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 repute for taking up advanced medical instances, together with individuals who’d been battling habit for many years. Some have been chronic-pain sufferers on excessive doses of opioids; others have been intercourse employees and other people dwelling 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,” stated Stevens, a main care and habit drugs 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 usually attended 6 a.m. breakfasts for homeless individuals, 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 stated 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 treatment — an possibility many docs would routinely dismiss for concern {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 not do medication and do your ache meds,'” Harrell recounted on a Monday night in October. So, “I am now 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 gained her awards and nominations in drugs, group service, and humanism. As an alternative of seeing sufferers in binaries — addicted or sober, with a optimistic or unfavourable drug take a look at — 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 targets, even when abstinence is not one in every 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 instances — out of the blue that was dangerous,” Stevens stated.
Versatile care or slippery slope?
Greater than 80% of People who want substance use therapy do not obtain it, nationwide information from the Substance Abuse and Psychological Well being Companies Administration reveals. Boundaries abound: excessive prices, lack of transportation, clinic hours which are incompatible with jobs, concern of being mistreated.
Some docs had been making an attempt to ease the method for years. The pandemic accelerated that pattern. Telehealth appointments, fewer urine drug checks, and drugs refills that last more grew to become the norm.
The consequence?
“Sufferers did OK and we really reached extra individuals,” stated Brian Hurley, the previous president of the American Society of Dependancy Medication. The group helps persevering with versatile practices, similar to serving to sufferers keep away from withdrawal signs by prescribing higher-than-traditional doses of habit treatment and specializing in restoration targets apart from abstinence.
However some docs choose conventional approaches that vary from zero tolerance for sufferers utilizing unlawful medication to setting stiff penalties for individuals who do not meet their docs’ expectations. For instance, a affected person who checks optimistic for road medication whereas getting outpatient care could be discharged and informed to go to residential rehab. Proponents of this technique concern loosening restrictions could possibly be a slippery slope that in the end harms sufferers. They are saying persevering with to prescribe painkillers, for instance, to individuals utilizing illicit substances long-term might normalize drug use and hamper the purpose of getting individuals off unlawful medication.
Progress needs to be greater than retaining sufferers in care, stated Keith Humphreys, a Stanford psychologist, who has handled and researched habit for many years and helps involuntary therapy.
“Should you give addicted individuals a number of medication, they prefer it, and so they could come again,” he stated. “However that does not imply that that’s selling their well being over time.”
Versatile practices additionally are inclined to align with hurt discount, a divisive method that proponents say retains individuals who use medication secure 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 medicine thought-about the gold normal to deal with opioid habit.
Stevens’ supervisors nervous she wasn’t doing sufficient urine drug checks and stored treating sufferers who used illicit medication as a substitute of referring them to greater ranges of care, similar 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. “Notice 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 instances at a breakfast for homeless individuals in New Orleans. Bey based Freestanding Communities, a company to assist susceptible individuals.
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Springgate forwarded that e mail to Stevens and inspired her to refer extra sufferers to methadone clinics, intensive outpatient care, and inpatient rehab.
Stevens understood the overall observe however could not reconcile it with the truth her sufferers confronted. She questioned how somebody dwelling in a tent, petrified of shedding 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 would possibly depart the well being system, however they’d nonetheless be sick.
“They only would not be getting care and maybe they’d be useless,” she stated 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 an alternative, they offered a joint assertion from Dr. Richard DiCarlo, dean of the LSU Well being New Orleans Faculty of Medication, 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 business,” they stated. “We stay devoted to increasing entry to therapy, whereas upholding the very 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 drugs docs exterior of Louisiana, who had no affiliation with Stevens or her employers. Each discovered her practices to be throughout the bounds of regular habit care, particularly for advanced sufferers.
Dr. Stephen Loyd, an habit drugs specialist and the president of Tennessee’s medical licensing board, stated docs working tablet mills sometimes have sparse affected person notes that checklist 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 stated.
Some individuals assume the “solely good reply isn’t any opioids,” similar to oxycodone or hydrocodone, for any sufferers, stated Dr. Cara Poland, an habit drugs specialist and affiliate professor at Michigan State College.
However sufferers might have them — generally for issues like most cancers ache — or require months to decrease their doses safely, she stated. “It isn’t as black-and-white as individuals exterior our discipline need it to be.”
Humphreys, the Stanford psychologist, had a special take. He didn’t overview Stevens’ case however stated, as a common observe, there are dangers to prescribing painkillers long-term, particularly for sufferers utilizing in the present day’s deadly road medication too.
Overprescribing fueled the opioid disaster, he stated. “It isn’t going to go away if we try this once more.”
“The factor that kills individuals”
After months of stress, Stevens’ supervisors informed her on March 10 to cease coming to work. The hospital was conducting a overview of her practices, they stated in an e mail considered by KFF Well being Information.
In a single day, lots of of her sufferers have 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 treatment thought-about the gold normal to deal with opioid habit.
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After Stevens’ departure, Bair was left with out treatment for 3 days. The withdrawal signs have been extreme — headache, nausea, muscle cramps.
“I used to be simply in bodily hell,” stated 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 an alternative, 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 danger. Bair “requires a better degree 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 stated 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 treatment once more.
“That is the factor that kills individuals,” stated 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 few month after Stevens was informed to remain dwelling, 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 stated she despatched the letters to about 10 individuals in hospital and medical faculty management. Most didn’t reply.
In Could, the hospital’s overview committee decided Stevens’ practices fell “exterior of the suitable group requirements” and constituted “reckless conduct,” in response to 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 continuing investigation, College Medical Heart stated it was required to tell the state’s medical licensing board.
The medical board started its personal investigation — a improvement that finally price 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 scientific choices based mostly on urine drug checks. However nationwide habit organizations supported such practices and promoted tailoring care to sufferers’ circumstances, she stated. Her response included a 10-page bibliography with 98 citations.
In October 2025, Dr. Elyse Stevens determined to go away New Orleans. Earlier than she left, she and her household burned her outdated prescription pads as “a ceremonial dying of an outdated life and start 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 applicable habit therapy.
In October, Stevens moved to the Virgin Islands to work in inside drugs at an area hospital. She stated she’s grateful for the welcoming locals and the monetary stability to help herself and her mother and father.
Dr. Elyse Stevens says goodbye to her mother, Mary Chaput, as they half methods on one in every of Stevens’ remaining days in New Orleans.
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However it hurts to consider 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 — by 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 stated, “legal responsibility is in abandoning individuals, too.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF.
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