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 over complicated medical instances, 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 staff and folks residing on the road.
“A lot of my sufferers are messy, those that do not know in the event that they wish to cease utilizing medication or not,” stated Stevens, a major care and habit medication physician.
Whereas different medical doctors prevented these sufferers, Stevens — who was conversant in New Orleans from her time in medical college at Tulane College — sought them out. She recurrently 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 coated in sores. Emergency room medical doctors had repeatedly dismissed her, so Harrell stated she eased the ache with avenue 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 medical doctors would mechanically 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 advised 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’ strategy 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 unfavorable drug take a look at — she measures progress on a spectrum. Are they showering day by day, cooking with their households, utilizing much less fentanyl than the day earlier than?
However not everybody agrees with this versatile strategy that prioritizes working with sufferers on their objectives, 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 occasions — 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 exhibits. Limitations abound: excessive prices, lack of transportation, clinic hours which can be incompatible with jobs, worry of being mistreated.
Some medical doctors had been attempting to ease the method for years. The pandemic accelerated that pattern. Telehealth appointments, fewer urine drug exams, and drugs refills that last more turned the norm.
The consequence?
“Sufferers did OK and we really reached extra individuals,” stated Brian Hurley, the previous president of the American Society of Habit Medication. 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 medical doctors favor conventional approaches that vary from zero tolerance for sufferers utilizing unlawful medication to setting stiff penalties for individuals who do not meet their medical doctors’ expectations. For instance, a affected person who exams constructive for avenue medication whereas getting outpatient care could be discharged and advised to go to residential rehab. Proponents of this methodology worry loosening restrictions may very well 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 aim 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.
“If you happen to give addicted individuals numerous medication, they prefer it, and so they might 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 strategy that proponents say retains individuals who use medication protected and that critics — together with the Trump administration — say permits unlawful drug use.
The controversy is not only 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 strategy.
In emails reviewed by KFF Well being Information, they expressed considerations about her prescribing too many ache tablets, a mixture of opioids and different managed substances to the identical sufferers, and excessive doses of buprenorphine, a drugs thought of the gold commonplace to deal with opioid habit.
Stevens’ supervisors fearful 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 commonplace of care,” the hospital’s chief medical officer on the time wrote to Stevens’ supervisor, Dr. Benjamin Springgate. “Word that that is the one commonplace of care which might seemingly be thought of 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 corporation 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 final apply however could not reconcile it with the fact her sufferers confronted. She questioned how somebody residing in a tent, frightened of dropping their possessions, would trek to a methadone clinic day by day.
Stevens despatched her supervisors dozens of analysis research and nationwide therapy tips backing her versatile strategy. 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 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 a substitute, 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 inner personnel points,” they wrote.
“We acknowledge that habit is a critical public well being drawback, and that habit therapy is a problem for the well being care trade,” they stated. “We stay devoted to increasing entry to therapy, whereas upholding the very best commonplace 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 medical doctors 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 complicated sufferers.
Dr. Stephen Loyd, an habit medication specialist and the president of Tennessee’s medical licensing board, stated medical doctors operating tablet mills usually 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 large distinction,” Loyd stated.
Some individuals suppose the “solely good reply isn’t any opioids,” equivalent to oxycodone or hydrocodone, for any sufferers, stated 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 stated. “It is not as black-and-white as individuals outdoors our discipline need it to be.”
Humphreys, the Stanford psychologist, had a unique take. He didn’t assessment Stevens’ case however stated, as a basic apply, there are dangers to prescribing painkillers long-term, particularly for sufferers utilizing at this time’s deadly avenue medication too.
Overprescribing fueled the opioid disaster, he stated. “It is not going to go away if we try this once more.”
“The factor that kills individuals”
After months of pressure, Stevens’ supervisors advised her on March 10 to cease coming to work. The hospital was conducting a assessment of her practices, they stated in an e 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 steady on day by day buprenorphine.
Luka Bair holds a movie of buprenorphine, a day by day remedy thought of the gold commonplace 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,” stated Bair, who works for the Nationwide Hurt Discount Coalition and makes use of they/them pronouns.
Though Bair ultimately bought a refill, Springgate, Stevens’ supervisor, did not wish 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 danger. 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 stated day by 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 individuals,” stated Bair, who ultimately 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 advised to remain residence, Haley Beavers Khoury, a medical pupil who labored together with her, had collected practically 100 letters from different college students, medical doctors, sufferers, and homelessness service suppliers calling for Stevens’ return.
One pupil 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 college management. Most didn’t reply.
In Might, the hospital’s assessment committee decided Stevens’ practices fell “outdoors of the appropriate 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 stated it was required to tell the state’s medical licensing board.
The medical board started its personal investigation — a growth that ultimately 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 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 previous prescription pads as “a ceremonial demise 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 exhibits 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 inner medication at a neighborhood hospital. She stated she’s grateful for the welcoming locals and the monetary stability to assist 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’ ultimate days in New Orleans.
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Nevertheless 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 that they had whereas in therapy together with her.
Stevens does 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 likely one of the core working packages at KFF.
