevented these sufferers, Stevens — who was aware of New Orleans from her time in medical faculty at Tulane College — sought them out. She frequently attended 6 a.m. breakfasts for homeless folks, volunteered at a homeless shelter clinic on Saturdays, and, on Monday evenings, visited an deserted Household Greenback retailer the place advocates distributed provides to individuals who use medication.
Award-winning care
One such night about 4 years in the past, Charmyra Harrell arrived there limping, her proper leg swollen and lined in sores. Emergency room docs had repeatedly dismissed her, so Harrell mentioned she eased the ache with road medication.
Stevens cleaned her sores on Mondays for months till lastly persuading Harrell to go to the clinic at College Medical Heart New Orleans. There, Stevens found Harrell had diabetes and most cancers.
She agreed to prescribe Harrell ache remedy — an possibility many docs would robotically dismiss for worry {that a} affected person with a historical past of habit would misuse it.
However Stevens was assured Harrell might maintain up her finish of the deal.
“She informed me, ‘You can’t do medication and do your ache meds,'” Harrell recounted on a Monday night in October. So, “I am not on cocaine.”
Charmyra Harrell credit Dr. Elyse Stevens with diagnosing her diabetes and most cancers and serving to her cease utilizing cocaine.
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Stevens’ method to affected person care has received her awards and nominations in medication, group service, and humanism. As a substitute of seeing sufferers in binaries — addicted or sober, with a constructive or detrimental drug check — she measures progress on a spectrum. Are they showering every day, cooking with their households, utilizing much less fentanyl than the day earlier than?
However not everybody agrees with this versatile method that prioritizes working with sufferers on their objectives, even when abstinence is not certainly one of them. And it got here to a head in the summertime of 2024.
“The identical issues I used to be high-fived for hundreds of occasions — out of the blue that was unhealthy,” Stevens mentioned.
Versatile care or slippery slope?
Greater than 80% of Individuals who want substance use therapy do not obtain it, nationwide information from the Substance Abuse and Psychological Well being Providers Administration reveals. Limitations abound: excessive prices, lack of transportation, clinic hours which can be incompatible with jobs, worry of being mistreated.
Some docs had been making an attempt to ease the method for years. The pandemic accelerated that development. Telehealth appointments, fewer urine drug exams, and medicine refills that last more turned the norm.
The outcome?
“Sufferers did OK and we truly reached extra folks,” mentioned Brian Hurley, the previous president of the American Society of Habit Drugs. The group helps persevering with versatile practices, equivalent to serving to sufferers keep away from withdrawal signs by prescribing higher-than-traditional doses of habit remedy and specializing in restoration objectives aside from abstinence.
However some docs desire conventional approaches that vary from zero tolerance for sufferers utilizing unlawful medication to setting stiff penalties for many who do not meet their docs’ expectations. For instance, a affected person who exams constructive for road medication whereas getting outpatient care could be discharged and informed to go to residential rehab. Proponents of this methodology worry loosening restrictions may very well be a slippery slope that finally harms sufferers. They are saying persevering with to prescribe painkillers, for instance, to folks utilizing illicit substances long-term might normalize drug use and hamper the objective of getting folks off unlawful medication.
Progress ought to be greater than maintaining sufferers in care, mentioned Keith Humphreys, a Stanford psychologist, who has handled and researched habit for many years and helps involuntary therapy.
“Should you give addicted folks a lot of medication, they prefer it, and so they could come again,” he mentioned. “However that does not imply that that’s selling their well being over time.”
Versatile practices additionally are likely to align with hurt discount, a divisive method that proponents say retains individuals who use medication protected and that critics — together with the Trump administration — say permits unlawful drug use.
The controversy isn’t just philosophical. For Stevens and her sufferers, it got here to bear on the streets of New Orleans.
“Unconventional” prescribing
In the summertime of 2024, Stevens’ supervisors began questioning her method.
In emails reviewed by KFF Well being Information, they expressed considerations about her prescribing too many ache drugs, a mixture of opioids and different managed substances to the identical sufferers, and excessive doses of buprenorphine, a drugs thought-about the gold normal to deal with opioid habit.
Stevens’ supervisors nervous she wasn’t doing sufficient urine drug exams and stored treating sufferers who used illicit medication as a substitute of referring them to greater ranges of care, equivalent to inpatient rehab.
“Her prescribing sample seems unconventional in comparison with the native normal of care,” the hospital’s chief medical officer on the time wrote to Stevens’ supervisor, Dr. Benjamin Springgate. “Observe that that is the one normal of care which might seemingly be thought-about ought to a authorized concern come up.”
Dr. Elyse Stevens and her husband, Aquil Bey, a paramedic, focus on affected person circumstances at a breakfast for homeless folks in New Orleans. Bey based Freestanding Communities, a corporation to assist susceptible folks.
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Springgate forwarded that electronic mail to Stevens and inspired her to refer extra sufferers to methadone clinics, intensive outpatient care, and inpatient rehab.
Stevens understood the final observe however could not reconcile it with the fact her sufferers confronted. She puzzled how somebody residing in a tent, petrified of dropping their possessions, would trek to a methadone clinic every day.
Stevens despatched her supervisors dozens of analysis research and nationwide therapy tips backing her versatile method. She defined that if she stopped prescribing the medicines of concern, sufferers may go away the well being system, however they might nonetheless be sick.
“They simply would not be getting care and maybe they’d be useless,” she mentioned in an interview with KFF Well being Information.
Each College Medical Heart and LSU Well being New Orleans, which employs Stevens and different physicians at UMC, declined repeated requests for interviews. They didn’t reply to detailed questions on habit therapy or Stevens’ practices.
As a substitute, they supplied a joint assertion from Dr. Richard DiCarlo, dean of the LSU Well being New Orleans Faculty of Drugs, and Dr. Jeffrey Elder, chief medical officer of College Medical Heart New Orleans.
“We aren’t at liberty to remark publicly on inside personnel points,” they wrote.
“We acknowledge that habit is a severe public well being downside, and that habit therapy is a problem for the well being care trade,” they mentioned. “We stay devoted to increasing entry to therapy, whereas upholding the best normal of care and security for all sufferers.”
Not black-and-white
KFF Well being Information shared the complaints in opposition to Stevens and the responses she’d written for supervisors with two habit medication docs outdoors of Louisiana, who had no affiliation with Stevens or her employers. Each discovered her practices to be inside the bounds of regular habit care, particularly for advanced sufferers.
Dr. Stephen Loyd, an habit medication specialist and the president of Tennessee’s medical licensing board, mentioned docs operating tablet mills usually have sparse affected person notes that record a chief criticism of ache. However Stevens’ notes detailed sufferers’ life circumstances and the intricate choices she was making with them.
“To me, that is the massive distinction,” Loyd mentioned.
Some folks suppose the “solely good reply isn’t any opioids,” equivalent to oxycodone or hydrocodone, for any sufferers, mentioned Dr. Cara Poland, an habit medication specialist and affiliate professor at Michigan State College.
However sufferers may have them — typically for issues like most cancers ache — or require months to decrease their doses safely, she mentioned. “It isn’t as black-and-white as folks outdoors our subject need it to be.”
Humphreys, the Stanford psychologist, had a distinct take. He didn’t assessment Stevens’ case however mentioned, as a common observe, there are dangers to prescribing painkillers long-term, particularly for sufferers utilizing at the moment’s deadly road medication too.
Overprescribing fueled the opioid disaster, he mentioned. “It isn’t going to go away if we do this once more.”
“The factor that kills folks”
After months of rigidity, Stevens’ supervisors informed her on March 10 to cease coming to work. The hospital was conducting a assessment of her practices, they mentioned in an electronic mail seen by KFF Well being Information.
In a single day, tons of of her sufferers had been moved to different suppliers.
Luka Bair had been seeing Stevens for 3 years and was secure on every day buprenorphine.
Luka Bair holds a movie of buprenorphine, a every day remedy thought-about the gold normal to deal with opioid habit.
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After Stevens’ departure, Bair was left with out remedy for 3 days. The withdrawal signs had been extreme — headache, nausea, muscle cramps.
“I used to be simply in bodily hell,” mentioned Bair, who works for the Nationwide Hurt Discount Coalition and makes use of they/them pronouns.
Though Bair finally acquired a refill, Springgate, Stevens’ supervisor, did not need to proceed the routine long-term. As a substitute, Springgate referred Bair to extra intensive and residential packages, citing Bair’s intermittent use of different medication, together with benzodiazepines and cocaine, as markers of excessive threat. Bair “requires a better stage of care than our clinic fairly can supply,” Springgate wrote in affected person portal notes shared by Bair and reviewed by KFF Well being Information.
However Bair mentioned every day attendance at these packages was incompatible with their full-time job. They left the clinic, with 30 days to discover a new physician or run out of remedy once more.
“That is the factor that kills folks,” mentioned Bair, who finally discovered one other physician keen to prescribe their buprenorphine.
Springgate didn’t reply to repeated calls and emails requesting remark.
College Medical Heart and LSU Well being New Orleans didn’t reply questions on transferring and discharging Stevens’ sufferers.
“Reckless conduct”
A couple of month after Stevens was informed to remain residence, Haley Beavers Khoury, a medical scholar who labored together with her, had collected practically 100 letters from different college students, docs, sufferers, and homelessness service suppliers calling for Stevens’ return.
One scholar wrote, “Make no mistake — a few of her sufferers will die with out her.” A nun from the Daughters of Charity, which ran the hospital’s earlier incarnation, known as Stevens a “lifeline” for susceptible sufferers.
Beavers Khoury mentioned she despatched the letters to about 10 folks in hospital and medical faculty management. Most didn’t reply.
In Might, the hospital’s assessment committee decided Stevens’ practices fell “outdoors of the suitable group requirements” and constituted “reckless conduct,” in accordance with a letter despatched to Stevens.
The hospital didn’t reply KFF Well being Information’ questions on the way it reached this conclusion or if it recognized any affected person hurt.
In the meantime, Stevens had secured a job at one other New Orleans hospital. However as a result of her resignation got here amid the continued investigation, College Medical Heart mentioned it was required to tell the state’s medical licensing board.
The medical board started its personal investigation — a improvement that finally value Stevens the opposite job supply.
In presenting her aspect to the medical board, Stevens repeated many arguments she’d made earlier than. Sure, she was prescribing highly effective medicines. No, she wasn’t making medical choices primarily based on urine drug exams. However nationwide habit organizations supported such practices and promoted tailoring care to sufferers’ circumstances, she mentioned. Her response included a 10-page bibliography with 98 citations.
In October 2025, Dr. Elyse Stevens determined to depart New Orleans. Earlier than she left, she and her household burned her previous prescription pads as “a ceremonial loss of life of an previous life and beginning of a brand new starting,” she says.
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Legal responsibility
The Louisiana state board’s investigation into Stevens is ongoing. Its web site reveals no motion taken in opposition to her license as of late December.
The board declined to touch upon each Stevens’ case and its definition of acceptable habit therapy.
In October, Stevens moved to the Virgin Islands to work in inside medication at a neighborhood hospital. She mentioned she’s grateful for the welcoming locals and the monetary stability to assist herself and her dad and mom.
Dr. Elyse Stevens says goodbye to her mother, Mary Chaput, as they half methods on certainly one of Stevens’ ultimate days in New Orleans.
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Nevertheless it hurts to think about her former sufferers in New Orleans.
Earlier than leaving, Stevens packed away handwritten letters from a number of of them — one was 15 pages lengthy, written in alternating inexperienced and purple marker — during which they shared childhood traumas and small successes they’d whereas in therapy together with her.
Stevens would not know what occurred to these sufferers after she left.
She believes the scrutiny of her practices facilities on considerations over legal responsibility greater than affected person security.
However, she mentioned, “legal responsibility is in abandoning folks, too.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working packages at KFF.
